PPT presentation template V108'ppt

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Commissioning of urgent care services in
polyclinics
Sue Dutch and Keith Ellis, Unscheduled Care
Project, HfL
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The London Commissioning Group has endorsed a new
delivery model for unscheduled care which was
developed during the first phase of the HfL
Unscheduled Care Project

• The model takes a tiered approach which
  encompasses three broad responses to patients
  unscheduled care needs
• Rapid/moderate
• Urgent
• Emergency.

• The new delivery model was developed based on
• An in-depth examination of unscheduled care
  systems in six PCTs across London
• Extensive consultation with stakeholders
• A review of the Consulting the Capital
  responses, key policy and literature.

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The current phase of the HfL Unscheduled Project
is focusing on supporting implementation of the
new delivery model
The deliverables of the current phase of the
project include

• A study of information and IT implications of
  the new delivery model
• A review of unscheduled care measures and
  metrics to identify measures that commissioners
  can use to assess the effective of the
  unscheduled care as a whole system
• Scoping of a pilot to test and evaluate
  integrated call handling and a single point of
  telephone access

• Good practice and case studies to support
  commissioning of unscheduled care services
• A service model for urgent care centres at the
  front end of emergency departments in hospitals
  and guidance for PCTs on commissioning the
  service model
• Guidance on governance arrangements for urgent
  care services across primary and secondary care
  in terms of the relationship between emergency
  departments, urgent care centres and polyclinics

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The new delivery model envisages the same range
of urgent care services being delivered in
hospitals and in polyclinics centres

• Key features of the urgent tier of the new
  delivery model include
• commissioning of urgent care centres (UCCs) at
  the front end of all emergency departments to
  provide an improved and focused response to
  people who attend with primary and urgent care
  needs UCCs will be staffed by
  multi-disciplinary teams including GPs, nurses
  and emergency practitioners including staff
  skilled in dealing with maternity, substance
  misuse and mental health problems
• commissioning the same range of urgent care
  services in polyclinic centres - it is envisaged
  these will networked to UCCs
• prompt and extended access to diagnostics and
  dispensing.

• The aims of commissioning urgent care services
  both in hospitals and in polyclinic centres are
  to
• significantly improve the journey for patients
  with as few steps as possible to definitive care
• provide greater consistency in service delivery
  and response to patients needs across access
  points
• reduce inequalities through better access
• deliver care closer to home
• address rising demand
• enable greater integration (between primary and
  secondary care and health and social care).

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An overview of the service delivery model
envisaged for urgent care services delivered by
urgent care centres and polyclinic centres
Specific UCC features
Specific polyclinic centres features
Common features of the service delivery model for
UCCs and polyclinic centres
Access Services will be provided to registered
and non-registered patients who self-refer and
who are referred by other health professionals.
LAS will stream patients and bring them to UCCs
or polyclinic centres where appropriate.
Urgent care services will be provided for a
minimum of 12 hours a day, 365 days a year
UCCs will operate 24/7
Streaming Patients will be streamed within five
minutes of arrival by an appropriately skilled
clinician. If necessary, patients will be
directed to an emergency department
Patients will be transferred by ambulance if they
are streamed to an emergency department
UCCs will be integrated with emergency departments
GP registration Patients will be able to register
with a local GP practice or the polyclinic centre
if they are not currently registered
Assessment and treatment Services will be
provided to treat any illness or injury that does
not require intensive or specialist care
including wound stitching and plastering.
Treatment will also include health and wellbeing
advice and, where appropriate, direction to
community services available locally.
Diagnostics Access to diagnostics including
x-rays, blood tests and electrocardiographs and
results available in lt4 hours
Patients will be able to be booked directly into
appointments for service delivered by the
polyclinic to address any ongoing needs including
follow-up appointments Where patients are
registered with the polyclinic centre or a GP
practice networked to the polyclinic centre, it
is envisaged that direct referrals will be able
to be made to specialist services to address any
ongoing needs. If a patient is registered
elsewhere, a recommendation will be made to the
patients GP where it is considered a referral to
a specialist service for an ongoing need may be
appropriate.

• Referral to specialist services
• Patients will be referred, where appropriate, to
  specialist services to address further immediate
  needs including
• community health services that may enable an
  admission to be avoided
• mental health and substance misuse teams
• Patients will also be directed to community
  services into which they can self-refer where
  appropriate

UCCs will make recommendations to a patients GP
where it is considered a referral to a specialist
service for an ongoing need may be appropriate.
Dispensing Dispensing services will be available
on site during the operating hours of the urgent
care services
Communication of episode of care A summary of the
episode of care will be sent to the patients GP
and a printed summary provided to the patient.
Polyclinics will advise their local UCC where it
is likely that a patient may present at the UCC
overnight.
Clinical governance and networking Clinical
governance arrangements will be established
across urgent care service provided in hospitals
and polyclinics so that all urgent care services
are networked to an emergency department for
professional support, clinical supervision,
training and advice on standard setting and
outcome measurement. Mechanisms will be
established to ensure consistency of approach
across UCCs and polyclinics including staffing
rotations, joint training and the use of common
protocols.
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Key features of service delivery model envisaged
for urgent care services delivered by polyclinic
centres

