Urgent Care Programme Board Meeting Friday 30 th May 10am 12pm Meeting room, Emergency Department, Homerton Hospital

Transcription

1 Urgent Care Programme Board Meeting Friday 30 th May 10am 12pm Meeting room, Emergency Department, Homerton Hospital 1. Introductions new faces for this meeting Dr Hannah Home - CCG Urgent Care Clinical Lead Dorothy Briffa - CCG Chair of the Children s Board Jackie Brett - Director, Hackney CVS Natasha Wills LAS Jarlath O Brien RICS Mischa Mills Communications Malcolm Alexander - Healthwatch 2. Actions from last meeting Chair May Cahill 3. Activity/Finance Data Initial Discussion Lead Anna Garner 4. Current A&E Performance Lead May Cahill 5. Paradoc Lead Natasha Wills 6. RICS Extended Hours Lead Jarlath O Brien 7. Links to Integrated care - Crisis Response Workshop Lead Mark Scott 8. Frequent Attenders Lead Wayne Gillon 9. Discharge Lead Jarlath O Brien 10. Step-up planning for winter months Lead Ryan Ocampo 11. Communications plan Lead Mischa Mills Chair: Dr Clare Highton Chief Officer: Paul Haigh

2 12. Voluntary Sector Urgent Care Bids Lead Jackie Brett and out of hours Lead Ryan Ocampo 14. OMU Audit Lead Emma Rowland 15. Any other Business and Future Agenda Items Lead May Cahill Chair: Dr Clare Highton Chief Officer: Paul Haigh

3 Urgent Care Programme Board Meeting Friday 30 th May 10am 12pm Meeting room, Emergency Department, Homerton Hospital Those who have sent apologies x Name Title/Organisation Name Title/Organisation Paul Haigh Chief Officer Dr Victoria Holt CHUHSE/PUCC Nick Yard LAS Those we are expecting to attend Name Title/Organisation Name Title/Organisation Dr May Cahill CCG Clinical Chair of the UCB Mark Scott Programme Director Ryan Ocampo Programme Manager David Wilson HUHFT Consultant in Emergency Medicine Emma Rowland HUHFT Consultant in Emergency Medicine Frank Coathorpe CSU Senior Provider Performance and Monitoring Manager Jean Lyon HUHFT Matron / Lead Nurse Siobhan Bay A&E Manager Wayne Gillon HUHFT Senior Occupational Therapist Anna Garner CCG Outcomes Manager Osian Powell HUHFT Divisional Director Integrated Medical and Rehabilitation Services Heather Finlay Patient Rep Malcolm Alexander HUHFT Consultant in Emergency Medicine Jarlath O Brien Head of RICs Chair: Dr Clare Highton Chief Officer: Paul Haigh

4 Those new to the meeting or in attendance Name Title/Organisation Name Title/Organisation Dr Hannah Home CCG Urgent Care Clinical Lead Dorothy Briffa CCG Chair of the Children s Board Jackie Brett Director, Hackney CVS Natasha Wills London Ambulance Service Chair: Dr Clare Highton Chief Officer: Paul Haigh

5 Chair: Dr Clare Highton Chief Officer: Paul Haigh

6 Urgent Care Programme Board Meeting Friday 28 th March 10am 12pm Meeting room, Emergency Department, Homerton Hospital Present at the meeting 1. Siobhan Bay 2. May Cahill 3. Sandra Cater 4. Frank Coathorpe 5. Victoria Holt 6. Elisha Johnson 7. Ben Knowles 8. Jean Lyon 9. Ryan Ocampo 10. Emma Rowland 11. Mark Scott 12. Nick Yard 1. Introduction and apologies Introductions were made around the table. Apologies were received from Anna Garner, Wayne Gillon, David Wilson, Heather Charles and the Local Authority representatives. 2. Minutes and matters arising The OMU pathways action had been completed; CHUHSE CQUIN no longer being taken forwards The wording around how far the target was missed should be changed to slight rather than significant 3. Primary Urgent Care Centre An initial review is to be done and brought back to the Urgent Care Programme Board meeting (UCPB) in May. An initial CCG strategy brainstorming session will take place in April. Victoria Holt has met with the CSU team leading this and provided him with information to start with. It was highlighted that this was the early stages of the review the feedback from members of the ED sitting on the UCB would have to be taken into account. It was flagged that Camden & Islington CCG were directing their patients to Homerton PUCC/A&E. This was Chair: Dr Clare Highton Chief Officer: Paul Haigh

7 not an issue for City and Hackney CCG but should be flagged in the PUCC redesign process if appropriate. Action Anna Garner is currently working on data regarding patient flows, etc. This would be presented at the next UCB. Action A list was needed of all the various services to which patients are navigated would be brought to future UCB Meetings for validation 4. Communications From 1 st April 2014, London Borough of Hackney will be the provider of all internal and external communications. They will initially be focusing primary care campaigns increasing GP registration and increasing awareness of Primary Care. They will be targeting groups that are currently over-represented at A&E and those that are under-represented at GP surgeries. Promotional communications will be used, along with internal communications in GP surgeries and A&E, etc. They will be engaging with Public Health, the CCG, GPs, Homerton A&E, PUCC, CHUHSE, Healthwatch, etc. There is currently a problem with standardisation across all 44 practices for patient registration, particularly as regards ID required. It was agreed that the message to be given to patients is that they should try to register with a GP but if they experience any problems, they can access PUCC walk-in centre directly and will be given assistance with registration there. A newsletter update is planned to profile the different positive parts of the service. This will be an internal update to our CCG stakeholders. Homerton has been in the top five in London for a very long time. All UCPB papers to be put on the CCG website going forward. It was requested that all attachments are formatted as one PDF document in future. A navigation website for Urgent and Integrated Care is to be set up for use by both clinicians and patients to show what services are available. It was requested that this be part of the CCG website, rather than a new web address. Chair: Dr Clare Highton Chief Officer: Paul Haigh

8 ACTIONS: BK/SC to continue with task groups and bring an update back to the next UCPB in May; MS/MC/BK/SC to discuss how GP registration could be standardised and bring an update to the next UCPB; BK/JL to link up to discuss the internal comms update. 5. A&E Clinical Navigators Communication issues have been identified e.g. GPs may be aware of services that are available, but this information has not filtered down to Reception staff. The Non-clinical Navigators (NCNs) have a folder with details of all services available which they would be able to share this. Non-recurrent funding has been increased to fund four WTE roles, rather than two. Public Health are also keen on extending the service further into the Service Centre, using a similar model. The NCNs would like to be in the assessment rooms with the nurses as they currently only have contact with patients after they have already been assessed and they are not clinically qualified to advise patients. They are also currently only in A&E and the rest of the hospital are not generally aware of them. This means that they have no contact with patients that are discharged from other areas and therefore do not get seen until they have returned to A&E. 6. Winter performance Congratulations were extended to HUHFT A&E for achieving their performance targets. A process is now in place for clinical assurance at times of any future underperformance. Handover targets with LAS are being consistently met and data recording targets are being met in the main. The validation process is working well. The winter funding came up too late last year and the timescales were challenging. Action The acute team and commissioning team will undertake a full review of last year s schemes so that work can start earlier this year, building on last year s successes. This will be brought to the next UCB. The 20m BCF budget Is to be managed by the CCG and the Local Authority together. Chair: Dr Clare Highton Chief Officer: Paul Haigh

