Case study Blackpool PCT Developing an urgent care centre

Case study Blackpool PCT Developing an urgent care centre Introduction This project was developed to support the remodelling of unscheduled care for the Fylde coast health economy. An audit of patients attending A&E suggested that 25% may be more appropriately treated by primary care and that this could be delivered by integrating primary care services on the acute trust site with an existing primary care assessment unit (PCAU) to create an urgent care centre. It was recognised that the development could also reduce nonelective admissions to secondary care. The project entailed radical redesign of unscheduled care services to deliver a service built around and responsive to the needs of patients. The development has progressed further to integrate wider services within the community around a whole systems approach to meet urgent health care needs which will also improve convenience, appropriateness, quality of care provision and care closer to home. The project is a partnership between NHS Blackpool, NHS North Lancashire and Blackpool, Fylde and Wyre Foundation Trust with key support from Fylde Coast Medical Services (NW) Ltd. What was the problem that the PCT set out to solve? A recent demonstration by NHS PCC primary care commissioning advisers confirmed that there was a significant productivity opportunity for the PCT. Blackpool has one of the highest rates for emergency admissions in England, coming in at 142 of the 152 PCTs, according to 2008/09 data. In seeking to reduce A&E attendances, Blackpool also set out to treat patients more appropriately to their health or social needs, improve quality of care, reduce waiting times, and provide care closer to home. Aims of the project The urgent care centre due to go live in April 2010, aims to provide a service combining the existing accident and emergency department (A&E), GP out of hours services, mental health services, social services and other primary care services. The centre will operate 24 hours a March 2010 www.pcc.nhs.uk 1

day, 365 days per year and provide clinical triage and signposting to the appropriate service through a single point of access. Following an audit of attendances, a modelling exercise led the to PCT expect to be able to deflect approximately 25% of all A&E activity to primary care. The audit also identified potential to reduce unnecessary non-elective admissions. The objectives of the service are to: Provide a single point of access for patients Provide consistent assessment face to face or via the telephone Signpost patients to the most appropriate service Provide immediate treatment or arrange appointments with the appropriate service. Improve integration of services across primary, community and secondary care Stay open 24 hours a day, 365 days per year Improve overall quality of care provision Increase accessibility to services based on need Provide care closer to home Create efficiencies by improving patient pathways Improve commissioning information of patient needs and the service required to provide unscheduled care Contribute to service redesign and development Improve and develop care pathways Maximise the use of existent services in terms of human resources skills, knowledge and competencies Contribute to workforce development by shaping the workforce to meet patients needs Include partner organisations to meet targets such as in- and out-of-hours GP services, out of hours nursing services, rapid response team, social services, mental health services and the local pharmacy service. March 2010 www.pcc.nhs.uk 2

Options An option appraisal was undertaken with multi-agency representation and three preferred options were put forward for consideration: 1. All services integrated in one urgent care centre site adjacent to A&E 2. Co-location of integrated core services as a hub in an urgent care centre adjacent to A&E, with other services being provided from hubs on the Fylde coast 3. Do the minimum. The second of these options was chosen to go forward to the feasibility and financial appraisal stage of the business case process. Project approach Blackpool established a project board comprising the key partners, and established subgroups to take the elements of the project forward, including an implementation group, mental health group, IT group, and finance group. A copy of the project plan is included in appendix A. Barriers and enablers The PCT identified several barriers including finance 1. Barriers - Finance is always a major challenge, especially when a sophisticated IT programme is required to facilitate the functioning of the service, NHS Pathways March 2010 www.pcc.nhs.uk 3

training, populating of the directory of services in terms of provider engagement, engagement throughout the process, technical links between IT systems, other organisational changes, TUPE issues, issues associated with redesign of services, change management. 2. Enablers: people, passion, perseverance and good working relationships Impact, outcomes and sustainability The service is expected to bring significant benefits to patients by improving access to unscheduled care. As part of the service implementation the PCT will be undertaking regular reviews from the perspective of not only the service providers but also a patient satisfaction survey. The results of the survey will be used to further improve the service. Other expected benefits include: Making the best use of the skills of all staff to shape unscheduled care services to meet patients needs To contribute to world class commissioning by improving information, identifying service requirements and influencing the commissioning and development of services. The project demonstrates the following competencies: Competency 1 Locally lead the NHS. The PCT has taken the lead for the project and is embarking upon major service delivery changes as a result of the implementation. Competency 4 -- Collaborate with clinicians. This whole project has been underpinned by a consistent dialogue between all partners including the full range of clinical staff. Competency 5 Manage knowledge and assess needs. Through the modelling and understanding of service usage the PCT have been able to identify the changes needed in urgent care services. Future ability to refine and undertstand the needs and service usage will be enhanced through the use of the NHS pathways and directory of services and better, more robust information recording. Competency 8 Promote improvement and innovation. The PCT has an opportunity to be ahead of the game in terms of the three-digit number with NHS Pathways and CMS directory of services already in place. (It is a reference site for NHS Pathways, and the first site in the country for face to face triage with the NHS Pathways team. Lessons learnt What have been the most important outcomes of this project and did it achieve what it set out to do? When we have a fully functional UCC delivering the aim, objectives and outcomes intended. Very confident of 25% +/- deflections in the first instance and a primary care services being provided to patients as appropriate at the acute site via the UCC. March 2010 www.pcc.nhs.uk 4

