Service Specification Minor Injuries Release: FINAL Date: 30/11/10 Author: Laura Smith Urgent Care Commissioning Manager NHS Derbyshire County Owner: Service Specification owner Owner s designation Owner s employing/representative organisation Document Reference: Service Specification (v3) N:\Governance\Corporate Governance\Website & News\Fairer Funding\Service Specification Minor Injuries final Feb 2011.doc
Document Information Document location : This document is only valid on the day it was printed. Document source: Primary Care Commissioning \Fairer Funding Implementation \ Specifications Authorship: This document has been prepared by: Name Designation Organisation Laura Smith Revision history: Urgent Care Commissioning Manager NHS Derbyshire County The current version of this document supersedes all previous versions. Revision date Summary of changes 15 December Amendment following final Clinical Reference Group review V2 2010 1 February 2011 Amendment following further Clinical Reference Group review V3 Approvals: This document requires the following approvals: Version Name Designation Signature Date of Issue Version Distribution: This document has been distributed to: Recipient Date of Issue Version Date for Service Specification to be reviewed: 30 th November 2011 Date of review Name Designation and Organisation Year 1 Year 2 Year 3 2
Contents: Section Page Document information 2 1 Introduction 4 2 Definition of service 4 3 Overall aims 4 4 Service outline 5 5 Model for the service pathways / 5 interfaces 6 Client group served / eligibility / access 6 criteria 7 Quality targets 6 8 Output and outcome measure 6 requirements 9 Service monitoring, evaluation and review 7 process / timescales 10 Workforce / staffing 7 11 Clinical and corporate governance 7 3
1 Introduction: All practices are expected to provide essential and those additional services they are contracted to provide to all their patients. This service specification outlines more specialised or additional services to be provided to all patients registered with a Derbyshire County GP. No part of this specification by commission omission or implication redefines essential or additional services. 2 Definition of Service: This service specification allows the treatment of minor injuries to be carried out in a GP practice. This service is not intended to be a replacement for existing Minor Injuries Units. Wounds over 48 hours should be dealt with usually through normal primary care services as should any lesion of a non traumatic origin. By definition these cases are usually the walking wounded. Ambulance cases are not usually accepted except by individual prior agreement between the doctor and the attending ambulance personnel. The scope of the service includes all patients registered, whether permanently or temporarily, with GP practices in Derbyshire. 3 Overall Aims: Practices will see and treat or refer patients with minor injuries as appropriate to their circumstances. It is not expected that practices will undertake a major restructuring of their clinics to provide this service, but they will be required to be responsive within reasonable limits. Extending the current minor injury local enhanced service to include all patients registered with a Derbyshire County GP would: Help reduce inequity of care across Derbyshire County; Provide convenient primary care locations for all patients; Offer choice for all patients; Provide a cost effective alternative to secondary care supporting national and local PCT priorities and ensuring value for money; The PCT is not proposing to actively market this service. In the future the GP consortia will be responsible for reviewing the urgent care pathway. Any consequent significant increase in activity in Primary Care will need to be adequately resourced through the commissioning process. 4
4 Service Outline: The service outline includes: (i) Initial triage including immediately necessary clinical action to staunch haemorrhage and prevent further exacerbation of the injury; (ii) History taking, relevant clinical examination, documentation; (iii) Wound assessment to ascertain suitability for locally based treatment and immediate wound dressing and toilet where indicated; (iv) Appropriate and timely referral and/or follow up arrangements; (v) Adequate facilities including premises and equipment, as are necessary to enable the proper provision of minor injury services including facilities for cardiopulmonary resuscitation; (vi) Registered nurses. To provide care and support to patients undergoing minor injury services; (vii) Maintenance of infection control standards. (viii) Information to patients on the treatment options and the treatment proposed. The patient should give consent for the procedure to be carried out and the completed consent form should be filed in the patient's lifelong medical record; (ix) Maintenance of records of all procedures; (x) Audit of minor injury list work at regular intervals. 