Dr Johanna Price hasn’t looked back since joining the urgent care home treatment service in west Kent five years ago. “I said I’d give it a year but I’m still here,” she says. Her colleague Dr Amy Heskett feels the same: “I joined when it was a pilot then became a bit addicted to it,” she says.
So what is the enduring appeal for these two specialist doctors who work with advanced clinical practitioners and healthcare assistants to deliver this innovative service run by Kent Community Health NHS foundation trust?
Community trusts will often have “hospital at home” services designed to provide extra support to patients discharged from hospital who have gone back to live at home. But in Kent the urgent care home treatment service has a completely different focus.
The priority of the multiprofessional team, led by a consultant geriatrician, is to prevent people living at home from being admitted to hospital in the first place – especially those who are older and frail, with long-term conditions.
A community associate specialist doctor – or in some cases an advanced clinical practitioner such as an experienced nurse or paramedic with postgraduate training – supported by an advanced healthcare assistant will visit patients in their own homes.
The team carries advanced medical equipment that would usually only be available in hospitals, such as intravenous drips, oxygen supplies and specialist diagnostic handheld machines, which can give on-the-spot results. The trust has two teams – one in west and another in east Kent. The teams take referrals from GPs, the ambulance service and the network of community hospitals. In west Kent the average number is 170 to 180 a month.
“We sit somewhere between hospital and the GP,” says Heskett. “We have good relations with local practices and patients will often flip between the two.”
Price, who spends about an hour with each patient, says seeing people in their own home has huge advantages. “Patients feel much more comfortable in their home environment – you can have easier conversations. They are happy to talk about what matters to them,” she says.
“You can see their knick-knacks, and find out about the patients – what makes them tick. You aren’t just focusing on the numbers and how many patients are on your list for that day.”
Heskett agrees: “If you are considering an operation or medication, for example, you can decide whether it suits the patient’s way of life or their priorities at that time. It’s a much more satisfying experience from both sides.
“I think in a more clinical setting you don’t pick up on these implications. In an emergency situation it’s obviously right to be in a clinical environment but when people are managing long-term conditions which affect their lives for many years and their family, that decision-making process becomes more complex.”
Dr George Noble, geriatrician and consultant lead for the team in west Kent says this way of working has created new patient pathways for older patients.
“We offer a greater level of support, more than a GP would typically offer and they don’t have the resources behind them that we have,” he says. “And now with point-of-care testing, what was previously done in a lab can be done in a little box in the patient’s home.”
According to Noble, the team’s advanced clinical practitioners enjoy more autonomy than they would usually experience in a hospital environment. “They have more freedom with us and are able to practise more independently,” he says. “I also think in our team the medical and social problems they face are more diverse and it’s a question of how do you manage that?”
Clinicians also have the opportunity to work more creatively. “Because it’s a developing specialty you have the chance to bring about change,” says Heskett. “You have the freedom to bring in new processes, so for somebody who loves to see results and to stick with something, it’s a fantastic career move.”
Working for one of the largest community trusts in England – which is ranked “outstanding” by the Care Quality Commission – is another plus for those doctors or advanced clinical practitioners attracted to this innovative practice model.
But living in the “garden of England”, as the county is often called, is an additional pull. An hour’s train ride to London, with cheaper house prices than the capital and a good network of schools, Kent is also an ideal place for family living.
“The balance for me is a good one,” says Price. “I’ve also found a job where I can really enjoy spending time focusing on my patients when I am at work and equally it works with my family as well.”
And what’s the appeal for Noble, who has been in west Kent for 22 years? “It’s the diversity of the job,” he says. “It’s never the same from one day to the next – and most of what we do improves the patient experience, and happier patients make for happier doctors and nurses.”
Find out more about roles in west Kent at Kent Community Health NHS foundation trust
