Croydon Urgent Care Re-procurement Scenario Appraisal Final Version PUBLIC ENGAGEMENT Page of 35
Introduction The NHS Five Year Forward View (5YFV) explains the need to redesign urgent and emergency care services in England for people of all ages with physical and mental health problems, and sets out the new models of care needed to do so. The urgent and emergency care review (the review) details how these models of care can be achieved through a fundamental shift in the way urgent and emergency care services are provided to all ages, improving out-of-hospital services so that we deliver more care closer to home and reduce hospital attendances and admissions. We need a system that is safe, sustainable and that provides high quality care consistently. The vision of the review is simple: For adults and children with urgent care needs, we should provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families. For those people with more serious or life-threatening emergency care needs, we should ensure they are treated in centres with the right expertise, processes and facilities to maximise the prospects of survival and a good recovery. One of the key mechanisms in integrating our services is through a change in how our residents currently access urgent care. NHS England through the integrated standards propose that there will be one single point of entry for people with an urgent care need. The offer for the public will be a single entry point - NHS - to fully integrated urgent care services in which organisations collaborate to deliver high quality, clinical assessment, advice and treatment and to shared standards and processes and with clear accountability and leadership. Central to this will be the development of a Clinical Hub offering patients who require it access to experienced GPs. It will also offer sign posting to other health professionals in the community, such as paramedics and mental health, so that no decision needs to be taken in isolation. The clinicians in the hub will be supported by the availability of clinical records such as Special Notes, Summary Care Record (SCR) as well as locally available systems. In time, increasing IT system interoperability will support cross-referral and the direct booking of appointments into other services. A plan for online provision in the future will also make it easier for the public to access urgent health advice and care. This will increasingly be in a way that offers a personalised and convenient service that is responsive to people s health care needs Put simply: If a person has an urgent need, they can phone a single number () and they will, if necessary, arrange for the person to see or speak to a GP or other appropriate health professional any hour of the day and any day of the week The graphic below shows the routes into the urgent care system Page of 35
The Integrated Urgent Care service, supported by an Integrated Clinical Advice Service (Clinical Hub) will assess the needs of people and advise on or access the most appropriate course of action, including: Where clinically appropriate, people who can care for themselves will be provided with information, advice and reassurance to enable selfcare. Where possible people will have their problem dealt with over the phone by a suitably qualified clinician. People requiring further care or advice will be referred to a service that has the appropriate skills and resources to meet their needs. People facing an emergency will have an ambulance dispatched without delay. Within Croydon we are well placed to further develop integrated urgent care services that align with the NHS England strategy for urgent care. There are 6 matured Networks with populations ranging from 5, to 88,. The graphs below show the expected population growth within each locality giving an overall population rise by of 3.99% The GP hubs described in this document will potentially be built upon to become the clinical hubs as described in the national strategy. Definitions of existing and proposed replacement services are detailed in appendix. The appendix also describes some of the services that will be linked to the hubs. National evidence shows that % of GP consultations are for minor ailments that could be seen elsewhere e.g. pharmacies. Page 3 of 35
Croydon Ward Populations 5- by GP Network Croydon Ward Populations % change 5-,, 8.% 7.% 7.8% 8, 6.% 5.% 4.55% 6, 4.% 3.73% 3.58% 4, 3.%,.%.9% East Croydon Thornton Heath Purley New Addington / Selsdon 5 6 7 8 9 Mayday Woodside / Shirley.%.% East Croydon Purley New Addington / Selsdon.58% Mayday Thornton Heath Woodside / Shirley Page 4 of 35
