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www.england.nhs.uk
Urgent and Emergency Care
Implementation of the Review
Keith Willett
Medical Director of Acute Care
NHS England
Inside Government 2016
www.england.nhs.uk
Medicine has changed …….. paramedics and GPs can
now do in the home or ambulance what, 10-15 years ago, we
did in A&E resuscitation rooms
Society has changed ….................... we have a ‘right
now society’ ……with very different expectations ……. and
that is technology savvy. ‘Let me live my life’ (control)
Our patients have changed …… an older
demographic, multiple age-related diseases, survive more
episodes of illness, frailty and dementia common
The NHS has changed little but ….
www.england.nhs.uk
UEC Review Vision
For those people with urgent but non-life
threatening needs:
• We must provide highly responsive,
effective and personalised services
outside of hospital, and
• Deliver care in or as close to people’s
homes as possible, minimising
disruption and inconvenience for
patients and their families
For those people with more serious or life
threatening emergency needs:
• We should ensure they are treated in
centres with the very best expertise and
facilities in order to maximise their
chances of survival and a good
recovery
Mental and physical health
Current provision of urgent and emergency care services
4
>100 million calls or visits to urgent and emergency services annually:
• 450 million health-related visits to pharmacies Self-care and self
management
• 24 million calls to NHS• urgent and emergency care telephone services
Telephone care
includes NHS 111
• 340 million consultations in general practice (2013/14)Face to face care
• 7 million emergency ambulance journeys999 services
• 16 million attendances at major / specialty A&E
• 5 million attendances at Minor Injury Units, Walk in Centres etc.A&E departments
• 5.4 million emergency admissions to England’s hospitals Emergency admissions
Provide care as convenient for the patient as complexity
of their illness allows, in the lowest acuity setting that is
appropriate, and at the lowest cost for the NHS
5
“CHANNEL SHIFT”
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UEC Review: arriving here
• Three phases to the programme 2013-15:
• Examined the challenges the UEC system faces, and what principles and objectives a new system should be based on COMPLETED
• Translation of ‘what’ needs to happen into ‘how’ these ideas can be operationalised COMPLETED
• NOW the final phase is focused on implementing those new models of care and ways of working
Phase 1
DESIGN
Jan – Oct 2013
Phase 2
PRODUCT
DELIVERY
Nov 13 – Dec 14
Phase 3 IMPLEMENTATION
Jan 15 – now
Helping people help themselves
Self care:
• Better and easily accessible information about self-treatment options
– patient and specialist groups, NHS111 on a digital platform
• Promote pharmacy access and patient group support
• Accelerated development of advance care planning, end of life care
7
‘Self-Care is what people do for themselves to
establish and maintain health, and to prevent and deal
with illness. It encompasses: hygiene (general and
personal), nutrition (type and quality of food), lifestyle
(sporting activities, leisure), environmental factors
(living conditions, social habits) socio-economic
factors (income level, cultural beliefs) and self-
medication.’
Helping people help themselves
• Right advice or
treatment first time
enhanced NHS111 the
“smart call” to make:• Improve patient information for call
responders (ESCR, care plan)
• Comprehensive Directory of
Services (mobile application)
• Greater levels of clinical input
(mental health, dental heath,
paramedic, pharmacist, GP)
‘decision support hub’
• Booking systems
GPs, UCCs, dentists, pharmacy
• Single point of access social care8
“Click, Call, Come In”
Future ‘Integrated Urgent Care’ service – ‘channel shifts’
Integrated Urgent Care
Patient calls NHS 111
NHS 111 Call-handler
CLINICAL ADVICE HUB
up to 60%
%Ambulance
%A&E
%Primary Care
%Dental/Pharm
% Other
%Homecare
7.9 %Information
Determining skill groups are required in the clinical hub GP, mental health nurse, pharmacist, dental nurse etc
More transfers to clinical hub:
- Complexity
- Streaming
- ‘Speak to GP’
Patient calls 999
999 Call-handler
Highly responsive urgent care service
close to home, outside of hospital
11
• Faster, convenient, enhanced service:
• Same day, every day access to general practice, primary care and
community services advice
• Harness the skills of community pharmacy in GPs, ED, UCCs, care
homes, minor ailment services
• Support the co-location of community-based urgent care services in
Urgent Care Centres and Ambulatory Care
• Develop 999 ambulances so they become mobile urgent community
treatment services, not just urgent transport services
• Ambulance response programme – needs based deployment
From life threatening to local – where
is the expertise and facilities?
