Front Door Streaming to Primary Care Hub Pilot DRAFT GOVERNANCE FRAMEWORK.

Transcription

1 Front Door Streaming to Primary Care Hub Pilot DRAFT GOVERNANCE FRAMEWORK. Created: Created by: Becca Robinson - Service Improvement Lead Bristol CCG Version: Draft v0.5 Last Review: Next Reviewed on: Reviewed by Name: Job Title: Julia Holman - Service manager, GPSU/GPST Service Manager Becky Hoskins - Consultant Nurse Emergency Care, UH Bristol Date Version Author Comments v0.1 BR Creation of draft document v0.2 BR Updated following meeting with Julia Holman v0.3 BR Updated following meeting with Becky Hoskins v0.4 BR Updated with information from BrisDoc and UH Bristol v0.5 EW Updated after discussions with Sarah Carr, Gill White and Sarah Wright on when to escalate risks to Bristol CCG, Brisdoc and UH Bristol s corporate risk registers and updated Appendix 2 Signed by UHB Clinical Director for Division of Medicine Name: Signature: Signed by BrisDoc Medical Director Name: Signature: Draft Front Door Streaming to Primary Care Hub Pilot v0.3

2 Contents 1. Introduction 3 2. Model for Clinical Care 3 3. Clinical Governance arrangements for patients under the care of BrisDoc 4 4. Clinical Governance arrangements for patients under the care of UH Bristol 4 5. Requirements for Education and Training 5 6. Resuscitation 5 7. Joint arrangements for operational management during the pilot 5 8. Monitoring and evaluation 6 9. Risk Management Incident Management Complaints Staff Line Management Arrangements for Monitoring Patient Satisfaction Standard Operating Procedure Business Continuity Review of Governance Framework 8 Appendices 9 2

3 1. Introduction This document sets out the governance framework for the Front Door streaming to Primary Care Hub Pilot at University Hospital Bristol NHS Trust and the arrangements that underpin its operation. This document has been jointly developed by BrisDoc Healthcare Services, University Hospital Bristol NHS Trust and Bristol CCG and therefore reflects an agreed model for governing the safe and effective delivery of the Front Door streaming to Primary Care Hub Pilot. It is a dynamic document subject to continual review and revision during the pilot. The objective is to define the respective roles and responsibilities of both individuals and organisations and the procedures adopted to secure safe governance of the service and patient care. This document has been developed by Becca Robinson, Julia Holman and Becky Hoskins and reviewed by the Front Door Service Design Group including: BrisDoc UH Bristol Bristol CCG Bristol Community Health 2. Model for Clinical Care The Front Door streaming to Primary Care Hub Pilot consists of: Primary care practitioners streaming patients to the Primary Care Hub who selfpresent at the Adult and Childrens Emergency Departments at University Hospital Bristol NHS Trust during the hours of the pilot Primary care practitioners seeing people streamed to the Primary Care Hub on level 4 of the Bristol Royal Infirmary Two patient pathways have been agreed: (See appendix 1) An adult pathway with primary care streaming to the Primary Care Hub A childrens pathway with primary care streaming to the Primary Care Hub An additional contingency pathway has been developed for occassions when a primary care streaming clinician is unavailable: (See appendix 2) ED triaging and directing patients to the Primary Care Hub The dispositions from the Primary Care Hub are: Patient discharged Patient referred onto another primary care (e.g district nurse) or secondary care (e.g Surgical assessment Unit) service Patient returned to ED (if condition deteriorates or additional investigations required) The indicative pathway to be followed will be identified at streaming dependent on capacity in the primary care hub. At all times accountability and responsibility will be clear. In order to ensure patient safety, it is anticipated that there will be flexibility in the way patient pathways are managed when different clinician skills are required. If patients require a return to ED or an onward referral, this won t require a formal referral but will be 3