,, 8, 6, 4,, Croydon Ward Populations 5- by Year 5 6 7 8 9 East Croydon Thornton Heath Purley New Addington / Selsdon Mayday Woodside / Shirley The scenario appraisal has taken into account the current and future demand for services which may be caused by 3.99% overall population growth by. Each scenario has been appraised using the parameters described within the Croydon Urgent Care Re-procurement Strategy which was presented to the CCG Governing Body September 5. Workforce Improving Access Affordability Safety and Quality Estates Need and demand The options have been scored as -Not Met - Partially Met and -Fully Met. For further detail on each scenario please see pages 6-9 Page 5 of 35
Scenario x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GPOOH: service co-located with UCC 57 x GP Hubs: 7 day extended opening at all 57 GP practices in Croydon Practices will be open from 8. to. hrs weekdays and from : to 6. hrs weekends and Bank holidays Workforce Improving Access Affordability Safety and Quality Estates Page 6 of 35
Assessment of Scenario Workforce Scenario is not sustainable as there are smaller practices (registered populations under 5,) and 7 single handed GP practices. The smaller practices would need to employ additional nurses and associates to cover the extended hours to meet the European Directive on working hours. This equates to.56 WTE additional staff within each practice, 89 WTE additional staff across the CCG Score Improving access This scenario would improve access locally Affordability / Value for Money This scenario is outside of the financial envelope by 8.6m Safety and Quality This scenario would be expected to provide quality and safety through the practices knowledge of their populations. Estates Some of the GP estates are not fit for purpose and would not be able to cope potentially with the increase in same day walk in demand Evidence suggests that this scenario could drive up demand for services by having a walk in component in each of the GP practices. Evidence also suggests that this could lead to GP practices seeing patients that could best be managed through Self Care or by a Pharmacist This scenario does meet national strategy to move towards 7 day working in Primary Care, but it does not take into account the evidence that % of GP appointments are for minor ailments and could be seen in pharmacies or through self-care Total 6/4 Summary of Scenario Scores 6 out of 4 Does not meet the following agreed markers: Workforce / Affordability / Page 7 of 35
Scenario x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GPOOH service co-located with UCC 5 x further UCCs for 6 hours-a-day / 7 days-a-week (Therefore 6 centres will cover the 6 Croydon localities) Workforce Improving Access Affordability Safety and Quality Estates Page 8 of 35
Assessment of Scenario Workforce Scenario is not sustainable given that the urgent care facilities specifications describe that an UCC must be staffed by multidisciplinary teams, including at least one registered practitioner and at least one healthcare practitioner. Arrangements must also be in place to have access to experienced junior doctor s and above in both adult and paediatric emergency medicine. The UCC must also have access to a medical or non-medical prescriber. The UCC would need dedicated Mental Health staff. The UCC would also need a radiographer and X Ray facilities at each site. This scenario requires a further 54 WTE specialist staff working across the additional 5 UCC, which we know from existing service provision would be a significant challenge given the current availability of workforce. Score Improving access The scenario would improve access locally Affordability / Value for Money This scenario is outside of the financial envelope by 8.79m Safety and Quality Estates This scenario due to the UCCs being stand alone would not offer the same level of safety as the current UCC which is colocated with the emergency department. Clinical Governance for each site would also be challenging to manage as the low level of demand for UCC services would impact on maintaining staffing competencies The UCCs would need separate dedicated space for children and for people presenting with mental health conditions. The estates would also need space for X-ray facilities. Currently only one site at Purley would lend itself to these requirements The current UCC has seen a 5.6% decrease in attendances from 36,66 (4/5) to 34,64 (Proj M6 5/6). Of the 4/5 attendances only 7,86 (%) of people attending required an X-ray. Of the 5/6 at M6 projection 34,64 only 8,86 (6%) required an X-ray. If there were 6 centres with X-ray facilities this would amount to 4 X-rays a day on each site with valuable staffing resources being wasted. For the Croydon people using Xray service outside of Croydon, if half of them instead went to the 6 UCC centres this would still only mean,6 Xrays more a year bringing the total up to 5. Xray a day. The current UCC is currently part of the ED refurbishment programme due to be completed in spring 7 and which therefore will be able to cope with the additional demand expected from the population growth. It would be expected that the majority of the current WiC activity would be absorbed into the integrated OOH, Pharmacies and back to the patient s own GP. It would be envisaged that people with a minor injury would attend an UCC. This scenario does not meet the UCC facilities specification as it is unlikely it will be able meet the standards consistently and does not meet the move towards 7 day working in primary care. UCCs are also required to be co-located with the ED under the national specification. Total /4 Summary of Scenario Scores out of 4 Does not meet the following agreed markers: Workforce / Affordability / Safety and Quality / Estates / / Page 9 of 35
