Clinical Hubs and UCS

Clinical Hubs and UCS Clinical Hub Staff Development Traditionally Clinical Hub staff join the Trust as call handlers and progress to dispatcher roles. Recent changes to Hub structure brought about by the introduction of NHS Pathways in the South has created more opportunities in the form of increased auditor capacity and new roles such as EMA Team Leaders. However this is not standardised across the Trust and in the North Hub some dispatchers are direct entry and do not have 999 call handling experience. Whilst some staff do remain within the Clinical Hubs for many years there has been a large number of Clinical Hub staff leaving for a variety of reasons including: Progression within SWASFT to student Paramedic/ECA roles; Capability management; Lack of internal Clinical Hub progression opportunities. When the South Hubs were using the AMPDS all dispatchers were qualified to answer 999 calls however since the move to NHS Pathways this is no longer the case. This has meant an increase in call handling numbers and a subsequent development of an EMA Team Leader role. This provides a new progression route for call handlers but it is a route that is not available to non NHS Pathways trained dispatchers. Only 3 dispatchers are able to answer 999 calls in the South Hubs at present. Additionally in the South Hubs the increase in call handling numbers has also led to an increase in the number of audit staff required. Again this is a route for progression that is only open to NHS Pathways trained staff and effectively this rules out dispatch staff applying for the roles. In the South Hubs the same CAD (MIS Alert C3) exists and is now fully virtualised as is the call handling on the ICCS telephony platform. This has provided greater economies of scale and resilience. The intention is for a virtual CAD and telephony solution for all Clinical Hubs and this is in due process. In this transition period there continues to be work undertaken to unify roles across the hubs and introduce nationally recognised qualification for call handling staff to standardised levels of competency, as described below. Upskilling call handlers (UCS and 999) SWASFT are in the process of adapting pre-existing Level 2, 3, 4 and 5 programmes for the hubs to improve patient experiences and are in dialogue with Page 1 of 8

numerous local FE providers. The level 2 and 3 qualifications can be offered as apprenticeships to qualifying staff and new starters where operationally feasible. SWASFT is currently reviewing how many apprentices can be recruited under such a framework and the infrastructure required to support this programme including the finer details pertaining to age range of apprentices, salary and hours staff members can work. Programmes will include contact centre operations, customer care and at a level 4 and 5; care, leadership and management. The programmes will be open to call handlers, clinical supervisors and any key roles agreed subject to a feasibility study on number of students we can support through an assessed work portfolio route and Trust priority. There will be no initial requirement for call handlers to enroll in these programmes as this would be inconsistent with the educational attainment level required at recruitment. It is proposed to offer Hear and Treat modules for call handlers to GP s and the Trust is developing a programme in association with UWE. Urgent Care Service Line (UCS) The Urgent Care service currently offers the following services: NHS 111 in Cornwall, Devon, Somerset and Dorset; Out of Hours in Dorset, Somerset and Gloucestershire; Single Point of Access in Dorset; MIU in Tiverton; Treatment Centre at the front door of Emergency Departments in Bournemouth, Poole and Dorchester. There are ambitions to grow these services across the whole Trust area. In order to do so a robust workforce strategy is required to deliver: A skilled clinical and non-clinical workforce capable of delivering high quality services in the right place, at the right time for our patients; A flexible workforce able to adapt to a changing and dynamic market; A sustainable workforce which is well led and supported with defined development opportunities to ensure adequate succession planning which will meet future needs. SWASFT will require a more integrated approach to its clinical workforce and there are likely to be opportunities to use a combined approach, using generic roles in urgent and emergency care as well as within the clinical hubs. Dual trained call handlers and supervisors are already being explored and a new UCS structure is in development. Page 2 of 8

