Improving out-of-hospital care in Westminster

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1 Improving out-of-hospital care in Westminster Between 2 July and 8 October 2012, NHS North West London is consulting on plans to improve hospital and community services as part of the Shaping a healthier future programme. We want to hear your views on the proposed changes. This document summarises the proposals for Westminster residents needing care in their own home, in GP surgeries and in other locations in the community. NHS Central London is responsible for commissioning services in the majority of the borough of Westminster. However, Paddington and Queen s Park are within the NHS West London group, which also covers all of Kensington & Chelsea. This factsheet covers the changes that will be made by NHS Central London. Residents of Paddington and Queen s Park should also read the Kensington & Chelsea factsheet. People are living longer but with more long-term conditions; and the population is increasing so we need to make changes to meet the health needs of local people. We want to provide more care closer to home so people can get easier and earlier access to care. This will mean we can help people stay healthy and potentially life threatening diseases can be picked up at an earlier stage when treatment is much more likely to be successful and can avoid patients ending up in hospital. Treatment and support in people s homes, GP surgeries and in the community allows people to maintain their independence, to recover more quickly and reduces the risk of acquiring healthcare infections. Our Vision 1. Easy access to high-quality care 4. Co-ordinated care for people with a long-term condition 2. Simpler planned care pathways 5. Less time spent in hospital 3. Quick responses to urgent health problems Page 1

2 How we will achieve our vision Within three years we will be spending between 5million and 6million more per year on health services in the community in Westminster. This will provide around 60 additional health workers including GPs and nurses. We have established quality standards for all services in the community to achieve. We will ensure care is provided in the most appropriate care setting we have already developed high-quality facilities such as the South Westminster Centre, Victoria Street Medical Centre, Soho Centre and Brampton House. We are also looking at developing two new health and social care centres in East Fitzrovia and Church Street. We will ensure everyone who would benefit from a care plan has one, and has access to the information and support they need, including being able to better care for themselves. This factsheet includes examples of how we are improving services in Westminster. A key part of this work is making sure that services work together in a more co-ordinated way. To ensure this happens we are developing: Three new health networks across Westminster which will focus services around the patients of groups of GP practices, including health and social care services, as well as and mental health staff. The networks put patients and GPs at the heart of an integrated system, ensuring all care providers work closely together to improve the outcomes for patients. Increase of capacity and a larger range of services from GP surgeries working together will form a key part of each network so we will be able to perform more tests and treat more complex conditions in the community so that patients don t need to go to hospital. Page 2

3 Easy access to high-quality care Our aim is that urgent cases will be dealt with within four hours and non-urgent cases within 24 hours, or patients can have an appointment with their own GP within 48 hours From January 2013, patients in Westminster will be able to dial 111 to be directed to the most appropriate care, 24 hours a day, seven days a week. The number will be manned by local healthcare professionals who can provide advice and book appointments on the spot. We are working with pharmacies to make sure that patients who are entitled to free prescriptions can access over the counter medicines free of charge without having to go to their GP first. We will also work closely with our patients to implement plans to help them live healthier lives, eat more healthily, lose weight and stop smoking. The urgent care centres (UCC) at St. Mary s and Chelsea and Westminster will be led by experienced local doctors and nurses. UCCs will provide better care for the majority of people who currently attend A&E but don t need these specialist services, allowing the A&E to concentrate on patients requiring their expertise (see text box to the right for more on UCCs) A number of GP surgeries will offer out of hours walk-in services to all patients not just those registered at that surgery. We will match GP practice opening and capacity to the times that patients wish to access GP services. This will improve access to urgent care for patients in the area and prevent unnecessary trips to A&E. We will ensure all services are flexible to meet the needs of the diverse population of Westminster. Working with patient representatives we will develop services for those within our community who find it hard to access health and social care services or who have special needs. By doing so, we will help to reduce inequalities in health outcomes for groups including the homeless and ethnic minority communities. Page 3