9 A new Integrated Care Programme Board is being set up, with a number of links to urgent care. It is expected that there may be problems in April when the winter funding finishes and Easter holidays begin. CHAPs has been extended for one month. Children are seen more in PUCC and CHAPs than in A&E. There have been less PUCC/CHAPs breaches this year. A business case will be submitted to the CCG for the end of April. ACTIONS: MS to bring a the governance framework of integrated care to the next UCB to discuss interlinks SB to put together a business case for the CHAPs service. 7. PARADOC This new service goes live today - a Paramedic and a GP will be working together. The aim is to try to treat more patients at home, rather than bringing them into A&E. Particular groups of patients will be targeted at first, starting with the elderly and eventually also including children and transient populations. There are two sources of referral crews on scene and the clinical hub. ACTIONS Paradoc data to be brought to the next UCB 8. Frequent Attenders Wayne Gillon will come to the next UCPB meeting to present this information. 9. London Quality Standards The CCG is inviting bids for non-recurrent funding to support achieving the London Quality Standards. Osian to advise on plans for this at the next UCPB meeting. The HUHFT are awaiting a pan-london update as all Trusts have a number of standards they are not meeting. 10. Any other business The next meeting is scheduled to take place in half-term. MC/VH/NY will not be here. Chair: Dr Clare Highton Chief Officer: Paul Haigh

10 ACTION: MS to advize regarding rescheduling. Chair: Dr Clare Highton Chief Officer: Paul Haigh

11 London Ambulance Service calls Number of Category A calls to London Ambulance Service from City and Hackney residents has increased: from 1340 in 2011/12 to 1500 in 2012/13 to 1600 in 2013/14 (7-9% increase per year; this increase is comparable to the increase across London of 5-13% each year. Number of calls stable across 2013/14: compared to increase over the year in previous 2 years Majority of these calls are Category A (R2) and Category C2: together making up nearly 70% of all calls Proportion of Category A calls responded to in 8 minutes and 19 minutes has remained stable over last 3 years: 75% of calls responded to in 8 minutes across all 3 years and slight decrease in number responded to in 19 minutes (from 99% to 95%). Both of these proportions are comparable to response rates across London Source: LAS CCG monthly report

12 London Ambulance Service action Following call to LAS vast majority of patients conveyed to A&E: of 37,620 calls in 2012/13 65% conveyed to an A&E (of patients conveyed to an A&E 66% of these were conveyed to Homerton A&E and 20% to Royal London) Stable % conveyed to A&E over time and similar 5 referred but not conveyed, alongside increase in proportion of patients not conveyed (from 16% in 2011/12 to 26% in 2012/13) and more patients conveyed elsewhere (Maternity/HASU/Trauma Unit) Proportion conveyed to A&E higher in the winter 71% in Jan-Mar as opposed to 68% in rest of year Source: LAS Referral Pathways report

13 111 calls Average number of calls to 111: 1440 per month over 2013/14 Majority of calls are in daytime (9am-3pm) or evening (7pm-midnight) together accounting for 60% of calls. Only 20% between midnight and 9am. Majority of calls are recommended to attend primary care: 61%. 17% are recommended to attend other service. Nearly 20% of calls are recommended to attend A&E or an ambulance is dispatched. Proportions of recommendation/action in response to calls stay reasonably constant across year. Source: NEL CSU; 2013/14

14 Out of Hours Primary Care calls Average number of calls increased with change of provider to CHUHSE by at least 5%: an average of ~1700 calls per month over last 2 years, but this has increased to 2140 since December 2013 and the appointment of CHUHSE (however this is a period so calls higher in winter but average over Dec March 2013 = 2035 (5% lower than winter 2013/14) Number of calls 30% in winter: average number of calls 2090 in winter months (Dec-Mar) compared to 1500 in rest of year Cost of CHUHSE contract: The provider is contracted to see 21,000 patients per year for an agreed price of 1,460,460 or 121,705/month. 21,000 calls is 30% higher than Harmoni saw from Dec 2012 to Nov 2013.

15 OOH CHUHSE action Majority of calls only telephone advice: 57%, but significant proportion (37%; ~768 per month) require attendance and 6% (~128 per month) require patient visit (data from Dec 2013 to March 2014) 98% of calls are routine/less urgent 1.6% urgent 0.7% emergency Small proportion of cases directed to A&E: 1.8% or ~ 50 cases per month/ 1.3% of calls directed to call 999/LAS (~36 cases per month)

16 A&E attendances Attendances increasing over time: there were 123,000 A&E attendances for City and Hackney patients in 2013/14, the same number as in 2012/13 but an increase from 2011/12 when there were 105,000 A&E attendances. This equates to an increase in the monthly average attendances from 9,600 in 2011/12 to 10,300 in 2013/14 Vast majority of attendances at Homerton: 70% of these A&E attendances for City and Hackney patients were at the Homerton (2013/14; 9% in same period at Barts Health) Source: SUS

17 A&E attendances Rate of A&E attendances 10% greater in City and Hackney than London average: converting the A&E attendances to a rate to be expressed per 1000 GP registered population shows that for the last 2 years the A&E attendance rate is 10% higher in City and Hackney than across London (average of 32 attendances per month per 1000 population in City and Hackney compared to 29 per 1000 London population) Source: HES

18 A&E attendances Data not directly comparable with previous slides as they have data on attendances for City and Hackney patients and this data is for attendances at the Homerton only (and is for all CCG patients) A&E attendances at Majors account for nearly 40% of all attendances and attendances at PUCC account for 30% (the remainder split between evenly between Injuries and Paediatrics) The proportions of attendances for each department are reasonably constant over time but attendances at PUCC have increased from 28% in 2011/12 to 31% in 2012/13 (with a corresponding decrease in those attending the Paediatric A&E from 20% to 17%) Source: Homerton Informatics Department

19 A&E attendances tariff/cost The vast majority of A&E attendances at Homerton A&E are non-complex: cat 1/2 investigations with cat 1/2 treatment: 40% of attendances are cat 1 investigation with cat 1/2 treatment and 25% are cat 2 investigation with cat 1 treatment (these proportions are matched when looking at the total of the top 5 providers). A&E attendances at Barts Health are more complex: with higher proportions of more complex investigations and treatments (nearly 30% are cat 3/4 investigation or treatment) Total spend on A&E attendances at the Homerton is 7.4million (2013/14) Spend for same period at Barts is 1.3million (higher cost than the proportion of activity suggests due to higher proportion of more expensive tariff attendances) Cost of attendances by attendance department i.e. tariff costs for Paeds, Majors etc, block for PUCC Source: SUS; 2013/14

