VIEWS: 3 PAGES: 19 POSTED ON: 1/30/2011
Urgent Care in Gateshead: Direction of Travel December 2006 Contents 1. Summary 2. Introduction Definition of Urgent Care What do People want from an Urgent Care Service? Purpose of this document 3. Principles for Urgent Care The NHS North East Vision, National Urgent Care principles How these will be delivered in Gateshead 4. Context The health status of the Gateshead population Working in Partnership What this strategy needs to include 5. Twenty-first Century Urgent Care Assessing the Level of Urgency of Care Provding the Right Response An Integrated Approach Within and Between Health and Social Care 6. What does this Mean for Patients in Gateshead? Care in the Home Community Based Services Hospital Based Services Specialist Centres 7. Where Are We Now? 8. Evaluation 9. What do we do Next? 10. Appendices Glossary of Terms Bibliography -1- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc 1. Summary This paper begins a discussion about developing and enhancing urgent care services for the people of Gateshead. It begins with a definition of what we mean by urgent care and some of the principles that apply to urgent care services. The document is structured as follows: Section 2 – provides a definition of urgent care and describes the purpose of this document, building on feedback from local discussions about future health services. Section 3 – focuses upon the aims and principles for urgent care and commissioning urgent care services. Section 4 – looks at the health of people in Gateshead, working with partners and the public and patients and the areas this work will need to cover. Section 5 – begins to describe, at a high level, how services might be provide, including the importance of ensuring robust assessment of need and working with other agencies, especially social care. Section 6 – develops this further with some ideas about how care could be provided in different settings appropriate to patient and carer need. Sections 7, 8 & 9 – look forward to what needs to be done next to make progress with developing plans for urgent care in Gateshead. One of the key aims of this document is to seek your views on the suggested direction of travel. Any comments, suggestions or questions you have about this document will be gratefully received by ???? 2. Introduction 2.1 What do we mean by urgent care? Urgent care is the range of responses that health and care services provide to people who require – or who perceive the need for – urgent advice, care, treatment or diagnosis. People using services and carers should expect 24 / 7 consistent and rigorous assessment of the urgency of their care need and an appropriate and prompt response to that need. Direction of Travel for Urgent Care, October 2006 -2- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc 2.2 What do people want from an urgent care service? We know from local discussions as part of Your Health, Your Care, Your Say that people want: To ensure services are available when, where and from whom they want them To be able to self refer to some services Adequate information about the health services available to them and how to access them To make sure that different agencies providing services are “joined up” Services to be provided conveniently including more services being provided in the local community 2.3 Purpose of this paper This paper aims to set out a strategic framework, or medium to long term view of how urgent care services should be developed for the future in Gateshead. It necessarily takes a high level, aspirational view for discussion, which once agreed will provide a guide to developing urgent care services over the next five to ten years. The paper begins to focus on what is required, building on previous work undertaken by a number of partner organisations, but deliberately does not look at who should or will provide services. This will be part of later work to commission urgent care services. While the long term focus should and will be on preventing serious illness and injury and improving the management of long term conditions, the aim of this work is to provide a service which will manage the health and social care needs of people requiring urgent access in Gateshead. While this is the case, it still needs to ensure that every opportunity is taken to make every patient contact an opportunity to promote good health. The strategy will need to ensure consistent quality and response regardless of where care is sought or by whom it is provided and will need to link to work already underway to improve health and social care services for people requiring planned care and those who have long term conditions. Other than dealing with urgent cases of acute exacerbation of these conditions, this paper does not cover these areas. 3. Principles for urgent care In considering principles for urgent care, the seven vision aims for NHS North East should be addressed. These were developed in collaboration with service users, providers and commissioners across the NHS North East area, which runs from Redcar and Middlesbrough in the south to the Scottish border and west to the Cumbrian border. -3- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc In addition the national consultation document Direction of Travel for Urgent Care: a discussion document (October 2006) sets out six principles which will also need to considered in the development be used to inform the development of urgent care in Gateshead. The work to deliver Urgent Care in Gateshead will be achieved by fulfilling the principles of urgent care set out in both the seven vision aims for NHS North East and the Direction of Travel for Urgent Care as illustrated below: NHS North East Vision Direction of Travel To be achieved in Aim for