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Integrated Urgent
Care Summit
London 28th November 2016
www.england.nhs.uk
David Radbourne
Welcome and
Introductions
Regional Director of Assurance and
Delivery, NHS England South
www.england.nhs.uk
3
Housekeeping
www.england.nhs.uk
4
Agenda
Item Time Title Speaker
10:00am-10:30am Registration and Refreshments
1.
10:30am–1:00pm
Welcome and Introductions Rachel Pearce
2. Vision for Integrated Urgent Care Prof. Keith Willett
3. Integrated Urgent Care in the South Region Rachel Pearce
4 Good Practice incl. Clinical and Non-clinical View, Early Adopters and Workforce
Helen Thomas, Nick Hall and David Davis
5 Moving into Action Rachel Pearce
1:00pm–1:30pm Lunch break
6. And 7.
1:30pm–2:15pm
and
2:30pm-3:15pm
Workshop Sessions:
1) Channel Shift
2) Vanguard Experience and Implementing IUC – Shared
Experience
3) Dorset’s Journey to Delivering an Integrated Clinical Hub
4) Fire as a Health Asset
5) Telemedicine Service
Duncan Watson
Helen Jones, Jodie
Liversage,
Dr Christine Johnson
Emma Williams
Rob Cole
Gary Passaway and Sharon
Hanley
8. 3:30pm-3:45pm Closing remarks Rachel Pearce
www.england.nhs.uk
Professor Keith Willett
Vision for
Integrated Urgent
Care
Medical Director, Acute Care, NHS England
www.england.nhs.uk
Redesigning Urgent and
Emergency Care Services IUC Summit - South Region
Urgent and Emergency Care
Keith Willett Medical Director for Acute Care
NHS England
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 ….
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
9
“CHANNEL SHIFT”
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
Sustainability and Transformation Plans
1. Ensuring that crisis resolution and home treatment teams are able to provide a 24/7
community-based crisis response and intensive home-based alternative to admission:
evidence base http://www.ucl.ac.uk/core-resource-pack/fidelity-scale
2. Ensuring acute hospitals have 24/7 UEC liaison mental health service meeting the core 24
service model as a minimum, and developing services for children and young people
http://mentalhealthpartnerships.com/resource/developing-models-for-liaison-psychiatry-services/
Crisis Care Concordat and SRG and UEC Network Assurance Framework
1. Ensuring provision of health based places of safety for people detained under S136 of the
Mental Health Act, working with police to improve local protocols and adherence to:
standards set out by the Royal College of Psychiatrists, and Mental Health Act Code of Practice.
2. Ensuring crisis care is an important part of UEC system-wide transformation, crucial in
developing coherent pathways and improving experience of care
3. Ensuring mental health is fully embedded within Integrated Urgent Care transformation
4. Ensuring local Directory of Services include accurate and continuously updated
information for mental health crisis services (CYP as well as adults), with contact details
5. Working closely with local Crisis Care Concordat groups that are already established and
will have necessary expertise to progress these priorities. 11
Mental Health Crisis Response- the key areas for 2016/17
Ill patient at home
Can they cope?
Are they safe?
Do they need
treatment?
Rapid response care support
Voluntary sector friend
Community / mental health nursing
GP In & OoH
s
Falls team
HOSPITAL ADMISSION
20-30% of elderly patient admissions are avoidable and
carry risk
When we can’t provide care or treatment in the community our NHS default is to a
higher acuity, higher cost facility
Provide personalised care as close to, or in, the patients home as
possible
www.england.nhs.uk
Developing of U&EC Network delivery plans 2016-2021
now aligned to the Strategic Transformational Plans
15
January February March April May June
2016/17 –
2020/21
planning
process
U&EC
deliver
y plan
proces
s
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 contracts Develop full STP
7DS for networked 5 specialties: Stroke, STEMI, V Sx, Trauma, PICU
public and professional
Clinical hub 111, 999, OoH GP
Mental health crisis,
information-sharing,
digital NHS111
2016
16-21
20% in
spring 2017 16-21
Autumn
2017
20% by
2017/18
www.england.nhs.uk
new offer; no consult in isolation
Helping people help themselves
Self care:
• Better and easily accessible information about self-treatment options
– patient and specialist groups, NHS111 on a digital platform as part
of NHS Choices (nhs.uk). Promote pharmacy access
• Accelerated development of advance care planning, end of life care
‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc), environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.’
17
Integrated Urgent Care
• 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 ‘GP Connect’
GPs, UCCs, dentists, pharmacy
18
“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
20
Dispositions of 111 calls triaged - monthly
From Feb 2015 to Jan 2016, the number of calls
recommended to A&E were 901,051 (75,088 per month or
2,469 per day), so on average each hour only one of the people attending an A&E department would have been
recommended by 111.
Of calls triaged, 8.2% were recommended to A&E in 12
months period slight higher than the 7.6% in 2014/15.
