Interspecialty Learning: Breaking the Barriers between Primary and Secondary Care

Saif Ahmad, Prit Chahal, Jane Little

Introduction

• An effective primary-secondary care interface is of growing significance to professionals and patients

• An understanding of commissioning and NHS management is important for doctors

Interspecialty learning

• Parallels with interprofessional learning

• Evidence- surprisingly scarce

Aims

• Evaluate a novel interspecialty learning exercise designed to educate GP and medical trainees on NHS management and commissioning

What was done

• 74 GP and medical trainees attended

• “NHS Management Structures and Service Re-Design”

• Whole day (not on hospital site)

The Intervention

• 6 mixed, randomly allocated groups

• Asked to re-design a service– E.g. Heart failure, diabetes

• Internet, consultants and expert patients

The Intervention

• Each group then pitched their business case to a commissioning panel– Dragons’ Den

“Dragons’ Den”

Questionnaires

• Pre- and post event (100% compliance)

• Assessed– 1) Perceived knowledge and skills– 2) Attitudes

Results...

Multiple variables pre- and post

A B C D E0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5Pre

Post

A- Combined teaching helpful

Understanding ofB- Patient centred approach to service designC- Evidence based approachD- Primary-secondary care interfaceE- NHS management structures

Likert score

Would recommend to colleague

Strongly DisagreeDisagreeNeutralAgreeStrongly Agree

Comments

• “Revolutionary way of learning”.

• “An excellent approach to teaching a relatively unfamiliar, drab subject”

• “...helped me to understand how both primary and secondary care can be integrated for the interest of the patient”.

Comments

• “Secondary care physicians seemed to blame problems on inappropriate GP referrals ie its all the GPs fault. Felt that day was focused on sorting out inadequacies in primary care. It was quite demoralising spending time working out ideas for them to be completely ripped apart”

Potential Partners

• Medics with A&E doctors

• Surgeons with anaesthetists

• GPs with anyone

• List is endless....

Ken Currie, Three Oncologists Scottish National Portrait Gallery © KEN CURRIE

Conclusion

• Interspecialty learning may modify trainees’ knowledge, skills and attitudes

• Regular exercises are likely to reinforce these benefits

• Potentially improve collaboration and patient care

Acknowledgements

• Mrs Karen Montrose• Mrs Jane Hind• Dr Nohaid Ilyas• Dr Jonathan Corne

References

• 1. Lingard, L., et al., The rules of the game: interprofessional collaboration on the intensive care unit team. Crit Care, 2004. 8(6): p. R403-8.

• 2. Pollard, L.C., et al., Perceived barriers to integrated care in rheumatoid arthritis: views of recipients and providers of care in an inner-city setting. BMC Musculoskelet Disord, 2011. 12: p. 19.