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Transcript of Greater Nottingham Urgent Care Vanguard Greater Nottingham Urgent Care Vanguard Integrated Urgent...

  • Greater Nottingham Urgent Care Vanguard Integrated Urgent Care Summit 28th November 2016

  • Who’s who

    • Helen Jones – Head of Urgent Care, Greater Nottingham CCGs

    • Jodie Liversage – IUC & Vanguard Project Manager, Greater Nottingham CCGs

    • Christine Johnson – Clinical Lead, Nottinghamshire & East Midlands

    Over to you . . . .

    Greater Nottingham Urgent Care Vanguard 1

  • Agenda 1. What do you want out of the session? 2. Background to our system 3. Programme Update

    • What we’ve been working on 4. IUC Must do’s 5. Lessons learned

    • Practical hints and tips 6. Greater Nottingham examples 7. ROI 8. Ongoing Challenges 9. Key Messages 10. Questions

    Greater Nottingham Urgent Care Vanguard 2

  • Background to our system Greater Nottingham IUC footprint is made up of a number of providers, each of which are contracted separately and in different stages of their contracting arrangements. OOH – Provided by NEMs and finishes July 2017. NHS 111 – Provided by DHU. Regional contract that has just been procured (3+2 years). UCC – Awarded to City Care October 2015 (3+2years). 999 – Provided by EMAS GP – Primary care development at different stages in different CCG’s.

    Greater Nottingham Urgent Care Vanguard 3

  • Programme update – What we have been working on. • MH crisis

    • ED dispositions

    • Green ambulance dispositions

    • Advanced clinical re-assessment

    • Dental nurses in 111

    • Pharmacist in 111

    Greater Nottingham Urgent Care Vanguard 4

  • What have we been working on - Enablers

    • Workforce

    • Clinical Governance

    • Capacity and Demand

    • IUC Team Resources

    Greater Nottingham Urgent Care Vanguard 5

  • 8 National Must do’s

  • The 8 Key Elements of IUC – Where are you?

    • How many of you plan your capacity and demand for 111 and OOH for bank holidays?

    • How many of you have clinical governance systems in place for 111 that includes external partners?

    • Do you know how many of your calls are currently passed to a Clinical Advisor (Nurse / Paramedic in 111, Dental Nurse, MH specialist, Pharmacist etc)

    • What % of time does your service have access to a GP to support 111/HCP referrals?

    • For your services that accept 111 referrals, how many can view patient information?

    Greater Nottingham Urgent Care Vanguard 7

  • What we have learned………. • Contractual positions are key. You have to have your contracts in line to be able to achieve

    IUC.

    • Relationships are essential. You will more than likely be expecting providers who historically went head to head for contracts to work together, the new way of working is important and will take time.

    • Technology is the biggest barrier you will face on this journey! You MUST work closely with your local and regional DoS lead, know what your systems can and can’t do and be pro-active in discovering what technology is due to be released.

    • Funding – what flexibility is there in current contracts to support the transition to IUC?

    • Engage your workforce from the beginning.

    • Understand your activity flow and map your IUC services to this flow.

    Greater Nottingham Urgent Care Vanguard 8

  • What we have learned continued…… • Understand and map what you currently have in place – you may not be as

    far off delivering as first thought • Engage the correct people early on – often a wider group than expected.

    Include all providers not just OOHs/111 and enabling team members (finance/informatics/DOS support)

    • Identify what can easily be done to get the ball rolling – need to balance short term developments within current contractual arrangements vs. longer term planning

    • Use the expertise and evidence nationally and in your area – don’t reinvent the wheel

    • Make your business case based on ROI for green 2 ambulance and ED dispositions. Clinical review of these should deliver return required to support investment from commissioning teams

    Greater Nottingham Urgent Care Vanguard 9

  • Greater Nottingham Examples – Part 1

    • Worked with current OOH providers to expand reemit to include ED/Speak to dispositions – increased clinical hub activity 70% of the time

    • Integrated workforce – additional GP support in primary care in ED to deliver the clinical hub support in hours – increases GP support to clinical hub 24/7

    • Expanded the remit of the clinical governance group to include End to End calls reviews – meeting CG indicator

    Greater Nottingham Urgent Care Vanguard 10

  • Greater Nottingham Examples –Part 2 • Increased the routine winter planning/bank holiday

    capacity planning work currently in place to weekly – meeting the requirement for capacity and demand planning

    • Used UCC/Primary Care in ED service which operates in hours to begin direct booking ED and primary care patients – working towards in hours appointment bookings

    • Tapped into existing work programme of ‘Connected Notts’ – development of Medical Interoperability gateway for data sharing

    Greater Nottingham Urgent Care Vanguard 11

  • ROI • Activity reduction at ED on 111 dispositions of 75% • Activity reduction of green 4 ambulance dispositions

    see, treat, convey of 100% • Activity reduction of green 2 ambulance dispositions

    see, treat, convey of 11% • Primary Care at the front door – new streaming model

    to deliver an increase from 13% seen treated and discharged to 20% in line with national guidance

    • 111 pharmacist to deliver 47% reduction in medication query/repeat prescription activity in OOHs

    Greater Nottingham Urgent Care Vanguard 12

  • Ongoing Challenges

    • Ability to develop in hours/OOHs appointment booking in a single call

    • Making the service sustainable – working on our commissioning strategy

    • Aligning contracts – looking at developing an alliance model of contracting – will this work?

    • GP engagement in delivering this – challenge for 17/18

    Greater Nottingham Urgent Care Vanguard 13

  • Key Messages

    • Look at what's in place already within your system.

    • What are other people doing to deliver IUC?

    • Rally the Troops.

    • If you do what you have always done, you will get what you have always got!

    Greater Nottingham Urgent Care Vanguard 14

  • Any Questions…………

    Greater Nottingham Urgent Care Vanguard 15