5 Model for the Service Pathways / Interfaces: The following list gives guidance on the types of injuries and circumstances that lead to the use of Minor Injury Services and is not comprehensive: (i) lacerations capable of closure by simple techniques (stripping, gluing, suturing); (ii) bruises; (iii) minor dislocations of phalanges; (iv) foreign bodies; (v) non-penetrating superficial ocular foreign bodies; (vi) following recent injury of a severity not amenable to simple domestic first aid; (vii) following recent injury where it is suspected stitches may be required (vii) following blows to the head where there has been no loss of consciousness; 5
(ix) recent eye injury; (x) partial thickness thermal burns or scalds involving broken skin: (a) not over 1 inch diameter ; (b) not involving the hands, feet, face, neck, genital areas. (xi) foreign bodies superficially embedded in tissues; 6 Client Group Served / Eligibility / Access Criteria: Patients in the following categories are not appropriate for treatment by the Minor Injury Service but the enhanced service covers the appropriate referral of these patients elsewhere: (i) 999 call (unless attending crew speak directly to the doctor); (ii) any patient who cannot be discharged home after treatment; (iii) any patient with airway, breathing, circulatory or neurological compromise (iv) actual or suspected overdose; (v) accidental ingestion, poisoning, fume or smoke inhalation; (vi) blows to the head with loss of consciousness or extremes of age; (vii) sudden collapse or fall in a public place; (viii) penetrating eye injury; (ix) chemical, biological, or radioactive contamination injured patients; (x) full thickness burns; (xi) burns caused by electric shock; (xii) partial thickness burns over 3cm diameter or involving: (a) injuries to organs of special sense; (b) injuries to the face, neck, hands, feet or genitalia; (xiii) new or unexpected bleeding from any body orifice if profuse; (xiv) foreign bodies impacted in bodily orifices, especially in children; (xv) foreign bodies deeply embedded in tissues; (xvi) trauma to hands, limbs or feet substantially affecting function; (xvii) penetrating injuries to the head, torso, abdomen; (xviii) lacerating/penetrating injuries involving nerve, artery or tendon damage. 7 Quality Targets: Practices can demonstrate that their partner, employee or sub contractor has the necessary skills to carry out the contracted procedures in line with the attached specification this will include resuscitation. (Training registers in place); Clinicians treating minor injuries should be able to demonstrate a continuing sustained level of activity to ensure clinical competence; 8 Output and Outcome Measure requirements: The service provider will not be required to submit activity or audit reports to the PCT. The PCT will monitor activity levels at hospital A & E and Minor Injuries Units. 6
9 Details of Service Monitoring, Evaluation and Review Process / Timescales: Practices should submit any significant event reports relating to this service to the PCT. 10 Workforce / Staffing: The practice must ensure that all staff involved in providing any aspect of care under this service must have the necessary training and skills. Doctors providing minor injury services would be expected to: (i) have either current experience of provision of minor injury work, or (ii) have current minor surgery experience, or (iii) have recent accident & emergency experience, or (iv) have equivalent training which satisfies relevant appraisal and revalidation procedures. Doctors carrying out minor injury services must be competent in resuscitation and, as for other areas of clinical practice, have a responsibility for ensuring that their skills are regularly updated. Doctors carrying out minor injury activity should demonstrate a continuing sustained level of activity, conduct audit data and take part in appropriate educational activities. Nurses assisting in minor injury procedures should be appropriately trained and competent taking into consideration their professional accountability and the Nursing and Midwifery Council (NMC) guidelines on the scope of professional practice. Those doctors who have previously provided services similar to the proposed enhanced service and who satisfy at appraisal and revalidation that they have such continuing medical experience, training and competence as is necessary to enable them to contract for the enhanced service shall be deemed professionally qualified to do so. 11 Clinical and Corporate Governance: Any GP practice delivering this service will be expected to be working towards the Care Quality Commission (CQC) registration and be compliant with the essential standards for quality and safety. 7