Urgent Care Centres

PresentationAndrew Parker

14th January 2008

Location of Urgent Care CentresEstablish a network of 8 Urgent Care Centres:

4 at the following sites• One at each of the two Acute hospitals open 24/7• One at each of the two Local General Hospitals open 24/7

4 at the following sites (opening times yet to be determined)• Herts & Essex Hospital• St Albans Hospital• Cheshunt Community Hospital• Hertford County Hospital

Key Themes From the Consultation

•Clarification of what an Urgent Care Centre will be?

•How will I know where to go?

•Need to provide viable, safe and sustainable services

•Significant Support for both Cheshunt & Hertford

•Communication, Communication Communication

Most appropriate treatment facilities

 

ProblemMajor A&E

Urgent Care Centres

GP surgery

Major accidents and trauma Serious medical problems such as a heart attack

Patients requiring resuscitation

Minor injury

Minor illness (in-hours)

Minor illness (out-of-hours)

Urgent Care Centres Service Models

The model of an urgent care centre is similar whether it is integrated or standalone.

Integrated Urgent Care Centre – Key Features

• Co-located with a Hospital A&E department.

• It acts as a “front door” to the A&E Department ensuring that patients are dealt with promptly and appropriately.

• This model would be open 24 hours a day, seven days a week.

Free Standing Urgent Care Centre attached to a Local General Hospital – Key Features

• Not co-located with a hospital A&E department. However, needs to provide integrated working with the nearest major accident and emergency department.

• All patients on arrival will enter via one front door.

• This model would be open 24 hours a day, seven days a week.

Urgent Care Centres Service Models

Smaller Urgent Care Centres – Key Features

• These smaller urgent care facilities will offer the same services as the free standing urgent care centres.

• All patients on arrival will enter via one front door to the reception area.

• These centres will only be open 12 to 18 hours at peak times as patient activity would not support longer opening hours.

All of the centres would house the GP out of hours service so there wouldbe medical cover during the evenings and at weekends even at thesesmaller ones. However overnight provision may not be at all of the centres

7 or 8 Urgent Care Centres?

The consultation document asked whether the 7th Urgent Care Centre should be atHertford County Hospital or at Cheshunt Community Hospital

Considerations taken into account:

• Proximity to other proposed service developments e.g. Barnet & Chase Hospitals, Princess Alexandra Hospital

• Health Equality Impact Assessment – deprivation in Cheshunt but more population growth in Hertford

• Demand for the services• Nurse-led model with GP out of Hours• Can we afford to provide 2 smaller urgent care centres at both sites?

7 or 8 Urgent Care Centres?

A number of descriptors have been used to compare the two sites including:

 • Ownership of estate• Current usage of the estate supporting patients/residents with

minor injuries and illnesses• Existing facilities available to support a smaller urgent care

centre

Benefits of 8 Urgent Care Centres• Both Hertford County Hospital and Cheshunt Community Hospital are current local

facilities therefore already known to patients and residents

• Additional urgent care centres will provide services more accessible to a larger number of residents

• Shorter travelling time for residents

• More choice

• Less patient flows to services outside Hertfordshire.

• Cost differential between establishing both Hertford County Hospital and Cheshunt Community Hospital is marginal as the 8 site solution was to have shorter opening times, although one site at Cheshunt Community Hospital is the cheapest

• Patient convenience

Dis-benefits of 8 Urgent Care Centres

• The critical mass of patients may not be achieved resulting in:– Shorter opening times – Reduced skill mix of staff

• Possible duplication of cost• Possible recruitment issues• Potential for “supply induced demand”• Extra costs incurred to fund 2 sites and 2 teams• Waiting times could increase especially at peak times as more

centres will lose economies & efficiencies of scale, as staff are spread more thinly over more sites, e.g. cover at lunchtimes will be limited and queues could arise.

Capacity Analysis shows that the majority of patients (75%) attend A&E between8am and 8pm therefore the optimum opening time would be 12 hours

• With Urgent Care Centres at both Hertford & Cheshunt approximately 20,000 patients will access these sites if the UCCs are open for 12 hours/day

• With an urgent Care Centre at Hertford approximately 13,500 patients will access this site. Cheshunt residents will probably access Chase Farm services rather than Hertford

• With an urgent Care Centre at Cheshunt approximately 12,500 may access this site, Hertford residents will probably access Lister, QEII & Princess Alexandra rather than Cheshunt

AccessibilityTravel Time Analysis Percentage of Population able to

access proposed sites

Number of Centres Within 10 minutes

Within 20 minutes

Within 30 minutes

Average travel

time in minutes

8 Urgent Care Centres 27.2% 95.3% 98.3% 12.6

7 UCC not including Hertford 24.5% 91.7% 98.3% 13.2

7 UCC not including Cheshunt 25.9% 90.3% 98.3% 13.3

Current arrangements 4 A&E + 2 MIU Sites

23.3% 84.8% 98.3% 14.0

Staff Skill MixIt is expected the main Clinical Staff will be:• GPs

• Nurses including Emergency Nurse Practitioners (ENP)

• Physiotherapists

With links to:

• Occupational Therapists (OTs)

• Emergency Care Practitioners (ECPs) & East of England Ambulance Service

• Secondary Care Clinicians e.g. A&E consultants, Elderly Care Physicians

• Social Workers

• Mental Health services

• Paediatric workers

CostsSummary Urgent Care Costs

Total Costs £'000 2 sites open 10.5 hours each 983 1 site - Hertford only open 12 hours 976 1 site - Cheshunt only open 12 hours 917

Achieving this VisionUrgent Care Centre Procurement for

Hemel Hempstead

• ‘Multi Stage Procurement Process’ to facilitate creativity & innovation

• Memorandum of Information a high level output based service requirement.

Achieving this VisionUrgent Care Centre Procurement for Hemel

Hempstead

• Agree final specification(s) with short listed providers

• There are also possible variations in the form of contract depending on the method of service delivery.

Timeline 08Urgent Care Centre Procurement for Hemel Hempstead

• January 08 Invite indicative proposals

• February/March 08Evaluate & shortlist from indicative bids.

• March/April 08Discuss & Refine with Shortlist

• May 08Invite & Evaluate final offers Interviews & recommend award.

• June 08Agree Contract & Operational Details

• July 08 –October 08Mobilisation period

Communication Strategy

• Hemel Hempstead procurement Stakeholder event in the selection process

• Publicity education campaign

• The proposed opening date of the urgent care centre at Hemel Hempstead is October 2008. This process will also be used to inform and advise on future models of urgent care centres, as they evolve.

Thank you & Questions