South East Health - Out of hours medical care, Primary care health services

The Roving GP service (RGP) is a pilot project delivered via Practice Based Commissioning (PBC) in Brighton & Hove. It has expanded from its original remit of working with six GP Practices to cover the whole of Brighton and Hove. The service has a GP on duty five days a week, from 9.00am to 4.30pm. Its purpose is to reduce unnecessary hospital admissions by providing GP home visits to patients with urgent care needs. Indeed, a measure of the Roving GPs’ success is that they are now able to keep the majority of patients they see out of hospital.

The service is staffed by a list of GPs including Dr Robin Warshafsky and Dr Marian Messih, with Dr Rachel Austin acting as an interim GP until Dr Sarah Leader joins in July. Most referrals come from GP practices. Others come from the Rapid Access Clinic for Older People (RACOP), paramedics and the Integrated Discharge Team at the Royal Sussex County Hospital. A small proportion are made by the Medical Assessment Short Stay Unit (MASU) for patients being discharged from hospital. “We’ve become a lot busier since the service expanded and are now out making visits pretty much all the time,” says Dr Warshafsky. “A Roving GP could spend up to an hour with each patient, and provide very much a bespoke assessment service.” Many of the patients the doctors see are elderly with chronic conditions, such as lung or heart disease, which have suddenly become more acute. Others include palliative care patients whose conditions have become unstable.

“Our first priority is to stabilise the patient, often by stepping up their medication, and we can usually make a full diagnosis the same day,” says Robin. “If we suspect a urinary tract infection, we’ll carry out urine tests at the patient’s home. If the issue appears to be medication related, we can take a blood test and get the results back within an hour or two. There’s also an ECG machine in the car so we can exclude acute chest pains requiring A&E attendance, without the patient automatically going to hospital.”

“The patients think it’s fantastic to be seen within an hour and have someone sit down and really focus on how they are. We’ll often prescribe medication and then work with other intermediate care services, such as community nurses, to keep the patient at home and make sure they’re looked after through the acute problem. We’ll then revisit, usually the next day, and make sure the management plan is working.”