SKIP into LIFE
SKIP into Life is a person-centered clinic which aims to improve the health and wellbeing of people with enduring mental illness by preventing and managing chronic disease. It is part of the Worrigee Medical Centre, a bulk billing practice near Nowra, South Coast NSW, with a SWPE of 5030.
Christine Turpin, the Practice Manager, said she saw the clinic as providing a great benefit to patients, with more time to connect with them and gain a better patient outcome.
See how the SKIP into Life clinic applied the building blocks in establishing their clinic
See the patient flow and MBS items used in the Skip into Life clinic
A clear plan
Clinical nurse consultant Ros Rolleston and Practice Principal Dr Annette Pham have been the key drivers for this clinic which began when the Worrigee Medical Centre credentialled mental health nurses expressed a need for help in managing their patients’ physical illnesses. Including Chris Turpin and Office Manager Hayley Dolphin in the planning averted potential administration issues. Goals included shared decision making and continuity of care as well as early referral to specialist services. A literature review was carried out first, with an examination of the clinic’s data to assess patient need.
A budget was developed for the project, but without the skills or experience to do this, help was sought from Greg Davis, CEO and the HR manager. The clinic is funded solely by the Medicare Benefit Scheme. The GP is always a part of the SKIP consultation and this collaboration is central to the funding model
Location and facilities
The clinic runs one day a week, with its own dedicated consulting room.
Staffing and HR
One of the biggest challenges has been implementing change in a large organisation and achieving consensus. Administration staff have not been allocated, which has affected the clinic’s ability to keep up with paperwork including financial modelling. More time spent in the planning stages may have averted later problems with allocating administrative resources.
External service providers, including dietitians, physiotherapists and optometrists were brought on board by the simple method of identifying providers and ringing them up to introduce and explain the clinic.
The McCormack and McCance model of person-centered care is used for the clinic, emphasising holistic care and engagement. Reflecting the multidimensional nature of this clinic, other resources used are a cardiometabolic screening tool; the NSW Mental Health Clinical Documentation Guidelines, the DSM-5 and various diabetes, cardiovascular and respiratory guidelines. The PDSA quality improvement approach was helpful in clarifying the goals of the clinic, but there is some disappointment that the quality improvement needs highlighted have not been implemented.
A new care plan template was designed by the clinic, but also implemented by the wider organisation. Active listening skills were found to be the most important, because people with mental illness often need a lot of encouragement to share information.
Supporting systems and processes
While the clinic has a reminder system, it has been frustrated by lack of resources. Data colection has also been affected by this shortfall in the project. This has been challenging and enlightening with valuable learning about our processes
Evaluation and improvement
Baseline and ongoing health data have shown improvements in patients, specifically in the areas of HbA1c, BMI and blood pressures. Concurrence with medication regime has improved, as has communication with GPs, who are handling less paperwork during SKIP consultations so have more time to talk with patients, strengthening therapeutic relationships. People with mental illnesses require a lot of encouragement to be a part of decision making. Signs of success are also when people articulate their needs and opinions.