Were there any particular barriers or enablers that were crucial to the success or failure of the project. The barriers are the usual HR, IT, finance but the partnership between the organisations and working relationships assist to push this development forward. There is a drive locally to undertake this and make it a success. The three Ps again; cliché but true. What advice would you give to other PCTs wanting to carry out a similar activity? Have a vision but make sure you undertake the detailed analysis. Learn from other areas before development especially around IT capabilities, contracts, finance. Consider all the elements/impacts HR, IT, finance, politics, culture, structure, systems, workforce and value for money. Spec up your ideal service, see how existing services could be brought together but if not look to start from scratch, ie spec up exactly what you want delivered, how, where and when, and commission that service. Were there any unexpected hidden costs whether financial, staffing, contractual, time or relationship? IT costs, HR costs, NHS Pathways impact on triage time/training required, audit, cost of trust managers time. This needs a full time project manager to deliver. In undertaking the above some hidden costs may be identified. But changes in legislation may impact even with a through examination to try and establish all costs even those potentially hidden. Organisational information Sharon Rourke Senior Commissioning Manager NHS Blackpool Blackpool, Football Club, Seasiders Way, Blackpool, FY1 6JX Sharon.rourke@blackpoolpct.nhs.uk 01253 651313 Maturity of project - new March 2010 www.pcc.nhs.uk 5

Appendix A project plan See below March 2010 www.pcc.nhs.uk 6

ID Task Name 1 NHS Pathways/CMS DoS Impl group 8 Phase 2 -Implementation UCC 9 Communication Strategy - NHS Blackpool 10 Arrange briefings to commissioners and Providers 11 Brief and presentation to commissioners (CEG) 12 Brief and presentation to Providers in line with CMS Dos phases 9 Nov '09 Dec '09 Jan '10 Feb '10 Mar '10 Apr '10 May '10 Jun '10 Jul '10 Aug '10 Sep '10 Oct '10 Nov '10 Dec '10 Jan ' 11 18 25 01 08 15 22 29 06 13 20 27 03 10 17 24 31 07 14 21 28 07 14 21 28 04 11 18 25 02 09 16 23 30 06 13 20 27 04 11 18 25 01 08 15 22 29 05 12 19 26 03 10 17 24 31 07 14 21 28 05 12 19 26 02 13 Facilitate continued internal communication/updates 14 Communication Strategy - Patients/Service Users/Public 15 Discuss communication strategy with UCC Project Board 16 Engage with Communications colleagues 17 Discuss methods to engage/consult with patients re: UCC - A & E minor service change 18 Engage with patients/service users/public 19 MARKETING - Advertising service to providers (NHS Direct, local GPs, Pharmacies, Provider services, etc) 20 HR & Training FCMS 21 New staff recruited 22 Training of new staff 23 Development of new FCMS T & Cs 24 Existent staff transferred to new T & Cs 25 TUPE & Training A & E 26 Commence TUPE consultation with A & E staff 27 Training of TUPE A & E staff 28 A & E/FCMS shadowing/familiarity period 29 Test period 30 A & E staff transfer complete 31 Finance 32 Identify budget for primary care stream HCPs 33 Commence Identification of budget for gateway, excluding OoH 34 Negotiate and agree budget and funding streams with partner Orgs 35 Negotiate & agree budget with Provider 36 Confirm budget for gateway 37 Set budget 38 Budget complete 39 Contract Development - Gateway 40 Develop service specification and KPIs, (monitoring defined and reports timescales, uniforms, facilities, stock arrangements etc) SR,SG BS,SG BS,DW/BVH,CC/coms,BS,JM HS,VS HS,VS CC,HF,DW/NHSB,RG, CC,NL,SR,SG CC/coms,BS CC,RG,,HF SL 01/04 DW/BVH,HS,VS DW/BVH,HS,VS HS,VS 01/04 SL,CC,SR,SG CC,DW/NHSB,RG RG,CC 18/03 CC/coms,BS 41 Review service specification and KPIs with Provider 42 Agree service specification and KPIs 43 Develop Contract 44 Contract signed and issued to Provider 45 Contract Development - Primary Care Stream 46 Approach GP led to provide Nursing/HCP staff to UCC 47 Provider commence recruitment of Nurses/HCP 48 Develop service specification/contract amendment HCP element 49 Review service specification/contract amendment HCP element SG CC,SR,SG,SL CC,NL,SR,SG,SL SR,SG,CC,NL 18/03 BS SG BS,SG 50 Agree service specification/contract amendment 51 Service commence 52 NHS Pathways development UCC 53 Review IT links/development needed 54 Adastra licences for multiple sites (WGD, GP Led, F/Wood, WiC) 55 Citrix -additional work 56 Adastra development of links in UCC/Configuration 57 Test techincal links 58 UCC IT links complete 59 CMS DoS Population 60 CMS Dos system development 61 Techincal links & CMS configuration 62 CMS DoS activate 63 IT Systems test period 64 CMS DoS ready for usuage DB,DW/NHS P,SB,VS,DW/BVH SB SB GC,DB,SB,VS,TS SG,BS 01/04 DB,DW/NHS P,VS,SB,DW/BVH DB,SB,VS 18/03 DB,GC,VS,SB,TS GC,SB,VS,TS GC,SB,VS,TS 18/03 Project: UCC Project Date: Thu 14/01/10 Task Split Progress Milestone Summary Project Summary External Tasks External Milestone Deadline Page 1