20 A&E attendances referral source 54% of people who attend A&E refer themselves: this proportion of all A&E attendances has been stable over the last 3 years (7% increase in absolute numbers over 3 years) 14% of attendees are referred by their GP: this proportion of all A&E attendances has been stable over the last 3 years (but 14% increase in absolute numbers over 3 years) There have been some large % increases in referral sources (generally sources with fewer absolute numbers of referrals) from 2011/12 to 2013/14: 50% increase in referrals from other healthcare providers 31% increase in referrals from emergency services 70% increase in referrals from social services Source: SUS

21 A&E attendances time and day 2012/ /14 Time of attendance; 2013/14 25% of A&E attendances are at the weekend: this is a constant for both 2012/13 and 2013/14 (for City and Hackney patients at all trusts) Variation in numbers of attendances on different days between 2012/13 and 2013/14 some very large e.g. a decrease from 30,00 attendances on Thursdays in 2012/13 to less than 10,000 in 2013/14 Attendances at different times of the day is constant between weekends and weekdays and over the last 2 years. Nearly 75% of attendances are between 8am and 8pm (divided equally between the 3 4hr periods within this). The fewest people attend A&E in the early morning 4-8am (only 5% of all attendances) 95% of people spent 4 hours or less in A&E in 2013/14 (over 50% spent 2 hours or less) Waiting time target achievement 12/13 and 13/14 Source: SUS

22 A&E attendances by practice Large variation in A&E attendance rates (per 1000 population) from 214 (Neaman) to 607 (Sorsby) Sandringham, Sorsby, Beechwood, Wick and Greenhouse all have attendance rate greater than 2 SDs from City and Hackney mean Attendance rates mapped against: patient satisfaction with access by distance of practice (or centre point of patient address) to HUH/other trust Source: SUS; 2013/14

23 Frequent attenders visits and patients 103,000 A&E attendances in 2013/14 were made up by 60,000 patients 40,000 patients attended A&E only once; 20,000 patients attended A&E 2-5 times; 1000 patients attended 6-10 times, 200 patients attended times and 90 patients attended more than 20 times (during 2013/14) Majority of visits to A&E are by those who have been more than once in a year largest proportion of visits is from those who visited 2-5 times (19,400 patients) Source: SUS; 2013/14

24 A&E admissions Admissions decreased slightly in 2013/14: total admissions increased from 16,500 in 2011/12 to 17,000 in 2012/13 and then decreased to 15,800 in 2013/14. at the same time as A&E attendances are increasing slightly. The drop of over 2000 admissions in 2013/14 came at a time when A&E attendances had remained at 123,000 from previous year levels. Vast majority of attendances at Homerton: 76% in 2013/14. 10% at Barts Health (similar to proportions of A&E attendances at different providers) Source: SUS

25 A&E admissions Rate of non-elective admissions at similar level to London average (excl dental, maternity, sickle): an average of 6.2 admissions per 1000 population per month. This is despite having a higher attendance rate than London. The conversion rate of A&E attendances to admissions in City and Hackney is lower than London and other WELC CCGs (fewer admissions per unit attendance) The conversion rate of attendances to admissions increased from 2009/10 (0.16) to 2011/12 (peaking at 0.23) but then decreased during 2012/13. Average admission rate is 0.2 (meaning 1 admission for every 5 attendances). Recent analysis by the CSU suggest there is a strong correlation between A&E attendances and admissions, but other factors are more important in dictating admission rates than attendance numbers Source: HES

26 A&E admissions LOS and time of admission Nearly 50% of emergency admissions via A&E have a length of stay of more than 2 days. However, the proportion of admissions which are >2 days has decreased slightly since 2011/12 Barts and UCLH have slightly higher proportions of admissions that have a LOS of more than 2 days. The Whittington have a higher proportion of admissions with a LOS of less than 1 day Emergency admissions via A&E cost City and Hackney CCG 34.1million in 2012/13 and 29.1million in 2013/14. Excess bed days charges make up 7% of that cost for both years. Benchmark as % of all admissions, to London average 50% of admissions admitted within 5 hours of arriving at A&E. Of these admissions 35% are admitted in the half an hour between 3hr 31mins and 4 hrs (the A&E target time) Source: SUS

27 A&E admissions discharge Vast majority of patients discharged to home (91% in 2013/14) Admissions to OMU cost, cost by other A&E department

28 Summary of patient flows for 2013/14 38,000 calls to 999 (42% of these Cat A) 65% (24,556) conveyed to A&E 4.3% of conveyances to HUH blue lights 19,700 calls to OOH GP 3% referred to A&E (or 999) 6% visited 17,200 calls to % (1,700) referred to A&E 9% (1,600) referred to ,000 A&E attendances (70% at Homerton) 54% self referral 14% GP referral 2% other healthcare provider 60,000 patients 71% within 8am-8pm (25% at the weekend) % each A&E dept Cost Attendance to admission ratio = 0.2 (20% of attendances admitted) 15,800 A&E admissions (76% at Homerton) 50% of admissions have LOS >2 days 22% admitted at 3h50m Cost 91% discharged home; 9% other Conveyance to A&E data for 2012/13 but no major change from 2011/12

29 Still to do Day/time of A&E attendance at different departments (data got from HUH Informatics) Cost of attendances by attendance department (where to get data from in absence of SUS data on departments) Waiting time target achievement (easy to get but is it relevant here considering it is extensively looked at elsewhere) Attendance rates mapped against (have data sources need discussion on distance to A&E how to measure and whether useful long job!): patient satisfaction with access by distance of practice (or centre point of patient address) to HUH/other trust Comparisons with national reports/other data sources?

30 Quality and Current interventions Quality measures? Current projects Cost

31 Things for Programme Board to consider How should we use the data to inform our commissioning plans? What would we like to see reported at the urgent care board on a routine basis? What is missing?

