County Durham has five community hospitals at Sedgefield, Chester le Street, Shotley Bridge, Barnard Castle and Stanhope which provide a range of healthcare services designed to meet the needs of the communities they serve.
We paid a visit to Sedgefield Community Hospital (SCH) and spoke to Advanced Clinical practitioner (ACP) Jo Havert and Clinical Lead for 2 of the Community Hospitals, GP Jonathan Smith.
Sedgefield Community Hospital has a strong focus on outpatient care and diagnostic services but also has an inpatient unit The Franziska Willer Ward at SCH cares for up to 26 patients who have received treatment at an acute site, usually either University Hospital North Durham or Darlington Memorial Hospital. The multidisciplinary team supports the ongoing treatment but also has a strong focus on recuperation, rehabilitation and reablement enabling people to return to the place they call home where at all possible.
We provide palliative care and patients may come to the Community Hospital for symptom management alongside social input where they will be fast-tracked to get them to their preferred place of care.
“In broad terms the conditions are mainly concerned with frailty,” adds GP and Clinical Lead Jonathan Smith, who visits the hospital three morning a week. “The average patient here is over 80 and at the moment the hospital has six patients over the age of 90.”
We also repatriate patients who may have been receiving super-specialised care at one of the hospital further afield. For example, we often have patients who have been under urology or neurology at James Cook University Hospital that come to SCH to continue their care so they can be closer to home…so important for them and their families.
We are fortunate in County Durham to have community beds in 5 localities and we do try to care for people as close to home as we can. However, this isn’t always possible and at times of pressure care may have to be continued at one of the sites which may not be the closest.
“Each of the five community hospital sites has a different number of beds,” explains Jo. “Sedgefield has the most with 26, Chester le street has 23, Shotley Bridge 18, Weardale have 20 and Richardson has 24. The time patients stay with us is variable, sometimes it’s just overnight whereas for others this can be several weeks depending on their needs but we all strive to get patients home as quickly as possible with the right care and support.
"We know how important it is to be in our own bed with our own cup of tea! Sometimes people do have to wait for a community bed as we are full and therefore you may not get the closest bed to your home but all our sites deliver the same care and rehabilitation. “
The clinical team
In the community sites, we have highly trained nurse practitioners available every day, supported by GPs on Monday, Wednesday and Friday mornings each week. This includes a ward round of the patients and to provide clinical support for any complex cases including speaking to families.
The nurse practitioners and GPs are part of a highly experienced ward multidisciplinary team consisting of the Ward Manager, nurses, healthcare assistants, therapists and therapy assistants and the domestic, portering and cleaning staff.
“The GPs are here to support the nurses to make any decisions that need to be made regarding the patients,” explained Jonathan. “We'll discuss the cases and the management of patients and conditions with the nurses as we go around the wards.”
“I think it definitely helps if you've experienced working in the community and then work in a hospital,” says Jo. “You’ve a better working knowledge of what services are available in the community and that sometimes makes it easier to think outside the box. I worked as a community advanced nurse practitioner and that definitely helped with someone I discharged recently. The lady had had some blood tests here and but was really keen to go back to her care home before we had the results.
“The tests then came back indicating some potential issues - I knew that her care home had a community advanced nurse practitioner (ANP) linked to it. So, I rang the nurse practitioner and asked for someone to go and assess her. She was reviewed in her care home, started on antibiotics and she didn't need to come back to hospital.
“Someone who hadn’t worked in the community might not have been aware that each care home has a linked ANP, and as a result she could’ve been sent back to hospital.”
Taking the pressure off acute sites
Jonathan explained his typical day: “Mornings start with the ward round, looking at any patients that the nurses want to talk to the GP about. We try to complete holistic assessments, looking at all the medications, the escalation planning, checking all the patients' blood tests, seeing what they're originally coming for, what is planned for that, any future appointments to be made - if we need any investigations.
“Sometimes when patients get transferred here from the acute hospital, there may still need to have scans or tests. So often in the community hospital we’re picking up those actions and things to be finished off, which all helps to take the pressure off the acute hospitals, lighten the load and help speed up discharges.
“Our aim is not to transfer any patients once here across to ED unless absolutely necessary. For instance, if a patient has sepsis and doesn’t want to go back to an acute hospital, they can stay where they are in the community site and be treated here.
“It’s not just rehab – some of the patients who stay at the community hospital are acutely unwell. There are patients on oxygen, on IV fluids and IV antibiotics, for instance. Patients have blood transfusions and there’s support for geriatricians, including bone protection while they're here, rather than being discharged and coming back as outpatients at the acute site.
“Sometimes patients are transferred here directly from A&E rather than being admitted to an acute site. For instance, someone who has had a fall but not actually broken a bone or had a significant injury. They might just need a few days recuperation, so they are sent here enabling more acutely unwell patients to be seen and cared for on the acute sites.”
More services than you might think
New services are regularly being made available at to the community hospital, such as ultrasound. Previously, if someone had a suspected blood clot in their leg for instance, a call would need to be made to Same Day Emergency Care (SDEC), get one of their ultrasound appointment slots in the main acute hospital. The patient would have to be transferred out, using an ambulance whereas now this can all happen in Sedgefield.
“A dietician comes once a week,” says Jo. “There’s podiatry as well as OT and physio. There’s also remote support that plugs into the hospital, such as tissue viability reviews, diabetic nurse specialists, geriatricians and movement disorder – all can be contacted to agree the right plan of care.”
There’s also a lot of linking up between teams and services. For instance, outpatients at SCH has a Movement Disorders clinic so if there’s a patient that could benefit from their specialist advice they will come round and review the patient at the end of their clinic. It’s this sort of multi-disciplinary team work, built up over time that enables the community hospitals to work effectively and with the patient at the centre
“Continuity of care is another great strength of the community hospital,” says Jonathan. “It's the same GPs that are coming every week, the same nurse practitioners that's here every day, the same physios and OTs - so everybody knows the patients.
Thank you
“I think one of the things that makes me feel like we’re doing a good job is the appreciation show by patients and there relatives,” says Jo.
“There’s more opportunity to spend time with the patients and the families in a Community Hospital and to make sure that they are fully aware of all aspects of their care,” adds Jonathan.
“Our hope is that we get people as well as we possibly can, and then get them as home and able to be independent as quickly as possible. And for those on a recurrent cycle of hospital admission and readmission, what can we identify reasons and find alternatives based on what is important to them.
“From the point of view that GP doing the work, it's a really rewarding job to do and work as part of a different team. It complements my GP work in practice and adds some positive variation to my working week.”