Scenario 3 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP Out of Hours service co-located with UCC 3 x further UCCs for 6 hours-a-day / 7 days-a-week (Therefore 4 UCCs will cover the Croydon borough e.g. one at Purley) Workforce Improving Access Affordability Safety and Quality Estates Page of 35
Assessment of Scenario 3 Workforce Scenario 3 is not sustainable given that the urgent care facilities specifications describe that an UCC must be staffed by multidisciplinary teams, including at least one registered practitioner and at least one healthcare practitioner. Arrangements must also be in place to have access to experienced junior doctor s and above in both adult and paediatric emergency medicine. The UCC must also have access to a medical or non-medical prescriber. The UCC would need dedicated Mental Health staff. The UCC would also need a radiographer and X Ray facilities at each site. This scenario requires a further 9 WTE staff working across the additional 3 UCC, which we know from existing service provision would be a significant challenge given the current availability of workforce. Score Improving access The scenario would improve access locally Affordability / Value for Money This scenario is outside of the financial envelope by 4.43m Safety and Quality Estates This scenario due to the UCC s being stand alone would not offer the same level of safety as the current UCC which is colocated with the emergency department. Clinical Governance for each site would also be challenging to manage as the low level of demand for UCC services would impact on maintaining staffing competencies The UCCs would need separate dedicated space for children and for people presenting with mental health conditions. Estates would need to have space for X-ray facilities. Currently only one site at Purley would lend itself to these requirements The current UCC has seen a 5.6% decrease in attendances from 36,66 (4/5) to 34,64 (Projected M6) 5/6). Of the 4/5 attendances only 7,86 (%) of people attending required an X-ray. Of the 5/6 at M6 projection 34,64 only 8,86 (6%) required an X-ray. If there were 4 centres with X-ray facilities this would amount to 6 X-rays a day on each site with valuable staffing resources being wasted.. For the Croydon people using Xray service outside of Croydon, if half of them instead went to the 4UCC centres this would still only mean,6 Xrays more a year bringing the total up to 7.8 Xrays a day. The current UCC is currently part of the ED refurbishment programme due to be completed in spring 7 and which therefore will be able to cope with the additional demand expected from population growth. It would be expected that the majority of the current Walk in Centre activity would be absorbed into the integrated OOH, Pharmacies and back to the patient s own GP. It would be envisaged that people with a minor injury would attend an UCC. This scenario does not meet the UCC facilities specification as it is unlikely it will be able meet the standards consistently and does not meet the move towards 7 day working in primary care. Total 3/4 Summary of Scenario 3 Scores 3 out of 4 Does not meet the following agreed markers: Workforce / Affordability / Safety and Quality / / Page of 35
Scenario 4 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GPOOH service co-located with UCC x further UCC at Purley for 6-hours-day / 7-days a week (Therefore UCC centres will cover the Croydon borough) Page of 35
Assessment of Scenario 4 Workforce Improving access Scenario 4 is not sustainable. UCC facilities specifications describe that an UCC must be staffed by multidisciplinary teams, with at least one registered practitioner and at least one healthcare practitioner. Arrangements must also be in place to have access to experienced junior doctor s and above in both adult and paediatric emergency medicine. UCCs must have access to a medical or non-medical prescriber. UCC would need dedicated Mental Health staff. UCC would also need a radiographer and X Ray facilities at each site. Scenario 4 requires a further 9.7 WTE specialist skilled staff within Purley UCC, which we know from existing service provision would be a significant challenge given the current