32 City and Hackney CCG Urgent Care Programme Board: Overview of A&E and LAS Performance Introduction This paper provides a brief review of A&E and LAS handover performance since 1st April 2014, before briefly touching on winter planning, although there is a separate paper on winter planning elsewhere on the agenda. A&E performance Since April 2014, overall A&E performance at the Homerton, and elsewhere in London, has been challenged reflecting continued pressures on the health system. The reduction in winter funding has not been matched by similar reduction in A&E pressures suggesting the need to begin to think about how to support A&E performance next year in the transition period when winter funding comes to an end. Monthly performance: The Homerton underperformed against the A&E standard for April 2014 with a performance of 94.86%. This figure has been calculated in line with DH methodology and is based on aggregated weekly A&E performance data, not calendar days, and covers the period Monday 31 March 2014 to Sun 27 April This methodology is shown in DH guidance Everyone Counts: Planning for Patients 2013/14 Technical Definitions Latest performance for the Homerton as at 27 May 2014 indicates that the Trust remains on track to achieve performance during May with a performance to date of 95.33%. Weekly Performance Week Weekending Total Attendances Total Breaches All Types % Patients seen within 4 hours PUCC Attendances (only) PUCC Breaches PUCC % seen within 4 hours 1 06/04/ % % 2 13/04/ % % 3 20/04/ % % 4 27/04/ % % 5 04/05/ % % 6 11/05/ % % 7 18/05/ % % 8 25/05/ % % Since the beginning of April 2014, the Homerton has reported that it met the weekly A&E standard five out of the last eight weeks, with the majority of breaches attributed to A&E assessment delays and Clinical delays suggesting areas for continued work. Performance at the PUCC during this period has remained strong. The Trust has cited increased attendances particularly late evening which has resulted in the Homerton reinstating middle grade shifts each night from 5pm to 2am until the end of the month to help manage late evening attendances. Staffing remains fragile: staff sickness and unfilled rotas tend to be cited as 1

33 contributory factors to A&E underperformance. Nonetheless, the Homerton reported a successful nursing recruitment drive which has resulted in appointment to all the vacant nursing posts (start dates to be confirmed). The Homerton has reported that it has recently appointed an SpR within A&E, although 4.5 vacancies remain the Trust is looking overseas to recruit. The Homerton have put in place a task force to support earlier discharge of patients which would help with patient flows. This is being reviewed formally at director level on a monthly basis and informally daily at bed meetings. It is suggested that the Homerton keeps the City and Hackney CCG Urgent Care Programme Board updated on progress with this work, with a view to see how other members of the UCB can support with this work. The process of clinical level discussions between the Chair of the UCB and the Homerton appears to be working well in terms of communicating pressures to other key stakeholders with a view to support the Homerton. The output of these discussions has been shared with NHSE via the A&E exception report demonstrating the strong partnership arrangements in place. Ambulance Handover Performance Ambulance handover performance which is closely aligned to performance in A&E remains good. Performance for April 2014 shows that the Homerton achieved three of the four ambulance handover standards: 30 minutes handovers (KPI 2), 60 minutes handovers (KPI 3), and recording of ambulance handovers (KPI 4). Although the Homerton continues to underperform against the ambulance handover standard for 15 minutes (KPI 1), along with other Trusts in London. LAS Hospital Turnaround: Apr 2014 (validated) Hospital Site KPI 1 : % within 15 mins KPI 2 : % within 30 mins Tracked KPI 2 & 3 (delays) KPI 4 : % HAS 30 Min Handover 60 Min Handover completed Waits Waits Homerton University Hospital 85.1% 100.0% % Newham General Hospital 51.3% 96.6% % Royal London Hospital 62.6% 95.1% % Whipps Cross University Hospital 47.3% 95.5% % London 50.5% 94.4% % Target 100% 100% % Latest available handover performance (unvalidated) for May based on 4 weekly rolling average as at 18 May indicates a more challenged performance possibly reflecting the pressures upon A&E, with the Homerton achieving the 60 minutes handover standard, and underperforming on the other three standards. LAS Hospital Turnaround: 4 weeks rolling average at 18 May currently unvalidated KPI 4 : % Data Tracked KPI 2 & 3 (delays) KPI 1 : % within 15 mins KPI 2 : % within 30 mins Completeness 30 Min 60 Min Hospital Site Handover Waits Handover Waits Homerton University Hospital 84.4% 99.3% % Newham General Hospital 56.7% 96.7% % Royal London Hospital 60.4% 93.9% % Whipps Cross University Hospital 40.1% 91.9% % Urgent Care City and Hackney CCG has led whole systems review on winter 2013/14 which was submitted to NHS England on 9 May. The findings of this review discussed elsewhere on the agenda under a separate paper will help inform two Tripartite Panel Urgent and Emergency Care events, both on the 24 June, being organised by NHS England on behalf of the London Regional Tripartite Panel. The events aimed at senior leaders from CCGs, acute, mental health, community providers and local authorities will look back at the challenges faced last winter and ensure that the lessons learnt from last year can be taken forward. The event will also provide an opportunity to celebrate some of the good practice examples from the system. 2

34 ParaDoc Data April 2013 Overall Referrals Total number of patients referred: 142 Total number of referrals accepted: 126 Average number of referrals per 12 hour shift: 4.7 (range 2 8) Average number of accepted referrals per 12 hour shift: 4.2 (range 2 8) Red 1 Calls: 8 Referrals from Clinical Hub Total number of patients referred: 26 Average number of referrals per 12 shift: 0.9 (range 0 4) Referrals from crews on scene Total number of patients referred: 116 Average number of referrals per 12 shift: 3.9 (range 1 8) Outcomes (includes all referrals and Red 1 calls) Seen & advice given: 44 Seen & treated: 65 Seen & referred to hospital: 16 Non conveyance rate: 87.2%

35 Patient Follow Up by ParaDoc Same day visit: 1 Next day visit: 11 Telephone follow up: 14 Resourcing GP shifts: 100% cover Paramedic shifts: 100% cover Nick Yard Ambulance Operations Manager City & Hackney

36 DRAFT PARADOC Service Specification Service Model This service aims to provide a joint paramedic and GP clinical response service for addressing urgent primary care needs. It aims to provide a responsive primary care-led service to patients in their own home, reducing unnecessary conveyance to A&E via ambulance. LAS will be lead provider, subcontracting GP cover from CHUHSE. Patient cohort for paradoc The service will provide a joint paramedic and GP urgent care response for adult patients with urgent care needs. The service will treat patients who are resident within the boundaries of the London Borough of Hackney and the City of London. Patients who will not be treated by Paradoc Residential addresses outside City and Hackney CCG boundaries. Patients in public places and business/work place locations Non-urgent or critical patients that do not need to be seen within an agreed timeframe of 6-8 hours The service will respond to urgent primary care cases rather than acutely ill patients. Referral Mechanisms Via ambulance clinicians following an on scene assessment as described above Via referrals from the LAS control room following an enhanced clinical telephone triage Via referrals from the LAS Control room for Red 1 AMPDS calls predominantly cardiac arrests Key Service Outcomes Increase in the number of patients seen by the London Ambulance Service who can be appropriately treated at home for an urgent primary care need Reduction in the number of patients inappropriately conveyed by ambulance to the ED Improved communication and referral pathways between LAS and other urgent care providers

37 Information reporting The provider should report on the following items to the CCG for all patient attendances on a monthly basis where a patient has been referred for the first time to paradoc: Referral Source Appropriateness of referral The intervention given The follow-up arrangements Evidence of whether a hospital visit was avoided Where patients are seen on a follow-up visit by paradoc, the provider should report on: The intervention given The follow-up arrangements The provider should report a summary of the above information on a monthly basis. The summary should include the total number of attendances per month and whether the attendance was for an initial referral or a follow-up visit. The provider should communicate the outcome of the consultation/attendance to the GP for whom the patient is registered with by 8am the following working day. The service should make a minimum of 8 attendances per 12 hour shift. Contractual Arrangement This service will be added to the existing LAS contract and paid for on a block basis.

