IUC and Vanguard. Greater Nottingham Integrated Urgent Care 1

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1 IUC and Vanguard The 2016/17 Vanguard funding has been confirmed at 1.3M This funding is to deliver the 8 elements of Integrated Urgent Care by March 2017 With careful management of funds we will be able to add other elements of the original Vanguard proposal that will enhance our Integrated Urgent Care System This includes the roll out of mental health navigation There is a requirement to report on spend and ROI on a quarterly basis a lack of implementation progress puts Q3 and Q4 funds at risk Greater Nottingham Integrated Urgent Care 1

2 Advancing Urgent and Emergency Care Vanguard Funded Transformation Programme 2016/17 Integrated Urgent Care Including extending Clinical Navigation to include Mental Health Transformation Programme 2016/17 (not Vanguard funded) Paramedic Capability Programme Consolidating Clinical Navigation Primary Care in Urgent Care Longer term Transformation Programme Delivering the 2020 patient offer Commissioning Specification for IUC Day to day System Resilience Operations Recovery Action Plan System Leadership and cultural change Managing system pressures and flow 2

3 Integrating Urgent Care: Right Care, right place, first time Greater Nottingham Integrated Urgent Care

4 UEC Review National Vision For those people with urgent but non-life threatening needs: We must provide highly responsive, effective and personalised services outside of hospital, and Deliver care in or as close to people s homes as possible, minimising disruption and inconvenience for patients and their families For those people with more serious or life threatening emergency needs: Mental and physical health We should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery 4

5 Provide care as convenient for the patient as complexity of their illness allows, in the lowest acuity setting that is appropriate, and at the lowest cost for the NHS CHANNEL SHIFT 5

6 Integrated Urgent Care Right advice or treatment first time enhanced NHS111 the smart call to make: Improve patient information for call responders (ESCR, care plan) Comprehensive Directory of Services (mobile application) Greater levels of clinical input (mental health, dental heath, paramedic, pharmacist, GP) decision support hub Booking systems GPs, UCCs, dentists, pharmacy Click, Call, Come In 6

7 Future Integrated Urgent Care service channel shifts 7.9 % Information Patient calls NHS 111 NHS 111 Call-handler up to 60% More transfers to clinical hub: - Complexity - Streaming - Speak to GP CLINICAL ADVICE HUB Patient calls Call-handler Determining skill groups are required in the clinical hub GP, mental health nurse, pharmacist, dental nurse etc % Ambulance % A&E % Primary Care % Dental/Pharm % Other % Homecare

8 Our Patient Offer for 2020 To deliver safer, faster and better patient care, our Greater Nottingham patient offer for 2020 will be A single number NHS 111 to offer advice, treatment and direct bookings to the most appropriate urgent care service (for both physical and mental health needs) at a time convenient to you Care close to home unless you need a specialist or emergency service That you will be seen by the most appropriate clinician, wherever you choose to go That your patient records are always available to clinicians treating you More clinician to clinician conversations across emergency and urgent care settings to discuss and agree the best care plan for you Critical services open 7 days a week Easy access to knowing which urgent care service has the shortest waiting times at any given time You will be involved as much as possible in decisions about your care That once you no longer require acute hospital care you will be transferred out of hospital safely and swiftly 8

9 8 key elements of integrated urgent care: Local delivery by March A single call to get an appointment out-of-hours (OOHs) 2. Data can be sent between providers 3. The capacity for NHS 111 and OOHs is jointly planned 4. The summary care record is available in the clinical hub and elsewhere 5. Care plans and patient notes are shared between providers 6. Appointments can be made to in-hours GPs 7. There is joint governance across local urgent and emergency care providers 8. There is a clinical hub containing (physically or virtually) GPs and other health care professionals 9

10 DELIVERING BETTER PATIENT OUTCOMES BY INTEGRATING URGENT CARE Process improvements to be implemented across a wide range of patients cohorts NATIONAL REQUIREMENTS FOR DELIVERY 16/17 PATIENT COHORTS PATHWAY IMPROVEMENTS ENABLING PROCESSES Mental Health Minor Injury (Mostly Healthy) Minor Illness (Mostly Healthy) Children and Infants Pharmacy Dental Long Term Conditions There is a clinical hub containing (physically or virtually) GPs and other health care professionals Appointments can be made to in-hours GPs A single call to get an appointment out-of-hours Joint Capacity Planning between 111 & OOHs Patient Information Data can be sent between providers The summary care record is available in the hub and elsewhere Care Plans and Patient Notes are shared between providers Joint Governance Frail and Older People PATIENT OUTCOME PRINCIPLES - Patients requiring face to face treatment will access this via the quickest route i.e. direct referral to a service - Patients requiring face to face treatment will have an option to access this via an appointment - Patients will give information once additional assessment will build on previous information Patients will access care in the community where possible and appropriate 10