ID Task Name 65 IT links between IMS (BVH IT system) & UCC system (data transfer development) 66 Operational protocols between UCC and remote sites? Direct booking from CMS DoS (F/wood EA, WiC, GP Led, etc) 9 Nov '09 Dec '09 Jan '10 Feb '10 Mar '10 Apr '10 May '10 Jun '10 Jul '10 Aug '10 Sep '10 Oct '10 Nov '10 Dec '10 Jan ' 11 18 25 01 08 15 22 29 06 13 20 27 03 10 17 24 31 07 14 21 28 07 14 21 28 04 11 18 25 02 09 16 23 30 06 13 20 27 04 11 18 25 01 08 15 22 29 05 12 19 26 03 10 17 24 31 07 14 21 28 05 12 19 26 02 BS,DW/BVH,SB,DB DW/BVH,DB,SB,BS,BK,HS,JM,SR 67 Identify services and phases of population 68 Populate phase 1 services (support UCC delivery) 69 CMS DoS training 70 CMS DoS Go Live 71 A & E IT integration 72 Exploratory discussions re: A & E link to Gateway system/triage UCC Project Board 73 Decision regarding A & E links to Gateway system/triage 74 If decision to implement Techinical links and configuration work SR,SG,BS,SL,HS,BK SB,DW/BVH,BS SB,BS,DW/BVH BK,AB,GC,JH,JM,SR,TS AB,JH,HS,GC DW/BVH,DB,BS,GC,DW/NHS P 75 Additional staff training for A & E link 76 Demographic data transfer/triage 77 Premises move 78 Establish Car Parking arrangements 79 Establish Location of GP cars (security/drugs) 80 Establish rental 81 Agree rental and allocation to providers 82 Rental agreement 83 Local Pharmacy Service 84 Relocation - Inform bodies of premises move 85 Operational processes - staffing, times, stock 86 LPS mobilisation ready for UCC 87 Integration UCC Services 88 Develop operational protocols 89 Operational protocols between OoH clinicians and Primary Care Stream 90 Review of PCAU governance arrangements 91 Integration GP Led HC - establish and ensure service flow of patients 92 Integration Equitable Access Site Fleetwood - establish & understand links 93 Integration elements complete 94 Phase three - Go live UCC 99 Phase 4 - Review of monitoring of service & development of reports 100 CMS DoS reports 101 Adastra reports 102 Review of service finance (expenditure against budget/any efficiency savings) 103 Commence CMS DoS population of service phase 2 104 Commence Phase 2 planning 105 Marketing 106 Planning to Advertise services to patients (changing patient behaviours, 999) Link to CHOOSE WELL Campaign see comms leads SL,BS,HS BS,HS,SL,EG BS,SL,CC,RG,EG,SG BS,CC,EG,RG,SL,SG BS,CC,SL,RG,SG,EG VS BS,HS,SL,DW/BVH BS,HS,SL BS, BS,SR,SG,CC,RG SR,HF,JM,SG 11/02 01/04 VS,HS,DW/BVH,BS GC,AB,SR,JM,NL,CC,SG,DW/NHS P,BK,JH,TS DB,HS,CC,SR,SG,NL,JM,TS CC,RG,SR,SG SR,TS,JH,BK CC/coms,SR,TS,SL Project: UCC Project Date: Thu 14/01/10 Task Split Progress Milestone Summary Project Summary External Tasks External Milestone Deadline Page 2