Unplanned Care: New model for Integrated Urgent Care GP consultation

Introduction The purpose of this presentation is to update CCF on development of the new integrated urgent care model The CCF are requested to: Note the progress to date Support the outline model and next steps proposed Acknowledge the significant workforce challenge – identify potential mitigations Identify features that could be included to provide primary care feel / approach

Background The new NEL IUC (111 & CAS) provides the single point of telephone access to urgent care in OOH – there is no direct telephone access to GPOOH Telephone assessment and treatment that was previously provided by GPOOH (CHUHSE) has moved into NEL CAS There is a requirement for a new model / service to provide the face to face element of GPOOH for patients who are referred onwards from NEL IUC Agreement from CCG to commission CHUHSE to provide stand alone GPOOH Face to Face service as an interim solution to March 2019 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

Programme of work – key developments Services in scope PUCC, GPOOH, Paradoc, Extended Access Hubs, Duty Doctor Urgent Care Reference Group established representatives from relevant services across all providers and CCG, chaired by a Ben Molyneux Initial scoping workshop – preferred model agreed redistributing GPOOH between all primary care services open outside core hour’s Series of core project team meetings - representation from the GP confederation and Homerton explored options for the interface / integration with PUCC no agreement of ideal model but consensus on key features & issues lack of local provider appetite to take on the OOH service Unplanned care board (June & July) acknowledged the system risk associated with award of the F2F GPOOH contract to an external provider Further discussions with all potential local providers CHUHSE and Confederation not in a position to take on OOH service Homerton willing principle to delivering the service

Developing integrated urgent care in C&H Existing service Future model There are more similarities between duty doctor and 111 Review 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 5 5

Paradoc – home visiting New model of Integrated urgent care in C&H PUCC / UTC GP extended access 999 / ED Duty doctor IUC GP F2F OOH Paradoc – home visiting Urgent primary care demand shared across the system during OOH Reserved capacity within extended access hubs – utilise agreed hub capacity as 1st choice to reduce demand on F2F GPOOH 1 appointment / hub on weekday evenings 1 appointment / hour / hub on weekends 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 as a minimum – 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 6 6

Home visiting GPOOH currently provide both base and home visits. Overnight (1130-0800) there is only one GP who manages both base and home visits with a colleague who works as a driver and receptionist Introduction of direct booking from NEL IUC into GPOOH makes this difficult to manage safely Proposed that Paradoc take on home visiting Aligns with principle of utilising all GP capacity in system and opportunity for skill mix Other areas doing / proposing similar Paradoc is in support and early discussions have taken place paramedic would visit, assess and treat the patient with a link back to the Paradoc GP / GPOOH GP if required Ideally the service would use Advanced Paramedic Practitioners (APPs) as they would have prescribing ability which would reduce reliance on the link with the GP APPs but availability might be an issue -potential to offer an APP support programme locally

Primary care ‘feel’ & Workforce Challenge Primary care approach Discussions with GP colleagues & GP Confederation about how to achieve this: GP lead, Education & training Urgent primary care pathways Anything else? Workforce challenge Ability to attract and retain GPs has been identified as the most significant challenge/success factor for the new model. A number of approaches have been considered to help manage this uniformity of offer to GPs, career development, indemnity This is a system risk that would impact all providers Need support from primary care colleagues to mitigate this risk ? Commitment to work number of shifts / year ? VTS trainers to work with trainee

Proposed next steps Contract negotiations with Homerton Development of service specification Draft contract Procurement advice from CCG contract team / Legal Consultation with clinical colleagues Unplanned Care Board 28th September 2018 Key features of service specification & contract CCG committees (October – November 2018 FPC Contracts GB Mobilisation – December – March 2019

Request of CCF The CCF are requested to: Note the progress to date Support the outline model and next steps proposed Acknowledge the significant workforce challenge – identify potential mitigations Identify features that could be included to provide primary care feel / approach