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

2. Background Calderdale GP PENDOC NHS Direct West Yorkshire

3. 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%

4. 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

5. 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

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

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

8. Single access model - past, present & future how has the model changed over time in unexpected ways? PENDOC coverage 199947 GPs85,000 patients 2003250438,000

9. 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

10. 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

11. 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%

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

14. 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

15. 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

16. 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

17. 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)

18. 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

19. 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

20. 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

21. 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

22. 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

23. Thank You!