There are future efficiencies to be gained from encouraging Paramedics to become clinical supervisors and floor walkers. The improved use of paramedics in UCS would improve the understanding of service lines on the front line, especially 111 and aid with the organisational need to redeploy experienced paramedics towards the end of their service, particularly those who are near retirement and find the physical challenges of front line duties more exacting. Call Advisors (Band 3) At the forefront of UCS are the Call Advisors, dedicated to providing responsive and high quality patient care to the patients who call 111. Staff in this service line are NHS pathways trained - the nationally implemented clinical triage tool, a requirement of all 111 providers. Call advisors use this tool to take patients through triage providing health advice or onward referral to an appropriate healthcare professional, utilising a Directory of Services. Whilst no previous experience is required our Call Advisors must be patient focussed and empathetic, demonstrating excellent customer service skills. On entry to call advisory roles staff receive three weeks full time pathways training, (also delivered part time over five weeks). This training is followed by 18 hours of supervised practice. Once in post Call Advisors are led and supported by Senior Call Advisors and they develop their skills through individual and organisational learning from regular call audits, 1:1 meetings and supportive coaching plans. Due to the complexities and importance of the role it will usually take a Call Advisor 6-9 months to be fully proficient in this area of work. To ensure skills are both established and maintained there is a common requirement of all staff to a minimum number of hours and regular working pattern. Call Advisors can grow established careers within the Trust and have a number of opportunities available to them. As entry level roles within the organisation these staff can develop and grow their careers either within the 111 or 999 call handling environment, within operational ECA roles in A&E or by moving into one of our support functions. Within the 111 service the opportunity for progression exists within the organisational structure, with established and committed call advisors being given the opportunity to act up into the Senior Call Advisor role. This first line supervisory role provides an excellent opportunity and a stepping stone into more senior operational roles within the UCS and the A&E environment. Page 3 of 8

Additionally we are keen to develop an interoperable Call Advisor who can work seamlessly across both 111 and 999, benefiting by doing so from a varied workload and an end to end experience of all the call handling environment within the Trust. Senior Call Advisors (Band 4) Senior Call Advisors are usually promoted from within, from the team of dedicated Call Advisors. This role is the first step into supervisory and performance management functions. NHS pathways trained, these Senior Call Advisors require excellent leadership qualities, demonstrable commitment and engagement and be able to guide, support and embed a culture of quality and performance. Undertaking critical functions such as call audits, appraisals and producing development and coaching plans are key to the role. There is an emphasis on supporting staff by identifying their individual learning needs and encouraging safe standards of care. This role is the first stepping stone to a wide range of management roles within the organisation but specifically within 111 it is the first step to developing into a Duty Performance Manager Role. Duty Performance Managers (Band 6) Duty Performance Managers play a role in the coordination and collective performance of the 111 call handling function. As a next step for 111 Senior Call Advisors or from supervisory roles within the 999 service selected staff can be NHS Pathways trained and their leadership qualities developed to enable them to inspire, lead and encourage staff throughout the call handling process. Staff in Duty Performance Management roles require management skills training and coaching and development in areas such as staff welfare, how to engage individuals and performance management. These roles will prepare the post holder for a wide range of more senior operational management roles across the Urgent Care Service and the wider Trust. Clinical Supervisor (Band 6) From a registered healthcare background and led by the 111 service manager, our Clinical Supervisors manage calls where NHS Pathways determines further clinical triage and intervention is required. Page 4 of 8

Clinical supervisors also undertake the role of clinical floor walker which is designed to manage the demand of clinical referrals by providing further assistance and support to our call handling teams. Typically Clinical Supervisors join SWASFT from an operational clinical role and require NHS pathways training and additional clinical modules. The intervention is delivered over 5 weeks full time or 7 week part-time. The Trust will sponsor the time required to fulfil this upskilling. The Trust is in the process of establishing an entry route into Clinical Supervisory roles for newly qualified band 5 staff nurse/paramedics. These would be provided on a trainee basis. In addition to the traditional career paths SWASFT is developing greater interoperability and resilience between the 999 and urgent care hubs. A pathway will be developed to enable clinical supervisors to operate and work between the clinical hubs. Established band 6 clinicians can take advantage of a wider variety of work combining clinical hub work with Out of Hours Triage and direct patient facing work. Additionally opportunities exist for established Clinical Supervisors to develop more strategically by moving into roles such as the Quality Development Lead role which has a greater focus long term clinical development. Quality Development Leads review audits and subsequent action plans, provide a clinical input into team members development plans, undertake SI investigations, manage complaints and deal with cases that fall under the duty of candour. Providing strong clinical governance these leads act as a subject matter expert for clinical quality standards, promoting safe and best practice across the Urgent Care Service Line. General Practitioners It is important that the Urgent Care service has access to medical leadership and support in order to inform best practice, and develop the multidisciplinary team. This will be led by the Trust s Medical Directors with a specific focus from the GP Associate Director to set direction around GP practice and governance. Supporting this will be a GP Lead for each county in which the Trust delivers Out of Hours services. The GP leads will be responsible for ensuring that the GP workforce is supported and working within the Trust s policies and governance framework. This will include the maintenance of good practice through clinical audit. The GPs working in each county will provide a variety of services; Page 5 of 8

