1. Domains Care Model HomecareOutpatientsInpatients Primary care

2. Outpatients Improve access to consultant opinion Reduce appointment waiting time Reduce follow ups Outpatient protocols Community LTC nurse practitioners One stop clinics Manage DNAs More consultant decision making Triage of all referrals Reduce unnecessary referrals Protocols for referrals Improve skills in primary care E-mail clinics (response within 24 hours) Daily consultant led clinics No outpatient nurses Generic/Department model

3. Inpatients Reduce A& E Attendance s Direct access to Nurse Practitioner GP referral to generic home care team Improve Outpatient access Improve primary/co mmunity care Reduce A&E Admissions Protocol driven care A&E Referral to home care team Improved access to outpatient Improve access to senior medical opinion Reduce Length of Stay Increase consultant input Improve access to diagnostics Morning Reports Nurse/Physi o service on acute words Protocol driven care Team job planning Morning reports – all admissions presented to appropriate specialist teams

4. Home Care Acute home care team Social care bridging capacity Community based LTC practitioners Telemedicine links Assistive technology – remote monitoring Self Care Expert Patient Programme Pharmacy Extended Service Identify and manage “frequent flyers” Pulmonary rehab provided locally