Bath and North East Somerset Urgent Care Service

Tees Resilience Event

14 October 2014

Content

• Background • An overview of the service• The streaming process• Impact so far• Challenges• Learning• The future

• An ageing population• Increasing demand and expectations• People living longer with long term conditions• Finite resources and inequitable use• Support of local clinicians• Fragmentation of services • Right care, right place, right person, right time• Services due to be re-commissioned: walk in centre,

GP out of hours

Drivers For Change

Urgent Care Service

• Purpose– To help people with urgent care needs to get the right advice or

treatment in the right place, first time• What It Is

– An Urgent Care Centre based at the front door of but separate from ED

– Staffed by GPs, Nurse Practitioners, Operational staff• What Does It Provide

– Streaming of ED attenders – to discharge– Urgent care by appointment– Home visits– Telephone advice

Accessing The Urgent Care Service

Referral to the Service Self presentation to ED or UCC

The Streaming Process

Step 1: Patient walks into centre

OTHER ROUTES OF REFERRAL:

Other healthcare professional

GP out of hours

GP in hours

Ambulance

NHS 111

The Streaming Process

Step 2: Receptionist checks if the patient has an appointment or is expected and collects demographics accordingly

The Streaming Process

Step 3 - The UCC Streaming Nurse: a. Reviews all cases in Patient First

and will select those with minor illness, minor injuries of more than 7 days duration, long term conditions, contraception and sexual health issues, and dental problems

b. Undertakes a brief assessment of the patient’s symptoms and advise on the best course of actionc. Completes and closes the case in Patient First and on the ED case cardd. Provides advice on how to access services in the future

The Impact So Far

• Streaming activity:– capturing13.5% of all ED attendances

= 23% of all self referral/walk in ED attendances

Note: 2% of activity arrives by ambulance

• Complaints = 0.19%

• Previous WIC activity (2.5k pm) hasn’t arrived at ED

The Impact So Far

The Impact So Far

• Developing the integrated approach

• Treating urgent as urgent

• Cultural change:– Patients– Staff– Other providers

The Challenges

• Maintains primary care focus

• Allows workforce to maintain and develop urgent care skills

• Avoids creep into emergency care

• Bridges work between primary and secondary care

Benefits Of GP/UCC Integration

• Fully integrated with NHS 111 • NHS 111 books appointments• PEMS to GP Practices• Access to Summary Care Records,

Special Patient Notes and soon GP records • Fully integrated with GPOOH• Economy of scale with GPOOH• Joint Clinical Governance (CCG, ED, UCC)

Benefits Of Vocare’s BDUC Model

• Further developing the integrated approach:

– Joint governance

– Joint training and education

• Improving patient flow

• Developing the workforce:

– Competency framework

– Clinical supervision

– Performance reviews

– Individual development plans

The Future

ANY QUESTIONS ?