availability of the specialist skilled workforce. The scenario improves access locally south of the borough through a 6 hour UCC and reduced complexity in services offered. There is reduced access in Central and New Addington / Selsdon. Score Affordability / Value for Money This scenario is within the financial envelope Safety and Quality This scenario due to UCC being stand alone would not offer the same level of safety as current UCC which is co-located with ED. Clinical Governance for site would be challenging to manage as low level of demand for UCC services would impact on maintaining staffing competencies Estates A site exists at Purley although this would need to be reconfigured to meet the UCC facilities specification Current UCC has seen a 5.6% decrease in attendances from 36,66 (4/5) to 34,64 (Projected M6) 5/6). Of 4/5 attendances only 7,86 (%) of people attending required X-ray. Of 5/6 at M6 projection 34,64 only 8,86 (6%) required an X-ray. If there were centres with X-ray this would amount to X-rays a day on each site with valuable staffing resources being wasted. For the Croydon people using Xray service outside of Croydon, if half of them instead went to the UCC centres this would still only mean,6 Xrays a year bringing the total up to 5 Xray a day (less than an hour in Purley). Activity at each site would be around 8,34 per year from current activity and repatriated activity. Current UCC is currently part of ED refurbishment programme due for completion in spring 7 and which will be able to cope with additional demand expected from population growth. It is expected that majority of current WiC activity would be absorbed into integrated OOH, Pharmacies and back to patient s own GP. It is unlikely that current UCC would be able to easily manage an additional 3, people who currently attend the two MIU in Croydon and it would not be envisaged that people with a minor injury would necessarily clinically need to attend an UCC This scenario would meet the national strategy in terms of service facilities specifications, however there is a preference for UCCs to be co-located with ED. It is expected these will managed in a joined up way. This scenario does not meet the move towards 7 day working in primary care. Total 6/4 Summary of Scenario 4 Scores 6 out of 4 Does not meet the following agreed markers: Workforce / Safety and Quality / Page 3 of 35
Scenario 5 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC 6 x GP extended 8. to. hrs 7 days a week centres with enhanced minor injuries capacity - these 6 GP centres will cover the 6 Croydon localities. Under the new urgent care contract a level of GP cover to the Hubs will be supported by investment in the minor injury skill base. Page 4 of 35
Assessment of Scenario 5 Workforce Improving access Scenario 5 is not sustainable, for 6 GP hubs an additional 6. WTE would be required to staff these hours-a-day for 7 days-a-week. The scenario would improve access locally but it would be unlikely that there would be sufficient staff to cover 6 GP Hubs within Croydon Score Affordability / Value for Money This scenario is outside of the financial envelope by.m Safety and Quality Estates There is a risk that by having 6 GP hubs that safeguarding for Children and Vulnerable Adults becomes more challenging. There would be a need to ensure that special notes and summary care records are able to be electronically transferred by 8 the next day There would be a requirement to locate 3 further suitable premises in either current GP practices or procure dedicated premises if this model is adopted. Using evidence it would be expected that 36,694 of the walk in patients would be seen in the hubs 3, of the minor injury patients would be seen in the hubs,55 activity requiring no investigation or treatment currently seen at the UCC activity would also been seen in the hubs,59 Home Visit and Base Visits would be seen in the hubs Total 63,946 This scenario does not take into account the new NHS clinical single point of entry which will reassure more people over the phone and will also direct people to self-care applications or walk in pharmacies. The new NHS will also be able to book people into the right service, first time within the GP hubs including primary care, community, prescribers and the urgent care centre. Total 3/4 Summary of Scenario 5 Scores 3 out of 4 Does not meet the following agreed markers: Workforce / Affordability / Safety and Quality / / Page 5 of 35
Scenario 6 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC 3 x GP extended 8. to.hrs 7 days a week centres with enhanced minor injuries capacity - these 3 GP centres will cover Croydon borough. Under the new urgent care contract a level of GP cover to the Hubs will be supported by investment in the minor injury skill base. Page 6 of 35
