VOL: 98, ISSUE: 20, PAGE NO: 37
Sheila Brooke, BSc, RGN, DipPHCN, ONC, is lead nurse manager, Southampton (Shirley) NHS Walk-in Centre, Southampton City NHS Primary Care TrustShirley walk-in centre, in a busy outer-city area of Southampton, was the 40th walk-in centre to be developed. It has been open for six months and, in that time, more than 10,500 people have been seen and assessed. Recognising and responding to local need, the centre hosts an asthma specialist nurse, a multiprofessional orthopaedic triage team and a social work information assistant. A sexual health clinic for young people is also held at the centre. Carers' groups and neighbours are encouraged to use its facilities.
Shirley walk-in centre, in a busy outer-city area of Southampton, was the 40th walk-in centre to be developed. It has been open for six months and, in that time, more than 10,500 people have been seen and assessed. Recognising and responding to local need, the centre hosts an asthma specialist nurse, a multiprofessional orthopaedic triage team and a social work information assistant. A sexual health clinic for young people is also held at the centre. Carers' groups and neighbours are encouraged to use its facilities.
Nurses and health care information assistants help people to gain access to centre staff. Nurse practitioners and experienced nurses have been employed from a wide range of backgrounds, including A&E, district nursing, health visiting, midwifery and practice nursing, as well as mental health and paediatrics. Joint posts have been developed which link NHS Direct and A&E with the centre. This rich skill-mix enables staff to evolve into autonomous practitioners who are able to work across boundaries.
Initially, many local GPs saw the walk-in centre as an unnecessary service that would increase patient demand. They believed that funding should have gone directly into general practice. It seems that some retain that view (May, 2002), while others are beginning to realise the value of the service.
Nurses no longer need to work under the instruction of a doctor. GPs should move forward and accept that appropriately educated nurses are capable of working independently (Lewis, 2001). Over 70% of the patients seen at the Shirley centre are managed in that setting. GPs could do much to support the development by recognising the skills of the nurses who work in these roles.
Nurses following evidence-based patient group directions administer medication, such as emergency contraception and antibiotics. This meets patients' needs and gives GP services more time to deal with more serious health care problems. With the patient's consent the consultation record is faxed to the GP and the nurses welcome any feedback this may generate.
Doctors may be anxious that allowing nurses to administer and supply antibiotics will increase their inappropriate use. However, the centre has seen more than 400 people with sore throats since it opened but has administered penicillin on only 14 occasions. Patients are also given self-care advice, supported by written information.
Critics of the service believe that easier access to health care encourages inappropriate use and discourages self-care (Royal College of General Practitioners, 1999). This does not seem to be the case at Shirley. People who use the walk-in centre present with a variety of problems that often require professional intervention, including urinary-tract infections, wound infections, ear infections and minor injuries. Most of them have tried but failed to get a doctor's appointment. In addition, data collected has revealed that 44% of the patients seen in March last year would have made appointments to see their GP if the centre had not existed.
Salisbury et al (2002) state that the overall aim of walk-in centres is to improve access to quality health care in a manner that is both efficient and supportive of other local NHS providers. This is in line with the government's agenda to modernise the NHS. I firmly believe that Southampton (Shirley) NHS Walk-in Centre fulfils this aim. Walk-in centres are pilots and are being closely evaluated.
Traditionally, GPs have been the gatekeepers to health services. These services are not coping with the needs of patients and it is disappointing to see such reluctance to change. Professionals should work together, using limited NHS resources to provide the best possible care for patients - more access points will support this.