Urgent Care Gateshead by- principle No barriers to health and My voice as a service Providing access to wellbeing users or carer is information and services clearly heard and as locally as possible and acted on. ensuring that the voices of service users are clearly heard and acted on to develop and improve services. Empowering people to make informed decisions about their health and welfare via effective communication and education. No avoidable deaths, injury My safety is Ensuring the highest or illness paramount to standards of safety for everyone who cares everyone involved in for me urgent care. -4- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc No avoidable suffering or My safety is Monitoring and reviewing pain paramount to achievements of services everyone who cares against national targets, for me national and local quality requirements. Ensuring incidents and near missed are reported and acted on. Providing a responsive, consistent and high quality urgent care service delivered by a variety of health and social care staff with appropriate knowledge and skills Developing an integrated Clinical Governance framework that supports joint working and models of shared care No helplessness I know how to access Ensuring everyone knows services if I have an how to access services if urgent need they have an urgent need and that they are sign posted to an appropriate level of care following robust initial assessment. Development and implementation of a communication and engagement strategy to support Urgent Care in Gateshead. No unnecessary waiting or If I have an urgent Ensuring that anyone delays need I can access needing urgent care can care quickly and access it urgently and simply. simply through a single phone call where possible. Robust assessment, intervention and referral based on care needs. -5- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Providing distinct pathways for people with minor and major illness / injury to speed up their progress through the system. No waste The care I receive Ensuring that the care meets my needs provided meets individual appropriately, taking needs taking account of account of the the urgency and value for urgency and value money. for money. Acting on feedback from service users and providers to eliminate waste. Ensuring that duplication is minimised by providing integrated and seamless services, common communication and referral pathways and compatible IT systems No inequality I can rely on getting Delivering equity of access the right care to ensure that everyone (including support for can rely on getting the self-care), whenever right care (including I need it and whoever support for self care) I am. whenever it is needed, whoever they are. Ensuring that care is physically accessible and that barriers presented by language, ethnicity, physical or mental ability are addressed In addition, urgent care services in Gateshead will be commissioned and service specifications produced which fulfil the aims of: Equitable and needs based access to care -6- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Flexibility and ability to adapt and change Right time, right knowledge & skills, right place Care closer to home Services provided locally where possible Geographically and physically accessible services Supporting plurality and choice Co-location and shared use of facilities Providing high quality responsive services Regular monitoring and review with a philosophy of continuous improvement. 4. Context 4.1 The health status of the Gateshead population Some areas within Gateshead are disadvantaged in terms of people‟s health and access to health care. A necessary early piece of work will therefore be to undertake a health needs analysis to identify where and what resources are required to best ensure access to appropriate levels of health care. Gateshead has an above average aging population and the number of younger people is diminishing so there will be significant issues related to ongoing care and support for a relatively large percentage of older people. This will have an impact on health and social care services in terms of demand and capacity, increased acuity (which we are already seeing), longer lengths of stay in hospital and relatively higher financial and resource costs per capita. 4.2 Working in partnership The direction of travel set out within this document is consistent with national and local policy, which emphasises the need for organisations and disciplines to work together as part of a „whole system‟ to deliver integrated and seamless care with the support of a highly skilled and modernised workforce. There is a commitment in Gateshead to ensuring patient and public involvement in the development of new services, and public discussion will be included in the proposals for the development of a new cohesive model of urgent care in Gateshead. Gateshead‟s Urgent Care Network, which is developing and leading the delivery of the strategy, seeks to build stronger, more responsive and accessible local urgent care services supported by a strong, modern workforce with the appropriate knowledge and skills to deliver twenty first century urgent care. 4.3 What this strategy includes The strategy will need to include a focus upon the following areas: -7- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc A clearer divide between the response to major illness or injury and minor illness or injury by streaming of urgent care and the development of „walk in‟ or „without appointment‟ services in a variety of locations where patients can receive immediate attention Consideration of where and how care is best provided safely. Discussion of a range of models to suit the varying demographics and health needs of Gateshead‟s local populations Building on