While reflecting on our Parkinson’s disease service at The James Cook University Hospital, Middlesbrough, we identified that our standard 15-minute review appointments in movement disorder clinic were not wholly suitable for patients struggling with advanced symptoms of their disease. Trying to help this group of people within the context of our standard movement disorder clinic was difficult and attempts made would likely send the rest of the clinic into disarray.
We were fortunate to receive a Health Foundation grant to be able set up a Parkinson’s advanced symptom unit (PASU) in September 2015, which runs in parallel to the movement disorder clinic. The PASU was set up as a rapid-access, multidisciplinary team, community-based clinic. Patients are holistically assessed by the team, including a consultant neurologist, Parkinson’s nurse specialist, community psychiatric nurse (CPN), occupational therapist, neuro physiotherapist, therapy assistant and pharmacist. Longer appointments are scheduled and there is follow up in the community from the therapists and the CPN as needed. Patients may be referred by various routes but may also self-refer.
What the service offers
Our interventions focus on improving mobility and balance, reducing falls risk, improving mental health and reducing caregiver strain. Medical treatments target motor fluctuations, low mood, cognitive impairment and hallucinations. There are also offered therapist-led assessments in clinic and at home, with an additional focus on improving social interaction and physical fitness.
We see regional referrals for patients for consideration for non-oral therapies; apomorphine, levodopa intestinal gel and deep brain stimulation.
We offer opportunities for cognitive assessment and invest time in diagnosing and managing Parkinson’s disease dementia. We see a range of mental health issues affecting our patient group. By working collaboratively with the local mental health trust (Tees Esk and Wear Valley NHS Trust), we have been able to access its hub-and-spoke infrastructure to initiate clozapine for Parkinson’s psychosis in a community setting.
We also spend time supporting our carers. They have often been coping long term with incredibly difficult circumstances and some have carer strain.
As an independent prescriber I see patients both in the movement disorder clinic and the PASU. In addition to undertaking their clinical assessment I routinely review medication. I also ensure that we communicate well with both the GP and community pharmacy about any changes to medication. I was delighted to engage in the Parkinson’s Masterclass (https://parkinsonsacademy.co/) over 2016, expanding my skills in managing Parkinsonian conditions. As a team we have noted a huge benefit of working as a multidisciplinary team not only for patients but also to our personal practice.
Improving patient care
Our results for the first year include:
- Improving patients’ quality of life and reducing caregiver strain
- Reducing response time for patients with distressing symptoms
- Reducing emergency admissions by 18% in the first six months
- Reducing length of stay
- Reducing falls
- Providing a cheaper model of care than ‘business as usual’ despite offering a more specialist service
- Community initiation of clozapine saving £9,500 per patient
- NHS data shows our Parkinson’s service in Teeside is cost-effective compared with trust with similar demographics
We were delighted to receive a Patient Safety Award for Managing Long Term Conditions in 2016 and a Parkinson’s Excellence Network Award in March 2017.
We hope to consolidate the service in the region. We plan to continue to develop mental health links and do further work around falls prevention. We have also been approached by international centre for social franchising who have done some investigative work to see if this model is something that could be rolled to other areas.
Correspondence and for more information, contact Viv Horton at: Vivien.Horton@stees.nhs.uk