Jumping the way of the frog's leg man

WHEN sales reps from drug companies ring up one of the North-East's newest primary care practices, they sometimes ask to speak to "Dr Galvani". That's when Allana Massingham, the nurse at the new Galvani Practice in Middlesbrough, has to explain that the doctor is not available. He died 206 years ago.

While the new Galvani Practice takes the name of a famous Italian scientist - the man who proved that a form of electricity could make a frog's leg twitch - the real inspiration is a social experiment in the scientist's home city of Bologna.

Martin Phillips, head of primary care at Middlesbrough Primary Care Trust, came up with the name because of his admiration for the way older people are cared for in the North Italian city, particularly in the suburb of Galvani. "It was an alternative approach to providing medical services to older people I came across some years ago," says Martin.

Bologna - which used to be known as "Red Bologna" because of the vice-like grip of the old Italian Communist Party over the city - pioneered the idea of separate medical services for the elderly, ensuring that old people in nursing and residential homes were well cared for.

"I suppose it is part of the different mentality towards older people that exists in Southern Europe. The old people even ran their own social clubs," says Martin.

Inspired by his experience in Bologna, Martin realised that the recent relaxation of regulations governing the way primary care services are delivered in the UK meant that a practice focused purely on the needs of care home residents was a real possibility.

Step forward Allana Massingham, a nurse practitioner with ten years experience at a busy Darlington practice and Mark Wright, an experienced practice administrator, who shared Martin Phillips' vision.

The idea was simple: instead of setting up a conventional medical practice serving an entire community, set up a specialised practice purely for care home residents. In that way, instead of elderly residents competing with younger patients for the attention of a GP, the practice nurses would actually spend their time visiting patients.

The big difference in the Galvani Practice is that the role which was formerly held by a GP is occupied by a specially trained "nurse practitioner".

With her enhanced training as a nurse practitioner, Allana reckons she can deal with the vast majority of health problems in care homes. If someone needs more specialised medical care, Allana simply calls in a GP contracted to work for the practice on a part-time basis.

It sounds radical, but it is not even the first such scheme in the region, let alone the country. That distinction belongs to the Durham Dales Practice based in Willington, County Durham.

When it went live in November 2002, the Willington scheme was the first experimental PMS (Personal Medical Services) pilot scheme of its kind in the country. Now, with more than 400 patients on the practice's books, it is a firmly established part of the NHS in this part of County Durham.

Catherine Ormerod, the lead nurse at Willington, who has also advised the Galvani Practice, is enthusiastic about the model of care.

"We have had a lot of positive feedback from the residents and the homes. They see a lot more of us than under the old system," she says. "Our nurses are very approachable and even the smallest problems can be dealt with. We still call them clinics when we go into homes but we don't line people up in a row in a waiting room."

If the Durham Dales practice is anything to go by, the outlook for these new-style practices looks rosy.

From modest beginnings, the Willington scheme - based in the Portland Nursing Home - now has 11 care homes on the books and is still expanding in terms of patient numbers and staff. Similar schemes are starting up in Durham City, Hartlepool and Newcastle.

While the Italian model is uppermost in Martin Phillips' mind, he admits that one of the main aims of the Galvani Practice is to take the pressure off hard-pressed local GPs. One of the most frequent concerns of busy family doctors is the sometimes onerous commitment to provide care to their patients who have moved into nursing and residential homes. Because such visits are often very time-consuming, GPs are expected to welcome this new type of practice.

Martin Phillips certainly hopes that by setting up such practices, more younger GPs will be encouraged to set up in Middlesbrough, an area which has one of the most severe shortages of family doctors in the country.

The Galvani practice is not the first attempt to try something different in Middlesbrough. Martin Phillips is also the ideas man behind two other radical departures in North-East doctoring.

By helping to set up the Fulcrum practice, which specialises in providing health care for drug users, and the Haven practice, which is specifically geared to the needs of refugees and asylum-seekers, Middlesbrough PCT is setting a cracking pace for other towns and cities to follow.

Allana Massingham stresses that it is early days for the Galvani practice but a large residential home near to their base in the Carter Bequest Hospital in Middlesbrough has expressed interest in the new service.

"We have written to all 68 residents asking if they are interested in transferring. It is now a case of waiting by the telephone," she adds.

But considering the success of the Willington scheme and the fact that there are 41 care homes within easy reach of the Galvani Practice, Allana is confident that it will take off.

Mark Wright stresses that the new approach should not be viewed as a cheap alternative to a conventional medical practice staffed by GPs.

"Allana will be able to deal with approximately 80 per cent of what she comes across. A lot of elderly people's health problems are chronic conditions such as asthma, heart disease and diabetes and nurses are educated to deal with these problems," he says. "We are not saying we will replace GPs, we want to complement them. We think this practice will be the first of many."

Allana says the advantages of the new approach are obvious to all parties.

"It will mean that come October, when it's time to do immunisation sessions, a home which has patients from 16 or 17 different GPs won't have to be visited by all those practices - we can do it." Another difference will be the emphasis on "pro-active" rather than "reactive" health.

"We will want to encourage residents to stay as healthy as possible, instead of coming in only when there is a problem," says Allana.

Catherine Ormerod says the other main advantage of the new specialised approach is the ability to get to know residents.

"It is very satisfying. We really get to know our patients," says Catherine.

"While Allana has never visited Bologna, she is inspired by the concept of the Galvani Practice. It is really about treating older people with respect and valuing them as part of society."