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SoWhoCaresAnyway E10 Leading with the Heart · SoWhoCaresAnyway

Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
People from healthcare, social care, the voluntary sector, community groups, and more.
To join me each week to find out, so who cares.
Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
where you can also catch up with previous episodes and read my blogs.
Hi and welcome to the next episode of So Who Cares Anyway.
In this episode I'm really delighted to have Heidi Edmonds join me.
I've known Heidi for quite a long time.
Heidi works in the lead role at Estuary View Urgent Treatment Centre and as far as I'm concerned Heidi's done some incredible things and incredible work.
So I really wanted to bring Heidi on today to share some of what she's been doing and talk about that a bit more.
So I'm just going to pass over to you Heidi and ask you to introduce yourself a little bit further please.
Thanks, Ruth, for that introduction.
That was very kind of you.
Um, yeah, so, uh, my name is Heidi Edmonds.
I'm the Clinical One Operations Manager at SGVU Urgent Treatment Centre in Whitstable.
I am actually in a joint role with a colleague who shares that role and responsibility.
with me.
So I'm a nurse by background.
I qualified in 1999 and most of my experience and background has been in urgent and emergency care.
So I started off working in the acute medicine ward in secondary care and then went to A& E, subsequently trained as an emergency nurse practitioner and has subsequently gone on to do my advanced clinical practitioner.
And I'm now a nurse consultant working in primary care in that urgent.
Treatment center environment.
Thank you, Heidi.
You've given us a bit of background.
And I suppose when I first met you, it was around that time when you were working, you'd already become that advanced practitioner.
But you were looking at that urgent treatment center, talking about the various staff, and The way that staff work there.
So I think I came to you to talk about levels of people work and what people do.
And we were working on that sort of competency framework.
But what I later discovered is that actually when you started in that emergency nurse practitioner role, you had really started to develop, I think probably a community of practice to begin with, but actually built on that to become quite a network that had made quite a difference for change.
So I wonder if you'd tell us a bit more about that, please.
Yeah.
So I think throughout my career.
I've always been someone who's wanted to make sure that I'm at the top of my game so that actually I'm able to deliver the best patient care that I'm able to.
So when I first started actually back in 1999 when I qualified, I qualified with a diploma in nursing and then I was fortunate enough to be seconded to do my pediatric training where I got another diploma.
And then nurses were coming out with a, a nursing degree.
So I subsequently went on and did my nursing degree, which was really to help support some of that education that I'd done because I was very much mindful, certainly in an urgent and emergency care.
sort of arena.
There's a lot of, you know, you see a lot of different things.
You see children, you see adults, and that can be really quite difficult when you're an adult trained nurse, or you've only got a speciality in a certain area.
So I've worked really hard to try and up my skills over the years with gaining minor injury and minor illness skills.
But I was also mindful that Other people were in that same position and I've always been very keen on education and people developing themselves to be the best that they can be in their roles.
When I started in the, it was originally a minor injuries unit at Whitstable and I was the nurse lead there and we used to see minor injuries, that was predominantly what our role was, so we saw minor injuries sort of Monday to Friday during core GP hours and then out of those hours.
So after the GP surgery shut and before 8 o'clock when we shut, and then at weekends we used to see minor injuries, minor illness.
And then in 2018 we became a pilot site for the urgent treatment centres.
And so, where we had been seeing minor illness, to some degree, after half six and before eight o'clock, and then at the weekends, it just meant that we were going to see a lot more of that, um, those sorts of presentations.
So, I think we were really fortunate, because where we were, a pilot site.
We didn't really change our delivery model.
We just needed more support from the GPs to be able to run that service.
So what that meant when I was very conscious that the staff there were sometimes being a little bit out of their depth.
And so for me, it was really important that they continue to learn and grow and develop and we supported them in that role.
And so one of the things that I was really.
Fundamental in doing where I was working was the PLT afternoons, which are the protected learning time that practices working in general practice tend to have a lot of that wasn't geared around urgent and emergency care.
So some of the content within that wasn't suitable for.
the nurse practitioners and the paramedic practitioners where I was working.
So, I was quite instrumental in setting up a rotor which allowed us to have some protected education time.