• Referral to specialist services - Patients will
  be referred, where appropriate, to specialist
  services to address further immediate needs
  including community health services and mental
  health services. Where patients are registered
  with the polyclinic centre or a GP Practice
  networked to the polyclinic centre, direct
  referrals will be able to be made to specialist
  services to address any ongoing needs.
• Clinical governance and networking - Clinical
  governance arrangements will be established
  across urgent care service provided in hospitals
  and polyclinics so that all urgent care services
  are networked to an emergency department for
  professional support, clinical supervision,
  training and advice on standard setting and
  outcome measurement. Mechanisms will be
  established to ensure consistency of approach
  across UCCs and polyclinics including staffing
  rotations, joint training and the use of common
  protocols.

• Access - Urgent care services will be provided
  to both registered and non-registered patients
  for a minimum of 12 hours a day, 365 days a year
• Streaming - Patients will be streamed within
  five minutes of arrival by an appropriately
  skilled clinician and transferred to an emergency
  department where necessary
• Assessment and treatment - Urgent care services
  will be provided to address any illness or injury
  needs that do not require intensive or specialist
  care including wound stitching and plastering
• Diagnostics - Diagnostics including x-rays,
  blood tests and electrocardiographs will be
  provided
• Dispensing - Dispensing services will be
  available during the operating hours of the
  urgent care provision

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Scenarios illustrating the service delivery model
for urgent care services envisaged for polyclinics
Scenario 1 - Molly is 82 and registered with a GP
practice networked to her local polyclinic
centre. She has a fall on a Thursday morning and
is found by her neighbour who calls an ambulance.
As the ambulance crew assess Molly as not
critical, they bring her to her local polyclinic
centre. Within five minutes of arrival, Molly is
seen by a nurse who assesses Molly as being a
little muddled but not at risk. The nurses
assessment confirms that Molly does not need to
be taken to the emergency department and advises
Molly that some tests will be taken and she will
will be seen shortly. Molly has blood tests
which come back fine and a urine test which
confirms an infection. Molly is seen by a GP who
provides a prescription which Molly is able to
pick up at the dispensary within the polyclinic
centre. The GP also alerts the community health
rapid response team who agree to review Molly
later that afternoon and the social care rapid
response team. The GP also suggests Molly
considers joining the active older person group
at the polyclinic for ongoing social support and
gentle exercise. Molly is provided with a
written summary of the episode of care. Mollys
GP is notified of the episode of care including
the suggestion that Molly joins the active older
person group at the polyclinic centre. The
community rapid response team visit Molly at home
later that afternoon to check Molly is drinking,
that her observations are stable and she is
taking her antibiotics correctly. They update
Mollys GP following the visit. The social care
team allocate a short term carer who visits that
evening to help Molly to bed and help with her
personal care. Mollys GP visits the following
day, reviews her medication and decides to stop
some of her regular tables which may have
contributed to the fall and possibly her mild
confusion. Molly is also given advice about
recognising urinary tract infections. The
community health team continue to visit daily
until Molly has made a full recovery. After
making a full recovery, Molly joins the active
older person group at the polyclinic.
Scenario 2 Michael is 42 and registered with a
GP practice that is not networked to his local
polyclinic centre. Washing up on Saturday
morning, Michael smashes a wine glass, cuts his
hand and thinks he might need stitches. Michael
has heard from a friend that his local polyclinic
centre which is within walking distance of his
house deals with minor injuries and the waiting
times are usually short. Within five minutes of
arrival at polyclinic centre, Michael is seen by
a GP who advises Michael should have an x-ray to
check there is no glass in the wound. After
waiting twenty minutes, Michael has his x-ray
done at the polyclinic centre. After a further
twenty minutes, Michael is seen by an emergency
nurse practitioner who confirms there is no glass
in the wound and stitches the wound. Michael is
provided with a written summary of the episode of
care including advice on wound care and advice
for his GP Practice nurse on removal of the
stitching. Michaels GP is notified of the
episode of care.
Scenario 3 Ivana is a 26 year old woman from
the Balkans who has been in London for 18 months
sometimes living with families to look after
children, sometimes staying with friends. She has
never been in one area for more than 6 months.
She has previously been told by friends that she
can not register with a GP because she does not
have sufficient residency qualification.
Previously when Ivana has been ill she has gone
to various AE departments but often feels that
her presence is not welcomed. She usually
attends AE with a stuffy nose and is normally
given antibiotics. Ivana is advised by a friend
that there is now a polyclinic centre near where
she is currently living where she can go for
treatment where appointments are not required and
you do not need to be registered with a GP. When
Ivana attends the polyclinic centre, within five
minutes of arrival she is seen by a nurse who
advise she will be seen by a GP shortly. She is
registered with the polyclinic centres GP
Practice and advised that she can continue to go
there even if she moves. The GP diagnoses
Ivanas illness as viral and suspects she may
have asthma. Ivana is given an appointment with
the polyclinic centres respiratory nurse to
assess her asthma and goes home without any
further treatment. Ivana is provided with a
written summary of the episode of care.
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Workshop questions