AAW PCT LOCAL ENHANCED SERVICEAAW PCT局部增強(qiáng)服務(wù)

1、.The CausewayGoring-by-SeaWorthingWest Sussex BN12 6BT Practice Name:Practice Address:Specification for a Locally Enhanced Service (LES)for the care of patients with Leg Ulcers 2008/09IntroductionAll practices are expected to provide essential and those additional services they are contracted to pro

2、vide to all their patients. This enhanced service specification outlines the more specialised services to be provided. The specification of this service is designed to cover the enhanced aspects of clinical care of the patient, all of which are beyond the scope of essential services. No part of the

3、specification by commission, omission or implication defines or redefines essential or additional services.BackgroundCurrent best practice and national guidelines recommend the use of compression bandaging for patients who have leg ulceration due to venous disease. It is recognised that the treatmen

4、t of this group of patients requires a specialist level of knowledge and skill and can be time consuming. GP practices will be offered payment for treating patients who have leg ulceration which requires compression bandaging via a Local Enhanced Service. Practices may also choose to take additional

5、 patients from neighbouring practices where this service is not available, and receive payment accordingly. As part of their essential GMS contract, practices should continue to identify and prevent, as far as possible, the development of leg ulcers in all patients considered to be at high risk. Thi

6、s would include patients with previous leg ulcer history, varicose eczema and those for whom elasticated hosiery is being used. Treatment should also continue for patients with leg ulceration for whom compression therapy is not a suitable option. Staff should be appropriately trained to undertake th

7、is work (see accreditation information below).Service outlineThe aim of the service is to appropriately manage the care of patients with new and existing leg ulceration who would benefit from compression bandaging therapy.The service will provide:Ø A full and holistic assessment of a patient wi

8、th leg ulceration to assess their suitability for compression bandaging. This will include the use of Doppler ultrasound as a diagnostic tool and screening for diabetes.Ø An individualised treatment plan based on national guidelines and evidenced best practice. (guidance available on the websit

9、e)Ø Regular dressings and bandaging according to an individualised treatment plan.Ø Ongoing review and reassessment, and referrals where appropriate to specialists, e.g. Dermatology or Vascular surgeons.Ø Patient education and lifestyle management with written support for patients and

10、 carers.The service provider will ensure:Ø Patients with leg ulceration due to venous disease receive a comprehensive holistic assessment.Ø Patients receiving treatment are regularly reviewed.Ø Essential Doppler ultrasound equipment is available within the practice, and maintained acc

11、ording to manufacturers instructions.Ø All clinicians providing the service have completed the relevant training course and are proficient and competent in the care of people with leg ulceration, including developing skills in the use of Doppler and compression bandaging.Ø Premises are sui

12、table for the provision of treatment of patients with venous leg ulcers, including the implementation of the standards for infection control and the safe disposal of contaminated waste.Ø Accurate, contemporaneous records are maintained.Ø For patients receiving treatment for venous leg ulce

13、ration from an LES practice and not their own GP practice the provider will ensure information regarding treatment and progress is regularly communicated back to the originating practice. Patient held records may be considered as a means of communicating up to date information.AccreditationØ Al

14、l clinicians providing the services have completed the relevant training course and are proficient and competent in the care of people with venous leg ulceration including skills in the use of Doppler and compression bandaging.Ø Existing practitioners already undertaking this role and who meet

15、the criteria set out within this LES are required to attend a Continuing Professional Development session within 6 months of the practice signing up to this LES, and have been accredited as competent by attending the Accreditation Workshop. Ø Nurses not possessing skills in the management of le

16、g ulceration with compression bandaging are required to undertake the minimum mandatory training of 2 days, followed up by a half day practical assessment session. Nurses will be encouraged to practice their newly acquired skills, with a trained mentor, between training sessions.Ø All practitio

17、ners providing leg ulcer services must update their knowledge and skills base every 2 years.Ø Evaluation and audit of primary care leg ulcer services will be undertaken regularly to ensure quality and standards, within the context of clinical governance, are being maintained.Appraisal criteriaT

18、he appraisal criteria will include both the generalist and special interest aspects of the work. CPD requirementsIt is expected that the level of training required for a GP providing an enhanced service isidentified in the GP's personal development plan. Where additional training is required, lo

19、calmechanisms will be found to address this. MonitoringThe practice must provide an annual audit of patients under this scheme, showing length of time to healing.PricingPractices will be paid £283.26 for each, complete, compression bandaging treatment. If a patients leg ulcer has not satisfacto

20、rily healed within 20 weeks, the practice may make a second claim, but must provide additional details, including reason for not referring to secondary care. If a patient has leg ulcers on both legs, the practice may claim for two payments.· The cost equates to assessment of 45 minutes, with 20

21、 weekly follow up consultations of 30 minutes, by an F/G grade nurse. An allowance has also been included for GP, admin and overhead cost.ApplicationGP Provider Application for Locally Enhanced Scheme 08/09 Leg Ulcers Practice Name:How will you meet the aims of the scheme?Briefly describe the servic

22、e to be provided and facilities available. Will providing this service adversely affect the practices ability to provide essential or additional services?Who will be providing the service?Do you have evidence of appropriate staff qualifications, if appropriate? How will you ensure staff providing the service remain suitably qualified?How will you monitor and audit service provision (refer to any requirements within the scheme). Please outline any other details relevant to your ability to provid