11 Indicative plan to deliver IUC 2016/17 Q1 Q2 Q3 Q4 2017/18 Commissioning Activities Delivered Outputs Suitable 111 provision secured ahead of formal agreement of longer term approach to Integrated Care Engagement and codesign of future integrated system Alignment with whole system transformation ambitions (inc. STP) / region) Direct Bookings from 111 ED Primary care streaming service Urgent Care Partnership set up with focus on developing skills for clinical hub Continued engagement and codesign of future integrated system Commissioner consensus Provider contributions Develop content of IUC service specification Sustainability and financial modelling Review of governance arrangements to move towards joint governance structure Direct bookings to UCC IUC specification for Greater Nottingham Confirm any procurement requirements Explore New payment mechanisms New contract arrangements Possible new provider arrangements Possible contract arrangements Joint Governance in place Direct bookings in place - GP practices Operational clinical hub Confirmed procurement approach (post 2017) Any required formal consultation Evaluate early clinical hub roll out elements Prepare formal procurement (if req) Clinical Hub in place supported by Joint clinical governance Directly bookable appointments Shared patient information Extended DoS / Access to Services Integrated workforce plan Formal procurement approach (if req) Suitable mobilisation period to ensure delivery during possible period of change Year 1 of new contract arrangements Consolidation of delivery and management model Possible year of transition for some elements of service delivery Monitoring, Reporting, Benefits Realisation, Evaluation 11

12 Delivery Structure Urgent Care

13 Integrated Urgent Care: Desired Outcomes Right Care: Services are meeting the need of the presenting patient Patients experience of UEC services is improved Staff morale improved Right Time: Patients and professionals spend less time navigating the urgent care system Care is offered at an appropriate time for patients and professionals Right Place: More patient care is managed in the community Patient accesses care in the correct place for their need Reduce crowding in ED 13

14 Right Care How will we measure progress? Integrated Urgent Care services meet the needs of the presenting patient Patient experience of Integrated Urgent Care is improved Staff morale is improved across Integrated Urgent Care Clinical outcomes are improved across Integrated Urgent Care Clinical safety and quality are improved across Integrated Urgent Care Number of early exits from 111 Number of people using the 111 early exit pathways available Number of integrated urgent care patient contacts classified as 'inappropriate' Mortality rate in integrated urgent care Number of repeat 111 calls by an individual in 24hrs Number of 111 dispositions that don't lead to a definitive clinical encounter Patient satisfaction with Integrated Urgent Care Number of patient complaints to Integrated Urgent Care Number of re-contacts to 111 (national IUC KPIs) 111 caller compliance with advice - as evidenced by the patient survey Average OOH call back time Average A&E waiting time Average UCC waiting time Average 111 call time Average green call time Number of repeat 111 calls by an individual in 24hrs Number of 111 dispositions that don't lead to a definitive clinical encounter Patient satisfaction with Integrated Urgent Care Number of patient complaints to Integrated Urgent Care Staff satisfaction with Integrated Urgent Care Staff turnover in Integrated Urgent Care Number of A&E re-contacts Number of UCC re-contacts Mortality rate in integrated urgent care Number of repeat 111 calls by an individual in 24hrs Number of 111 dispositions that don't lead to a definitive clinical encounter Number of re-contacts to 111 (national IUC KPIs) Number of integrated urgent care patient contacts classified as 'inappropriate' Mortality rate in integrated urgent care Number of users accessing the MIG Number of users accessing the SCR Number of integrated urgent care Sis 14 IUC Clinical Governance Group operational

15 Progress / attainment at April 2016 National Requirements Local Objectives RAG Status Patient Pathways A single call to get an appointment out-of-hours Appointments can be made to inhours GPs There is a clinical hub containing (physically or virtually) GPs and other health care professionals Contact GP dispositions from 111 that are given out of hours can lead to a face to face appointment with a clinician during the Not met same call via the clinical hub by April 2017 See GP in hours dispositions from 111 can lead to an appointment with an in hours GP via the clinical hub by April Not met 2017 GPs and other healthcare professionals are providing further assessment, treatment and advice to 111 callers and green Partially met ambulance dispositions as part of a clinical hub by April 2017 Effective protocols, training and systems facilitate the transfer of appropriate 111 and green ambulance calls to the clinical hub, Not met and encourage the clinical hub to manage patient needs remotely, rather than face to face by April 2017 The clinical hub has been tested and evaluated by April 2017 Not met Joint Capacity Planning The capacity for NHS 111 and OOHs is jointly planned 111 and out of hours service providers jointly plan their service capacity by April 2017 Not met 15

16 Progress / attainment at April 2016 National Requirements Local Objectives RAG Status Joint Governance There is joint governance across local urgent and emergency care providers Joint Capacity Planning Data can be sent between providers The summary care record is available in the clinical hub and elsewhere Care plans and patient notes are shared between providers Monthly clinical governance meetings take place between integrated urgent care providers and commissioners, including an end to end review of patient journeys by April 2017 Clinical incidents are appropriately reported and responded to throughout all the integrated urgent care patient pathways by April 2017 The local integrated urgent care Clinical Governance Lead attends the Urgent Care Network meetings by April 2017 Patient data is sent from 111 to all receiving care providers at the point of referral by April 2017 All local urgent and emergency care providers send their patient data to GPs (to be accessed via the MIG) by April 2017 The information in every patient s Summary Care Record is available to all local integrated urgent care providers either directly or via the MIG (with GP agreement) by April 2017 All local GP practices have either enabled access to the MIG or have been encouraged to enable access to the MIG by April 2017 The information in every patient s care plan and special patient notes is available to all local integrated urgent care providers by April 2017 On target Partially met On target Partially met Partially met Partially met Partially met Not met 16

17 Risks / challenges Risk: Failure to develop a multi provider response to integrated urgent care will result in a fragmented approach that will not adhere to IUC commissioning standards or meet the needs of the system Challenge: Balancing delivery of day to day operational requirements in our system alongside planning and implementing Integrated Urgent Care in line with national requirements Challenge: Identifying the most appropriate route and options for procurement in the medium term. In a context of differing contract timescales and a desire to encourage and potentially incentivise providers to work together to deliver IUC to best effect 17