4 Urgent care centres Under the proposals, all nine hospitals in North West London will have an urgent care centre (UCC) that is open 24 hours a day, seven days a week. For Westminster, these will be at St. Mary s and Chelsea and Westminster hospitals. These centres will be able to treat most illnesses and injuries such as: üüchest infections üüminor scalds and burns üüsimple fractures üüstomach pain üüinfections of the ear, nose and throat. UCCs are staffed by experienced GPs, supported by nurse practitioners. They will have emergency department experience and will have had training in a broad range of specialities, including, for example, children, elderly care and psychiatry. UCCs do not provide treatment for medical and surgical emergencies that are likely to need admission to hospital. If patients at a UCC suddenly need more urgent or complex care, they will be transferred to a hospital with an Accident and Emergency (A&E) department. Currently, far too many people go to A&E departments for minor issues and with underlying health problems. UCCs will be better placed to address these problems. Simpler planned care pathways Too many outpatient appointments occur in hospital when they could happen closer to the patient s home. To improve this situation for patients, we have provided consultant-led specialist services in the community. These cover areas including musculo-skeletal, gynaecology, skin, diabetes, heart and lung conditions. Our Patient Referral Services will work with patients so they understand the choices available to them, allowing patients to make an informed choice of where and when they wish to receive their consultations. We will improve the way we support people with complex mental health conditions in the community. This includes supported discharge to ensure that when a patient is discharged from hospital, the mental health team, GP and patient work together to develop a care plan. We will also provide a single point where patients can go to access all the care they need. Quick responses to urgent health problems We will expand our rapid response team to ensure that there is access to both GP and nursing care 24 hours a day, seven days a week. Within four hours of an at risk of admission to hospital assessment, the team will go to a patient s home. We will aim to avoid unnecessary admission by providing expert advice, services, tests or the supply of equipment. Page 4

5 Co-ordinated care for people with a long-term condition We are starting a new Well watch programme which will work with patients whose health and well being is deteriorating. The team is made up of a range of health and social care professionals and will ensure patients are receiving the right care as early as possible. This will help people stay well and greatly reduce people s risk of needing a hospital admission. When discharged from the programme, patients will be better able to manage their conditions and access support when they need it. Working alongside Well watch, the Integrated Care Pilot (ICP) in Westminster will help people aged over 75, or with diabetes. We will proactively work to enable people to live at home with a co-ordinated care plan, developed with the patient. End of life care plans will be developed with those patients who are nearing the end of their lives to ensure they receive the support they need in the place they would most prefer to receive it. Most people prefer to die at home and we will increase our capacity to provide hospice at home support for patients and their carers. We will improve the way we address the psychological aspect of long term conditions and work with GPs to address health anxieties and phobic disorders. Improper taking of some medicines (or adverse reactions to them) can be the cause of some hospital admissions. We are looking at introducing a new team who will work with GPs to monitor patients on these drugs, ensure the medication is being taken properly and assess the changing needs of the patient. This will include monitoring patients who are taking diuretics to reduce the number ofpatients admitted with dehydration and renal failure. Less time spent in hospital To ensure people do not have to stay in hospital longer than necessary, we will put in place properly planned support for patients when they return home. Community staff will work within the hospital to ensure hospital and community teams coordinate effectively to make sure delays in discharge do not occur. The patient s GP and other providers of health and social care will be involved in coordinating an individual s discharge plan as well as continuing care needs. So that people can be treated at home and avoid unnecessary trips to hospitals, we will establish a psychiatric liaison service which will work with staff in St. Mary s and Chelsea and Westminster hospitals. For those patients who do need to be admitted, mental health specialists will work with hospital staff, mental health teams, social care and voluntary services to support the patient when the time comes for them to leave hospital. Page 5

6 The proposals include delivering more services outside of hospitals, closer to people s homes and changes to some services at the following hospitals West Middlesex, Central Middlesex, Charing Cross, Chelsea and Westminster, Ealing, Hammersmith, Northwick Park, and St Mary s. Further details of the changes proposed can be found at You can also request a copy of the consultation document by: consultation@nw.london.nhs.uk Phone: (Freephone) Post: FREEPOST SHAPING A HEALTHIER FUTURE CONSULTATION (This must be written in capital letters and on one line. No stamp required). Westminster 36GP Practices 3Health Networks GP practice Page 6