Assessment of Scenario 6 Workforce Scenario 6 is sustainable, for 3 GP hubs an additional 3. WTE would be required to staff these hours-a-day for 7 days-a-week Score Improving access This scenario improves access. Affordability / Value for Money This scenario is within of the financial envelope Safety and Quality Safeguarding for Children and Adults would need to ensure that special notes and summary care records are able to be electronically transferred by 8 the next day and/or access to patients own notes was available. Estates It is highly likely that the existing estates will be able to accommodate the 3 clinical hubs Using evidence it would be expected that 6,5 of the walk in patients would be seen in the hubs 3, of the minor injury patients would be seen in the hub,55 activity requiring no investigation or treatment currently seen at the UCC activity would also been seen in the hubs.,59 Home Visit and Base Visits would be seen in the hubs Total 43,764 This scenario takes account of the to extend Primary Care over a 7-day week and the requirements for the specification for urgent care centres. Total 3/4 Summary of Scenario 6 Scores 3 out of 4 Partially meets the agreed markers of Workforce Page 7 of 35
Scenario 6a x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC x UCC for hours-a-day for 7 days-a-week located at Purley 3 x GP extended from 8. to.hrs for 7 days-a-week centres with enhanced minor injuries capacity these 3 GP centres will cover Croydon borough. Under the new urgent care contract a level of GP cover to the Hubs will be supported by investment in the minor injury skill base. Workforce Improving Access Affordability Safety and Quality Estates Page 8 of 35
Assessment of Scenario 6a Workforce Scenario 6a UCC is not sustainable given that the urgent care facilities specifications describe that an UCC must be staffed by multidisciplinary teams, including at least one registered practitioner and at least one healthcare practitioner. Arrangements must also be in place to have access to experienced junior doctor s and above in both adult and paediatric emergency medicine. The UCC must also have access to a medical or non-medical prescriber. The UCC would need dedicated Mental Health staff. The UCC would also need a radiographer and X Ray facilities at each site. This scenario requires a further.94 WTE staff working within Purley UCC for a hour period plus an additional 3. WTE staff for the 3 GP Hubs. A partly met score is applied as the unit would run for hours as opposed to 6. Score Improving access This scenario would improve access across the hubs and access to UCC Affordability / Value for Money This scenario is outside of the financial envelope by.6m Safety and Quality Estates There is a risk that by having 3 GP hubs and UCCs that safeguarding for Children and Adults becomes more challenging by having a wider range of access points for patients. There would be a need to ensure that special notes and summary care records are able to be electronically transferred by 8 the next day. The GP Hubs to work towards access to patients own notes. It is highly likely that some of the existing estates will be able to accommodate the 3 GP hubs There is an existing site at Purley that would meet the specification for X-ray. There would also need to be dedicated space for children and people with people with mental health conditions Using evidence it would be expected that 6,5 of the walk in patients would be seen in the hubs 3, of the minor injury patients would be seen in the hub,55 activity requiring no investigation or treatment currently seen at the UCC activity would also been seen in the hubs.,59 Home Visit and Base Visits would be seen in the hubs Total Activity 43,764 The current Urgent Care Centre has seen a 5.6% decrease in attendances from 36,66 (4/5) to 34,64 (Projected M6) 5/6). Of the 4/5 attendances only 7,86 (%) of people attending required an X-ray. Of the 5/6 at M6 projection 34,64 only 8,86 (6%) required an X-ray. If there were centres with X-ray facilities this would amount to X-ray a day on each site with valuable staffing resources being wasted. For out of area use of Xray if 5% of people needing Xray were repatriated back to the two UCC this would still only amount to an additional,6 Xray a year bringing the total up to 5 Xray a day (less than an hour in Purley). Activity at each site would be around 8,34 per year from current activity and repatriated activity. The current UCC is currently part of the ED refurbishment programme due to be completed in spring 7 and which therefore will be able to cope with the additional demand expected from population growth. This scenario takes account of the to extend Primary Care over a 7-day week. The UCC part of the scenario does not meet the requirements of the urgent care facilities specifications which detail that UCC must be open at least 6 hours a day which has further impact on costs and workforce. UCCs are also required to be co-located with the ED under the national specification. Page 9 of 35