Management of patients within the NHS 111 clinical queue who have complex care needs to co-morbidity and poly pharmacy healthcare requirements. In addition these GPs will provide clinical oversight and support to the NHS 111 Call Advisors and Clinicians to minimise inappropriate hot transfers to the 999 ambulance service and inappropriate disposition to emergency departments within 1 hour; Clinical telephone triage in order to ensure that patients receive the most appropriate response for their needs. This triage will be carried out in the Trust s Clinical Hubs and also from local Treatment Centres. GPs will also provide cover in the Trust s busy treatment centres. This will enable medical leadership for other healthcare professionals working in this environment. In addition, GPs will provide mobile cover in order to carry out two vital functions: Provide home visits for patients who have been assessed as needing this service from a GP; Visit treatment centres run by Nurse Practitioners of ECP s in order to provide medical support. The Trust will work with GPs and commissioners to provide GP RRVs which are able to respond to Red 1 999 calls in order to deliver early intervention when a patient has a life threatening condition. GPs will also respond to Green category 999 calls in order to provide care locally and avoid unnecessary conveyance to emergency departments. The Trust recognises that there is a national shortage of GPs and this is a threat to service delivery. In view of this a key element of this strategy is to attract and develop both GP Registrars and fully qualified GPs. This will require a coordinated approach and engagement with primary care colleagues and commissioners. The Trust will take the following action: Set up a sub group of the Trust Board for GPs led by the Trust s Medical Director; Program regular meeting with GP Federations led by the GP Lead for each county; Offer a variety of methods for GPs to work with the Trust. These will include sessional contracts and GPs who are directly employed by the trust. The latter may be solely employed by the Trust or may be employed part time by the Trust and part time by a primary care practice. The Trust will work with primary care colleagues to develop packages which will attract new GPs to these roles by offering a breadth of work and experience; Seek to increase the potential for GPs to carry out remote telephone triage from their own homes providing appropriate arrangements are in place to ensure that information governance is maintained. The Trust will develop Page 6 of 8

this opportunity in the knowledge that many highly experienced GPs across the South West are due to retire. In view of this the Trust would seek to offer the opportunity for GPs to triage from home during peak periods at evenings and weekends to attract this highly skilled and experienced potential part time workforce; All GPs will be offered the opportunity to train and mentor other clinicians working in the Trust s urgent care setting; Explore opportunities to enhance the core GP workforce with other medical staff, such as, more junior and trust grade level physicians. Developing our Nursing Workforce There are a variety of roles within the Trust s Urgent Care Service which are ideally suited to nurses as well as Paramedics and Emergency Care Practitioners. Specifically, nursing staff will be required for the following roles; Clinical Triage in NHS 111 Clinical Hubs, taking immediate electronic patient transfers from NHS 111 Call Advisors (warm transfer) and also managing the clinical queue to ensure that patients receive a clinical call back within a timeframe which depends on clinical need; Clinical Floor Walking in NHS 111 Clinical Hubs to minimise unnecessary or inappropriate hot transfer to the 999 ambulance service or 1 hour dispositions to emergency departments; Clinical Triage in the Out of Hours Clinical Hubs to ensure that patients are directed to the most appropriate healthcare provider or receive a home visit from a suitably qualified healthcare professional; Working under the supervision of a GP in some Urgent Care Centres; Working autonomously in some Urgent Care Centres; Providing a mobile service undertaking home visits to patients; Working within our Single Point of Access; Proving frontline patient care within our Minor Injury Units. The Trust recognises the need to attract and develop highly skilled nursing staff to deliver urgent care services. This will entail the development of a program which creates multi-skilled nurses to deliver the variety of services set out above. The Trust will employ the following strategy: Direct recruitment of qualified Band 7 Advanced Nurse Practitioners (ANPs) with prescribing rights; Partner with other organisations in order to merge Out of Hours Treatment Centres with Minor Injuries Units wherever they are collocated to form Urgent Care Centres. This will enable ANPs working for community services to be utilised more efficiently and effectively; Development of Band 6 Nurse Practitioner (NP) posts which enable opportunities to work across the remit of Urgent Care Services which will Page 7 of 8

develop and provide a greater scope of practice, underpinned by a formal education pathway to the ANP qualification; Development of Band 5 nurse development posts working across the Urgent Care Service in order to gain a thorough grounding in the Trust s service delivery model and enter the NP/ANP development program; Provide a formal modular placement for Student Nurses from Bournemouth University, Plymouth University and University of Western England in order to attract new nurses to the Urgent Care Service in the future. Page 8 of 8