4 managed through a clear handover of patients between clinical teams, thus maximising continuity of care across primary and secondary care. 3. Clinical governance arrangements for patients under the care of BrisDoc Patients streamed to the primary care hub will be registered on the system by the ED reception staff and will remain under the care and governance of BrisDoc. The patients seen will be within the individual ANP's/GP s scope of practice in line with their NMC/GMC Code of Conduct. The decision to take full responsibility and accountability for this patient will lie with the BrisDoc clinician. A clinical assessment will take place and a treatment plan formulated in line with the individual clinicians scope of practice. If following patient assessment, the clinician feels that a further medical assessment is required, then the clinician can contact one of their colleagues in GPSU/OOH for advice or further support. Clinical Audit will be used across the Primary Care Hub Team to ensure quality care and to identify any improvements required. If any clinical concerns are identified, they will be acted on within an appropriate timescale, based on clinical urgency in order to ensure excellence in clinical standards and patient safety. The Primary Care Hub clinicians will have 100% of all their cases assessed for the first month of the pilot. A percentage of the cases will be assessed monthly thereafter. (Any new clinicians will also have 100% cases assessed for the first month to ensure patient safety and if there are any concerns about a particular clinicians performance then the percentage of cases being assessed can be increased.) The BrisDoc Medical Director will oversee the clinical leadership of the primary care team. The Medical Director will take ultimate responsibility for clinical governance of BrisDoc patients. 4. Clinical governance arragements for patients under the care of UH Bristol Patients streamed to the ED departments will be registered on the Medway system and will remain under the care and governance of UH Bristol. ED patients will be managed in line with the Trusts clinical policies and procedures. 4

5 5. Requirements for education and training and clinical competencies expected The Lead Nurse for the pilot is developing a competency framework for the nurses. 6. Resuscitation 6.1 Resuscitation Arrangements BrisDoc and the Trust have reached a shared agreement on arrangements to support the resuscitation of patients presenting to both the GP Support Unit (provided through the strategic alliance between BrisDoc and UHB) and GP Out of Hours and the Primary Care Hub (provided by BrisDoc as a sole provider). The Trust has confirmed that the provision of a combined adult and paediatric resuscitation trolley for the Ambulatory Care Unit in which both the GP Support Unit and the GP Out of Hours base and the Primary Care Hub operates will be the responsibility of the Trust, together with the checking, maintenance and re-stocking of the trolley. The management of the trolley will be carried out by UHBristol staff and in accordance with Trust policy. The agreed location for the trolley within the ACU is the ward area of the unit. When the last patient has left the ACU/GPSU, the Resuscitation trolley will be moved to the main corridor within Ambulatory Care Unit for the duration of the OOH shift, so that it is in the vicinity of the area used for patient care by the OOH Service and the Primary Care Hub. It will be moved back to the ward area of the ACU at the end of each shift. It will be the responsibility of the Host covering each OOH shift to ensure that this is actioned. 6.2 Training Requirements for BrisDoc clinicians in the Primary Care Hub. The induction process will cover the location and the contents of the trolley. Clinicians working in the Primary Care Hub will be required to complete adult and paediatric BLS training on an annual basis so that they can commence resuscitation in accordance with the agreed SOP while awaiting the arrival of the Resuscitation Team on the unit. Compliance will be monitored through BrisDoc s workforce governance arrangements. 7. Joint arrangements for operational management during the pilot A weekly pilot review meeting will take place during the pilot and representation will include a minimum of one representative from each of the following: BrisDoc UH Bristol o Children s representative o Adult representative Bristol CCG The weekly pilot review meetings will act as a vehicle for the day to day operational and clinical management of the pilot. The Service Design Group will review the pilot at the monthly meetings and will escalate any unresolved issues that require decisions to the Project Board. A full review of finances will be undertaken at 2 months to inform the length of the pilot. 5

