PT  - JOURNAL ARTICLE
AU  - Nishaan Khoosal
AU  - David Swanson
AU  - Girish Purohit
AU  - Cath Morgan
AU  - Amit Bharkhada
TI  - The combined care clinic: a strategy in improving quality and efficiency related to essential patient reviews in the UK
AID  - 10.3399/bjgp19X703565
DP  - 2019 Jun 01
TA  - British Journal of General Practice
PG  - bjgp19X703565
VI  - 69
IP  - suppl 1
4099  - http://bjgp.org/content/69/suppl_1/bjgp19X703565.short
4100  - http://bjgp.org/content/69/suppl_1/bjgp19X703565.full
SO  - Br J Gen Pract2019 Jun 01; 69
AB  - Background Standardised delivery of patient care remains an essential facet of the NHS. In 2004, the general practice contract for delivering specific primary medical services incorporated a financial payment: Quality Outcomes Framework (QOF). In majority of practices, these reviews are completed by the practice nursing healthcare team.Aim To understand if the combined care (CC) clinic improves the efficiency in delivering patient reviews.Method The CC clinic was designed in 2015 inviting patients with diabetes; who may also have other long-term conditions, to be addressed in a ‘one stop’ approach. It is implemented by healthcare assistants (HCAs) supported by apprentices, who perform standard checks such as blood pressures, urine dipstick checks, smoking data, and health promotion that are protocolled. Where there are abnormalities noted, the HCA is able to escalate to the practice nurses who are supported by a GP lead.Results QOF diabetes data were reviewed from 2015–2016 (636 patients on register) and 2016–2017 (649 patients on register). Results showed a marked percentage increase between years in the following indicators: DM003 (last blood pressure measurement ≤140/80 mmHg) 7.29%; DM006 (proteinuria/microalbuminuria) 6.20%; and DM009 (foot exam) 3.21%. All other diabetic indicators apart from two showed a percentage increase. The proportion of patients seen between April–October also increased in the subsequent year.Conclusion The CC clinic provides a method of patient review in an efficient process, without the need for multiple visits, thereby increasing practice capacity to focus on other aspects of patient care and work streams.