So, every six weeks we built a rotor that allowed us Um, half of this, because we can't close an urgent treatment center, we don't have a lunch break where we can say, Oh, it's going to be training now at lunchtime, because patients come in at whatever time, and sometimes they need urgent help during that time.
So we built a rota, really, around half the team coming to protected training in the morning, and half during the day.
The team coming for four hours in the afternoon.
And that has, that's been going since 2015, I think 2017, sometime around there.
And I think that's where my real passion for growing and developing and supporting my staff.
Going through and then after we'd become a pilot site and it was going to be an established urgent treatment center it was still fundamentally staffed by nurse practitioners, paramedic practitioners and Urgent is whatever the patient says it is, whatever they think it is And so I think when you look at the service spec of an urgent treatment center It it kind of says minor injury, minor illness and it lists a lot of conditions that are minor illness ones.
But actually, in reality, patients will arrive with absolutely anything and the service spec is that we will see anyone from, you know, not to, whenever.
So, yeah.
The clinicians need to be I was able to assess and take a really good history from all of those patients or the parents.
And so for me, that continued development, growth, education has just been really fundamental to make sure that I'm leading and, We're delivering the safest service that it can be.
And just because we can assess and we can take a history from anybody, doesn't mean we necessarily are able to diagnose or know what's wrong with that patient.
What we're good at doing is, we're good at signposting where appropriate, and we're good at identifying.
sort of big sick, little sick.
We're good at identifying whether someone needs treatment versus non treatment, and whether that's urgent versus non urgent, and whether someone needs a referral versus a non referral.
So I think that's where my kind of passion really came from, around patient safety and continually growing the staff and developing them.
And it sounds to me as well that you're thinking about patient safety, which is absolutely paramount, but you're also thinking about the safety of your staff, because you talked about the fact that people felt out of their depth at times, and you needed to make sure that they had that.
education.
And one of the things I've always said is actually nothing's when somebody presents with something minor you never know it's minor at the time because how do you know what's a minor illness until you've gone through everything.
So it's very difficult and if we don't know when people come to see people like yourselves then actually how do they know themselves whether it's minor or not.
So there's a lot of knowledge and skills and it's very difficult for somebody to Differentiate between those before they turn up and I really like the way that you've talked there as well, Heidi, about how you almost put this package of wraparound around for yourself and your staff to make sure you've got that way to develop and grow.
And I'm just wondering if you have got any other things that you put in place to support your staff and to help them as well.
Yeah, I think definitely the, um, education is definitely one of the things I think one of the things that I was really mindful about having worked in urgent and emergency care in an emergency department was actually there is that old adage that we care for patients and sometimes as an organization, we don't always look after our staff.
And so I was really quite mindful about that, that actually urgent and emergency care has a really high turnover of staff.
And, um, With staff often experiencing burnout and, you know, it takes its toll when you are subjected to that sort of emotional turmoil sometimes in the role that we're in.
So, um, things like, um, setting up clinical supervision groups is again something that I'm quite interested in.
Passionate about because, I think, coming from a minor injury background, minor injuries generally tend to be something that you can assess a patient, diagnose, manage them, treat them, know that they've broken an ankle, know that they've broken a finger, know that they've got a wound that needs suturing, and you can then end up almost doing that whole wraparound episode of care and finishing and completing that and sending the patient on their way, and it's really satisfying.
Illnesses, medical conditions and things can leave you in that sort of very vulnerable position that sometimes you're not actually sure what's wrong with the patient.
You know, and even our medical colleagues don't always know.
I had a conversation with a GP once who said about 80 percent of the time, they're not sure on the diagnosis.
It becomes clearer as maybe symptoms develop in two or three days time.
I often use the analogy of jigsaw puzzles, and one of my colleagues actually uses a phrase that they feel that they're a bit of a health detective.
They're trying to find out all these clues to find out what's going on with a patient.
And so actually providing that level of support and understanding for other clinicians, because that's where sometimes they can feel at risk, vulnerable, because they don't know definitely what's going on with a patient.
And that can sometimes mean that they wake up in the middle of the night thinking, Oh God, I didn't think about that.
X, Y, and Z or that patient could have had that.