6 The Project Board will make the final decision on the effectiveness of the pilot and whether it will continue beyond the 4 months. 8. Monitoring and evaluation Agreed pilot data will be provided on a daily, weekly and monthly basis to the Service Design Group to give an overview of what has been achieved during the pilot. A draft evaluation plan for the pilot has been developed in collaboration with Bristol CCG and the Collaborations for Leadership in Applied Health Research and Care (CLAHRC). This plan has been shared and discussed with the Front Door Service Design Group. The evaluation plan is being further discussed with Brisdoc IT Lead, UBH Information Lead, the CLAHRC Effectiveness Team Lead and the Bristol CCG Business Intelligence Lead to agree how the information will be captured, how frequently and who will collate and report on the data. 9. Risk Management There will be a project risk log established for the Primary Care Pilot that relates to specific pilot risks that may include the following types of risk: Clinical Patient Experience Facilities and Equipment Record Keeping Resource/Financial Management of Stakeholders/Communications The project risk log will be reviewed at the monthly service design meetings. Risks with a score of 12 and above will be discussed by the Front door/ucc Project Board, who will decide whether to escalate the risk for inclusion in the Bristol CCG risk register, the BrisDoc risk register and the UH Bristol risk register. Risks that relate solely to BrisDoc or only relate to UBH will be managed separately by BrisDoc and UHB respectively within internal governance forums but shared at the monthly Project Service Design Group meeting as part of risk mitigation and/or shared learning. The project risk log will be supported by a proactive approach to identifying risks so that any potential constraints to the pilot delivery can be addressed promptly before they develop into issues that could affect performance. The format of the project risk log will therefore be segmented to document and score risks, issues and the actions agreed to mitigate risks and address issues. Risk register matrix (Appendix 3) 10. Incident Management There will remain separate and distinct processes internal to both organisation for internal reporting of incidents that do not affect the partner organisation. In general, however, there should be a culture of openness and information sharing. Incident reporting will be via Datix 6

7 online (UHB) or the DAC (BrisDoc). An incident that affects both organisations and the integrated delivery of respective services should be recorded on both systems. In this scenario one officer will be designated as the investigating officer and will investigate the incident, summarise lessons learnt and propose any actions required to prevent a reoccurrence of the incident. This member of staff will act on behalf of both organisations throughout this process and will ensure that both the BrisDoc DAC and UHB Datix are updated. The outcome of the investigation will be reported at the Service Design Group meeting. Updates to the DAC in BrisDoc will be managed via to the Compliance Officer in BrisDoc s Head Office. In the case of a Serious Untoward Incident occurring, the management of that incident will be as set out above. The management and timescales of the process will be governed by the Bristol Clinical Commissioning Group and should be reported to the Commissioning Support Unit within 48 hours of the incident being discovered. The incident will be logged on the STEIS database as a SUI (Serious Untoward Incident) and the process for investigation and reporting will be overseen by commissioners. 11. Complaints Complaints received by either organisation that relate even remotely to care or services provided by the partner organisation should be shared by secure communication routes (NHS.net if ) between UHB Division of Medicine Patient Complaint Coordinator and the BrisDoc Head of Governance. The investigation and response to such complaints should be coordinated. UHB Division of Medicine Patient Complaint Coordinator/Acute Services Managers will have access to the BrisDoc Service Manager to clarify ownership of complaints received by UHB that may belong to BrisDoc. Complaints that are related to one organisation only will be managed by that organisation but shared with the Service Design group where they relate in any way to the Primary Care pilot. Additional meetings will be set up as required with key individuals to provide a forum where formal significant event analysis (incorporating both incidents and SUIs) and complaints are performed. The weekly pilot review will retain an overview of all learning from complaints and incident investigations so that service and quality improvement can be planned and implemented where required. These will be shared and discussed as part of the monthly Service Design Group meetings. 12. Staff Line Management GPs within the pilot will be clinically managed by the Medical Director of BrisDoc and operationally managed by the Service Manager. 7