lessons learned in the Emergency Services Collaborative and Primary Care Collaborative and sharing best practice to reduce duplication, promote consistency and foster an inclusive and integrated approach. Increasing joined-up services between health and social care, the voluntary sector and other service providers. Improved referral and communication pathways to ensure that patients can quickly and easily access other services they need – irrespective of who provides it – without unnecessary delay, the need for onward referral or duplication of effort. This includes moving across organisational and professional boundaries. Integrated multi-agency care pathways for patients across primary and secondary care, health and social care and between disciplines Promoting greater flexibility amongst and between professional groups in responding to and providing urgent care by developing a minimum/core knowledge and skills set and a range of more specialised skills and competencies which reflect the Urgent Care Competency Framework. Establishing strong links with the community matrons, specialty teams and support the development of their role in reducing unplanned care episodes through case management and anticipatory care planning Developing links with intermediate care services working closely with community matrons, speciality healthcare professional teams and a range of urgent care and/or in-reach and out-reach Teams -8- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc 5. Twenty-first century urgent care In parallel to the national discussion paper Direction of Travel for Urgent Care the development of an urgent care system for Gateshead, which is and remains fit for purpose in the twenty first century, will need to deliver: a consistent and rigorous way of assessing the level of urgency a means of providing the right response to meet the need assessed. an integrated approach within and between health and social care 5.1 Consistent and rigorous way of assessing the level of urgency As illustrated above, there are many routes for people into urgent care, ranging in scale from self help and information from NHS Direct and self referral through to use of paramedics via the “999” service. As shown these can either be face to face or over the telephone. The key to simplifying this range of possible entry routes is to ensure that there is a single, consistent means of rigorously assessing the urgency of care need and moving the patient into the most appropriate level of care for their needs. This should be the focus of this work on urgent care, to develop a system of assessment which all service providers link into. There is potential for some, or all of this to be delivered via systems such as NHS Direct or NHS Pathways, -9- C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc which is currently being piloted in the North East by the North East Ambulance Trust. 5.2 Providing the right response to meet the need assessed As with any aspect of healthcare, various levels of care can be described based upon the severity of the illness and the location where care is ideally provided. For urgent care four levels can be considered ranging from minor illness or injury which can be managed either in the home with advice from NHS Direct, pharmacists or by an urgent care team through to very specialist urgent care in the case of, for example, a serious road traffic accident with multiple injuries or severe heart conditions requiring very specialist care. Specialist trauma A&E and Hospital Care Care in GP surgeries, Primary Care Centres, Walk in Centres Care in the home or close to home The levels of care described are not intended as a hierarchy through which patients would move after individual assessment at each level. In order to minimise delays in providing appropriate treatment, one of the key functions of assessment will be to sign post patients directly to the appropriate level of care for their needs. 5.3 An integrated approach within and between health and social care Services can only be improved by genuinely working with local people and partner agencies. At the heart of this work therefore is a continuing emphasis on listening to and acting upon the views of local people and professionals. The latter includes GPs and hospital consultant colleagues, practitioners working in emergency and urgent care, nursing staff, contractor professions such as pharmacists, optometrists and dentists, managers of services, colleagues within allied health professions such as physiotherapists and podiatrists and colleagues in other agencies such as Social Care and Health (formerly Social Services), the North East Ambulance Service and NHS Direct. - 10 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Through working with others we hope to achieve changes within the whole system of urgent care, which will mean that patients have better signposting and improved access to responsive services and will have quality outcomes and a better experience of using those services. This will be achieved by developing referral pathways and communications, including those between urgent care and planned care. 6. What does this mean to patients in Gateshead? Viewed from the patient‟s perspective, these levels of care suggest a range of services illustrated diagrammatically below and expanded upon in the following sections. Specialist trauma centres Hospital Based services Multiple trauma Accident & emergency Community based More serious Primary care centre services accidents Health Care in Centres Information the home Minor accidents Advice Urgent Mental health Dentists care Patient services team Out of Community mental hours health services Community matrons GP GPs Forensic mental Walk in Centres health Services Hospital Emergency Coronary Admissions Care Units Access to Cardiothoracic and neurosurgey 6.1 Care in the home - 11 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Care in the home will be delivered via: The development of urgent care teams to provide a response to urgent health and social care need 24 hours per day, every day of the year via nurse led assessment and interventions within the patient‟s home. Out of hours GP and dental services to meet urgent care needs. Diagnosis and treatment in the home by paramedics Using existing services such as NHS Direct and/or NHS Pathways to assess patients over the telephone. 