Urgent Care Challenge

Transcription

1 Urgent Care Challenge Selecting the Right Path in Pre-Hospital Care Dr David Ratcliffe FRCGP Deputy Medical Director

2 NWAS receives almost 1.3 million 999 calls each year manages over 950,000 patient episodes covers a population of 7 million people which is expected to grow 3% by In many areas 54%* of all patients arriving at ED by ambulance ended up in one of these *74% of admissions were over 65 years of age

3 Less than 10% of incidents are actually life threatening Fallersmakeup17%ofall999activity Patients with known long term conditions call 999 six times more often than other service users They are admitted on average 3 times per annum Their average length of stay is between 3 and 5 days depending on underlying condition at an average cost of 1739 (Kings Fund 2012)

4 Transforming urgent and emergency care services in England Urgent and Emergency Care Review Keogh 2013 we must connect all urgent and emergency care services together so the overall system becomes more than just the sum of its parts we must provide highly responsive urgent care services outside of hospital so people no longer choose to queue in A&E.

5 Transforming urgent and emergency care services in England Urgent and Emergency Care Review Keogh 2013 we know that 40% of patients attending A&E are discharged requiring no treatment at all; there were over 1 million avoidable emergency hospital admissions last year; and up to 50 per cent of 999 calls requiring an ambulance to be dispatched could be managed at the scene

6 Healthier Together Reconfiguration different units with different roles? Community ( out of hospital) Standards-crucial for development of emergency deflection for NWAS

7 Access and Responsiveness DRAFT V3 Individuals will have access to professional health and social care advice and triage provided 24 hours a day, seven days a week and directed to the most appropriate service to meet their health or social care needs. Everyone will be assured of access to primary, community and social care within 2 hours in case of urgent health or social care need. People identified with a less urgent health needs will have access within 6 hours. People identified with a less urgent social care need will be contacted by social services the same day. Outcomes Individuals will be able to use primary care as their first port of call when accessing health services. Individuals with an urgent health or social care need will have rapid access to primary care, community and social care services. Increased satisfaction with access to health and social care services. Reduced use of the ambulance service, attendances at A&E and emergency admissions to hospital. People will have access to NHS Dental and NHS sight test services over extended periods Example measures % of A&E /UCC attendances with a primary care condition. 90% respondents in the annual GP survey opening hours are fairly or very satisfied with their general practice opening hours. Annual GP survey Out Of Hours survey 90% respondents very or fairly satisfied by 2016/17 % Reduction in LTC related attendances/admissions Increase social care customers receiving an initial assessment and advice same day Increase customers whose needs are resolved through online services Increase customers who receive health and social care rapid response services instead of NWAS for non medical emergencies Reduction in carer breakdown Reduction in admissions to short and long term care What this will mean for me I know who to contact and when, even in a crisis When I need urgent care, I have rapid access to an appropriate health or social care professional I have access to health and social care advice 24 hours a day, 7 days a week Primary care access is simpler and easier than going to A&E for me I have support to help me to access the most appropriate health or social care service to meet my needs Greater Manchester commitment to You: Delivering We will ensure the that right there is care, good access at theright to primary time,, community in the and right social care place services across all parts of Greater Manchester By April 2015 children between 0-5 years will be able to access primary care services appropriate to their need the same day We will increase the use of different communication and technology for accessing services

8 General Practice 31% of all NWAS Paramedic Emergency Service activity between 12:00 and 15:00 is from a healthcare professionals

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10 The Destination Conundrum Self Care

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13 The Development Process Initial Drivers PCT Reconfiguration Admission Avoidance The Stockport Medical Referral Model Workforce Capability Diagnosis v Discriminator Recognition The Clinical Congress and the Manchester Triage System A Collaborative Approach Evaluation...in Burnley this urban - system Cooke/Cobden paramedics report cannot reliably 2010 predict which patients do and do not require emergency department care... (Levine et al 2006) We believe that there is an urgent need for clarification of the role of Burnley UCC to the public and to NHS staff. It is our opinion that more cases could be dealt with at the...paramedics have very limited ability to predict whether transported patients require admission or the level of care required... (Silvestri et al 2002) Burnley UCC particularly if primary care, elderly care and paediatric services and their links with the UCC were improved. Work with the ambulance service could also increase the number of cases going to Burnley UCC by ambulance...in our system, the pre-hospital diversion policies should not be based solely on paramedic determination... (Levine et al 2006)

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15 Delivering the right care, at the right time, in the right place

16 Self Care

17 Current Workstreams Healthier Together and Integrated Care:- Children s Pathfinder Frail elderly/dementia Pathfinder ( with AGMA) Gynaecology Cardiology Medical Trauma

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19 Current Workstreams Electronic Referral and Information Sharing System (ERISS)

20 Electronic Referral & Information Sharing System (ERISS)

21 ERISS Secure electronic notification of referral information to other service providers. Pre-defined, searchable pathways based on patient s postcode or GP Practice. Secure portal for organisations to inform NWAS of care planning information & enable creation of alert flags. Automated reminder system to prompt review of care planning information. 100% audit trail for all activity on system. Fully configurable reporting.

22 Current Workstreams Electronic Referral and Information Sharing System (ERISS) GP referral schemes

23 GP referral scheme Cumulative data to January 2014 Area Number of Referrals Number of Referrals Accepted Number of Referrals Declined - Operational Number of Referrals Declined - Clinical Hospital Attendance and/or Admission Avoided Deflection Rate Greater Manchester % Cheshire % Mersey % Lancashire % Cumbria Total %

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26 Current Workstreams Electronic Referral and Information Sharing System (ERISS) GP referral schemes Frequent Callers Schemes

27 NWAS Policy/Procedure Pilot Site 23 Patients identified as Frequent Callers Collectively generated: 118 calls a month Post intervention: 3 calls a month Right Care, Right Place!

28 Current Workstreams Electronic Referral and Information Sharing System (ERISS) GP referral schemes Frequent Callers Schemes Community Care Pathways

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30 TO TURN DOWN THE FLOW WE NEED:- Tools are applicable to the acute presentation of the unknown patient and allow the paramedic to stop and think about alternatives to the ED. Enable shared decision making and improve Clinical Governance. Populated Community Care Pathways to create known patients which will pre-alert the paramedic to a specified care need. Solutions for the patients can be variable and locally developed, but have to plug in to our outputs. To provide co-ordinated and robust referral systems.? New / modified delivery model for NWAS?

31 Change through collaborative working & integration

32 Any questions?