Case Study - Stockport NHS Foundation Trust

Urological Hub and Spoke Model

Stockport NHS Foundation Trust’s pilot project considered how to extend a urological hub and spoke model for the provision of services to patients in Macclesfield.

Day case and outpatient services were to remain at Macclesfield District General Hospital and all inpatient and emergency services were to be transferred to Stockport’s Stepping Hill hospital. At the start of the project rotas for Stepping Hill meant the model wasn’t feasible. In its previous form staffing levels meant that a middle grade rota could not be supported. Instead, consultants joined the rota to make it a 1:5 on call rota, not something that was European Working Time Directive (EWTD) compliant.

Click here to view the Pilot page >>>

During the project the trust introduced specialist nurses to extended roles both at the Macclesfield site and in community settings to release existing medical staff for appropriate training as well as providing more effective out of hours cover. Consultants at Stepping Hill also changed their rota to include the Macclesfield site. Having identified gaps in capacity that needed to be filled in order to become EWTD compliant to incorporate the Macclesfield site, Stockport recruited a clinical fellow and two staff grade doctors into their middle rota. This allowed the trust to move from a 1:5 rota to a 1:6 rota. The hospital is also set to recruit an additional specialist registrar to take the rota to 1:7 and is aiming to become EWTD compliant a year early.

Without this (clinical involvement) the project would not have been successful as it did involve significant change to both the medical and senior nursing team.
Lynn Nuttall

Lynn Nuttall, project lead for the Stockport pilot says that not only has it benefited patients and staff, it has meant that the trust has been able to ensure that its urology service is more ‘robust’, she said: “I would definitely recommend it as a model for other trusts to think about using and it could be rolled out to other services and specialties. For certain trusts that are vulnerable to reorganisation this hub and spoke model can help them whilst at the same time ensuring EWTD compliance.”

Lynn also feels that it is of paramount importance to get clinical involvement at an early stage. Stockport enlisted its clinical director Stephen Brown as a clinical champion, she said: “Without this the project would not have been successful as it did involve significant change to both the medical and senior nursing team.”

Key Learning
Ensure clinical involvement
Helps achieve EWTD compliance

Stephen agrees, he said: “The only urology consultant based at Macclesfield was ready to take on a less demanding role and the staff grade doctors were very much in a dead end position so they were keen to expand their experience to progress their careers. When it was explained to them that even though they would have a different on call rota and they would be travelling more, but that they would also gain better training and get specialist recognition, they were happy to change. The great thing is that from August 2008, a year early, we will be EWTD complaint.”

Feedback

We’d like to know what you think about this case study, please complete this form:

Font size

Key Messages

Education and Training
Health and Safety