And I think dealing with that uncertainty through things like clinical supervision, you can actually explore some of those issues with the staff, making them feel that actually they're not on their own.
This is completely normal.
with dealing with that.
I think perhaps as nurses I've always felt that our training probably doesn't quite, it's great, I'm really pleased to be a nurse and I love my training and things like that, but when you start moving into the advanced practice role, a lot of the building blocks and the foundations that medics learn as they go, they learn all their anatomy and pathophysiology right at the very beginning and they use those as building blocks to build on their career.
Whereas I think as, um, nurse practitioners and advanced clinical practitioners, we learn that in a different roundabout.
We learn that afterwards.
So we then have to underpin All of that experience and that, just that we've gained by walking the walk and talking the talk, we then um, de pin it with some of the more theoretical and some of the more technical knowledge that we don't necessarily have right at the beginning.
Yeah, and I can really relate to that.
As you know, Heidi, I worked in general practice and that bit of waking up at night thinking, Did I do this? Did I do that? Should I have asked something else? And it does leave you feeling quite vulnerable, actually, and it's really important.
So I don't know if you listened to Rebecca Meyer's episode, but she was talking very much about that emotional labor, which is what you've really just talked about.
Dealing with people, helping people, not that uncertainty.
Also, seeing some distressing things at times.
So I think that clinical supervision and that wraparound is really important.
is really important.
What I'm interested in is, you've talked about there, you've spoken about the fact of medics, um, you know, our doctors, our colleagues, that they have gone through a very different way of training than perhaps we have at nurses or other health professions.
We've spoken about paramedics, but quite a few don't have that sort of medical background and we learn that.
And I think some of it is about that critical thinking, which is what I think you were talking about.
I always likened it to a crossword puzzle actually.
Some answers you got easily and some answers were a bit more cryptic.
to try and find them out and you weren't sure, but it's that sort of thinking that we get later that we have to use in a different way.
But I'm just wondering, what do you think the difference is between, or what, what different things do you think that people might bring as an advanced practitioner, whether they be a nurse and a paramedic than a doctor say, because obviously everybody's got their assets, everybody's useful, but do you see any sort of clear, obvious benefits or? And I don't want this to be different between one profession and another, it's just what do we each bring is what I'm asking.
Yeah, I think one of the things that's I suppose different with nurses than a medical model is we want to do the whole package for the patient.
So in an urgent treatment centre we've got our colleagues who are healthcare assistants and we've got nursing associates in our team who help support us.
But equally, we can do the ECG, we can take the patient's bloods, and we can do that all in that one wraparound consultation.
Whereas often with a medical colleagues, they'll send the patient off to the nurse to have their bloods done and arrange another appointment for them to have their ECG done.
So part of our training, I suppose, and with GPs as well, to be fair, it's a lot of barrel and holistic care of the patient.
But I think that ability to be able to do all of those little things.
And I think also a lot of us have really concentrated and specialized quite specific areas, so a lot of people will have worked in one area for quite a long time, whereas with the sort of medical training, I think you get lots of rotations, which I think is also a benefit, which I think is an advantage with the medical type training.
They get really good sort of periods of time with specialities, so we'll gain a greater understanding, whereas I think perhaps that's slightly lacking within the nursing profession.
But equally being able to do that ECG and giving that health promotion advice at the same time that you're doing the consultation, you can feed all of those little bits into the picture.
So I think more rounded is quite good.
Yeah, I think I'd agree with you there and it is a different approach and I think really it just to me, to my mind has always been absolutely that's why we need that multidisciplinary team.
We do need lots of people to be working to look after people because actually we all bring those different perspectives and those different assets that we've got.
Yeah, I think that's why sometimes it can be challenging for Advanced Clinical Practitioners or Nurse Practitioners to be able to stick to your 15 minute appointment times because Actually, when you want to do the ECG, you want to do the bloods on that patient, actually, that doesn't always fit in with those timescales, which is why I suppose, in some respects, working in an urgent treatment centre, your time with your patient, obviously, you need to be mindful that there's other patients in the waiting room and if you give someone half an hour, they will feel half an hour.
It's important that you're mindful about use of resources.
