1. Developing Urgent Care Services in Redditch and Bromsgrove Dr Marion Radcliffe: GP and Urgent Care Lead Mick O’Donnell: Head of Strategy

2. Outline of Content What are the key issues and drivers in Urgent Care? What have we done to improve Urgent Care in Redditch and Bromsgrove? What do we plan to achieve for the population of Redditch and Bromsgrove in the future?

3. What are the issues and drivers in Urgent Care? Rising Demand, Rising Expectations Changing demography – (size and age) Emphasis on long term conditions and frail elderly Shift to prevention and prediction Opportunities for care outside of hospital Increasing demand National public focus and call for change (e.g. Keogh Review - Nov 2013)

4. Rising Demand, Rising Expectation: Headline Figures Over the past c. 10 years nationally: – A&E attendances risen from 14m to 16m pa - + c.15% – Calls to ambulance service risen 5m to 9m pa – Emergency admissions to hospital risen from c.4m to 5.2m - + c.30% – Primary care consultations have risen from 4.1 to 5.5 per patient - + c.35% Future demographic growth will put greater demand on existing services A step change in the pattern and nature of urgent care provision is required

5. Urgent Care in Redditch and Bromsgrove (i) What is the position in Redditch and Bromsgrove? What does the data tell us? (ii) What have we achieved to date? (iii) What are we planning to do?

6. What is the position in Redditch and Bromsgrove? Analysis of recent years data shows:  Countywide reduction in A&E attendances between 2011/12 and 2013/14; the Alex saw a reduction of c.2,000 A&E attendances 2013/14  Worcestershire Acute Hospitals Trust is not achieving the 95% 4 hour A&E target, 93.6% in 2013/14. Performance at the Alex is better at 94.4% in 2013/14  Emergency attendances for Redditch and Bromsgrove residents in 2013/14 fell by 1.6% Comparisons with similar CCGs nationally show RBCCG has lower rates of emergency admissions for:  Total emergency admissions  Adults with long term conditions, and for potentially avoidable admissions  Children with lower respiratory tract infections, and the same rate for children with long term conditions GP Services  RBCCG has a high level of satisfaction with GP services (90 % rate as “very good” or “fairly good”; National GP Patient survey shows strong correlation between poor access to GP services and high A&E use)  67% of users rate GP Out of Hours service as “very good” or “fairly good” – but below national score

7. The following charts show RBCCG in red and other similar CCGs (in its ONS cluster) in yellow. Horizontal lines show the England and cluster average

8. Emergency admissions for acute conditions that should not usually require hospital admission (adults) Age/sex standardised rate per 100,000 population

9. Unplanned hospitalisation for chronic ambulatory sensitive conditions (adults) Age/sex standardised rate per 100,000 population

10. Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Age/sex standardised rate per 100,000 population

11. Emergency admissions for children with lower respiratory tract infections Age/sex standardised rate per 100,000 population under age 19

12. Patient experience of GP services % who report their experience as “very good” or “fairly good”

13. Patient experience of GP out of hours services % who report their experience as “very good” or “fairly good”

14. Need to plan for step change in Urgent Care Services for our population Nationally the A&E attendance rate is over 500 for every 1,000 people aged over 83. The emergency admission rate is similar for those aged over 85. Within the next 10 years whilst the total Redditch and Bromsgrove population will increase by c. 6.5% the 85+ population will almost treble from c. 3,900 to c. 10,700 (277%) We must ensure that we provide better ways to meet our populations growing needs through our Redditch and Bromsgrove Urgent Care Strategy

15. What are we doing to improve Urgent Care services for Redditch and Bromsgrove residents? Priority for 2013/14 and 2014/15 – “Reduce inappropriate unscheduled admissions” “Improve processes once patients are admitted”  Developed Redditch and Bromsgrove Virtual Ward  Centred on Primary Care medical staffing model  18 virtual beds; 12 beds at PoWCH  Care Homes enhanced service linked to GP Practices: improve patient experience and reduce admissions  GP Ambulance scheme  Additional winter capacity agreed and in place  Working with partners and stakeholders – UCS Board, Well Connected, local Urgent Care Group  Resulted in reductions in A&E attendances and emergency admissions

16. What will we do to improve Urgent Care services for Redditch and Bromsgrove residents in the future? Urgent Care will continue to be a priority for the CCGs work in 2014/15 and beyond including;  Develop plans for increased level of locally based ambulatory care and assessment, diagnosis and treatment services  Review and develop plans for PoWCH beds  Evaluate and embed Virtual Ward  Increase capacity and capability  Continue collaborative working with partners and stakeholders  Utilise Integrated Care/Better Care Fund to improve out of hospital care for people  Further opportunities within self care, preventive care, shared care and technology  Introduce ‘Primary Care Streaming’ at the Front Door of the Alexandra Hospital  Support Member Practices in the transformation of the care of patients aged 75 or older, reducing avoidable admissions

17. Primary Care Assessment – 24/7 See & Treat MIU ADULT ED|MAU Ambulatory Care PRIMARY CARE TRIAGE PATIENT GP REFERRAL BLUE LIGHT COMMUNITY SERVICES SOCIAL CARE VIRTUAL WARD Direct route to ED Our draft Alexandra Hospital ‘Primary Care Front Door’ ACUTE INPATIENT BEDS PAU SAU Primary Care Streaming Home Expert in-reach Expert in-reach support support Expert out-reach support

18. Inpatient Care (POWCH) Short stay beds Medium stay beds Enhanced Care Teams (Virtual Ward/Hospital at Home) Including: Intermediate Care; Night Sitters; Social Care Assessment, Diagnostic & Treatment Service (Ambulatory Care) Including: same day diagnostics; follow ups; reviews; 'Hot Clinics CENTRAL ACCESS POINT HOSPITAL SERVICES GENERAL PRACTICE HEALTH, SOCIAL CARE AND VCS CARE HOMES Our outline plan for the Integrated Community Hub