Transcript NHS England presentation template v2
Urgent and Emergency Care Review
Unlocking the potential of Out of Hospital Care
If it’s really serious I want specialist care Help me to help myself and not bother the NHS If only they could talk to my GP?
Ambulance Leadership Forum 2014
Treat me as close to my home as possible please
www.england.nhs.uk
UEC Review Vision
For those people with
urgent but non-life threatening
needs: • •
We must provide highly responsive, effective and personalised services outside of hospital, and Deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families
For those people with more
serious or life threatening
emergency needs: •
We should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery
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Current provision of urgent and emergency care services
>100 million calls or visits to urgent and emergency services annually
: Self-care and self management •
438 million health-related visits to pharmacies (2008/09)
• •
24 million calls to NHS urgent and emergency care telephone services
•
300 million consultations in general practice (20010/11)
•
7 million emergency ambulance journeys
• •
14.9 million attendances at major / specialty A&E departments (2012/13) 6.9 million attendances at Minor Injury Units, Walk in Centres etc (2013/13)
Emergency admissions •
5.3 million emergency admissions to England’s hospitals (2012/13)
UECR: The Why? – Care closer to home
www.england.nhs.uk
Helping people help themselves
Self care:
• Better and easily accessible information about
self-treatment options
– patient and specialist groups, NHS Choices, pharmacies • Accelerated development of
advance care planning 5
•
Right advice or treatment first time - enhanced NHS 111 the “smart call” to make
:
• • • •
Improve patient information
for call responders (SCR, care plan) Comprehensive Directory of Services
Improve levels of clinical input
(mental health, dental heath,
paramedic
, pharmacy,
,
GP)
Booking systems
for GPs, into UCC or A&E, dentist, pharmacy
1 500 000 1 200 000 900 000 600 000 300 000 0
Growth in NHS 111 Call Volume
NHS 111 Calls by month
Calls offered (left axis) Of calls answered, % in 60 sec (right axis) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
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NHS 111 Call Volume – front end to urgent care
Patients are predominately referred to lower urgency settings Dispositions callers (where callers are referred to) 999 Ambulance National 11% 7% A&E / UCC 111 Caller dials 111 Call handler answers Demo graphics taken Pathways triage 85% transfer
21%
Clinician takes transfer
www.england.nhs.uk
Referral GP OOH 62% GP in hours 1% Community service Dental 7% 1% Pharmacy 14% 7
Summary Care Record: Creating the records
• SCRs are an electronic record containing key information from the patient’s GP practice • As a minimum SCRs contain medication, allergies and adverse reactions • Improved functionality coming soon to make it easier for GPs to create SCRs with additional information for those patients that need them most.
46m
SCRs created
(82%)
Close to
2m
SCRs created last month
To find out more or enable SCR: [email protected] or @NHSSCR
Summary Care Record: Benefits
To find out more or enable SCR: [email protected] or @NHSSCR
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NHS 111 (service specification and standards)
•
Enhanced 111 service
: Smart call to make, helping people get the right advice or treatment in the right place, first time. This service will: • Be an
integral part of the Urgent Care Network
• Have
knowledge about you and your medical problems
, so the staff advising you can help you make the best decisions;
PILOT
• Allow you to
speak directly to a wider range of professionals
( e.g. nurse, doctor,
paramedic
, mental health team, pharmacist);
PILOT (GP)
• If needed,
directly book you an appointment
at whichever urgent care service can deal with your problem, as close to home as possible; • Still provide you with an
immediate emergency response
if your problem is more serious, with direct links to the
999 ambulance service
, and the enhanced ability to book appointments at Emergency Centres.
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Highly responsive urgent care service close to home,
outside of hospital
•
Faster, convenient, enhanced service:
•
Same day, every day access
to general practitioners, primary care and community services • Harness the skills and accessibility of
community pharmacy
•
24/7 clinical decision-support
for GPs,
paramedics,
community teams from (hospital) specialists
– no decision in isolation
• Support the
co-location of community-based urgent care services
in
Urgent Care Centres
and Ambulatory Care centres. • Develop
999 ambulances
so they become
mobile urgent community treatment services
, not just urgent transport services
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Ambulance Services
•
Transport
Treatment
:
Community-based provider of mobile urgent and emergency healthcare
, fully integrated within Urgent Care Networks. Principles to underpin this transformation would include: • Emphasis on
supported treatment in community settings
•
Single consistent triage system, DoS and universal referral rights
• Successful “
hear and treat
” - closer integration with 111, timely access to relevant patient information and care plans,
support of interdisciplinary clinical hub
(current low 3.4% high 10%)
•
“see and treat”, inter-disciplinary working
across traditional organisational and professional boundaries, with guaranteed timely access to primary care, mental health provision, social care and
specialist clinical advice 24/7 (current low 27.4% high 51.5%)
•
Development of the ambulance workforce, education programmes
coupled with changes to organisational culture, will be essential to long-term success
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Urgent Care Centres
•
Community-based primary care facilities
providing access to urgent care for a local population. •
To encompass
Walk in Centres, Minor Injuries Units, “Darzi” Centres etc , including those currently designated as “Type 3 A&E Departments”. • A
consistent nomenclature
should be accompanied by a consistent service, so that patients are clear about what they can expect from all Urgent Care Centres • To achieve this it is suggested that
two important principles
underpin the development of Urgent Care Centres: • access to a
full range of urgent care services
•
24/7 access to the Urgent Care Network
Serious and life threatening conditions – expertise and facilities