But if you can all do that and capture and do all those things in that one appointment, you're actually reducing the pressure on the service by not having to take a phlebotomy appointment, not having, and for the patient journey, that's so much better as well.
If they can do it in a sort of one stop shop, that's really good, I think.
And I think that's really useful.
And I think the other bit that perhaps that I always felt that, As a nurse you might bring is education as well.
So actually if you can do some of those things, not only are they not coming back for another appointment, but you might actually be given some education that prevents them from even needing to come back again at all, or finding out while you're doing those things, you find out a little bit more about who they are, what else they need and what else is going on, so that you can treat those things as well.
So, I think it's, As you say I think everybody comes with that holistic approach but I think that it's something about that sort of way that nurses and others work that you can sometimes just find out a little bit more about that.
Yeah definitely definitely and that health promotion it's really quick just to say give someone a prescription for an antibiotic for example it's a lot harder to actually explain to someone why maybe antibiotics on this occasion is not.
You know, it's not the right treatment for them.
And even if you end up at the end of the consultation giving them a prescription for the antibiotics, actually you've sown that seed for their next attendance, that maybe, okay, maybe I'll self manage a little bit more before I Go to the doctors, even if you don't prevent it on that occasion.
Because I think we often get scenarios where we've spent a long time with a patient telling them why they don't need the antibiotics, and then for whatever reason, maybe their symptoms get worse or something, and they go and see a GP the following day, and the GP gives them the antibiotics.
And probably if they came to see us on a second occasion with something not getting better, our thresholds of giving the antibiotics might have been a bit less.
But that can be really challenging with perhaps the patient then not feeling that they were given a good service on their first attendance.
So I'm going to move on now as well, because I mentioned at the beginning and we talked about that network.
So what you've talked about here is you've talked about the education, that wraparound support for your staff, being aware of their emotional labour that we've talked about.
And you've also talked about that clinical supervision for them, which I think is really important.
But one of the things That you spoke about at the beginning was actually making sure that what you were doing was about providing the best care.
And I think looking after your staff is really important to make sure that they have that.
But one of the other things that you've done is that you've set up some quite wide networks that spanned beyond where you work.
I think they started off quite small, but they've expanded beyond that.
And they actually spanned, uh, span across the whole of the integrated care system, if I've got that right now, and they've slowly grown and you've really led that.
And I know that they've made a massive influence to the way that urgent treatment centres, but also other things work.
So I wonder if you could give me a bit of a background about that and share that please.
Yeah, thank you.
So when I was an emergency nurse practitioner, I used to be quite an active member of an emergency nurse practitioner forum, which was delivered.
Across the organization where I worked, and I think I've been really fortunate in the past to have some good role models, and some, you know, some people that I've used as examples where I've been doing things, so, yeah.
I was a regular member, an active member of this Emergency Nurse Practitioner Forum.
And then when I left the acute trust where I was working, and I moved to Estuary View, I was very much mindful that I didn't have the same networks or the connections that I had previously when I worked for a really big trust and a big organisation and had all that kind of support around me.
And one of the things that I really wanted to make sure was that we weren't out of the loop and missed things, the updates and things like that.
So I blagged my way a place to stay on this forum as an outsider and joined it.
And I was really keen because that gave me the opportunity that if things had been updated in the hospital, I could take them back to my workplace and say, Guys, this is what's happening.
They've changed the follow up Thor.
So it was really important for me to do that because I felt that there was a little bit of risk associated with not being up to date, not knowing what was happening around the community.
And I've always been one to think that actually if a patient is going to an acute hospital site, to an A& E department or an urgent care centre, they really need to have the same level of care when they come to a non co located, a community provider.
So that's what kind of happened, and then the person that was chairing it retired, and they asked for a volunteer to take over chairing it, and no one seemed that keen, and I think we've all got our day jobs, and it's all quite stressful, but for me, I had the greatest interest in making sure that that forum continued, because that was my kind of linking with the Trust, so I ended up volunteering to chair it, um, and which was really useful and then when we became an Urgent Treatment Centre, instead of it being an Emergency Nurse Practitioner Forum, it later became the Urgent Treatment Centre Clinical Forum.
