Kent and Medway PTS Key Process Flows – V1.0 dated 27 May 16

For all routine updates on Patient Transport please use CLERIC on-line or speak to your relevant G4S point of contact - Please refer to the relationship maps on pages 10 – 15 for further details

For further guidance on our feedback process please refer to Page 20

Methods -

Email - km.pts1@nhs.netPhone – 0800 096 0211

Web - www.km-pts.co.ukIn Person - Speak directly to your G4S on-site team or relevant Area Manager

For further escalation please follow one of the below escalation processes

1. Service Specification Failure Escalation Process – Page 162. Clinical Dispute Process – Page 18

3. Out of Contractual Scope Dispute Escalation - Page 19

To book transport please use our CLERIC on-line booking system via www.KM-PTS.co.uk/NHS or phone 0800 096 0211.

On-line booking is quicker, allow you to track the progress of the crew allocated to the journey and will allow you to provide near live-time updates to patients

For further booking guidance please refer to -

1. Booking process for patients with higher medical needs that basic PTS – Page 3 2. Booking process for people identified with Mental Health needs - Page 5

3. Guidance for Community Healthcare Providers – Page 64. Guidance for London Trusts / Bromley and Bexley CCG’s – Page 8

Please also note that Cardiac, Neo-natal Intensive Care Unit (NICU) and Children’s Acute Transfer Service (CATS) journeys are out of the scope of this contract and should be booked through the relevant Service Providers

Please make sure you have the following details –

Patient details (remembering patient confidentiality rules)Journey details – to/from locations, time of pick up

Details of any concerns

Giving Service Feedback

Escalation

Booking Guidance

Ref & Journey type Required standardNotice required prior to scheduled

arrival/booked ready time

Performance reporting

threshold

1a - Journey booked in advance - Outpatient arrival.

Patients to arrive on time and no more than 75 minutes

prior to their appointment time 0r no more than 60 minutes

if it is the first appointment of the day for that clinic

n/a 95%

1b - Journey booked in advance - Time bound Haematology-

oncology patients that are receiving IV chemotherapy and

children outpatient arrival.

Patient to arrive within 15 minutes of their scheduled

appointment timen/a 95%

1g - Outpatient return journey - All bookings.Return Journey patients to be collected within 60 minutes

of the identified booked ready time

Booking to be made when booking

inward journey85%

2a - Journey booked in advance - Discharge.Patients to be transported within 60 minutes of the

identified booked ready timen/a 95%

2b - Journey booked on the day - Discharges.Patients to be transported within 120 minutes of the

identified booked ready timen/a 90%

2c - Journey booked on the day - Time bound discharge - care

package.

Patients to arrive within 15 minutes of the identified

required arrival time4 hours 95%

2d - Journey booked in advance - Time bound discharge - care

package.

Patients to arrive within 15 minutes of the identified

required arrival timen/a 95%

3a - Journey booked in advance - Transfer of care.Patients to be transported within 60 minutes of the

identified booked ready timen/a 90%

Outpatients

Discharges

Transfers

Kent and Medway KPIs

Standard NEPTS

Renal PTS

Ref & Journey type Required standardPerformance reporting

threshold

1a - Arrival time Patients to arrive on time and no more than 15 minutes prior to

or later than their scheduled appointment 95%

1b - Return journey. Return Journey patients to be collected within 30 minutes of the

identified booked ready time. 95%

1c - On the day bookings and

transfers.

Patients to be collected within 15 minutes of booked ready time

(requires 2 hours’ notice of booked ready time)95%

Section 1 Patient journeys

Page 2

Kent and Medway Intermediate Tier Transport

Does the patient require continuous care or a clinical intervention on the

journey?

Is an appropriately trained escort available -

1. Trained HCP 2. Competent carer

3. Competently trained parent

SECAmb to transfer patient – Call Booking line 0300 200 1067

No

Yes

Yes

Risk assessment by trust clinician required before further analysis can

be undertaken

No

No

No

Yes

This flow is for patients who have higher medical needs than standard PTS transport

No

Yes

No

Has a risk assessment been carried out and documented by a

competent medical clinician?

Is the patient assessed as being at Level 2/3 ?

Is the patient in, or expected to go into, active labour within 12 hours

Is it likely that the patient will need to travel under ‘blue lights ‘

at any point of the journey

Has the patient been declared stable and likely to stay so for the

duration of the journey by a medical clinician?

