Nicola Wingate

I work in a multiple disciplinary team in a new GP Virtual Ward Service which is akin to ' Hospital at Home ' .It is a ' step up' service ; taking referrals from ambulance crews , 111 , Community GP's and other healthcare providers to provide increased support and medical supervision to patients who are acutely unwell . The aim is to keep them out of hospital.

It is also a ' step down' service and can take on hospital patients who need ongoing hospital level care , for example nebulisers , iv antibiotics , increased care needs , physiotherapy and regular medical review. This is delivered in their home environment . The service tries to keep patients in their own homes where possible and prevent the consequences of hospital admission such as loss of mobility from prolonged bed rest , poor nutrition and the risk of hospital acquired infection. It also facilitates hospital discharges and frees bed spaces.

I work with a team of nurses , Physiotherapists , Occupational therapists and Pharmacy.

There is an MDT daily where we discuss and formulate a treatment plan for the patients on our list , I carry out home visits where needed and all the usual administrative roles of a GP such as answering prescription requests , arranging investigations , liaising with the hospital teams when patients are not following the expected trajectory in their recovery , and discharge paperwork/ handover to their regular community GP

I work one PA/week as a Medical Examiner. The Medical Examiner service reviews all deaths in Hospital and , since September 2024 , community settings.

Three questions need to be addressed ;

1.Does the case need to be referred to the Coroner ?

2.What is the cause of death? It is important to establish the cause of death as accurately as possible , both for the sake of the family and in the interests of recording accurate public health data.

3.Were there any significant omissions or concerns regarding the patients care that need to be escalated via appropriate clinical governance pathways ?This is so that any learning can be drawn from the case and care improved for future patients.

Approximately 8 cases are allocated each session to be scrutinised and then we meet with the attending clinician ( in hospital cases ) to discuss the case prior to completion of the MCCD.

Occasionally it is necessary to speak to the bereaved family if they have any concerns or queries , and also to liaise with the Coroners office.

Providing cover for the Hospice inpatient unit as well as working with Hospice at Home to manage patients in the community .