And actually, we were then in a privileged position.
Where we had been a pilot urgent treatment centre for two or three years, it was really a good opportunity for us to share some of our learning and some of our knowledge around what's worked well as an urgent treatment centre and what things we've learnt along the way and how we could have done things differently.
So I then started, yeah, chairing the UTC clinical forum, which became much bigger.
Then started inviting other stakeholders who were interested in running urgent treatment centres and knowing a little bit more about that.
So then we invited people from CCAM, the 111 DOS, and we have representatives from all across Kent and Medway urgent treatment centres who attend.
So, what you haven't mentioned there is that you were actually, when you were running this clinical forum, you were actually linked in with what were clinical commissioning groups and later on the Integrated Care Board as well.
So I'm just wondering if you'd explain how that worked and what the benefit of that was.
How did you get that voice with them and how did that benefit both you and them? Yeah, so I think that came about, um, more by accident really.
I think things start off small.
I was never someone who thought, Oh, do you know what? I'm going to be speaking and chairing a, a forum that has representatives from quality teams from other GP practices, from clinical directors for things.
I think the ICB were, or the Integrated Care Board, were really interested in linking us with other UTCs that were starting on their journey, because they saw the benefit of our experience being Shared with other units and so they've been really supportive.
Um, they provided admin support for it.
Okay.
Um, and it became, you then got linked in with other people and someone would suggest, Oh, you want to invite, can we invite? You know, someone from IC24 to join the meeting and things like that.
So they've been really supportive by providing that admin support to help make it sustainable, I suppose.
And you've said there that it happened by accident, but I think what you've described here is that actually you were really motivated.
You weren't motivated to become.
the chair of something really big but you were motivated to make sure that you were really kept in the loop so that you really knew what was going on and what was the best thing for the people that were coming to see you and it was that passion and drive made you step up that got you to step up to become the chair and it was that passion and drive probably that People started to notice what you were doing and started to think, actually Heidi's leading this or maybe the group, the clinical forum as a whole, but they could see that things were happening, which meant that you were linking in with all of those other people.
to make those things happen.
And for anybody who's on the call who perhaps doesn't understand advanced practice so much, I think what's really important, it's often called advanced clinical practice, but actually there's those four pillars, isn't there? The clinical pillar, where you're doing the things that you've spoken about earlier on, whether that's, you know, taking a history or whether that's something like taking somebody's blood sample, but all the way through to then your research.
Which is making sure that you're using best practice and evidence based.
You've talked about that education bit, making sure you do the education of yourselves and others.
But what you're really demonstrating here, Heidi, is that leadership, and stepping up in that leadership.
And you're not talking about, I'm the leader.
But you're stepping up to do that leadership in a way that is collective that's with other people to say actually what can we do together to make this work.
So I think that's really what you're describing and I think that's really important and quite admirable.
I think for me my leadership style absolutely, you know, I recognize that without blowing my own trumpet that I have.
Good leadership skills, but I think they're also quite subtle and I'm not a for anyone that knows me really well I am someone who's really suffered in the past from imposter syndrome and I still have got those little niggly voices I'm not ashamed to admit that and I just think actually for me, I'm happy to share my vulnerabilities with people and it's something that I have actually struggled with over the years, so it doesn't come, it comes naturally, I think, for me to be a leader because whenever, you know, anything that even I do in my personal life, I tend to be the person that kind of takes charge and the leadership role of it, but I think I'm quite great.
Subtle in my leadership style, quite mellow in it, and I'm not overly confident in it.
But then equally, I have never been an overly confident practitioner.
But I think those are the things that kind of keep you real and keep you grounded.
Actually, By not being overconfident, you're always checking in and making sure that actually what you're doing is right.
It fits people's needs and You can adjust it all the time based on reflecting on what you're doing So although it happened by accident, you're absolutely right.
It was my passion and my drive to want to you know, keep that link and that networking with people that are in the know.
It's through my desire of wanting to make sure that actually not just myself but my colleagues are the best that they can be.
And that patient safety that I've talked about previously.
Yeah, so for me that is really important.
And then also I think going on from that, once we'd had all this experience of being a pilot UTC and actually it being run really successfully and we had the patient feedback, our patient satisfaction is amazing even still now.
