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Appendix 2 - Urgent Care in Gateshead

VIEWS: 3 PAGES: 19

									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




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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


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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.



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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.




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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.



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                                                      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


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         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:


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      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




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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,



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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.




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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


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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.


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         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


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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?


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      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



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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.



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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.




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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




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