Total 7/4 Summary of Scenario 6a Scores 7 out of 4 Does not meet the following agreed markers: Affordability / Page of 35
Scenario 6b x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC x UCC for 6 hours-a-day for 7 days-a-week located at Purley 3 x GP extended from 8. to.hrs for 7 days-a-week centres with enhanced minor injuries capacity these 3 GP centres will cover Croydon borough. Under the new urgent care contract a level of GP cover to the Hubs will be supported by investment in the minor injury skill base. Workforce Improving Access Affordability Safety and Quality Estates Page of 35
Assessment of Scenario 6b Workforce Scenario 6b UCC is not sustainable given that the urgent care facilities specifications describe that an UCC must be staffed by multidisciplinary teams, including at least one registered practitioner and at least one healthcare practitioner. Arrangements must also be in place to have access to experienced junior doctor s in both adult and paediatric emergency medicine. The UCC must also have access to a medical or non-medical prescriber. The UCC would need dedicated Mental Health staff. The UCC would also need a radiographer and X Ray facilities at each site. This scenario requires a further 9.7 WTE staff working within Purley UCC plus an additional 3. WTE staff for the 3 GP Hubs. Score Improving access This scenario would improve access across the hubs and access to UCC Affordability / Value for Money This scenario is outside of the financial envelope by.6m Safety and Quality Estates There is a risk that by having 3 GP hubs and UCCs that safeguarding for Children and Adults becomes more challenging, by having a wider range of access points for patients. There would be a need to ensure that special notes and summary care records are able to be electronically transferred by 8 the next day. The GP Hubs to work towards access to patients own notes. It is highly likely that some of the existing estates will be able to accommodate the 3 clinical hubs There is an existing site at Purley that would meet the specification for X-ray. There would also need to be dedicated space for children and people with people with mental health conditions Using evidence it would be expected that 6,5 of the walk in patients would be seen in the hubs 3, of the minor injury patients would be seen in the hub,55 activity requiring no investigation or treatment currently seen at the UCC activity would also been seen in the hubs.,59 Home Visit and Base Visits would be seen in the hubs Total Activity 43,764 The current Urgent Care Centre has seen a 5.6% decrease in attendances from 36,66 (4/5) to 34,64 (Projected M6) 5/6). Of the 4/5 attendances only 7,86 (%) of people attending required an X-ray. Of the 5/6 at M6 projection 34,64 only 8,86 (6%) required an X-ray. If there were centres with X-ray facilities this would amount to X-ray a day on each site with valuable staffing resources being wasted. For out of area use of Xray if 5% of people needing Xray were repatriated back to the two UCC this would still only amount to an additional,6 Xray a year bringing the total up to 5 Xray a day (less than an hour in Purley). Activity at each site would be around 8,34 per year from current activity and repatriated activity. The current UCC is currently part of the ED refurbishment programme due to be completed in spring 7 and which therefore will be able to cope with the additional demand expected from population growth. This scenario takes account of the to extend Primary Care over a 7-day week. The UCC part of the scenario also would meet the requirements of the urgent care facilities specifications which detail that UCC must be open at least 6 hours a day. This does not meet the national specification for the co-location of UCC to ED. Page of 35
Total 8/4 Summary of Scenario 6b Page 3 of 35
Scores 8 out of 4 Does not meet the following agreed markers: Workforce and Affordability Page 4 of 35
Scenario 7 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC x WiC (Walk in Centre) based in the centre of Croydon x MIU (Minor Injury Units) from 4.hrs to.hrs 7 days a week in Purley and Parkway Page 5 of 35
