A Health Service for the Patient
Published: 28 May 2007
It has been argued that “walk-in centres do not relieve pressure on other parts of the NHS” (such as emergency care or traditional GP practices). The evidence we have clearly demonstrates that the majority of all ‘walk-in centre’ attendees are dealt with at the centre with no need for further referral . However what is it that you want your “walk-in centre” to achieve? That is the place to begin planning. If you design a walk-in centre to around receiving ‘minor injuries or ‘out-of-hours’ care – it may make sense to co-locate it with an A& E department but even in this case it is NEVER about reducing patient numbers – it is about delivering a health service to those who might otherwise be shunted into a system not designed for them or indeed might never receive one.
One of the many advantages of a modern no appointment primary health care service is that the evidence shows that young people (and in particular young men) feel more comfortable attending and discussing their concerns. Often the hours of opening and the location are more convenient and there is time for a longer consultation.
In short the health service should be designed to meet the needs of the community. “Walk-in centres” are not a magical way of making patients disappear, they are one way of meeting patient needs. The health needs of different communities will vary and therefore so will the type of health service we as healthcare professionals have to provide and which the Welsh Assembly Government has to prioritise. Thankfully the political parties appear to be acknowledging this need. Dr Brian Gibbons AM has spoken often of the need to develop innovative primary care. Plaid Cymru spoke of developing wellbeing centres in their manifesto and the Liberal Democrats of ‘health hubs’. The Conservative Party want to pilot a walk-in centre . Times change and we as healthcare professionals have a duty to respond to and shape this change. The Royal College of Nursing believes that accessible primary health care is vital to the prosperity and wellbeing of the community and it is too important therefore for any one organisation to be protectionist about their comfort-zone. In the end it is the needs of the patient that must be put first.
Quotes from Nurses working in walk-in centres and in primary care
Primary care is at the heart of health care delivery and practice nurses are vital contributors to that care. They often work in isolation only able to access training within their own time. As a facilitator of practice nursing I promote their role and aid them meeting their training needs. The practice nurse contribution to care is constantly underestimated and undervalued yet they drive the delivery of chronic disease management having a positive effect on the quality and length of life in many people of all ages.
Nicola Joyce, Practice Nurse Facilitator, Bridgend, Wales
I used to work as a community nurse, and then I applied for a post as a nurse adviser at the Walk-in Centre in July 2001… I work autonomously, but there is a GP on the premises who acts as a resource to be used by nurses. Initially the change in role was quite a shock… These roles really do give nurses permission to liberate their talents, it’s wonderful. A good number of people come here and the unit has a really good reputation in the area, so we often have a very full waiting room. It’s the first port of call for many people...You literally don’t know what’s coming through the door next. We’ve got the facilities we need on site, so for example we can take an X-ray, interpret it and plaster straight away. Similarly we can deal with acute medical conditions, for example starting antibiotics for a chest infection as necessary.
Liz Wood, Clinical Nurse Educator, Loughborough, England
My main role in surgery is chronic disease management. All the clinics are nurse led. I have responsibility for reviewing all patients on the chronic disease registers, which allows the GP extra time for his surgery duties. I am in the process of changing the way in which the patients attend these clinics. If a patient has more than one chronic disease I want them to have one appointment instead of two or three. This system will improve patient care and make more effective use of my time. I feel that nurses are not valued for the responsibility that we have in the work place and it is about time that the Government gave us the credit we deserve.
Ellen Kenworthy, practice nurse, Cwmbran, Wales
I work as a nurse practitioner with a GP practice in the inner city. My range of duties varies and includes all the general practice nursing such as cervical cytology and travel health, to chronic disease management and opportunistic screening. The extended duties include triage, emergency treatments or dealing or treating those patients requesting same-day appointments. This includes any walking and wounded, rashes and requests for general health advice on pyrexia and tummy upsets.
Daxa Vaidaya, nurse practitioner, Leicester, England