1. Ilkeston Hospital DTC – Extending the Role of Community Hospitals Paula Clark - Erewash PCT

2. Starting Point Traditional community hospital – large & modern GP beds and GP led medical cover One existing day case theatre with visiting Consultant teams New Outpatient Facility X-ray and ultrasound Minor injuries unit 90 beds Catchment population up to 120,000

3. Committed staff, GPs and local population Acute local providers with significant developments Primary care at the edge – workload and morale PCT wanting early wins and identity for itself and its constituents A few champions and track record for innovation – nurses, visiting Consultants and GPs

4. The Environment Strategic context Plans for shift of care from secondary to primary care Concern re growth rates of referrals and non- elective admissions vs capacity and workforce Primary care access targets vs workforce shortages PCT context Desire to provide services close to home for patients Recognition of need for modernisation

5. The Vision To move away from the traditional community hospital image by creating a modern hospital for the people of Erewash PCT that: Provides real choice and quality for patients & GPs Retains investment within the PCT & creates opportunities for income generation Provides opportunities for staff to enhance their skills and hence improve recruitment and retention Provides a test bed where new ways of working could be trialed on a small scale

6. First Steps Where were our pressures? Financial, Primary Care Access, Social Services What were we doing well now? Could we do more? Extended nurse roles, GPwSI, daycase surgery, inpatient care, rehabilitation, palliative care What would we like to do? Provide more for patients locally, repatriate investment, fill in service gaps, push the boundaries! What were others doing? Community Hospitals Association, leading edge PCTs, day case surgery review

7. What Could Be Done Differently? Changing clinical leads Changing clinical roles Changing care management pathways Changing scope of services

8. The Hurdles Safety concerns from acute providers Day case rates Shifting money Consultant sign up Workforce Capital availability

9. Moving Ahead Changing Clinical Leads ENP led minor injuries unit with GPwSI Extending nurse role on wards Changing Clinical Roles ENPs – carpal tunnel injections Physiotherapy triage GPwSI – cardiology, dermatology Changing Care Management Patterns Repatriation of rehab patients from across Erewash Changing Scope of Services Diagnostic and Treatment Centre

10. Ilkeston Hospital DTC Two day case theatres – up to 4,000 day cases & 1,000 more outpatients (added to 14,000) Two scoping rooms – urology, hysteroscopy and endoscopy Echo-cardiography service 16 day beds

11. Under Construction! Optometrists with Special Interest GPwSI – plastic surgery and dermatology day cases PCT held waiting lists in orthopaedics and ophthalmology from April 1 st Day rehab with Social Services Radiographer endoscopists 23 hour beds to extend day surgery Further income generation for PCT

12. The Lessons Understand the local strategic context Build evidence to support your plans – what are your strengths and what has been learned elsewhere Support the clinical champions and give them the headroom they need Ensure sign up from all stakeholders Ensure clinical governance and risk aspects are covered Understand and agree how funds will shift or what the call will be on growth