Yes

No

Yes

Yes

G4S to confirm level of crews based on following criteria

(see next page)

Trust to provide appropriately

trained escort or alternative PTS

provider

No

Page 3

Kent and Medway – Minimum Level of Transport to be booked

Page 4

PTS Level 0PTS Level 0 +

Escort

Intermediate Tier

CrewIntermediate Tier Crew + Escort

Venflon - no fluids

Urine catheter

low rate O2 below 28%

Subcutaneous Syringe driver

FracturesWill require risk assessment

from clinician prior to

patient being moved

High rate O2 above 28% over 4Ltrs

Intravenous Syringe pump

Basic ECG monitoring

Chest drain

IV running

Tracheal Suction

Oro pharyngeal suction required

Minimum level of transport to be booked

Remarks

Patients with mental health needs booking process

Is the booker aware of the patients mental

health history?

Has the patient been risk assessed by a clinician?

Is the patient at risk of absconding or self harm?

Will the patient be under the influence of drugs or alcohol at the

time of being collected?

Is a medical escort (i.e nurse / HCA / Doctor) travelling with the

patient?

Will the patient travel under medication /

sedation?

Yes

Yes

No

Will the patient travel with medication / sedation?

No

Is the medical escort fully aware of the patients condition, fully briefed and competent to deal with the patient?

Does the patient self-medicate?

Yes

No

Yes

No

Yes

No

Yes

Yes

Yes

No

NoRequirement to review patients history before

continuing with booking

Trust to provide fully briefed and competent escort or provide own

transport.

Requirement for patient to be assessed before continuing

with booking No

Yes

This flow chart is to support patients with a mental health condition that may put themselves, or G4S staff at risk, during a journey or who may require additional support

G4S Move PatientG4S move patient

with Trust provided escort

Page 5

Community Healthcare Setting

Journeys in scope

· Kent and Medway registered patients going to, or from, NHS funded medical treatment outside of any Primary Care appointments. This includes -

· Patients going to a step down bed in a hospice / care homes

· End of life journeys

· Patients in receipt of continuing healthcare funding

Please note that the actual Point of Care is less relevant than the treatment being provided

Journeys NOT in scope

· Patients going to, or coming from, a primary care appointment

· Patients going to, or coming from, care homes / hospices for non-clinical treatment

· Patients going to, or coming from, care homes / hospices for medical treatment not funded by the NHS

· Patients undergoing private treatment

· Patients that are not registered with a Kent or Medway GP

Page 6

Adding a PoC should not delay transport and therefore this process should be completed within 24 hours.

Should the PoC not be already in our CLERIC booking system then the booking will need to be taken over phone by our booking centre

This process flow for adding locations to the agreed PoC list

PoC not available on on-line booking system

HCP required to call booking call centre to book appointment

Is the appointment an on-the-day journey?

G4S Call centre will complete booking and allocate as pending until PoC is

confirmed

G4S to speak to relevant CCG & CSU to confirm if PoC is a commissioned

secondary care service

Was CCG / CSU contactable

G4S Move PatientAnd review with

CCG / CSU as soon as possible

Was PoC confirmed

G4S move patientAnd PoC added to

approved list

Yes

No

G4S to speak to relevant CCG to confirm if PoC is a commissioned

secondary care service

No

Yes

Yes

No

G4S advises requesting party that transport is not available and

signposts to other travel options

HCP / Patient phones booking line

Adding new Points of Care (PoC)

Page 7

Guidance for London Trusts

Definition of a Kent and Medway Patients

Patients who reside in Kent and Medway and are registered with a Kent, Medway GP

Patients who reside in Kent and Medway and are not registered with a GP

Patients who do not reside in Kent and Medway but are registered with a GP within Kent and Medway

Patients who do not have a registered address or GP and wish to be transported to an address within Kent or

Medway where they are considered “usually resident” following the “who pays” NHS guidance

This will mean that patients will be registered under one of the following CCG’s

Dartford Gravesham and Swanley Ashford

Canterbury & Coastal Swale

Medway

South Kent Coast Thanet

West Kent

Booking Guidance

If patients are booking their own transport they will be required to book via our booking line - 0800 096 0211

If HCPs are booking then they will also be able to book via our on-line booking portal - www.KM-PTS.co.uk/NHS

There will be the requirement to make patients ready after outpatient appointments, this can be done via the above

contact details

Our higher clinical needs booking process should be used to provide guidance if the clinical condition of the patient can

be supported by G4S trained crews.

