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Developing Integrated Out Of Hours Services Making Healthcare Mutual.

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Presentation on theme: "Developing Integrated Out Of Hours Services Making Healthcare Mutual."— Presentation transcript:

1 Developing Integrated Out Of Hours Services Making Healthcare Mutual

2 Thursday Programme John Hutton-MP- Speech attachedJohn Hutton-MP- Speech attached Mark Reynolds- Chair NAGPCMark Reynolds- Chair NAGPC David Carson- DoHDavid Carson- DoH Peter Hunt- Director MUTUOPeter Hunt- Director MUTUO Cliff Mills- Solicitor CobbettsCliff Mills- Solicitor Cobbetts Rick Stern- PCT CERick Stern- PCT CE Stephen Bellamy- GPStephen Bellamy- GP Carolyn Clarke-Co-op ManagerCarolyn Clarke-Co-op Manager Jane Harris- NurseJane Harris- Nurse Mike Dixon- Chair NHS AllianceMike Dixon- Chair NHS Alliance

3 Friday Programme John Heyworth-President BAEMJohn Heyworth-President BAEM Kathy Jones- London Amb SvcKathy Jones- London Amb Svc Paul Jenkins- NHS DirectPaul Jenkins- NHS Direct Andy Lee- NHS DirectAndy Lee- NHS Direct Mo Girach- SELDOC CEMo Girach- SELDOC CE Bill Forsythe- PCTBill Forsythe- PCT John Davies -TasmaniaJohn Davies -Tasmania

4 DOH Key Issues David Carson

5 The service will be taken over in exactly the same way it is run currently. Currently the service is a GP run co- operative that wishes to cease trading. Once we are ready to take over the operational running of this service. We would like to do this on The service will then be directly managed by the PCT. It has two GPs working from 6.00 to midnight and then one GP working midnight to 8.00 am. There are two nurses working giving telephone triage and telephone advice to patient group directives set up by the GP co- operative. The two drivers that cover the evening shift double up as receptionists. There are two cars available to take GPs out to patients requiring visits. Both cars are fitted with mobile communications and computer connected to the one at the base. The service will be taken over in exactly the same way it is run currently. Currently the service is a GP run co- operative that wishes to cease trading. Once we are ready to take over the operational running of this service. We would like to do this on The service will then be directly managed by the PCT. It has two GPs working from 6.00 to midnight and then one GP working midnight to 8.00 am. There are two nurses working giving telephone triage and telephone advice to patient group directives set up by the GP co- operative. The two drivers that cover the evening shift double up as receptionists. There are two cars available to take GPs out to patients requiring visits. Both cars are fitted with mobile communications and computer connected to the one at the base.

6 The midnight to 8.00am shift has one GP, one driver and one nurse working. This does occasionally mean that the nurse could be on the premises alone. We will be addressing this issue. It is hoped that the service will be expanded to include social care and community staff being available out of hours but we are very aware that these trained emergency care practitioners are not yet available. We are hoping to be able to send the most appropriate member of our out of hours multidisciplinary team to assist the patient. We envisage the cars being used to take other members of the multidisciplinary team out to patients. This will ensure that staff are not out visiting patients on their own. The midnight to 8.00am shift has one GP, one driver and one nurse working. This does occasionally mean that the nurse could be on the premises alone. We will be addressing this issue. It is hoped that the service will be expanded to include social care and community staff being available out of hours but we are very aware that these trained emergency care practitioners are not yet available. We are hoping to be able to send the most appropriate member of our out of hours multidisciplinary team to assist the patient. We envisage the cars being used to take other members of the multidisciplinary team out to patients. This will ensure that staff are not out visiting patients on their own.

7 Key areas Development Frameworks & PrioritiesDevelopment Frameworks & Priorities Sustainability and resilienceSustainability and resilience QualityQuality StaffingStaffing Organisational competencyOrganisational competency Provider integrationProvider integration Risk managementRisk management Provider supportProvider support

8 Development Frameworks & Priorities Everybody needs a system visionEverybody needs a system vision Have we to much narrow thinking (Budgets, Service)Have we to much narrow thinking (Budgets, Service) Excessive focus on facilitiesExcessive focus on facilities Integrated servicesIntegrated services Are PCTs running local agendas with little reference to whole systemAre PCTs running local agendas with little reference to whole system Are commissioners operating in NHS provision safety zone without long term viewAre commissioners operating in NHS provision safety zone without long term view COOPs be patientCOOPs be patient COOP Membership ? ChangeCOOP Membership ? Change

9 Sustainability and resilience 1 Reality check nowReality check now Resilience need in call handling and face to face serviceResilience need in call handling and face to face service Underpinned by staffing and clinical management structuresUnderpinned by staffing and clinical management structures Resilience will not be present as effectively in small servicesResilience will not be present as effectively in small services

10 Sustainability and resilience 2 Skill mixSkill mix –Will take time –Who builds the teams (Will not just happen because they are in the same building) –Leadership needs the competency to deliver and develop the service NHSD integrationNHSD integration Ambulance readinessAmbulance readiness

11 Quality Meet the standards now and all the timeMeet the standards now and all the time Clear and will remainClear and will remain Apply equally to PCT servicesApply equally to PCT services Will be monitoredWill be monitored All the standards will applyAll the standards will apply Increasing clinical elementIncreasing clinical element Success is not just seeing patientsSuccess is not just seeing patients –But seen by appropriate member of staff –And appropriate quality treatment or advice

12 Staffing Need more skill mixNeed more skill mix Support centrallySupport centrally Attention needed to governance and team arrangementsAttention needed to governance and team arrangements Added value from access to senior staff (GPs)Added value from access to senior staff (GPs) The policy is that OOH doctors seeing providing primary services have to be on performers listThe policy is that OOH doctors seeing providing primary services have to be on performers list RecruitmentRecruitment COOPs and Commercials shift your thinkingCOOPs and Commercials shift your thinking Yet to see more than a few adverts for OOH staff!Yet to see more than a few adverts for OOH staff!

13 Organisational competency LeadershipLeadership Managerial and clinical management and leadership competencyManagerial and clinical management and leadership competency Track record is important (lets use what we have properly!)Track record is important (lets use what we have properly!) Capacity planningCapacity planning Knowledge baseKnowledge base

14 Provider integration Attention to governance and organisational interfaceAttention to governance and organisational interface Joint venturesJoint ventures –OOH CAT C and NHSD Calls –Face to Face A&E, WICS, Community nursing Have to have a provider to integrateHave to have a provider to integrate –Are we loosing too many Operational interface is vitalOperational interface is vital

15 Risk management Hear a lot about riskHear a lot about risk Shared risk is a reduced riskShared risk is a reduced risk Staffing fluctuations moderated by effective recruitment but also scale issue hereStaffing fluctuations moderated by effective recruitment but also scale issue here Financial riskFinancial risk

16 Provider support Mutual optionMutual option COOPs will need supportCOOPs will need support Do not underestimate the scale of provider change on both sidesDo not underestimate the scale of provider change on both sides CommissioningCommissioning Commercial providers need to share risk too and be attractedCommercial providers need to share risk too and be attracted

17 Summary More to doMore to do Mutual transfer another significant stepMutual transfer another significant step Real change in the way services are influenced and developed and ownedReal change in the way services are influenced and developed and owned Many PCTs have worked out where and when and by which individual staff groupsMany PCTs have worked out where and when and by which individual staff groups Who makes sure it all works every day and night all the time is crucialWho makes sure it all works every day and night all the time is crucial Take time to reflect and find the common ground with your PCTsTake time to reflect and find the common ground with your PCTs


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