8 ANPs within the pilot will be managed by the ANP Professional Lead and operationally managed by the Service Manager. 13. Arrangements for Monitoring Patient Satisfaction Patient Satisfaction Surveys will be posted to 100% of patients seen in the Primary Care Hub. These will be checked against Medway to identify any patients that may not be appropriate to be sent to (such as death, end of life care etc.). 14. Standard Operating Procedures (Appendix 4) This separate document describes the operational process that will take place during the pilot. This is a live document and will be updated as the pilot progresses. 15. Business Continuity (Appendix 5) If escalation was required in real time the following people would be contacted: BrisDoc Operational manager Julia Holman, , Julia.holman@nhs.net UH Bristol adults Becky Hoskins clarifying UH Bristol children s Lisa Davies clarifying Bristol CCG Elizabeth Williams on , Elizabeth.williams@bristolccg.nhs.uk or Becca Robinson on , Rebecca.robinson@bristolccg.nhs.uk The weekly pilot review meeting will review any pilot risks or issues that need mitigating or addressing. An IM&T business continuity plan is being developed by Debs Lowndes in Brisdoc. If a primary care streaming nurse is not available the ED nurses will triage and direct the appropriate patients to the Primary Care Hub for the hours of the pilot. During this time the patient will remain under the governance of UH Bristol until they are registered onto on Level 4 at the Primary Care Hub. The number of times this occurs will be captured as part of the evaluation of the pilot. 16. Review of the Governace Framework This document has been reviewed by the Service Design Group as part of the planning for the Front Door Primary Care Streaming and Hub Pilot. 8

9 Appendices Appendix 1: The two patient pathways An adult pathway with primary care streaming to the Primary Care Hub A children s pathway with primary care streaming to the Primary Care Hub Appendix 2 Contingency pathway ED triaging and directing patients to the Primary Care Hub Appendix 3: Risk register matrix Appendix 4: Standard Operating Procedures for adults In development Standard Operating Procedures For Children s In development Appendix 5: Business continuity flow chart In development 9

10 To Be Process Flow for Streaming Children from ED to Primary Care Hub V0.6 Patient Parent and Child arrive Parent and Child leave Streaming Nurse Stream patient ED PCH ED Receptionist Check available appointments Available slots Add patient to No available slots Record tally Book appointment Issue directions card Add patient to Medway Treated by ED Primary Care Hub Reception AC receptionist to inform GPSU call handler 16:00-18:00 (weekdays only) OOH receptionist 18:00 22:00 (weekdays) and 14:00 20:00 (weekends) Arrived in Advanced Nurse Practioner / GP Patient treated as required Referral required No referral required Referral to Community Team and returned to ED BNSSG resident Not local Electronic message sent to local GP Printed discharge summary sent to GP Draft Front Door Streaming to Primary Care Hub Pilot v0.3

11 To Be Process Flow for Streaming Adults from ED to Primary Care Hub V0.5 Patient Patient arrives Patient leaves Streaming Nurse Stream patient PCH Check available appointments No available slots ED Record tally ED Receptionist Add patient to Available slots Book appointment Issue directions card Add patient to Medway Treated by ED Primary Care Hub Reception AC receptionist to inform GPSU call handler 16:00-18:00 (weekdays only) OOH receptionist 18:00 22:00 (weekdays) and 14:00 20:00 (weekends) Arrived in Advanced Nurse Practioner / GP Patient treated as required and referred on and returned to ED BNSSG resident Not local Electronic message sent to local GP Printed discharge summary sent to GP 11

12 To Be Process Flow for Adults and Children s contingency pathway - ED triage to PCH V0.5 Patient Adult / Parent and Child arrive Adult / Parent and Child leave ED Receptionist Add patient to Medway Triage patient ED Treated by ED ED Triage Nurse PCH Check printed diary for available adult/ child appointments No available slots Available slots Record tally Medway Hand patient triage notes and copy of ED card Issue directions card Primary Care Hub Reception Add patient to Book appointment Arrived in AC receptionist to inform GPSU call handler 16:00-18:00 (weekdays only) OOH receptionist 18:00 22:00 (weekdays) and 14:00 20:00 (weekends) Advanced Nurse Practioner / GP Review ED documents Patient treated as required and referred on and returned to ED BNSSG resident Not local Electronic message sent to local GP Printed discharge summary sent to GP 12

13 Appendix 3: Risk Register Matrix 13