(Based upon the Annual Report of the WICs published in December 2002, on a personal visit to Knowle Park WIC and on information provided by Linda Prosser and staff at the Knowle West WIC)
There are 2 Walk In Centres in Bristol. Both provide a nurse-led service. These include the following:
The management and treatment of minor injuries
The management and treatment of minor illnesses
Health promotion and a provision of information
The nurses are able to dispense medication via the use of Patient Group Directions (PGDs) for minor conditions. They can also prescribe emergency contraception.
Location
The City Gate Walk In Centre opened in August 2000 and is located in Broad Street using a shop-front location. It offers fast access to services for local residents, for the homeless population and to a large daytime business and visitor population. The opening times are 8 am to 8 pm, 7 days a week. The centre will also take blood if this has been requested. The South Bristol Walk In Centre opened in September 2000 and is located within the Knowle West Health Park. It is sited within a building that is shared with Social Services and the Healthy Living Centre. The opening times are 9 am to 9 pm, 7 days a week. The Centre is supported by the local community and by statutory and voluntary agencies.
The WIC project was started in September 2000 – initially as a pilot study. It has developed fast since its inception and is no longer a pilot study.
The Knowle West Centre is just starting to develop mental health services – particularly for children and adolescents.
Number and type of patients seen
The original Business Plan stated that the WICs would accommodate 50 patients per day at each centre. his estimate has been exceeded. The central Bristol WIC saw an average of 64.7 people per day between September 2001 and August 2002. he comparable figure for South Bristol WIC was 65.5 people per day.
At both centres – there is a wide age range of people attending. However a particularly large number of people were seen aged 21 to 44. Very few older people attended.
Staffing
Both the Bristol WICs are staffed by a team of experienced nurses ranging from a Health Care Support Worker to an H Grade Clinical Nurse Manager. The nursing teams rotate their duties between the 2 centres. In addition there is a team of administrative support staff. At the Knowle West Centre there are 2 nurses on duty at any one time and one of these is paediatrically-trained.
Miscellaneous points
It seems that patients refer themselves to the Walk In Centre. Only about 5% of patients are sent on to their general practitioner or to a hospital as an emergency. There are 2 sexual health clinics per week at the Knowle Health Centre.
At the moment there is no direct medical involvement in either centre and there are no x-ray facilities. I was not able to obtain much information regarding the day of the week that is busiest at the Walk In Centres. However, I was told that about 100 people per day are seen at the weekends at the Knowle West Centre – indicating that the weekends are particularly busy.
Audit
1. I have not seen any data regarding the effect on attendances at general practitioner surgeries or at A&E Departments. I have not seen any mishap data. It is understood that in May 2002 a re-diverting of non-urgent 999 calls away from the A&E Department at the BRI was introduced. Avon Ambulance Trust apparently divert some non-urgent patients directly to the WICs for assessment and treatment as appropriate. It seems that a comprehensive list of conditions that can be referred to the WICs has been agreed. This system is said to be working well.
2. The Department of Health has developed clinical assessment protocols which have now been fully implemented by the 2 WICs. All members of staff have received intensive training. This was one of the DOH requirements prior to implementation. This system was originally designed for use by non face to face NHS direct staff. In its current form it uses algorithms for the nurse to use in order to diagnose an outcome for the patient.
Costs
The total cost of the Walk In Centres September 2001 to August 2002 was £1,387,937.00. Slightly more than £860,000 was accounted for by the South Bristol WIC. The average cost of attendance was £22 for City Gate and £36 for South Bristol.
Future development
The national pilot site status with the Department of Health ended in September 2003. It is intended that the WICs will continue to develop a comprehensive and consistent nurse-led service which supports other health care and social care providers. The following areas of possible expansion are noted:
An expansion of sexual/family planning services
Developing closer links with NHS Direct and exploring the possibility of rotating NHS Direct staff across the 2 WIC centres.
South Bristol Hospital. At the time of writing – there is uncertainty, but great hope, regarding the building of a South Bristol community hospital. Unfortunately there is insufficient room on the Knowle West Health Park site for a community hospital. If such a hospital were to be built – it may be sensible for the Walk In Centre to be moved to the site of the proposed new hospital. X-ray facilities would be available and there would be the possibility of direct medical involvement.
Finally:
I greatly enjoyed my visit to the South Bristol WIC. I was impressed by the enthusiasm of the people there and by the keenness to innovate. (My thanks are due to Michelle Whittle, Paediatric Nurse Practitioner, who spent an hour describing what was happening at the South Bristol WIC. I am also most grateful to Linda Prosser for providing information and the necessary introductions). A considerable amount of information has been obtained from the Annual Report of the Bristol WICs.)
RLH