1. Bath and North East Somerset Urgent Care Service Tees Resilience Event 14 October 2014

2. Content Background An overview of the service The streaming process Impact so far Challenges Learning The future

3. 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

4. Bath And North East Somerset Urgent Care Service Urgent Care Centre (RUH) Out of Hours Medical Cover to Two Wards Homeless Healthcare Service GP Out of Hours Service

5. 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

6. Accessing The Urgent Care Service NHS 111 Healthcare Professional ED Triage UCC Streaming Referral to the ServiceSelf presentation to ED or UCC

7. 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

8. The Streaming Process Step 2: Receptionist checks if the patient has an appointment or is expected and collects demographics accordingly

9. 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 action c. Completes and closes the case in Patient First and on the ED case card d. Provides advice on how to access services in the future

10. 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

11. The Impact So Far

13. Developing the integrated approach Treating urgent as urgent Cultural change: –Patients –Staff –Other providers The Challenges

14. 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

15. 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

16. 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

17. ANY QUESTIONS ?