1. Unplanned Care: New model for Integrated Urgent Care
GP consultation

2. 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

3. 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 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.

4. 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

5. 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

6. 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

7. 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

8. 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