Single access model - past, present & future Paul Wilding - Medical Director NHS Direct West Yorkshire

Background Calderdale GP PENDOC NHS Direct West Yorkshire

NHS Direct nurse triage Patient calls PENDOC controller General practitioner review GP telephone advice 46% Home visit PCC appointment Nurse tel. advice 999/A&E 21% 52% 33% 43% 5%

Single access model - past, present & future how did we get started? (1) clinical leadership coincidence - opportunity seized mutual commitment to partnership working shared objectives - seamless patient centered high quality care, demand management

Single access model - past, present & future how did we get started? (2) progressing a good idea - single number access to multi-disciplinary OOH care clear benefits to patients and all stakeholders pushing against an open door resources - central and local

Single access model - past, present & future how did we get started? (3) In summary: foundation for the future

Single access model - past, present & future how has the model changed over time in unexpected ways? Increased coverage

Single access model - past, present & future how has the model changed over time in unexpected ways? PENDOC coverage GPs85,000 patients ,000

Single access model - past, present & future how has the model changed over time in unexpected ways? clinical governance outputs – audit, performance & risk management co-location of ambulance control

Single access model - past, present & future how has the model changed over time in unexpected ways? mental health NHS CAS - wider role out stalled, call- times and triage outcome single telephone assessment call-streaming

NHS Direct nurse triage Patient calls PENDOC controller General practitioner review GP telephone advice 46% Home visit PCC appointment Nurse tel. advice A&E & Others 21% 52% 33% 43% 5%

Single access model - past, present & future How will the model look in the future?

Single access model - past, present & future What else was unexpected? pace of NHS policy initiatives Carson Review, REC (GMS GP Contract) sense of urgency – PCT OOH funding time bomb

Single access model - past, present & future How did the development broaden out? dental services, community nursing leadership - managerial & clinical communication & marketing extension to in-hours cover

Single access model - past, present & future How did the development broaden out? by accessing local expertise e.g. palliative care to create a special patient pathway

Single access model - past, present & future How can we grow connections with other parts of the system in the future? dedicated unscheduled care provision by all agencies across the 24 hour divide technology – EPR (and compliance with with confidentiality requirements)

Single access model - past, present & future How are we overcoming professional boundaries and traditional roles? communicating the vision of a multi- disciplinary OOH workforce and telephone triage service managing sensitivities e.g. GPs attracting new investment – Developing NHS Direct

Single access model - past, present & future How did we overcome professional boundaries and traditional roles? extension to in-hours cover GPs benefiting from locality NHS provision towards a 24x7 emergency access model

Single access model - past, present & future How can we overcome professional boundaries and traditional roles in the future? working with the wider NHS e.g. MA Changing Workforce Programme, NHS Direct

Single access model - past, present & future How can we overcome professional boundaries and traditional roles in the future? by a delivering safe & effective service acknowledging different attitudes to risk/uncertainty be pragmatic e.g. selected caseload

Summary pole position for progressing a regional approach towards a single access pathway to emergency/ unscheduled care manager/clinician partnership all agencies must be engaged Primary Care must assume a leading role in Emergency Care Networks

Thank You!