Category: New Ways of Working

Winner: The Bromley and Greenwich New Ways of Working project

Since 2002, Oxleas foundation trust's mental health services in Bromley andGreenwichhave been operating aNew Waysof Working programme.

Feedback from service users, carers and GPs revealed that a review of outpatient clinics and acute inpatient services was needed to achieve more efficiency and consistent evidence-based care pathways across our services.

The trust approached the project as a partnership between nurses, doctors, pharmacists, GPs, managers and users and carers. The idea was to work out what could be changed to make the service accessible, to use time more efficiently and to support enhanced roles in nursing and other disciplines.

Trust director of clinical services Geraldine Strathdee says: "We approached new ways of working by asking our staff how they were spending their time, where they spent their time, what they spent it on and how they could spend time more efficiently. We wanted to find ways of doing routine things better rather than introducing a series of brand new changes."

The trust then organised a focus group of 52 senior Oxleas doctors to develop an audit tool to identify how we were using our clinic and ward round times. Geraldine explains: "We asked them to talk about what took most time at clinics. The list included assessment, physical health checks, risk assessments, medication checks, educational input and CPA related stuff.

Efficiency drive

"Our audit showed that in 40 per cent of outpatient clinic appointments, the service user did not need to keep returning to see the consultant, as they were meeting with senior and expert CPNs and other care co-ordinators."

The trust also looked at why service users were returning to the clinics and found that they came for review of physical healthcare, medication needs and to obtain information.

The trust worked with service users and carers to find expert alternatives to attending clinics. It introduced two rapid access clinics a week and an enhanced role for GPs who work as visiting medical officers in nursing homes.

Feedback is that service users feel more able to get the help they need when they need it. They prefer not to keep coming back to clinics if they can see their care co-ordinator. A staff survey finds high levels of job satisfaction with enhanced roles.