1. Where we need to get to by 2011 Clare Smith Unit Operational Manager, Cardiac Aberdeen City Community Cardiology Planning Day

2. 18 Weeks RTT- Why? 18 weeks – what is counted and what isn’t? Where are we now? What do we need to do to move forward? Aberdeen City Community Cardiology Planning Day

3. Waiting Times= Acute care The Scottish Government has set out the vision for a stronger NHS in Scotland that will make better use of NHS capacity to deliver a better deal for patients. A major element in achieving this vision will be a new national waiting time standard: From December 2011, 18 weeks will become the maximum wait for treatment following referral by a GP for non-urgent patients. “Better Health, Better Care” (Scottish Government, December 2007) The 18 weeks Referral to Treatment (RTT) Standard is an integral element of the strategic objectives set by the Scottish Government that will structure decision ‑ making and give clear focus to delivering better health services for the people of Scotland. Aberdeen City Community Cardiology Planning Day

4. Why? The end of queuing as a rationing mechanism The end of inequitable service The end of an ever distancing tail The end of the anxiety and worry which goes with waiting The end of stage of treatment guarantees Aberdeen City Community Cardiology Planning Day

5. What is Counted and What Isn’t? The clock starts for a RTT period on the date of receipt of referral to: a consultant-led service a referral management centre Aberdeen City Community Cardiology Planning Day

6. Definitions A Consultant Led Service is: Where a Consultant retains overall clinical responsibility for the service, care, professional team or treatment. This is applicable whether it be in the Acute or Primary Care setting The Consultant will not necessarily be physically present for each consultant led activity. Diagnostics are included within this provided the patient will be assessed and might, if appropriate, be treated by a medical or surgical consultant-led service before responsibility is transferred back to the referring health professional. This is also known as “straight-to-test” Direct access referrals to diagnostic services are excluded if the referral is not part of a straight-to-test referral pathway. Referral Management Centre is: A referral management centre is any service that incorporates any intermediate levels of triage and assessment between traditional Primary Care and Secondary Care. Aberdeen City Community Cardiology Planning Day

7. Case Study 1 Mrs. T was referred to the Dr Hannah’s consultant led CP clinic at her local hospital in Peterhead. At the first outpatient appointment, Mrs. T was examined by the GPSI who diagnosed angina and commenced medical management. Although Mrs. T saw a GPSI rather than a Consultant, her 18 weeks RTT clock still started on the day that the hospital received the referral. This is because the clinic was running as an independent chest pain clinic as part of the Andrew’s team. Case Study 2 Mrs V visited her GP complaining of breathlessness and palpitations. Her GP decided to refer her for an echocardiogram at the local hospital cardiology department to help inform her of the best way to manage her condition. No 18 weeks RTT clock has started, as the GP has made a referral for diagnostic test with the intention that the responsibility for the patient remains with the GP: there is no immediate intention for the patient to go on to see a consultant-led service. Case Study 3 Mr G attended his GP complaining of chest pains. His GP referred Mr G to his local hospital. All referrals are triaged by clinical and administrative staff in the Referral Management Centre, who assessed the information contained in the referral document, and passed the referral (as per agreed protocols) to the chest pain clinic in the neighbouring hospital. Mr G’s RTT clock started when the referral was received by the Referral Management Centre, even though the hospital did not receive the letter until three days later. Aberdeen City Community Cardiology Planning Day

8. What Does this Mean for Current Services in the Community? What does this mean for current services in the Community? GPOA Echo = No waiting Times GPOA ETT = No Waiting Times GPOA Holter = No Waiting Times ARI and DAB GPSI CP Clinics = Waiting Times Consultant Community Clinics = Waiting Times Aberdeen City Community Cardiology Planning Day

9. Better Care Without Delay is about adding value to the patient journey and ensuring patients access the appropriate Services when they need to whether that be in the Acute or Primary Care setting. Aberdeen City Community Cardiology Planning Day

10. Where are we now? Aberdeen City Cardiology Planning Day 12 Weeks Targets all DAB, ARI and Aberdeeshire met.

11. Aberdeen City Community Cardiology Planning Day N.B. The RACPC Route is the same from AG onwards but has a 2 weeks appointment guarantee for the OPA. Now 12 wks Cardiology OPA Revascularisation 16 wks AG 26 wks

12. Aberdeen City Community Cardiology Planning Day N.B. The RACPC Route is the same from AG onwards but has a 2 weeks appointment guarantee for the OPA. 2011 Cardiology OPA <5 wks AG <9 wks Revascularisation <18 wks

13. RACPC Review Revision of RACPC and roll out across GP practices Clear referral routes Timeous access to RACPC Waiting Times Aberdeen City Community Cardiology Planning Day

14. Number of Weeks WaitingNumber of Patients on List Echo General GPOA Echo Holters General GPOA Holter GPOA ETT Echo Gen GPOA Echo Holters Gen GPOA Holter GPOA ETT ARI 6-7mths 28wks 2wks8wks15wks________7685088138_________ DAB _______ ______________________ _ ______________ INV 16wks2wks9/10wks530 KCH _______4wks______________ _ _______ 0_______ _ PHD 9wks_______ 23_______________ TUR _______9wks_______19wks1wk_______20_______202 Aberdeen City Community Cardiology Planning Day N.B No Waiting Times are applied to ‘General’ Diagnostics but they are being monitored by the Executive pending roll out.

15. Better planning and scheduling of resources. (Readiness Assessment Tool) Planned alternative referral and treatment routes that speed up access and reduce waiting times allowing patients to be seen by the right person, in the right place, at the right time. (Readiness Assessment Tool) Centralised points of referral that minimise the number of queues and simplify communications for patients, healthcare professionals and the administrative and support teams. (Readiness Assessment Tool) Clear rapid signalling processes in the system that can alert all teams involved in a patient process about changes in service provision due to unforeseen circumstances such as absence/illness or interruptions to normal service. (Readiness Assessment Tool) Improvements in queue management through pooled lists and streamlined patient processes. (Readiness Assessment Tool) Aberdeen City Community Cardiology Planning Day What do we need?

16. Aberdeen City Community Cardiology Planning Day Patient Centered Service Review Developing a Plan for Aberdeen City Community Cardiology i.e. shifting the balance of care out of the Acute setting What does ‘Shifting the Balance of Care’ actually mean? ‘…improve the health of the people of Scotland by shifting the emphasis towards health improvement, preventative medicine and more continuous care in the community. …We aim to improve access to care and treatment through a general shift in the location of services and care. For example, a wider range of diagnostic procedures and specialist services are being embedded into communities through Community Health Partnerships. We expect to see less acute hospital centred activity as we continue to develop our community infrastructure and community hospitals. This will enable us to get a better balance between planned and unscheduled care’ www.scotland.gov.uk

17. Model of Care One Size Does not Fit All Aberdeen City Community Cardiology Planning Day Areas of commonality between Aberdeenshire and Aberdeen City i.e. need for GPOA Echo and Holters For Discussion Is the GPsWI model correct for a City Solution? Should Community Cardiology be provided by Speciality Drs within the Community? How do the costs stand up?

18. Other Considerations for Discussion PatientConsiderationsResources  GPOA Echo  GPOA Holter  Chest Pain NP  Other Cardiology NP  All Re-referrals  Criteria  Competencies  Accountability  Patient Focused?  Appropriateness  Frequency  Waiting Times  Referral Systems  Training  Physiologists  Cardiologists  GPSWI  Registrars  Specialist Drs  Cross Cover  Admin  IT  Accommodation  Current Service levels  Nurse-Led Aberdeen City Community Cardiology Planning Day