1. INTEGRATED URGENT AND EMERGENCY CARE IN GLOUCESTERSHIRE WORKSHOP 2nd December 2016

2. Purpose of the Workshop
To discuss and identify the benefits of further integration of elements of the urgent care system in Gloucestershire.
To share some of the work to date on the future model for urgent care in Gloucestershire.
To discuss opportunities in relation to the procurement of Primary Care Out of Hours, NHS 111 and an integrated Clinical Hub.
To obtain your views on the problems we need to address and the opportunities this presents.

3. Transforming Urgent and Emergency Care in England
For those people with urgent but non-life threatening needs:
We must provide highly responsive, effective and personalised services outside of hospital, and
Deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families
For those people with more serious or life threatening emergency needs:
We should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery

4. 5 key elements of change
Providing better support for people to self care
Helping people with urgent care needs to get the right advice in the right place, first time.
Providing highly responsive urgent care services outside of hospital so people no longer choose to queue in Emergency Departments
Ensuring that those people with more serious or life threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and a good recovery.
Connecting urgent and emergency care services so the overall system becomes more than the sum of its parts.

5. Public accessing Urgent and Emergency Care
A&E
MIIU
Dentist
GHAC GP
Pharmacy
Out of Hours
999
MIIU
A&E
Pharmacy
111 GP
Community Teams
NHS Choices
Google
ASAP
GP website

6. Adult Social care helpdesk Single Point of Clinical Access
Health Care professionals accessing
support and advice
Adult Social care helpdesk
Single Point of Clinical Access
Colleague
Clinical Support Desk
Patients GP
Locality Hubs
Hot Advice
GCare
MiDOS
Health Care Professional line Out of Hours
Mental Health helpdesk

7. Vision for Integrated Urgent and Emergency Care
To provide a more closely Integrated Urgent Care service which is simple to access and navigate, in which organisations collaborate to deliver high quality, clinical assessment, advice and treatment and to shared standards and processes and with clear accountability and leadership.
To become straightforward for patients to access urgent care (Click and Call)
“Call” 999 for critical problems
“Call” 111 if Urgent advice is needed
In the future NHS111 on line will be an opportunity (Click).
To create an Urgent and Emergency care system that delivers the right care, first time for the majority of patients through a networked model 7 days a week. Same day responsiveness is an expectation of the modern healthcare system.
To harness technological advancements to bring care closer to people homes
To provide better advice and support for self care, immediate telephone advice from a qualified clinical practitioner and a booked appointment in the right service when required.
To guide the patient to the correct level of care and to provide clarity as to which services are provided, where and when.

8. Integrated Urgent Care

9. “The Clinical Hub”
A ‘Clinical Hub’ offering patients who require it access to a wide range of clinicians, both experienced generalists and specialists. It will also offer advice to health professionals in the community, such as paramedics and emergency technicians, so that no decision needs to be taken in isolation. The clinicians in the hub will be supported by the availability of clinical records such as ‘Special Notes’, Summary Care Record (SCR) as well as locally available systems. In time, increasing IT system interoperability will support cross-referral and the direct booking of appointments into other services

10. The Gloucestershire emerging model
Patient has Emergency or Urgent Care need
Ambulance dispatched
999
NHS111
Own GP
111 Digital
Social Care
Clinical hub
Virtual or Physical/ Multidisciplinary Team/Access to Directory of Service
Dental
Self Care
Opportunity to directly book appointments
Vol Sector
Own GP
Community Services
Mental Health
Urgent Care Centre
Pharmacy

11. Urgent care centre –at least 12hours per day 7 days per week
Minor injuries/ minor illness
Urgent primary care appointments
Primary care out of hours services
Diagnostics and near patient testing
Clinical/non clinical navigation/triage/ signposting
Access to the other key services such as mental health crisis, community based rapid response
Integration between providers
111 and clinical virtual hub triage, local practices and walk in

12. NHS England IUC Metrics
For calls to 111 made in the out of hours period, where the disposition agreed with the caller is “Contact Primary Care Service”. More than 70% of these calls will have the appointment booked before the call ends?
For calls to 111, where the disposition agreed with the caller corresponded to “Contact Primary Care Service”, and which resulted in an in-hours face-to-face appointment with a clinician: More than 5% of these calls will have the appointment booked before the call ends?
For calls to 111 where the patient needed further contact (either face-to-face or on the telephone): More than 50% have the information captured during the first call available to the next person to make contact?
For calls to 111 or 999 that are transferred to a clinician: 50% have the Summary Care Record available to that clinician?
Organisation that receives Care Plans and Special Patient Notes share them with the Ambulance Service and all organisations providing the IUC service?
Within the clinical hub, 24 hours a day, seven days a week, there is at least one GP working?
Of calls answered, more than 30% result in a patient speaking to a clinician?
The Directory of Services (DoS) is set up to provide accurate, real-time information to searches by NHS Pathways, Integrated Urgent Care services and mobile applications?
More than 50% of green ambulance dispositions (via 999 or 111) receive clinical assessment.

13. Benefits for patients
I will be supported to help myself and not bother the NHS
I only have to tell my story once
I will receive same day responsive care to my perceived Emergency or Urgent Care need
The ambulance service were able to provide care to me in my own home
I will be treated as close to my home as possible
People will only access the Emergency Departments with serious or life threatening needs
It will be simple for me to get the right advice in the right place first time
It is efficient and effective and provides high quality care
As I pass through the system it will be seamless in delivery
It is simple to navigate around the system
Decisions about my care will be taken with my full involvement
I will be enabled to prevent development or deterioration of a condition that will affect my health and wellbeing

14. Benefits for Health Care Professionals
Care is provided by a full multidisciplinary team
Care is provided by a full multidisciplinary team
The system is simple and guides good informed choices by patients, their carers and clinicians
Promotes the appropriate and effective sharing of relevant patient information across and between
My patients will be consistently provided with high quality and safe care
It ensures effective utilisation of workforce and acknowledges and supports current challenges
It provides access to the right care in the right place, by those with the right skills, first time
Improves decision making through access to records

15. What works well and what doesn’t?
Group Session 1
What works well and what doesn’t?
and
What are the MUST Dos we should include in the new service specification?

16. Describe the Clinical Hub model for Gloucestershire
Group Session 2
Describe the Clinical Hub model for Gloucestershire

17. Group Session 3
What are the significant obstacles we all face in delivering the Integrated Model?

18. What are the standards we wish the Integrated Model to deliver?
Group Session 4
What are the standards we wish the Integrated Model to deliver?

19. High Level Procurement Timetable: Project A and Project B
Advert placed 3/10/16
Deadline for receipt of PQQ submissions 21/10/16
PQQ evaluation 21/10/16 – 28/10/16
Dispatch ITT documents to shortlisted bidders 31/10/16
Deadline for receipt of ITT submissions 25/11/16
ITT Evaluation process 25/11/16 – 23/12/16
Extraordinary GCCG Governing Body Meeting 12/01/17
Formal Contract Award 24/01/17
Mobilisation / Contract Implementation
Contract Start Date 01/06/17
Development of the specification in line with the Glos Urgent Care Strategy
Engagement events – 02/12/16 & 14/12/16
Advert placed 09/01/17
Deadline for receipt of PQQ submissions 17/02/17
PQQ evaluation 17/02/ /03/17
Dispatch ITT documents to shortlisted bidders 06/03/17
ITT Evaluation process 02/05/17 – 02/06/17
Extraordinary GCCG Governing Body Meeting 22/06/17
Formal Contract Award 04/07/17
Mobilisation / Contract Implementation
Contract Start Date 01/04/18