Unplanned Care: New model for Integrated Urgent Care GP consultation

Introduction We came to CEC and CCF in September to update on the new integrated urgent care model There are no changes to the way forward as described at the last meeting However, some questions were raised that we wanted to address further relating to provision PUCC

Background -what was presented previously Unplanned Care Work stream committed to review all existing urgent care services and develop a new model of integrated urgent care to be implemented from April 2019. Aims of new model: provide consistent access to urgent primary care across 24 hour period integrate existing primary care services - enabling providers to work together effectively align with and accepts referrals from NEL IUC manage demand on A&E Support delivery of the 4 hour standard for City and Hackney Agreeing a new GP OOH service was the most time-pressured element as a new service needs to be in place by March 2019. It is a very challenging service to provide given the scarcity of GP workforce.

Developing integrated urgent care in C&H Existing service Future model There are more similarities between duty doctor and 111 Review of service planned Q4 2018/19 in order to consider within context of NEL IUC performance PUCC Duty doctor GP extended access GP F2F OOH Paradoc All of these services will share management of total urgent care demand Interface between GP OOH and PUCC Management of patient flow via NEL IUC and A&E front door Efficient use of GP workforce through shared capacity and potential for skill-mix Expansion of current service to take on home visiting overnight Innovative solution with utilises alternative skill mix to reduce pressure of GP workforce 4 4

Paradoc – home visiting New model of Integrated urgent care in C&H – (as presented previously) PUCC / UTC GP extended access 999 / ED Duty doctor IUC GP F2F OOH Paradoc – home visiting Urgent primary care demand will be shared across the system during OOH Homerton will provide the new GP OOH service which will operate alongside PUCC and ED. Reserved capacity within extended access hubs – utilise hub capacity as 1st choice to reduce demand on F2F GPOOH priority Robust interface between GPOOH & PUCC to enable best management of total urgent primary care demand in OOH (walk in and via NEL IUC) Ability to pass patients between services – this will be possible via NEL IUC and A&E front door Scope to enhance interface to include flexible / shared clinical staffing which would provide the opportunity for use of skill mix to reduce the pressure on the GP workforce Primary care approach / feel in all services 5 5

New model of Integrated urgent care in C&H – further detail Homerton agreed to deliver the new GP OOH service Homerton will continue to provide PUCC within the new model Rationale for this is as follows: City and Hackney need to provide a service that meets the national Urgent Treatment Centre (UTC) requirements, just as we need to provide GP OOH services Benefits of having PUCC and GP out of hours delivered by the same provider at the same site and co-located with A&E PUCC review completed last year – PUCC supports system delivery of the 4 hour wait – as a department it delivers 99% 4 hour performance and relieves pressure on majors PUCC supports overall VFM and flow by treating patients that arrive at ED within a lower acuity and lower cost environment Moving demand away from the hospital site is a long-term challenge, and as yet no clear evidence that it has been achieved in any system, therefore a co-located primary care stream is required PUCC sees a range of acuity of patient, many are not suitable for primary care PUCC opening hours 0700 – 0300, and can see non-registered and out of area patients Some discussion in workstream around more radical transformation of all services – Desire to not destabilise current provision of different parts of the system, including PUCC and duty doctor Insufficient time to do that within deadline for landing OOH solution This is a step towards further system integration

Developments in PUCC We are working with PUCC to address concerns that we hear from system partners Commitment to progress re-direction - though this requires wider system support and consensus on how to do this safely Commitment to deliver a primary care feel in both PUCC and GP OOH Contracting model ensures that CCG will always pay less than if patients seen in A&E Drop in activity rates will trigger a contractual review

Next steps Contract negotiations with Homerton for GP OOH Homerton committed to instilling primary care feel in the service CCG committees (October – November 2018 FPC Contracts GB Mobilisation – December – March 2019