Developing and Delivering an Integrated Clinical Assessment Service

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1 Developing and Delivering an Integrated Clinical Assessment Service David Merriweather Project Manager NE&NCUECN Petrina Smith Strategic Head of Integrated Urgent Care NEAS Ed Hutton Service Improvement and Development Manager NEAS NHS organisations and providers across the North East and North Cumbria

2 Content Introduction The NEUECN Vanguard Programme The Clinical Hub Project Vanguard evaluation Integrated Urgent Care Delivering a Clinical Assessment Service Outcomes of the Clinical Assessment service Plans for the future of IUC Summary and Conclusion

3 Vanguard Achievements

4 Vanguard Achievements

5 The Benefits of a Clinical Assessment Service (NHSE 2015) More calls going to clinicians More warm transfers (More cases dealt with in a single call) More direct appointment booking into services Less repetition of information by patients A improvement in patient outcomes More informed decisions by better access to records More advice/home Care

6 The Clinical Hub Project

7 Project Outcomes IUC HUB ACTIVITY OUTCOME PHASE 1 % IUC HUB ACTIVITY OUTCOME PHASE 2 % Self Care Advice 38% Refer to: Walk in Centre/MIU 14% Pharmacy 1% Advised to make Routine GP Appt 10% GP OOH 4% Community Service 1% Dental 1% Failed Contact 4% Other 0% Social Services 0% Refer to 111 0% Crisis Team TOTAL ALTERNATIVE DISPOSITION 75% Advised to go to A&E -Amb Transport 6% Advised to go to A&E own transport 16% Admission 3% Admitted-Amb Transport 1% Self Care Advice 16% Refer to: Walk in Centre/MIU 30% Pharmacy 0% Advised to make Routine GP Appt 3% GP OOH 19% Community Service 3% Dental 0% Failed Contact 0% Other 0% Social Services 0% Refer to 111 0% Crisis Team 8% TOTAL ALTERNATIVE DISPOSITION 80% Advised to go to A&E -Amb Transport 13% Advised to go to A&E own transport 7% Admission 0% Admitted-Amb Transport 0%

8 Vanguard Evaluation

9 Limitations Programme and evaluation timescales. Data limitations Attribution Patient/service user involvement.

10 Evaluation Outcomes Delivered on time and in budget Lessons learned incorporated into planning Improved ability to access services More appropriate A&E attendance severity levels

11 Number of ED attendances by referral source and severity of condition

12 Evaluation Outcomes Increased sharing and replication Increased levels of specialist involvement Information sharing Reduced number of Type 1 A+E attendances Cost effectiveness of clinical hub

13 Evaluation Recommendations 16 recommendations 6 process and implementation 3 with a patient focus 3 for professional staff 4 for the health and social care economy

14 Evaluation Recommendations (CAS) Patient experience Patient level outcome data Review of data on self care Workforce strategy Engagement with call handlers Monitoring of ROI for CAS Monitoring of MDT outcomes

15 NE&NC UEC Network The network has moved forward a range of innovations to improve the urgent and emergency care system across the North East. After two years as a national Vanguard area, it has moved onto a new footing with an ambitious strategy for the next three years.

16 Network Vision To reduce unwarranted variation and improve the quality, safety and equity of urgent and emergency care provision. The network brings together stakeholders to radically transform the system at a scale and pace that could not be delivered by a single organisation alone.

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19 The Current CAS Availability, Workforce and Pathways Original opening times Weekdays: 6.00pm 10.00pm Weekends: 8.00am 8.00pm Some pathways already operate across the full OOH period (through the night) and 24/7. Workforce Advanced Practitioners (both paramedics and nurses) GPs

20 An alliance approach Integrated Urgent Care Alliance Board Integrated Urgent Care Alliance (IUCA) Board Clinically led Focussed on assessing effectiveness of existing pathways and developing new ones Governance Future pivotal role in enabling the newly commissioned 111/IUC service Board members NEAS (chair) Acute Trusts Mental Health Trusts OOH Providers Local Pharmacy Network Local Dental Network Palliative Care Network UEC Network PMO

21 The service The hub model The hub model Specialist 24/7 x 365 days Acute specialists (e.g. cardiology, geriatric medicine, respiratory, etc) Direct access for Health Care Professionals (including Core CAS clinicians) to support assessment and or any onward referral Support to call handlers Pharmacy 6pm-10pm weekdays 8am-8pm weekends and Bank Holidays Pharmacist in Core CAS Community pharmacy staff Medicine dispositions queries Repeat prescriptions Minor ailment dispositions CORE CAS Ambulance revalidation Dental Full OOH period Dencall staff Dental triage Emergency OOH treatment GP OOH integration Full OOH period GP OOH staff Telephone triage Speak to dispositions Triage of 999 and 111 calls Patient welfare checks ED dispositions Mental Health 24/7 x 365 days Crisis Teams Crisis dispositions transferred to Crisis Teams Provided by NEAS = Provided by Alliance = Provided by Acutes = Frail and elderly patients Full OOH period Nurses/Paramedics Clinical triage of calls from Health Care Professionals based within nursing homes

22 Results Impact on ED Disposition Impact on ED disposition

23 Results Impact on ED Referrals from NHS111 Impact on ED referrals from NHS111

24 Results Mental Health Pathway Mental Health Pathway

25 Results Speak to Primary Care Pathway Speak-to primary care pathway

26 Delivering channel shift Impact on the system Delivering Channel Shift 75% of ED dispositions are shifted to an alternative service or to self care 3% of all NHS111 calls result in an ED referral. The national target is 5% 43% of speak to dispositions are re-routed away from a same day service and to self care 130+ patients per month in mental health crisis avoid ED and are directly referred to NTW/TEWV

27 Making a difference to patients Patients we have helped Patients we have helped Condition Service Benefit Elderly patient already seen at routine GP appointment with raised BP and chest pains. Concerned that Prednisolone eye drops exacerbating chest pains Middle aged patient with chest pains following a fall and chest injury. Patient had already been treated at ED but no analgesia prescribed Paediatric head injury Redirection from an ED referral to own GP by a CAS clinician CAS AP worked with CAS GP to develop management plan Redirection from ED to UCC by a CAS clinician AP provided subsequent advice on obtaining prescription Redirection from ED to self care by CAS clinician as no concerning symptoms present Patient avoided wait at ED Ambulance dispatch avoided Patient avoided wait at ED Patient received a prescription from UCC rather than ED. An ED prescription would have only covered a short period and probably resulted in a further visit to GP/UCC Patient and family avoided ED Parents assured and educated on head injury management

28 Next steps for CAS Next Steps for CAS Integration of CAS: to include: Ambulance re-validation ED/Speak to pathways 111 clinical advice Mental health pathways solutions for Durham and Darlington Pharmacy pathways NHSE initiative Dental pathways Dencall Star line 5,6 and 7 Speak-to primary care Access to specialty advice Single point of access integration

29 Please Consider: Gaps in provision? What will good look like? How will we measure success? As a professional/ As a service user

30 Contact David Merriweather Project Manager North East and North Cumbria UEC Network