Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

NHS Fife

Initial thoughts

NHS Fife has welcomed Realistic Medicine. It is timely and has been well received by doctors in Fife across primary and secondary care. The six key themes resonate with our experience in the service of areas we need to improve.

What have we done so far?

In addition to the case study describing the gypsy traveller initiative, NHS Fife is focusing on using data to understand variation in treatment and investigation rates as well as in prescribing in line with the national Effective Prescribing Programme.

We have introduced a frailty team in the Emergency Department to identify people who do not require urgent hospital admission but do need rapid multidisciplinary assessment and appropriate package of care to look after them in the community. The team has already demonstrated benefit by reducing admissions since it was introduced.

What next?

NHS Fife has seen a significant increase in the feedback from patients and relatives through Patient Opinion and we are now preparing to engage with our communities using Patient Voice. We are promoting the Good Conversations work for all staff in order to prepare staff to discuss difficult issues in a way that enables patients to make their own decisions about care.

We acknowledge the need to improve the information provided to patients to enable genuinely informed consent to be realised in partnership with their clinicians. Ideally this should be early in a care pathway and we will consider how we support primary care clinicians to start this conversation. It will also require consideration of how we improve health literacy in our communities.

We are working to update our consent forms to ensure patients receive adequate information in a format they can understand.

Final thoughts

We need to think about the circle of engagement when trying to undertake Realistic Medicine in practice: Listen - Engage - Do - Feedback - Listen.

Photographs of Social Prescribing community meetings at Heathery Wood Gypsy Traveller site in Fife.