Late Visiting Service
Wakefield was chosen to trial the Late Visiting Service. The service focuses on supporting GPs to carry-out appropriate urgent visits through Community Matrons, who will conduct home visits to housebound patients that require an urgent same-day appointment in the afternoon.
Previously, patients who were unable to receive a visit or treatment by the doctor would typically call 999, or access other NHS services such as A&E. The Late Visiting Service helps to prevent this and ensures that patients are treated at home on the same day.
Community Matrons are based within the Connecting Care Hubs which means they can then refer patients into the Hubs services; should they require more support.
The Late Visiting Service was originally piloted in five practices in the West of Wakefield and five practices in the East of Wakefield, covering a practice population of 92,200. Phased roll-out of the model began in April 2018, which will continue throughout the year until all practices on board.
From August 2017 to March 2018, the service has seen the following outcomes:
- 55% hospital admission avoidance from those practices utilising the service
- 396 accepted referrals of which 212 were admission avoidance
- 84% of patients seen in two hours
- 98% of patient seen in four hours.
Late Visiting Service in action - A case study of delirium and frailty
A Community Matron attended a late visit with 98 year old bed-bound patient. Family members had called their GP and requested a visit as they were concerned at the sudden fluctuation in their family member's condition and behaviour.
The patient looked severely frail and cachexic, and the family were caring for the patient without any support from a formal care provider.
History revealed that the patient had recently been treated for recurrent urinary tract infections (UTIs) and a chest infection. The family also mentioned that the patient had expressed her wishes not to be admitted to hospital for any further treatment, however, no advanced care plan or "Do Not Attempt Cardiopulmonary Resuscitation” (DNACPR) was in place.
Clinical examination identified that the patient had lower urinary tract symptoms and also a lower respiratory tract infection. The fluctuating behaviour may also have been attributed to delirium which can lead to confusion, but can be treated with appropriate antibiotics.
The family were advised to encourage the patient to complete the prescribed course of antibiotics, ensure the patient was taking in constant fluids and to reassure them in relation to where they are, who they are and encourage exposure to familiar objects, should a confusion episode occur.
Following the visit, the Community Matron liaised with the patient's GP and arranged a patient follow up visit. The patient was added to the gold standards framework register, so that monthly discussions could take place in relation to best patient care. Discussions regarding of end of life care also took place with the patient and family members, which resulted in plans being put in place to ensure that the patient’s wishes to be cared for at home were respected.