38 READMISSIONS REINVESTMENT Extension of RICs Funding: From 1 st April 2014 to 31 st March Lead: RICs Board. A. Extended hours of SPA and CRS 200k pa There are two elements to this scheme. Our expectation is that this additional funding will ensure that RICs will be provided and available beyond the agreed service specifications as follows: SPA - additional 5 hours Monday Friday; - additional 14 hours Saturday & Sunday; CRS additional 4 hours Monday to Friday; - Additional 24 hours Saturday to Sunday. Clarification of what extended hours will be operated will be provided to the commissioners by 17 March This should be provided to Devora Wolfson and cc d to Mark Scott. B. Rapid response home care for night sitting 30k pa This will provide a commissioning budget to enable the service to buy-in additional support and packages of care overnight to support people to stay at home and avoid transportation to hospital. There are no additional KPIs required for these additions to the contract, beyond those for the mainstream RICs service. However the provider will be expected to report on activity related to the additional hours, by source of referral. The provider will also be expected to report on activity for the rapid response home care for night sitting service. The RICs commissioners will want to: Ensure that the provider establishes a robust pathway with CHUHSE (the GP out of hours service) and with LAS to maximise use of RICs as an alternative to transportation to hospital by 30 th June 2014; Understand use of the service during the extended hours; Undertake an audit during 2014/15 with Homerton University Hospital Foundation Trust (HUHFT) A&E to review out of hours (OOH) presentations at A&E, and the number of those that could have been avoided by a different community response involving RICs and report this to the RICs Board no later than 31 st March 2015; February 2014 Chair: Dr Clare Highton Chief Officer: Paul Haigh

39 Ensure that the provider enters into robust sub-contractual arrangements to support home sitting. This funding will form part of the refreshed joint commissioning arrangements between LBH and the CCG from 1 st April LBH, as the lead, will fund the Trust for this service and the mainstream RICs. It should be excluded from any invoice to the CCG. From 1 st April 2015 this service, alongside the main RICs will be commissioned via the Better Care Fund. It is expected that the service will deliver the agreed RICs metrics and contribute to the achievement of the overall BCF metrics. February 2014 Chair: Dr Clare Highton Chief Officer: Paul Haigh

40 City and Hackney Care Plan Date of assessment: Short date letter merged Date of review(s): Section1: If you are unwell please contact us sooner rather than later If moderately unwell with mild symptoms, i.e. ( Off your legs slightly breathless/cough, temperature, etc). District Nurse (Mon-Sun 08:30-23:00hrs) Community matron (Mon Fri 08:30-17:00) Named GP (Mon Fri 08:00-18:30) Name: Usual GP Surname Usual GP Phone Number GP out of Hours Service Name: CHUHSE Telecare (alarm) pull your cord for assistance If having mental health symptoms such as feeling worse than usual. Other (e.g. patient with mental health problems or dementia) Name: If very unwell and need emergency care (i.e. experiencing significant difficulty breathing / chest pains, etc.) or a major mental health emergency such as high risk of harm to yourself or others. Call 999 immediately Section2: Your contact details Name: Full Name Title: Title NHS number: NHS Number Date of Birth: Date of Birth Address: Home Full Address (single line) Contact Number Patient Home Telephone Key safe door access code:

41 Named GP(s): Practice Phone Number: Usual GP Phone Number Practice Address: Usual GP Full Address (single line) Your Care coordinator is (if appropriate): Do you live alone? Help available? Language: Main Language Interpreter needed: Communication Problems: Deafness: Can t get to the door? Other Issues: Are you a carer? Single Code Entry: Is a carer Section3: Your consent to treatment and to sharing information Are you able to consent to or decline treatment? If No do you have Lasting Power of Attorney for health and welfare? Has the above been verified? Are you able to consent to or decline sharing of information? Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] (please make an assessment of capacity if indicated Do you give consent to share information with other healthcare professionals involved in your care, e.g. Out of hours GP service, nursing service? Do you give consent to share information with the multi-disciplinary Team (social services and voluntary organisations)? Yes [ ] No [ ] Yes [ ] No [ ] Do you give consent to share information with particular carers/relatives/friends (please advise names and contact details)? Section 4: Information about your main carer

42 Single Code Entry: Carer's details Single Code Entry: Primary carer's address Single Code Entry: No carer involved Single Code Entry: Referral for assessment of needs of carer Keyholder: Additional emergency contact (if appropriate): Name: Telephone: Relationship: Section5: Your Medical Information Medical Information Please provide details of relevant long term conditions or other significant medical or social conditions including: Incontinence, hearing, vision fall, social isolation, mental health and alcohol or substance use and dementia: Problems Allergies: Allergies Medication Current medication (list of medication, indication for each drug): Medication This list of medication is correct on the date of assessment. Please check the most up to date patient list or EMIS summary. How is repeat medication obtained, which pharmacist? Dosette box: Yes [ ] No [ ] Pharmacy contact details: Single Code Entry: Pharmacy Other medication problems (e.g. does not like to take medication): Anticipatory Care Is your health and ability to look after yourself getting worse (see SPICT tool)?

43 Are you on the maximum treatment that you can have for your long term conditions (see SPICT tool)? Anticipatory care plan agreed: Yes [ ] No [ ] Anticipatory drugs supplied: Yes [ ] No [ ] Are you happy for a CMC record to be created? Yes [ ] No [ ] Has a CMC record been created? Yes [ ] No [ ] Emergency care and treatment discussed: Yes [ ] No [ ] Do you wish to make an advance care plan for end of life? Yes [ ] No [ ] If so, what is your preferred place of care: Has advanced care plan: Yes [ ] No [ ] Do you wish to make an advanced decision to refuse treatment (e.g.: cardiopulmonary resuscitation has the patient agreed a DNR or what treatment should be given if seizures last longer than x do y etc.) Yes [ ] No [ ] Has DNAR discussion taken place? Yes [ ] No [ ] Section 6: Care Package Providers (Key people involved in your care, contact details and brief details of care provided) Type of Service Details Contact number Community Nurse and/or Community Matron Clinical Nurse Specialist Hospital Team: Ward Sister or Consultant Frequent Attender at A&E Therapies team Social Services or other care agencies Mental Health team

44 Alcohol/Substance Use team Dementia advisor Section 7: Care Plan Your Wishes and Goals Your main concerns and wishes about your health and your care. Your plans for self-care. Any action taken? Do you have any care needs which are not being met? Any action taken? Risks Identified Risks Identified (Including increased falls, low mood, frailty, dementia loss of ADL or worsening of symptoms of long term condition or risk of hospital admission): Key Action Points For example: guidance on intervention / deterioration, unmet need to support patient (specify), agreed plan in emergency (ICE)/ useful situation etc. Section 8: Sharing of care plan Care plan has been discussed with you Yes [ ] No [ ] Care plan has been discussed with your carer Yes [ ] No [ ] Care plan discussed at practice team meeting Yes [ ] No [ ]