6.2 Community based services Community based care will be delivered via: Assessing and caring for people with minor ailments or injury at a variety of locations including community pharmacies, optometrists, dentists, health centres and GP surgeries. Developing practitioners (i.e. GPs, nurses and other professionals such as physiotherapists) with a special interest in urgent care, sports and other minor injuries. Robust access routes for assessment and care of the most vulnerable e.g. patients living in nursing and residential homes and children who sustain an injury or become ill at school. Developing an interface with intermediate care services linking closely with Community Matrons, Speciality Teams and the range of urgent care and/or in-reach and out-reach teams Further development of walk-in-centres (or primary care / urgent care centres) to complement the existing facility in Bensham and which are situated across Gateshead to provide easy local access to integrated urgent care services for people with minor injuries and illnesses. These should be readily accessible by bus, Metro and car for those able to make their way to them. Potential locations for these will be evaluated and may be in western Gateshead and near the transport interchanges in the town centre and at Heworth and on the Queen Elizabeth II hospital site. Such centres could provide some diagnostic facilities such as simple pathology testing, ultrasound and x-ray facilities linked electronically to hospital sites and GP Practices to enable remote viewing of images and test results. - 12 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Exploring the potential to relocate some out patient/ambulatory clinics into a community setting and/or explore use of telemedicine to facilitate access to specialist opinion. 6.3 Hospital Based Services Hospital based care will be delivered via: A clearer divide between the assessment and management of „majors‟ and „minors‟ streams of urgent care within A&E. Seamless and integrated management of medical and surgical emergencies to provide a consist response and prioritised according to clinical need. Access to specialist urgent medical, surgical and mental health facilities including coronary care, intensive and high dependency units. GP and potentially primary care practitioner direct access to more specialised diagnostic tests and investigations, where this is appropriate, with the provisions of results reporting, interpretation of results and guidance on clinical management. Access to rapid response advice and guidance from Consultants and other secondary care clinicians via telephone and/or electronically to support management of patients in or close to their home. Development and implementation of urgent care referral pathways across health and social care. 6.4 Specialist Centres In a relatively small number of cases the patient‟s condition is of such severity or there is a need to provide rapid access to very specialised services, for example cardiac surgery, neurosurgery or forensics, which can only be safely and effectively provided in specialist centres where people with the required knowledge and skills are concentrated. These services will be available in centralised locations ensuring the necessary level of skills, knowledge, equipment and facilities are available. Where appropriate work will be undertaken with other agencies e.g. Northern Specialist Commissioning Group (NSCG) to ensure services are available. 7. Evaluation - 13 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Evaluation of the impact of this strategic framework will be important to understand its impact, monitor achievements and identify areas for further work. Evaluation will include: Patient experience of services and care provision to understand if the care received is in the right place, at the right time, beneficial and meets the principles set out in Section 3. Staff views and comments to identify their experiences of working within urgent care services and workforce issues. Stakeholder review to understand the local care communities‟ views and experiences of the impact of the strategy and its implementation. Achievement of national targets for example related to A&E and Walk in Centre waiting times and response times in GP Out of Hours service Monitoring against locally agreed targets, objectives and priorities to demonstrate achievement and identify where further work is needed. Review of activity and capacity across urgent care provision to understand if there are any shifts and changes as a result of implementation. Review of clinical quality of care provision against national and local quality requirements for example Standards for Better Health and where possible using existing clinical governance frameworks and processes. A detailed evaluation and monitoring framework will be developed to support implementation of Urgent Care in Gateshead: Direction of Travel. 