Um, recent patient survey that we did of our unit that we sent to patient access our services.
97 percent of patients rated our service as good or very good, which for urgent and emergency care is, I think it's pretty good in as much as most people are not very happy because they wait longer than they need to.
They're in pain and discomfort and it's not a great time or period in their lives often.
So that's really good.
So we had a lot of learning that we could share with others.
And equally, they've still got things that they bring to the table, and we benefit from that as well.
So my unit benefits because someone else has done something and has got a really good idea about doing something better, and why would we not try and work collaboratively together to prevent us all doing little pockets of work, when actually we could share all the work that everyone's done and produce a fantastic piece of work at the end of it.
A fantastic model and you told me about some of those things in the past but before I go on to that I'm going to come back to that leadership bit and you talked about that imposter syndrome which I think many people talk about and I'll say yes I've been there myself and I still get that and you're right what it does do is it makes you check in and I think that's actually quite an important thing to to do.
It's a check in all the time, whether it's that clinical or that leadership.
And because of that, I think that's why you've gone down that road of rather than being I'm the leader, which is definitely not what you're about or like, as to be in that collective and distributed leadership.
So whilst you're leading, you're actually bringing people with you.
And bringing them on board so that you've got that piece, which is where you say, Oh, you're doing this here.
We're doing that.
Let's bring that together, which comes on to allowing people to all feel that they're able to collaborate and share that learning.
And I think the bit that really shines through as well is that actually Your understanding of how people might feel at work, your understanding of how people might feel when they come to see you because, as you just said, they're in pain and those types of things really shows your compassion and if you look about all the things at the moment around leadership and what sort of leaders we're looking for and need in the NHS but also in health, social care, wherever, it is that collective distributed And compassionate leadership, and you're talking about doing and being all of those sort of things, Heidi, I'm going to come back to that collaboration bit as well.
So you told me a story once and you might not particularly remember it.
So you might have another one.
But you told me a story one time about how you had worked together.
as urgent treatment centers across Kent and Medway to make sure that there was the same processes and the same things happening and it came through that shared learning.
So I don't know if you want to share that one or if you've got something else in your mind of some sort of shared learning that's happened across Kent and Medway that has come out of this group that you might want to share with people to give an idea of what difference that might make.
Yeah, so one of the things that we did right at the very beginning was The patient group directions, PGDs, which people use quite often.
And these are basic protocols where clinicians who are not prescribers, who are not non medical prescribers, can administer medication based on a certain criteria.
So it would be for routine things that we would use in an urgent treatment center, analgesics, antibiotics, that type of thing.
And.
There were three big groups of people that were using, or groups of organizations that were using these PG ds, the Acute Trust.
This was in East Kent at the time.
So the acute trust, the community trust, and also the community.
So non-trust community providers of urgent treatment centers.
And actually there were slight nuances, differences between the pgd.
So for example.
If you worked in one organisation, you couldn't give flu clocks a ceiling to a child under the age of one.
Because your PGD wouldn't allow you to do it, but another one your PGD said you could so they were just slight nuances Some of them were historic because some organizations didn't see children under the age of one Okay, but once we all became urgent treatment centers the service spec was that we saw any any person over the age of zero, really.
So what we did was we worked really closely together.
Unfortunately, only two of those big groups of organizations were able to work together.
I think sometimes manpower resources, what's going on in individual organizations at the time, made it quite challenging.
But two of those organizations, we work together to standardize those PGDs, which is all about patient safety as well, because you could get a clinician who works on a bank or agency who works in one organization and works in another.
And if their PGDs are slightly different, then it could result in them making a slight error, or you've got a gap in the service that actually you could have a situation where You know, a child under the age of one has a little paronychia or something and needs antibiotics for whatever reason or some other condition, an affected insect bite or something.
And in one organisation they could give the antibiotics as a PGD and another one they couldn't.
And it's not, that's perhaps not the best example, but we worked really well and collaboratively to bring that together.
Another piece of work that we did was around paediatric transfer and this is a piece of work that we've done quite closely.