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•
Two levels of hospital based emergency centres
•
Emergency Centres *
- capable of assessing and initiating treatment for all patients •
Specialist (Major) Emergency Centres*
- 40-70 larger units, capable of assessing and initiating treatment for all patients,
and
providing a range of specialist services (direct, transfer or bypass). •
Emergency Care Networks
•
Connecting all services
together into a
cohesive network
so the overall system becomes more than just the sum of its parts •
Operational and Strategic
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Urgent Care Networks
Networks would function at two levels : Operational Urgent Care Networks
would describe
local communities of clinicians (System Resilience Group)
who work together to achieve the best outcomes for patients within the urgent care system
Strategic Urgent Care Networks
would operate over large populations encompassing
specialist provision, all severity and complexity,
all relevant stakeholders to plan, oversee and monitor network performance
Conveyance / bypass / critical care transfers become central component of effective network
www.england.nhs.uk
Shape and structure of the new system and key constituent parts…
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Progress update
•
Continue to “build in public”
•
8 Work Programmes:
• • • • • • WHOLE SYSTEM PLANNING AND PAYMENT, COMMISSIONING AND ACCOUNTABILITY
PRIMARY CARE ACCESS – NHSE strategy 111 service specification and standards
DATA, INFORMATION AND CARE PLANNING
COMMUNITY PHARMACIES – Call for Action
EMERGENCY DEPARTMENTS and EMERGENCY CARE NETWORKS • • AMBULANCE TREATMENT SERVICE
WORKFORCE (HEE)
I T E R A T I V E
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Progress update
•
Implementation phase of the Review
: Aims to convert the work done so far into a national framework to guide commissioning of UEC services:
Update report
•
Delivery Group
own and describe the
key national products
from the Stage 1 Report
– primacy to out-of-hospital
• •
Regional roadshows June-Sept 2014
Working with
System Resilience Groups
,
CCG and NHSE Ops Teams
as they develop 2 and 5 year operational and strategic plans • Working through the
NHS Commissioning Assembly
to co-produce
commissioning guidance and specifications
(throughout 2014/15) •
Release guidance, standards and outcome metrics
for Commissioners regarding UEC Networks, centres, and
clinical models for Ambulance Services
(after 5 year Forward View)
www.england.nhs.uk
UECR: What – Big Tickets
www.england.nhs.uk
UECR: Big Tickets
3.1.1 Guidance on clinical models for treatment on scene by ambulance services 3.1.2 Develop a new single curriculum for Paramedics Best practice/case studies on how GP advice best accessed/can add value to ambulance and A&E
www.england.nhs.uk
UECR: Big Tickets
3.5.1 Provision of specialist hospital advice to other parts of the system 5.2.1 Deploy Summary Care Record Commissioning standards and procurement strategy for universal booking across the UEC system
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Consulting and testing
•
Design to Delivery:
• NHSIQ mapping support/pilots
testing ideas and models
(Integration Pioneers, PM Challenge, 111 pilots and 7DS early adopters) •
New Commissioning Standards for NHS 111
: • Clinician access to relevant patient’s medical and care information • Access and treat to specific care plan where available • Increased clinical advice to support call handlers • to book appointments with urgent or emergency care providers
Future payment options for UEC
•
Proposal suggests that the way forward could be a single, consistent payment approach for every type of service in the system, made up of 3 elements and linked to quality metrics and part of 3-5 year contracts
: •
Core capacity element:
substantial and fixed in year, to reflect the ‘always on’ nature of urgent and emergency care:
Facilities and service standards
•
Volume-based and variable,
to limit the impact of unpredictable fluctuations in demand on individual providers across the system;
Process measures – formative not summative
•
Incentives and sanctions
: Using provider-specific and system-wide quality metrics as eligibility criteria for different rates of fixed and volume-based funding, and as the basis for bonuses and penalties, to support service change and promote quality improvement:
Patient outcome measures (transfers of care, residence, PROMs) Patient safety and experience measures (mortality, SAEs, PREMs)
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So your future ……….
More support for “hear and treat” and “see and treat”
CLINICAL ADVICE HUB
, protocols, shared metrics, ambulance service paramedics as recipient and contributor Integrate or
better interoperability
of 111 and 999
Shared patient information/care
plans across all providers Universal
booking rights
into live Directory of Services
Access to community support
– primary care, falls services, mental health teams, community nurses, mental health team
Paramedics much greater role
in clinical advice, orchestrating community responses, in UCCs and EDs and for critical care transfers Ambulance services central to design of Strategic Urgent Care Networks
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Cochrane Database Systematic Rev. 2013 Mar
Helicopter emergency medical services for adults with major trauma.
Galvagno SM Jr 1 , Thomas S, Stephens C, Haut ER, Hirshon JM, Floccare D, Pronovost P.
Due to the methodological weakness of the available literature, an accurate composite estimate of the benefit of HEMS could not be determined. Although five of the nine multivariate regression studies indicated improved survival associated with HEMS, the remainder did not.
The question of which elements of HEMS may be beneficial for patients has not been fully answered.
Future work in this area should also examine the costs and safety of HEMS, since multiple contextual determinants must be considered when evaluating the effects of HEMS for adults with major trauma.
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The challenges fed back to us
1.
Payment system reform and incentives
(QP and nCQUINs)
2.
Information sharing
3.
Workforce and skills shift
4.
New models of primary care
Urgent and Emergency Care Review
It’s like everyone knows all about me I’m alive cos I had specialist care really fast Its great to share and learn so much with this group
Progress: DEFINITELY . . . . BUT ONLY THROUGH YOU
I feel so much better for not having to go all the way to hospital