Engaging the unworried unwell - PDF document

12/10/2012 Engaging the unworried unwell” RCGPAnnualConference,Glasgow2012 Affluent well well Deprived Health literacy and educationDo not appear in statistics –PTI, research etc Worried unwell unwell 12/10/2012 45+years old, �malefemalePossibly multimorbid including psychologicalLikely to have alcohol/addictions issues Attend unscheduled care possibly in crisisMultiple DNAs, A&E or OOHs attendancesAttendance may not be related to chronic disease Present late in disease –especially cancersComplex and time consumingPoor prognosis at presentation, difficult to (ittihlil) manage pa n, expec t a ons, psyc h o l Knock on effect to family if terminal care/death becomes bad experience. Poor coping mechanisms etc 12/10/2012 100 S1/DkA 40 60 Breast CancerColorectal Cancer S tage 1/D k Stage 4/Dukes D Present late in disease –especially cancersComplex and time consumingPoor prognosis at presentation, difficult to (ittihlil) manage pa n, expec t a ons, psyc h o l Knock on effect to family if terminal care/death becomes bad experience. 12/10/2012 Individual GPsKey to these consultationsGive the patient your time Trytodealwiththeimmediateproblem deal with immediate problem If patient feels that it has been worth their effort, more likely to come back. Opportunism :Do what you can to get them to come backSick line, investigations, point out abnormalities (finger clubbing) or briefly discuss what could be done at a follow up appointment. Once the patient re-attends and begins to engage then the next steps can start to be Multimorbidity, esp. psychological distressPoor material circumstances ( housin trans p ort (g,p, j ob insecurity)Poor family circumstances (illness in relations, alcohol and drug misuse)Poor knowledge of health and resourcesLow expectations Appointments system –longer consultations, catch up time, mechanism for continuityMore patients are seen in open (i.e., walk-in) clinics or fitted in that day in the most deprived compared with least deprived Crisis can be dealt with in this way but to engage patients they must see the GP that they have opened up to Funding –more GP time = more GP sessions = cost. DNA policy –patients making repeated appointments but DNAing –rather than off the list, these are patients that may need more input –phone call prior to confirm appt. Mechanism to filter the stress/demands and protect yourself 12/10/2012 ExternalDeep End GroupHealth BoardLack of secondary care generalists until 65yrs old–single disease area specialists Wherearethespecialistsinmulti specialists multi DNA policy for vulnerable groupsTraditional screening does not workPersonal/local approach/proactiveMove away from the “one contract fits all” but fits better if you have a large socio-economically diverse practice population What makes a good Deep End GPs: PATIENCE, OPPORTUNISM & USE OF RESOURCESWhat makes a good Deep End practice? RAPPOINTMENTS FLEXIBLE/LONGER APPOINTMENTS CONTINUITY & MORE GPsWhat else helps Deep End GPs/practices? PEER SUPPORT (Deep End/Locality groups), EVIDENCE, FUNDING/POLICY