A Case Study of Mary

Patient: Mary, a 72 year old woman.


Symptoms: Shortness of breath.


Patient action: Mary makes an appointment with her GP regarding her shortness of breath.


GP action/investigation: The GP conducts a physical examination of Mary and finds that her breathing seems normal. More questions are asked by the GP as to when the shortness of breath occurs. For example, does exercising trigger this? Does Mary have a cough? Is there any pain when she breathes?


When Mary answers no to all of the above, the GP begins to ask about her lifestyle. Has she ever smoked or worked in a smoky environment? Are there any current issues in Mary’s life which may be making her stressed or anxious?


Mary explains to the doctor that she has smoked since the age of 17, although only around three cigarettes a day. She further goes on to explain that her husband has recently moved into a care home, and she is struggling to manage the financial implications of this and to keep up with payments to WDH for their house. This is making her feel very anxious. In addition, since her daughter moved abroad she hardly sees anyone and is feeling very socially isolated also.


In the past: The GP would have had to make separate referrals to:


  • Mary’s local Mid Yorkshire Hospitals NHS Trust (Mid Yorks) hospital for a chest X-ray, to rule out any lung conditions such as Emphysema
  • The WDH Wellbeing Workers to help support Mary with her WDH housing payments, which in turn should help with her anxiety also
  • Age UK Wakefield and District to join the be-friending scheme to help combat her social isolation.


Benefit of the PIC File: However, with the Hubs and PIC file in operation, the GP simply needs to:

  1. Make a referral to Mid Yorks for the X-ray
  2. E-refer or telephone-refer directly into the Hubs with the information provided during Mary’s appointment.


The X-ray referral will be organised separately by Mid Yorks. The Hub referral will arrive at the Hubs who will create a PIC File and determine the relevant organisations which Mary requires; facilitating Mary’s integrated care package of appropriate services.


Each organisation (Mid Yorks, WDH and Age UK), alongside Mary’s GP, will be able to view and input summary notes into the PIC File so Mary’s care and outcomes can be seen by all involved with her care. Overall, ensuring a real time overview of Mary’s care is provided.