Assessment of Scenario 7 Score Workforce There is an existing workforce that covers the walk in centres and the minor injuries units Improving access This scenario maintains current access, however currently the MIU are only open 6 hours a day Affordability / Value for Money This is the current scenario Safety and Quality Estates Current services Edridge Road was rated good in October 4 by the CQC. The UCC met all standards apart from the environment standards September 4. The MIU at Purley and Parkway was registered by CQC on April 3.and are yet to be inspected on monthly % patient satisfaction samples rates have been % CQC Report September 4 states that the UCC environment does not meet standard. The ED/UCC is to be refurbished by April 7. The current Urgent Care Centre has seen a 5.6% decrease in attendances from 36,66 (4/5) to 34,64 (5/6) M6 projection. No impact has been seen in either walk in centre or UCC from the reduction in hours at Purley or Parkway. Current activity at the MIU projected for 5/6 has risen by 56% to 3, with a 4% decrease in redirections. Activity at WiC for 3/4 totalled 38,445 and in 4/5 activity totalled 36,694 representing a decrease of 4.6% Croydon is expecting to see an overall population growth of 4.49 % with East Croydon expected to see a growth of 7.% and Thornton Heath 5.85%. The refurbishment of the EC/UCC has been designed to meet the needs in population growth. The urgent care facilities specification recommend that UCC are open at least 6 hours a day and co-located with the emergency department on hospital sites. This scenario does not meet the national requirements to extend primary care over a 7 day week period. Total /4 Summary of Scenario 7 Scores out of 4 Does not meet the following agreed markers: Page 6 of 35
Scenario 8 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC Workforce Improving Access Affordability Safety and Quality Estates Page 7 of 35
Assessment of Scenario 8 Workforce Workforce within the current urgent care centre would need to be able to absorb an additional 3, minor injury attendances during the day each year and OOH would need to be able to absorb an additional 7,4 people currently seen at Edridge Road in out of hours. An additional 35 people during the day and an additional 46 people after 8.3 and at weekends. GP Practices and Pharmacies would need to be able to absorb the additional 9,654 activity seen during the day at Edridge Road which would equate to less than patent per day across the 57 GP Practices Score Improving access This scenario would reduce access to services by reducing existing site locations to one from four Affordability / Duplication This scenario is within the financial envelope Safety and Quality The centralising of expertise makes the scenario safe with quality easily maintained through regular CQC inspection Estates Estates capacity would need to be able to cope with an additional 35 people a day and an additional 46 people after 8.3 and at weekends In 5/6 M6 projection there were 3, people seen and treated within the MIU s 6 a day at Parkway and 9 a day at Purley. This was an increase of 56% on 4/5 but still an 8.5% decrease on 3/4 activity. On initial screening for 5/6 only, were redirected to an UCC. Activity at WiC for 3/4 was 38,445 and in 4/5 activity was 36,694 representing a decrease of 4.6%. 46% were seen after 8.3 and at weekends. Without further provision within primary care it is likely that people may choose to attend the UCC which would have insufficient capacity to manage the additional activity and see people quickly and efficiently We would anticipate that the activity from the WIC and MIUs would potentially be repatriated to primary care and UCC. This scenario meets the requirements of the urgent care facilities specifications. This scenario does not meet the national requirements to extend primary care over a 7 day week period. Total 8/4 Summary of Scenario 8 Scores 8 out of 4 Does not meet the following agreed markers: Improving Access / Page 8 of 35
Scenario 9 x UCC (Urgent Care Centre) for 4 hours 7 days a week Based at the front of A&E x GP OOH service co-located with UCC x GP extended 8. to.hrs 7 days a week centres with enhanced minor injuries capacity - these GP centres will cover Croydon borough Under the new urgent care contract a level of GP cover to the Hubs will be supported by investment in the minor injury skill base. In the Map opposite one GPH would not be available Workforce Improving Access Affordability Safety and Quality Estates Page 9 of 35
Assessment of Scenario 9 Score Workforce Scenario 9 is sustainable, for GP hubs an additional WTE would be required to staff these hours a day, 7 days a week. Improving access This scenario reduces access depending on the siting of the GP Hubs Affordability / Duplication This scenario is within the financial envelope Safety and Quality Managing safeguarding for Children and Adults within two hubs would be achievable There would be a need to ensure that special notes and summary care records are able to be electronically transferred by 8 the next day. The GP Hubs to work towards access to patients own notes. Estates It is highly likely that some of the existing estates will be able to accommodate the clinical hubs Using evidence it would be expected that 6,5 of the walk in patients would be seen in the hubs 3, of the minor injury patients would be seen in the hub,55 activity not requiring investigation or treatment currently seen at the UCC activity would also been seen in the hubs.,59 Home Visit and Base Visits would be seen in the hubs Total Activity 43,764 We would anticipate that the excess WIC patients would potentially be repatriated to primary care and UCC. This scenario takes account of the to extend Primary Care over a 7-day week and the requirements for the specification for urgent care centres. Total /4 Summary of Scenario 9 Scores out of 4 Partially meets the agreed markers of Improving Access/ Page 3 of 35