Our escalation and complaints processes are highlighted in this pack and will be the same for K&M patients travelling in

and out of the London Trusts

Bromley and Bexley CCG’s

Bromley and Bexley Patients who have appointments within Kent and Medway Trusts will be eligible to apply for the

service. For guidance this includes the following Trusts / Hospital sites –

Dartford and Gravesham Trust

Medway Foundation Trust

East Kent Hospitals University Foundation Trust

Maidstone and Tunbridge Wells NHS Trust

Medway NHS Foundation Trust

Medway Community Healthcare (MCH)

Kent and Medway Partnership Trust (KMPT)

Kent Community Health NHS Foundation Trust

Page 8

Maidstone and

Tunbridge Wells Trust

Medway Foundation Trust

Kent Community

Health Trust

East Kent Hospitals

University Trust

Kent and Medway Partnership Trust

Area Manager –

West

Area Manager – East

Area Manager - South East London

Renal Area Manager

EKHUFT (Renal)

Kings Trust (Renal)

GSST (Renal)

Dartford and

Gravesham Hospital Trust

London Trust (Outpatients and

Discharges)

Medway

Community Healthcare

Lot 1 – K&M General PTS

Lot 2 – Renal PTS

Lot 3 – DGHT General PTS

G4S Management Trust / Point of Care Relationship Owners

Individual Points of Care List to Follow

Trust Senior Relationship Owner

Point of Care Breakdown

Page 9

1. Operational Relationship Map – Kent and Medway Acute Sites (0800 to 1900)

Ward Staff

Site Controller

QEQM - phone numberK&C – phone number

William Harvey – phone numberMedway Maritime - phone number

Maidstone – phone numberTunbridge Wells - phone number

G4S Day Control

Site Operations Team Ops and Control Manager

On Call Director Assistant Site Director

G4S Area Manager East / West Kent

email Ops and Control Manager

Service Delivery Manager

MFT - phone number / emailQEQM – phone number / email

K&C – phone number / emailWilliam Harvey – phone number / email

MTW – phone number / email

Trust Management

Level 1

Level 3

Level 2

Page 10

2. Operational Relationship Map – Community / Mental Health Points of Care (0800 to 1900)

Ward / Clinical / Support Staff

G4S Day Controlphone number

Appropriate Manager

Appropriate Senior Manager

G4S Area Manager East / West Kent

emailOps and Control Manager

Ops and Control Manager

Service Delivery Manager

MTW – phone number / emailQEQM – phone number / email

K&C – phone number / emailWilliam Harvey – phone number / email

MFT - phone number / email

Trust Management

Level 1

Level 3

Level 2

Page 11

3. Operational Relationship Map – Renal (0800 to 1900)

Ward Staff

Site Controller

Tunbridge - Phone NumberDartford – Phone Number

K&C – Phone Number

G4S Day Control

Site Operations Team Ops and Control Manager

On Call Director Assistant Site Director

Renal Area Manageremail

Trust Management

Level 1

Level 3

Level 2

Page 12

Operational Relationship Map – DGT (0800 to 1900)

Ward Staff

Site Controller

DVH Site Controller Phone Number

G4S Day Control

Site Operations Team Ops and Control Manager

On Call Director Assistant Site Director

DGT SDMPhone Number / Email

Trust Management

DVH Area ManagerTom Maidman

Ops and Control Manager

Level 1

Level 3

Level 2

Page 13

Operational Relationship Map – London Trusts (Discharges and Outpatient Appointments)(0800 to 1900)

Ward Staff G4S Day Controlphone number

Appropriate On-site Manager

Appropriate Senior Manager

G4S Area Manager West Ops and Control Manager

Trust Management

Level 1

Level 3

Level 2

Page 14

Operational Relationship Map – Out of Hours (1900 – 0800)

Ward Staff Out of Hours Control

0800 0960211

Appropriate Duty Manager Duty Senior Manager

Duty SDM / TL

Out of Hours Control0800 0960211

Trust Management

Level 1 / 2

Level 3

Page 15

Escalation Process – Failure to meet Service Specifications

Are G4S in breech of the defined KPI Service Standards?

Has the situation been resolved to an acceptable level for the

patient / HCP?

G4S to ensure patient is informed about new collection time. KPI Failure logged for trend analysis and review

Review of resources undertaken by G4S in consultation with

Patient / HCP

Yes

No

Patient informed that issue is still being resolved

Has the situation been resolved to an acceptable level for the

patient / HCP?

G4S to ensure patient is informed about new collection time. KPI failure recorded for trend analysis and review

Yes

Level 1 Escalation

Level 2 EscalationG4S management review of

resources undertaken

No

Patient informed that issue is still being resolved

Has the situation been resolved to an acceptable level for the

patient / HCP?

G4S to ensure patient is informed about new collection time. KPI failure recorded for trend analysis and review

Yes

Level 3 Escalation

G4S senior management review of resources

undertaken

No

Able to request below additional

resources from control –

1. Cross allocation from other K&M Lots

2. G4S Central Team

3. Support from other G4S Contracts

Able to review resources allocated to Lot

Able to authorise -

1. Staff Overtime

2. 3rd

Party / Sub-contractors

Patient prioritised as HIGH PRIORITY and transported via trust organised 3rd Party

Issue raised to Ops Director to consider invoking BCP

SI raised to CCG within 24 hours

Will delay in journey put patients safety or clinical condition at serious risk?