12
• Identify and designate available services in hospital based emergency centres
• Urgent Care Centres – primary care, consistent, access to network
• Emergency Hospital Centres - capable of assessing and initiating
treatment for all patients
• Emergency Hospital Centres with specialist services - capable of
assessing and initiating treatment for all patients, and providing specialist
services: transfer or bypass access, 24/7 specialist network support
• Emergency Care Networks:
• Connecting all services together into a cohesive network
overall system becomes more than just the sum of its parts
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new offer; no consult in isolation
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Established 23 Urgent and Emergency
Care Networks – the purpose
• Based on geographies
required to give strategic
oversight of urgent and
emergency care on a regional
footprint
• 1 - 5million population based
on population rurality, local
services
To improve consistency of quality, access and set objectives for UEC by
bringing together STP/SRG members and other stakeholders to address
challenges that are greater than a single LHE can solve in isolation
Integrated (NHS 111 + OoH) service
Clinical decision support hub
Stocktake / designation
Access specialist services:STEMI, Stroke, Trauma, PICU, vascular
Four (of ten) 7DS standards
Developing of U&EC Network delivery plans 2016-2021
now aligned to the Strategic Transformational Plans
18
January February March April May June
2016/17 –
2020/21
planning
process
U&EC
delivery
plan
process
30
Submit full
STP
30
Submit final
delivery plan
Plan for
a plan
Draft delivery plan,
including 2016/17 year
one module
8
Submit plan
for a plan
11
Submit first draft
delivery plan with
year 1 (2016/17)
deliverables
Finalise detail of delivery
plan
12
Check and
Confirm
meeting
8
First
submission
of 2016/17
Operational
Plans
11
Final submission
of 2016/17
Operational Plans,
aligned with
contracts
Develop 2016/17 Operating
Plans and contractsDevelop full STP
7DS for networked 5 specialties: Stroke, STEMI, V Sx, Trauma, PICU
public and professional
Clinical hub 111, 999, OoH GPSPoA SC, information-sharing,
digital NHS111
2016
16-21
20% in
spring 201716-21
Autumn
2017
20% by
2017/18
Summary Care Record: Creating the records
• SCRs are an electronic record of
key information from the
patient’s GP practice
• As a minimum contain medication,
allergies and adverse reactions
• Enhanced Record option available
now for 96% GP practices, 73%
999 and 85% NHS111
> 2.5mcontacts in last
year
12 secs
To find out more or enable SCR: [email protected] or @NHSSCR
56mSCRs
created
(>97%)
www.hee.nhs.uk
UEC Workforce headlines
• Emergency Medicine up to full recruitment 2015/16 (75+ yr)
• £1.2m PEEP investment in paramedics – 2000 grads by 2020
• Transforming Emergency Care workforce ACPs, PAs
• Pharmacists in GP, ED, Care homes, Clinical advice hub
• 111 workforce development, competences, progression
• Physicians Associates: 4 Universities 150, 1000 by 2020
• 53 Trusts ED Pharmacy team projects
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Outcomes, standards and specifications
• Shift to outcome measurement for whole system
Nationally there is a need for standards and specifications to:
• help describe the networked system
• to enable commissioners/providers to have the information for system-wide outcomes
• monitor and improve performance
Will build upon existing standards and clinical quality indicators:
– i) clinical pathways ii) patient experience iii) staff experience
testing in UEC Vanguards in 2016
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UEC Vanguards
• Focus on i) local health systems with strongest network progress
and ii) addressing greatest operational challenges
• Accelerate pace of change
• Drive new ways of working across organisation boundaries
• Tripartite support for implementation, help remove barriers
• Test beds for new UEC initiatives (relationships, workforce,
clinical decision support hubs, payment model, channel shift
gains, new indicators)
• Meet explicit requirements on implementing best practice and
national policy expectations
24
A new strong consumer offer to the public:
NHS urgent care starts to look like what the patients tell
us they want, not what we have historically offered
• A single number – NHS 111 – for all your urgent health needs
• Be able to speak to a clinician if needed
• That your health records are always available to clinicians treating you wherever you are (111, 999, community, hospital)
• To be booked into right service for you when convenient to you
• Care close to home (at home) unless need a specialist service
• A ‘999’ ambulance response based on need (clinical, time, convey)
• Provide specialist decision support and care through a network
…….. we will change patient and staff behaviour through experiential learning
Developing of U&EC Network delivery plans 2016-2021
now aligned to the Strategic Transformational Plans
25
January February March April May June
2016/17 –
2020/21
planning
process
U&EC
delivery
plan
process
30
Submit full
STP
30
Submit final
delivery plan
Plan for
a plan
Draft delivery plan,
including 2016/17 year
one module
8
Submit plan
for a plan
11
Submit first draft
delivery plan with
year 1 (2016/17)
deliverables
Finalise detail of delivery
plan
12
Check and
Confirm
meeting
8
First
submission
of 2016/17
Operational
Plans
11
Final submission
of 2016/17
Operational Plans,
aligned with
contracts
Develop 2016/17 Operating
Plans and contractsDevelop full STP
7DS for networked 5 specialties: Stroke, STEMI, V Sx, Trauma, PICU
public and professional
Clinical hub 111, 999, OoH GPSPoA SC, information-sharing,
digital NHS111
2016
16-21
20% in
spring 201716-21
Autumn
2017
20% by
2017/18