45 READMISSIONS REINVESTMENT Frequent Attenders at A&E 49k pa Funding: From 1 st April 2014 to 31 st March Lead: CCG Urgent Care Programme Board Our expectation is that this service will take lead responsibility for: Developing and sharing care plans with the registered GP, the OOH service and LAS for all City and Hackney CCG registered patients identified by HUHFT A&E as frequent attenders (i.e. attending A&E 10 times or more in the previous twelve months). Engaging with the practice of each patient to support the implementation of the agreed care plan; Agreed care plan to be in place for all identified patients by 30 th September 2014; Reviewing subsequent attendances by those patients and amending and sharing plans as requested; Identifying to the CCG Urgent Care Board any pathway or service requirements to minimise frequent attendees on a regular basis; Ensuring GP registration of City and Hackney resident frequent attendees without a registered GP including appropriate registration with Greenhouse Practice; Ensuring input of mental health services as required e.g. Tavistock/ HPM to each care plan to consider mental health needs of patients alongside physical needs; Undertaking an annual review of all City and Hackney registered patients attending A&E ten times or more in the previous twelve months to identify any additional frequent attender patients where care plans are required. The outcome of the service is: A reduction in the number of A&E attendances and LAS conveyances by patients identified in the cohort; A reduction in the number of patients attending A&E ten or more times in the previous twelve months; A reduction in the number of frequent attenders who are currently not registered with a GP; An increase in the number of frequent attenders having mental health input. Metrics for each outcome to be agreed with Urgent Care Board by 30 April The service will report to the Urgent Care Board every six months on: The above KPIs; The number of frequent attender meetings held per patient outlining engagement by the registered GP; Any learning from the group which could be shared across the wider clinical community on minimising frequent A&E attendances. February 2014 Chair: Dr Clare Highton Chief Officer: Paul Haigh

46 Ensure that each patient has a care plan, including mental health needs/services involved which is agreed with the patient s GP and patient s carers by 31 December 2014; Develop a pathway and management protocol for the management of pain, in conjunction with the CCG Planned Care Board by 30 th June 2014; Ensure that the pain management protocol reflects best practice and is agreed via the JPG; Ensure unregistered City and Hackney patients register with a GP; Undertake an annual patient satisfaction survey about their interaction with the MDT; Undertake an annual discussion with each practice about the care plans for their registered patients as part of the CCG s Integrated Care arrangements. The service will be expected to report on progress against each of these metrics to the LTC Programme Board every six months, commencing in September The service will be expected to deliver (as proposed by the service itself): A reduction of 10 15% of NEL admissions for SA10E and SA10F HRGs over the course of this contract; An average length of stay for patients admitted with SA10E and SA10F HRGs of less than five days. February 2014 Chair: Dr Clare Highton Chief Officer: Paul Haigh

47 READMISSIONS REINVESTMENT Discharge management 163k pa Funding: From 1 st April 2014 to 31 st March Lead: CCG LTC Programme Board/ Better Care Fund governance. We are commissioning HUHFT as the lead provider of an extended discharge management team made up of the following: Part time psychologist; Additional housing input; Additional social work input; Home from hospital service commissioned from VCS; Training and OD support. HUHFT will hold sub-contracts with the relevant providers for their input to the service. This service is to be provided to all patients registered with City and Hackney CCG practices. As the lead provider, HUHFT will be responsible for the delivery of the service and will be required to demonstrate appropriate interfaces with the Homerton Psychological Medicine service. We envisage this service integrating with the current hospital discharge team we commission and both being commissioned as a total package to support discharge from the Better Care Fund in 2015/16 and impacting on the BCF metrics. We therefore expect the service to make an overall impact on delayed transfers of care and length of stay/ excess bed days. Our outcome measure is an expectation that: Discharge planning will commence at the point of admission; The service will agree with patient representatives (via Healthwatch) by 30 th June 2014 at least two patient-determined standards relating to good discharge and produce six monthly monitoring information on adherence to these; The service will link with other HUHFT services to support the delivery of the following standards which form part of the proposed 2014/15 CQUIN. February 2014 o Face to face and documented assessment of patients over 75 requiring medication support and/or have at least one co-morbidity including dementia who are known to the ACN service (district nursing or community matrons) by the ACN service within 48 hours of admission to hospital and a care plan and discharge plan agreed; o Patients over 75 requiring medication support and/or have at least one co-morbidity including dementia who are already known to the ACN service (district nursing or community matrons) or are identified as Chair: Dr Clare Highton Chief Officer: Paul Haigh

48 frail/at risk are contacted by the allocated nurse (or nominated person) either by a home visit or telephone contact within 48 hours of hospital discharge. Documented assessment and outcomes reported to the GP within 24 hours of patient contact via the electronic letter system, including any suggested amendments to the care plan; o Hospital discharge summaries to include a clear multidisciplinary patient centred care plan agreed by the consultant with the patient, (and carer if appropriate), confirming action for GP and for community services and communicated to the patient s GP and with the multidisciplinary team. Reporting on performance against the metrics will be undertaken and managed as part of the 2014/15 CQUIN process. Each year we will want to review with the Trust any complaints received at the Trust and/or, via Healthwatch in relation to discharge and ensuring an action plan is in place to address issues. February 2014 Chair: Dr Clare Highton Chief Officer: Paul Haigh

49 Step-up planning for winter months Urgent Care Programme Board 30 May 2014

50 Summary Winter Review In line with the yearly planning cycle for surge management, the Urgent Care Programme Board is reflecting on Winter performance across the health economy. Recent winter performance reports have reflected well across multiple service providers in City and Hackney A common theme emerging from a recent submission to NHSE where all service providers were asked to reflect on winter planning process on performance was that the notification of available funding to support Winter should be made earlier to allow for recruitment and appointment to posts The CCG is considering whether it should be more pro-active in the approach to Winter and to not wait for notification of Winter Funds The submission is attached as appendix 1 Consideration and recommendations for the Board The board is asked to make comments and reflections on Winter performance and the planning process The board is asked to task service leads with making outline bids and plans for Winter investment that set-out: staffing levels, grades of staff, timing, stepping up and stepping down of resource throughout the Winter months and into the spring bank holidays The board is asked to consider whether it should host a local winter planning workshop across the health economy