Summary Results of Scenarios Scores The table below shows that of the scenarios scored above 85%. Scenarios 6 and 9 (MPS = maximum point score) Scenario MPS % W IA S&Q E N&D NS Total Quality AF Max Score 4 43% 6 6 4 4% 3 4 % 3 3 4 4 43% 4 6 5 4 % 3 3 6 4 93% 3 6a 4 43% 7 7 6b 4 57% 8 8 7 4 7% 8 8 4 57% 6 8 9 4 86% Affordability Scoring Criteria Assumptions Option is 5% of current baseline Option is % of current baseline Option is current baseline (+/- k) Summary Scenario 6, 7 and 9 all scored 7% or more. Scenarios 4, 6, 7, 8 and 9 all fall within the affordable financial envelope. Page 3 of 35
Appendix Impact Flow Assessment Appendix Service Specification Page 3 of 35
Service Component Specification for Existing Services and Options: Access Times Diagnostics Workforce Linked Services Activity 4/5 Premises Requirements OOH Telephone advice Home visits Roving GP, 8.3am to 5pm Monday to Friday Base visits 8.3pm 8.am W/days 4hrs weekends/ bank holidays Nil GP Nurse EMT Driver GP hubs LAS DOS Virtual Clinical Hub GPs in hours UCC 3596 Waiting room Consulting rooms Car Urgent Centre 4/7 GP led with nursing Mental Health Liaison Alcohol Service Back slab Fractures Effective streaming to deliver more care in UCC from ED Shift in care from UCC to GP Hubs and Primary Care Accessible by ambulance 4/7 X ray ECG Bloods (results within an hour) Full-time GP Practition Emergency Nurse Practitioners Nurse Manager Admin Radiographer ST4 Registrar ED, MH Liaison OOH LAS GP Hubs 3666 Waiting room Consulting rooms Separate area for children Separate area for mental health Urgent Centre 6/7 GP led with nursing All ages Mental Health Liaison Alcohol Service Back slab Fractures Effective streaming to deliver more care in UCC from ED Shift in care from UCC to GP Hubs and Primary Care 6/7 8.am to am X ray ECG Bloods (results within an hour) Full-time GP Practition Emergency Nurse Practitioners Nurse Manager Admin Radiographer ST4 Registrar ED, MH Liaison OOH LAS GP Hubs Not Known Waiting room Consulting rooms Separate area for children Separate area for mental health Emergency prescription Accessible by ambulance Page 33 of 35
Service Component Specification for Existing Services and Options: Access Times Diagnostics Workforce Linked Services Activity 4/5 Premises Requirements Urgent Centre /7 GP led with nursing All ages Mental Health Liaison Alcohol Service Back slab Fractures Effective streaming to deliver more care in UCC from ED Shift in care from UCC to GP Hubs and Primary Care Emergency prescription Accessible by ambulance /7 8.am to 8.pm X ray ECG Bloods (results within an hour) Full-time GP Practition Emergency Nurse Practitioners Nurse Manager Admin Radiographer ST4 Registrar ED, MH Liaison OOH LAS GP Hubs Not Known Waiting room Consulting rooms Separate area for children Separate area for mental health MIU x Minor injuries Walk-ins Emergency prescription pm to 8pm, 7 Days a week GP Nurse Practitioner Receptionist Admin UCC GP led HC 84 Waiting room Consulting rooms Treatment rooms Reception Current locations Purley and New Addington GP Led HC (Walk in Centre) Minor illnesses Walk-ins Emergency contraception Emergency prescription safe haven 8am to 8pm, 7 days a week GP Nurse Practitioner Receptionist Admin UCC MIU 36,694 Waiting room Consulting rooms Treatment rooms Reception GP Hub Access to GP hub should be via as far as possible to encourage patients to phone before they walk; But walk-ins accepted; Minor illnesses; Simple minor injuries; Access to all Croydon patients records; crisis records and DOS Video appointments ; Repatriation of repeat patients to their own GP practice Promotion of self care One GP hub to be allocated as a safe haven 8am to 8pm, 7 days a week Full-time GP Practitioners Nurse Manager Admin LAS GP in hours Virtual Clinical hub Rapid Response OOH Not Known Waiting room Consulting rooms Treatment rooms Reception Page 34 of 35
Service Component Specification for Existing Services and Options: Access Times Diagnostics Workforce Linked Services Activity 4/5 Premises Requirements E-consultant (video access to specialist health consultants) Emergency prescriptions Sign posting to local mental health advice and services Focussed on locally sensitive need Co-location with other services where necessary Access to Co-ordinate My Care and Palliative care records Routine audits based on clinical and urgent care audit tool Promote self-care E-prescriptions Emergency contraception Accessible by ambulance Page 35 of 35