Yes

No

Page 16

Escalation Process – Failure to meet Service Specifications

Priority 1 Patients - to reach level 3 escalation within 1 hour

· Renal Patients · Haematology-oncology patients that are receiving IV chemotherapy· Transport of Children· End of Life Transfers · The discharge of patients home where a time bound care package is required

Priority 2 Patients - to reach level 3 escalation within 2 hours

· Discharges· Transfers for care · Transport of patients requiring admission to an inpatient mental health unit

Priority 3 Patients - to reach level 3 escalation within 4 hours

· Outpatient appointments

Page 17

Clinical Dispute Process

Following the G4S booking process the patient journey has been identified as not being a level 0 / level 1 patient, therefore not in-scope for G4S.

In order to avoid delays in patient transport this process should be completed within 1 hour of the booking being

made

Has the situation been resolved and the appropriate Service

Provider Identified?

Appropriate Service Provider moves patient

Case reviewed by Clinical Manager for any lessons learnt

SECAmb to contact G4S to conduct an internal review the clinical

booking process

Yes

Level 1 Escalation

Has SECAmb already rejected the journey

because of the patients clinical status ?

Yes

Signpost to SECAmb booking line - 0300 200

1067

G4S Site Controllers / Day Control will not be able

to make clinical decision but will review against the

agreed guidelines

No

No

Has the situation been resolved and the appropriate Service

Provider Identified?

Appropriate Service Provider moves patient

Case reviewed by Clinical Manager for any lessons learnt

Review the clinical status of the patient conducted between –

G4S SDM G4S Clinical Governance Manager

Trust Clinician

SECAmb EOC – 01622 740400

Yes

Decision to be agreed on which service provider is

responsible for the clinical needs of the patient.

This should not factor in available resources

No

Level 2 Escalation

SECAmb move patient as default

CCG informed and review of decision undertaken at next contract performance meeting

Page 18

Escalation Process – Journey Out of Contractual Scope

Patient journey has been identified as being outside of the agreed Service Specification

Eligibility Review to be undertaken –

G4S Call Centre Manager HCP / Patient

Was it because the patient was not going to, or coming from, NHS funded medical

treatment*

Yes

G4S Move PatientReview undertaken and

any training gaps identified

Patient / HCP sign posted to alternative providers

Was it due to patient failing eligibility?

Did Review change decision?

Yes

Yes

No

No

YesRefer to Adding points of

care flow diagram (Page 7)

No

Was it because the patient was not a Kent and

Medway Patient

* - Excludes Primary Care

^ - G4S will ensure that reasonable attempts have been made to contact the relevant CCG for authorisation

Yes

Was it because the patient is an out of area

repatriation?

Patient / HCP signposted to alternative provider

No

Yes

Patient / HCP signposted to

alternative provider

Can the patient be moved with out impacting the core

service? No

Yes

G4S to seek authorisation from paying CCG

Has patients CCG agreed to pay for journey?

Yes

G4S Move Patient

No

Patient / HCP signposted to

alternative provider

Was the relevant CCG contactable?^

No

K&M CCG underwrite journeyG4S move Patient

Yes

Is it a Discharge Journey?

Patient / HCP signposted to

alternative provider

No

Yes

Page 19

Patients / HCP want to provide feedback directly to G4S

Initial Investigation carried out within 10 working days

Details captured in

Info-Exchange

G4S Complaints Team informed and allocate

feedback as – Complaint Concern

Compliment

Email – Km.Pts1@nhs.net

Phone – 0800 960 211

Written - Kent and Medway PTS Contract, Swift House, 18

Hoffmanns Way, Chelmsford, Essex, CM1 1GU

Via Web – www.km-pts.co.uk

No YesIs the feedback a formal complaint?

Feedback presented to patient / HCP

Relevant SDM / Area Manager

Informed

Is the incident a safeguarding or SUI? Yes

SUI / safeguarding

process instigated

No

Investigation undertaken Trust

PALS team and CQC informed

Info-Exchange assigns the

investigating Officer

1. Patient Updated 2. Incident closed

3. Root Cause Analysis conducted

Patients / HCP updated every 5 days

Are PALS team happy with outcome Yes

No

Initial Investigation carried out within 7 working days

Details captured in

Info-Exchange

Info-Exchange informs the

relevant SDM

Local Investigation Undertaken

Feedback Process

Is the feedback a concern?

Yes

Is the feedback a compliment?

Yes

No

Details captured in

Info-Exchange

Relevant Crews and SDM informed

Reviewed for best practice and

circulated internally

Longer Term trend and root cause analysis

conducted

Page 20