51 Review of Winter 2013/2014 Summary Please send your summary to: by 5pm on Friday 9 th May 2014 General Information - Please use this cover sheet to summarise the headlines from your health economy s 2013 / 2014 winter review. Name of Urgent Care Working Group Please list the organisations that contributed to this review. Lead contact details - Please provide the and phone number for the person coordinating the review, in case there are queries with your return Top three winter schemes and allocation Please list the three schemes which accounted for the biggest spend from 13/14 winter monies allocations City and Hackney Urgent Care Programme Board Ryan Ocampo, r.ocampo@nhs.net, Programme Manager May Cahill m.cahill@nhs.net, Clinical Lead Scheme 1: Range of schemes in Homerton University Hospital Trust A&E, urgent care and associated departments (e.g. diagnostics, support staff Phone: Allocation: 1.3m Scheme 2: GP out of hours Allocation: 103,000 Scheme 3: East London Foundation Trust Allocation: 109,000 Winter Review - Please provide a minimum of four bullet points to summarise your answers to the following questions Which winter schemes/approaches have gone well this winter, and should be carried forward into 14/15? In your answer, please be clear regarding what additional benefits the centrally funded winter monies has provided. Context The City and Hackney Clinical Commissioning Group Urgent Care Programme Board (CCG UCPB) has provided leadership on urgent care and winter planning across the local health economy. The UCPB has brought key stakeholders together from the Homerton (both clinical and operational), LAS, Hackney Local Authority, City and Hackney CCG, and NELCSU to support whole systems joint working across the local health economy. The CCG will build on this to develop a whole system approach for urgent care across the health economy. Reflections on acute trust winter schemes/approaches: The ability to use winter funding for staffing other than in the ED enabled the Homerton to consider more innovative ways to support A&E performance compared to previous years where the focus was heavily on ED resource and dealing with additional demand rather than considering ways to better manage/reduce demand. The Trust also welcomed the fact that it was invited to submit whole system winter plans, which included support from other teams/depts. outside of the ED (such as support services and medical staff). This enabled the Homerton to bolster available staffing and enabled a whole hospital response to the ED standard. This should therefore be carried forward in 2014/15. The Homerton reported that to help manage surge pressures the Trust (from an organisational perspective) looked at what was causing the pressure points in the system and slowing down flow through ED. The Trust then put systems/resources in place to help manage these pressure points such as an extra ED SpR shift in place until 2am, paediatrics, and portering. The dominant performance indicator that has helped shape and informed the work of the City and Hackney CCG s UCPB has been the 4 hour A&E standard. This has resulted in the development of improvements in monitoring and reporting arrangement at a local health economy level to enable the health economy to respond to times during the winter when the Homerton has been under particular pressure. As a result of partnership work, the Homerton ended 2013/14 having achieved the weekly A&E standard 42 weeks out of 52. Indeed, since the 1st November 2013, the Homerton achieved this weekly standard 19 weeks out of 22 weeks. As part of its winter planning preparation work the City and Hackney CCG UCPB intend to look at ways of strengthening the work of the group, and identify metrics to support local delivery. Reflections on the GP out of hours schemes/approaches:

52 CHUHSE, a start-up Social Enterprise provider, secured the contract for the City & Hackney GP out-of-hours service in September 2013 and agreed a commencement date of December 2nd That is the time when demand for the GP OOH service (and generally in the urgent care sector) is increasing with the onset of winter illnesses. Faced with all of the challenges of establishing a new service at that time of year and given the variability of demand it was important to support the provider by allocating a sum of money to be used in the event that activity was at a higher level than anticipated. CHUHSE was also given the opportunity to apply for further funding if that became necessary. As it transpired, activity was higher than originally expected. As a result of the additional Winter support, the provider was able to immediately extend shifts, increase clinical staffing and recruit additional GPs. The speed with which CHUHSE was able to respond to the additional activity and immediately increase the clinical staffing prevented any unnecessary burden on A&E or other urgent care services. That would have been the likely result had the CCG not supported the provider with access to resources enabling them to move very quickly when the demand issue was highlighted. In addition to the rota capacity funding, having access to funding for Pulse Oximeters available for all GPs enabled CHUHSE to immediately emphasise the role its duty GPs have in avoiding admissions. Reflections on mental health support schemes/approaches: East London Foundation Trust reported that the following schemes were particularly helpful with managing pressures during the winter: Employing an extra doctor to work hours, five nights a week helped reduce the wait for an on-call doctor and thus helped reduce patient waiting times and minimised breaches. Increasing nursing staff during out of hours and at busiest times for A&E helped reduce patient waiting times. Extra staff in Home Treatment Teams (HTT) allowed for an increase in caseload capacity and thus helped prevent inpatient admissions to City and Hackney Centre for Mental Health. Having a dedicated senior nurse for Homerton University Hospital liaison allowed for inpatients in Homerton Acute Wards to be supported better. Which are the key areas for improvement /approaches not to be repeated in 14/15? Please indicate why things didn t go well, and outline any associated winter funding, if any. Overall reflections One of the key lessons from winter 2013/14, was the need for pan-london planning to be undertaken earlier in the financial year so that new initiatives would have had time to imbed before the onset of winter pressures. Earlier provision of winter funding approval and allocation of resources would be welcomed by local partner agencies. Reflections on acute trust winter schemes/approaches: The Homerton noted that late approval and allocation of resources has meant that many schemes could not start at the optimum time due to needing to recruit into posts. The recruitment process could only begin once funding was confirmed. Earlier knowledge of available funds / resources, and how to access them would enable better planning, as it would ensure optimisation of the use of the monies available and help manage the winter pressures better in the future. Reflections on the GP out of hours schemes/approaches: CHUHSE was awarded the GP Out of Hours contract late in the winter planning stage so was unable to input in to the winter planning process as others in the City & Hackney healthcare community. That was of course unavoidable as the contract was subject to a competitive tendering process and we are sure that CCG colleagues will wish to include CHUHSE from the start of the 2015/15 process. Reflections on mental health support schemes/approaches: East London Foundation Trust (ELFT) noted the very tight timescales to facilitate staff recruitment created a resourcing impact onto other services. Earlier notice of allocated funds would have enabled the Trust to have devised and implemented a robust plan to recruit suitable & sustainable staff. ELFT noted that as a result of the experiences of surge pressures this year, the liaison service will now be run by Homerton Psychological Medicine (with management responsibility passing from ELFT to the Homerton). This new service will be supported by increased resources provided via RAID.