More recently, and especially for the non co located UTC, so ones where we haven't got an A& E department or a paediatrician down the corridor, how do we transfer which patients or which children, if they need to be seen by a paediatrician, are safe to go with their parents in the car, and which ones actually we need to call an ambulance for.
So we've worked collaboratively with other colleagues in urgent treatment centres, and then we shared that with the wider community.
UTC clinical group.
to say, actually, this is what we've produced, feel free to adapt it however you would like to do it.
And another example of where we've worked collaboratively was on a redirection policy.
So, the non co located urgent treatment centres in East Kent, they're all commissioned to run and provide services till 8 o'clock in the evening.
None of us shut our doors till 8 o'clock.
Okay.
Certainly during the summer months, when it's lighter, people are at the beach till half seven, eight o'clock and injuring themselves.
We could be in situations where you've got ten, fifteen patients waiting in the waiting room at sort of still ten to eight o'clock.
And clearly the clinicians, a lot of clinicians working in urgent treatment centres do twelve hour days, twelve and a half hour days.
Yeah.
It's not safe.
for them necessarily to be working way past that time and also they need to probably, they might be on the shift the following day.
So we implemented a policy whereby a senior clinician, experienced clinician will assess those patients waiting in the waiting room who will arrive late and make decisions about whether it's safe for them to Wait to be seen till the following day or whether they need to be signposted to another organization that offers a 24 hour service and as a result of that obviously for work life balance and clinicians feeling supported that they can go home at a reasonable time then that's been really useful and that's something we shared across and we agreed as a whole.
And as you say, that comes into that patient safety as well.
So, there's a whole lot of things that come out of that.
And you were saying about the flu cloxacillin example with a child under one just now, perhaps not being the best example, but actually, that's a really important example because most It means that in some areas that baby would be treated, but in other areas they would have to be referred on to somebody else.
So, it's quite an important thing that you're describing there, and I think that's three really important examples.
Well, with the flu cloxacillin example, Actually, there are still urgent treatment centres where the clinicians are still not happy to see children under two.
So we just, to make sure the document was fit for purpose for all the units and it was the same document, we just put a simple caveat on there saying if it's within your scope of practice or you're deemed competent to be able to do that.
So that actually it covered those units who were still on the beginning of their journey and some of their clinicians are not still that comfortable in seeing children or, and.
It's one of those things right at the very beginning I said, although we can assess and take a history from all of these, everyone that walks through the door, it doesn't mean we can necessarily diagnose or treat everybody.
So again, just because we've got the ability to do the PGD, actually the individual clinicians need to recognize their own skills and their limitations and their knowledge.
And I think that's one of the great things about working in urgent care is that there's always someone to ask.
Part of our role is, you're not the final decision maker all the time.
Do you know what I mean? You've got phone a friend.
We're discussing it.
Two minds sometimes are better than one.
Yeah, and it gives you that support as well because if somebody else comes up with something the same or similar to yourself Then it makes you feel more confident.
So yeah, I think that's a really important thing So Heidi, I'm aware of time and you've shared so much here But what I'm wanting to ask you is what would be your key take home points for people to take away today messages? Or is there anything that you think actually what would be really useful to happen is so I suppose my key messages would be I suppose around that networking and that providing support is important, not just for patients but for staff.
So it's got lots of things around retention of staff and staff's job satisfaction.
And all of those things are really valuable because actually if we don't look after our staff then, then we have issues, don't we, around, Being able to deliver the services that we want to, which then impacts on patients ultimately.
So I think actually our workforce is one of our key, should be a key priority because ultimately a happy clinician is then going to do their best for their patients.
And so it's going to be definitely felt on the delivery of care that's able to.
So for me.,
supporting staff through, whether it's mentorship, whether it's through clinical supervision, whether it's giving people,, being able to pick the phone up and saying, Oh yeah, I know you, because we've had a conversation.
And then being able to say, could you help me out, or I don't know what I'm doing here, or What would you do in your unit? I think just makes life a lot easier.
Thank you.
That's really nice and a good takeaway.
So supporting those staff, looking after staff, they are the key asset, as you say, that we really need.
So thank you very much for joining me today, Heidi.
I've really appreciated it.
And it was great to have you on.
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