8. Where are we now? In focusing on the future provision of urgent care, it important to recognise progress which has already been made towards the vision for urgent care services in Gateshead. While detailed work has been undertaken to map out and describe current services, it is not the intention of this document, which needs to look to the future development of services to repeat this. 9. What do we need to do next? - 14 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Test the high level model and principles described with a wider range of stakeholders including health and social care professionals, public and patients and partner organisations. This document is the beginning of this process. Develop an action plan which sets out the actions, who will lead on delivering these and the timescale for completion, recognising that there will be short, medium and long term actions. Continue to develop a standard, cross sector range of performance indicators. Use the National Workforce Competence Framework for Emergency, Urgent and Scheduled Care (May 2005) to develop, agree and deliver the range of knowledge and skills required to deliver twenty first century urgent care. Develop integrated care pathways including referral and access criteria including consideration of generic versus specific responses for e.g. children requiring urgent care. Develop information systems to support provision and monitoring of urgent care. Develop communications and engagement strategies to test out this work, develop it further and inform people of changes to pathways etc. Take advantage of opportunities, particularly around estates and premises which might enable quicker delivery of the strategy. Raise awareness of the general public about existing services and pathways and sign posting people to use services appropriate to their needs. Developing a marketing and communications plan for developing and implementing the urgent care strategy. Appendix 1: Glossary of Terms Used in This Document - 15 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Accident and Emergency Department (A&E) – based within a general hospital setting, A&E Departments offer specialist care to patients requiring healthcare attention for more serious ailments or injuries. Community Matron – nurses who support patients living with a long term health condition who frequently require healthcare, including hospital admission. Community Matrons play an important role in coordinating a patient’s care. They work with the patient and other professionals involved in their care, to develop and implement an anticipatory care plan. This means that proactive or planned healthcare is delivered to patients, which will hopefully minimise the need for emergency admission to hospital or emergency visits to the home. The aim is to improve the overall patient experience. Emergency Care – immediate healthcare required for a serious and / or life threatening health condition. Emergency Care Practitioner (ECP) – experienced nursing or paramedical staff with further specialist training, which enables them to manage patients requiring urgent or emergency healthcare for particular ailments or injuries. General Practitioner (GP) – Medically qualified primary healthcare professional with whom patients are generally registered. GPs are based in community based surgeries and offer a wide range of family health services. In Hours – during normal GP surgery opening hours i.e from 8.00am to 6.00pm weekdays. Excludes evenings, weekends and bank holidays. Integrated Services – joined up services, which enable patients to easily transfer between one service and another so accessing the care they need for their condition in a timely and coordinated fashion. Intermediate Care – short term care, usually up to 6 weeks. Intermediate care services aim to provide patients with an intensive period of support and / or active treatment which will help to prevent inappropriate admission to hospital, facilitate timely discharge from hospital or minimise the likelihood of long term dependence on health and / or social care services in the future. Minor Ailments and Injuries – less serious injuries or health conditions, which do not significantly affect the patient’s day to day functioning but would benefit from early healthcare attention. Moderate Ailments and Injuries – more serious than the above. The patient’s day to day functioning is affected by the condition although it is not life threatening. Out of Hours (OOH) – outside of usual GP Surgery opening hours i.e. evenings, weekends and bank holidays. Unscheduled Care – healthcare, which is unplanned or unexpected. - 16 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Patient and Public Involvement - involvement of members of the public in planning, developing or evaluating health services. Urgent Care – healthcare required for a minor to moderate health problem, which would benefit from early treatment but which is not usually life threatening. Urgent Care Centre (UCC) – provides assessment and treatment for minor through to moderate ailments and injuries. Walk In Centre – a centre, which patients can walk in to and receive treatment for their health condition without an appointment. - 17 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc Appendix 2: Key Documents The following documents herald significant change for the way urgent care is delivered : The NHS Plan – a plan for investment, a plan for reform, 2000 Raising Standards for Patients: New Partnerships in Out Of Hours Care. 3 Year Planning Guidance, 2001 Reforming Emergency Care Guidance, 2004 A Patient Led NHS – Implementing the NHS Improvement Plan, 2005 Commissioning a Patient Led NHS, 2005 Independence, Well Being and Choice: Our Vision for the Future of Social Care For Adults in England (Green Paper) March 2005 Our Health, Our Care, Our Say: A New Direction for Community Services, January 2006 - 18 - C:\Docstoc\Working\pdf\287a50a9-cd51-4dcc-85f6-fbb4461819ff.doc
"Appendix 2 - Urgent Care in Gateshead"