53 What was done differently in winter compared to previous winters, and what have been the effects of these alterations? Any other reflections from winter 13/14 which would be helpful to capture The biggest difference this year compared to previous years was the ability for the acute trust to utilise the resources in other areas outside of the ED department, recognising that a whole systems approach to helping improve performance in urgent care is required. There are also a number of additional innovations in the pipe-line that were initiated by discussions on Winter Planning, for example, o Paradoc o Duty Doc o Extended Hours o Overnight Nursing Upon full mobilisation and implementation, the local health economy will have increased capacity in primary care therefore relieving the pressures on traditional urgent care centres. An initial report to the Urgent Care Board showed that of the 51 patients seen by the Paradoc service only 4 patients required onward hospital treatment. Paradoc is a joint scheme between the LAS and CCG whereby a GP accompanies an emergency response unit on calls which are clinically triaged as appropriate to be seen by emergency units but are not defined as life threatening. The most common theme emerging from all our healthcare providers is that early provision of funding notification and approval would be helpful in managing resource and recruiting to additional posts before the start of winter (in November) as this would enable a more proactive managed approach to support effective delivery of services to patients during winter. The Homerton observed that surge pressures across the whole health economy could be more effectively managed through involvement of all partner agencies (social care, LAS, community and voluntary services) at an early stage. The health and social care systems do not work independently and it is important to understand what each organisation is doing and where their pressures lie. Next steps - Please provide a minimum of four bullet points to summarise your answers to the following questions How are you going to deploy and manage winter monies differently in 14/15, to ensure they have the maximum effect? The CCG is reviewing the impact of all its Winter schemes through the Urgent Care Board The Urgent Care Board plans to run focused sessions with partners from across the health economy to review the Winter performance and start to plan for Winter Resourcing in summer for 2014/15. What key changes you will be making over summer to prepare for winter 14/15? Please indicate any high-level actions and associated timeline for these changes. The CCG does not plan to manage the allocation of winter monies differently for 2014/15 as a robust process is currently in place whereby bids for an allocation of resources are invited for review by a prioritisation committee. Upon approval of bids, specifications, KPIs and reporting frameworks are agreed by the Urgent Care Programme Board. The CCG is undertaking an ambitious programme of activity through its Urgent Care Programme Board that will impact upon its plans for Winter 14/15, these key schemes will add capacity and improve clinical quality of care across the urgent care system with an overarching goal of reducing the burden on Emergency Departments. It is anticipated that this will also impact Winter performance. A summary of these schemes is as follows: An evaluation of the Paradoc pilot will be carried out in the late Spring to assess its impact and to explore opportunities for further funding, should the data reflect a positively on Winter performance and unnecessary conveyances in general. There is further work to develop clinical pathways for ambulatory care to access alternative services other than Emergency Departments, eg. The PUCC, ACERs and FRDT. There is the work around facilitating improved working across health and social care to particularly around Intermediate Care and Reablement Service we should see reduction in hospital admissions and more people with complex conditions supported in the community in a timely manner and with appropriate multidisciplinary interventions Developing the primary urgent care centre further to ensure appropriate clinical pathway based on best practice is planned for 14/15 with a view to implementation in 2015/16.

54 Further development around extended hours for GP primary care services and increasing capacity and joint working between primary and secondary care, extended hours, duty doc and extended nursing. Additional capacity for the non-clinical navigators and developing their work further into the local authorities service centre to ensure members of the public have a better understanding of health services. Developing the communication strategy for urgent care to assist local communities to access the right care at the right time. Winter Review - Please provide a minimum of four bullet points to summarise your answers to the following questions

55 Communication Plan Item A&E WALK IN CENTRE NAVIGATORS AND GP REGISGRATION PRIMARY CARE DUTY DOCTOR, EXTENDED HOURS, CHUHSE URGENT CARE RAPID RESPONSE OMU Potential Timeline MAY JUNE/JULY JULY SEPTEMBER NOVEMBER JANUARY

56 Communications plan for Tollgate Walk-in Low-key campaign emphasis on legacy PCT decision in Nov 2012 Serve notice to provider effective 31 July (NHSE to inform CCG) Provide information to remind users of the extended hours appointment services at Tollgate centre itself, and at three Hackney bases that provide extended hours including one in that patch (in CCG and CareUK website, at Tollgate, relevant GP practices) Remind users of newly commissioned out of hours service CHUHSE (CCG and CareUK website, Tollgate, relevant GP practices) Send a note to CHUHSE, Homerton Hospital, nearby GP practices, and the Hackney extended hours service base in that patch informing them of the closure. Ensure that other key stakeholders are made aware of the final closure date and the alternative arrangements to mitigate this closure (LBH, Overview and Scrutiny committee, lead Cabinet member for health, etc)

57 111 and OOH briefing Urgent Care Programme Board 30 May 2014

58 Summary 111 The existing 111 provision in City and Hackney is delivered through an emergency step-in arrangement with PELC, who cover City and Hackney, Newham and Tower Hamlets. The temporary contract will come to an end on 31 March 2015 see attached appendix for full details. See urgent care data review pack for detail on metrics and calls Consideration and recommendations for the Board Agree to extend existing contract until 31 March 2016 Agree to work in collaboration with Newham and Tower Hamlets Consider increasing footprint to cover WELC geography (Waltham Forest) Receive expressions of interest for clinical representation on a Task and Finish Group to develop case for change, service model, service specification, business case and stakeholder engagement on behalf of Urgent Care board

59 Summary OOH CHUHSE has been providing the OOH service since 2 December The contract was awarded following the completion of an open competitive tender process. The provider mobilised the service during the busy winter period. The provider experienced some teething difficulties in their first 2-4weeks of operation. These initial technical issues have been resolved. While the provider is performing satisfactorily to well (90%>) in the majority of the key performance areas, there have been issues with adjusting capacity to match call volumes. This is particularly evident in quality requirements 8 and 9, which relate to call answering (NQR 8) and telephone triage (NQR 9). NQR 8 and NQR 9 have been a particular area of focus at the performance review meetings and the provider has been working with both the out-sourced call handling service at Barts Health and with their own workforce to improve capacity and efficiency with handling and managing calls. While the performance remains non-compliant (below 89.9%) the data demonstrates that there has been month on month improvement There will be continued focus in this area until performance improves The quarterly report is attached as appendix 2 Recommendation The Urgent Care Programme Board is asked to note the quarterly performance and quality report of the out of hours service and make recommendations on any areas of particular concern or interest.

60 Briefing note Title: East London & the City NHS 111: Summary of Next steps Date: 9 April 2014 Submitted to: Jane Milligan, SRO ELC NHS 111 Author: Kristina Valentino Background and Context Following competitive tender and Department of Health assurance process the NHS 111 service for East London and the City (ELC), comprising Newham, Tower Hamlets and City and Hackney CCGs, was launched on 12 March 2013, provided by NHS Direct. In June 2013 NHS Direct informed Commissioners of their intention to withdraw from the provider market. Following a successful EOI process, the Partnership of East London Cooperatives (PLEC) was appointed and fully mobilised as the step-in Provider for the ELC 111 service on 5 November In line with other contracts nationally the ELC 111 contract (currently provided by PELC) is due to expire on 31 March As such, it is essential ELC CCGs start to consider the process for reprocurement of the local NHS 111 service. The NHS 111 Futures Programme, managed by the national NHS 111 team at NHS England have issued a first draft of the commissioning standards for NHS 111 going forward. This document outlines the national standards of the service Commissioners may wish to consider however they will form the basis for the assurance process each Provider and Commissioner will need to complete before any service can go live. The NHS 111 Futures programme have issued a collaboration proposal for the commissioning standards requesting feedback on the draft document and evidence of good practice which will be reviewed and, where agreed, incorporated into the next iteration of the commissioning standards expected in October The next iteration of the commissioning standards will also include evidence and recommendations from the pilot programmes that have been launched over the spring and summer..