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

2. 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

3. 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 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

4. 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

5. 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

6. 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

7. Home visiting GPOOH currently provide both base and home visits.
Overnight ( ) 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

8. 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

9. 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

10. 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