May 2016 IUC delivery
31%
1%
84%
51%
29%
22%
38%
45%
0%
0% 20% 40% 60% 80% 100%
70% F2F appts in one OOH call Q1
5% F2F in-hours appts in one call Q2
50% Info transfer to clinician Q3
50% Clinician SCR access Q4
50% Care Plan access Q5
30% transfer to hub & GP 24x7 Q6
Joint capacity plan approved Q7
Review E2E and share actions Q8
All 8 key elements
Population of England resident in a CCG delivering Integrated Urgent Care in May 2016
Predicted IUC delivery
41%
24%
84%
60%
39%
49%
69%
70%
18%
0% 20% 40% 60% 80% 100%
70% F2F appts in one OOH call Q1
5% F2F in-hours appts in one call Q2
50% Info transfer to clinician Q3
50% Clinician SCR access Q4
50% Care Plan access Q5
30% transfer to hub & GP 24x7 Q6
Joint capacity plan approved Q7
Review E2E and share actions Q8
All 8 key elements
Population of England resident in a CCG predicting IUC delivery by 1 April 2017
Highly responsive urgent care service
close to home, outside of hospital
23
• 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
Ambulance Response Programme
The Ambulance Response Programme is now testing the following changes:
Trialling of Dispatch on Disposition in all 10 ambulance trust sites
Trialling of pre-triage set of ‘nature of call’
questions to identify arrest and peri-arrest events
Introduction of further additional 2 minutes for clinical triage (Red 2)
New code set for clinical benefit / operational efficiency
3 services: NE, West Midlands and YAS
Review of A19 Conveyance
From life threatening to local – where
is the expertise and facilities?
25
• Identify and designate available services in hospital based emergency centres
• Urgent Care Centres – urgent primary care, consistent, part of 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
A total of 129 urgent care facilities
are currently operating. Of these:
• 12 are standalone Urgent Care
Centres (standalone UCC)
• 8 are co-located UCCs with an
Emergency Department (co-
located UCC)
• 26 are Walk in Centres (WIC)
• 83 are Minor Injury Units (MIU)
Urgent Care facilities across the South Region
26
www.england.nhs.uk
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
tested in UEC Vanguards in 2016
www.england.nhs.uk
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/A&E Delivery Board
members and other stakeholders to address challenges
that are greater than a single LHE can solve in isolation
29
A new clear and consistent offer to the public:
NHS urgent care starts to look like what the patients tell
us they need, not what we have historically offered
2
9
• A common 24/7 access: NHS111 for all your urgent health needs
• Be able to speak to a clinician if needed (integrated clinical hub)
• That your e-health records are always available to clinicians wherever you are (GP, 111, 999, community, or hospital)
• To be booked into right service convenient to you
• Give care close to home through ambulatory care / frailty teams
• A ‘999’ ambulance response based on need (clinical, conveyance)
• 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
30
January February March April May June
2016/17 –
2020/21
planning
process
U&EC
deliver
y plan
proces
s
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 contracts Develop full STP
7DS for networked 5 specialties: Stroke, STEMI, V Sx, Trauma, PICU
public and professional
Clinical hub 111, 999, OoH GP SPoA SC, information-sharing,
digital NHS111
2016
16-21
20% in
spring 2017 16-21
Autumn
2017
20% by
2017/18
www.england.nhs.uk
Integrated
Urgent Care in
the South
Regional Director of Assurance and
Delivery, NHS England South
David Radbourne
www.england.nhs.uk
32
Regional trajectories – Delivery of IUC
www.england.nhs.uk
National speakers:
Nick Hall - Head of Integrated Urgent Care
Delivery, NHS England
Helen Thomas - National Medical Advisor
Integrated Urgent Care, NHS England
David Davis - NHS 111 Workforce National
Clinical Lead, NHS England
Integrated
Urgent Care
Nick Hall, Head of Integrated Urgent Care Delivery
November 2016
www.england.nhs.uk
Confusing (and piecemeal?) system
35
www.england.nhs.uk
36
Current position
Since it was launched in August 2010, NHS 111 has received more than 45 million
calls. It currently handles around 14 million calls a year.
• Survey results in 2015-16 show that:
• 28% of those that called 111 who would have gone to A&E, only 8% actually
received a disposition to attend A&E from NHS 111
• The latest patient satisfaction survey reports show that:
• 89% very to fairly satisfied for latest data (2015-16) with the service they received
• The A&E Plan states that providers should increase the number of calls transferred for
clinical advice to 30% by March 2017 - the all England average is currently 21.3%
• Where we expected that 20% of the population would be covered by March 2017, the
latest CCG census shows that CCGs expect to exceed this and deliver all 8 key
elements of IUC covering 38% of England's population by April 2017
• The Joint National 3 year Workforce Development Programme is half-way through with
outputs and products currently being tested and validated
www.england.nhs.uk
The vision for a functionally integrated 24/7 Urgent
Care Service:
Four key components of service -
1. Access
2. Assessment
3. Advice
4.Treatment
www.england.nhs.uk
An Integrated Urgent Care Service Model
The Clinical Assessment Service will be
central to bringing urgent care services
together. Surges in demand to be
managed by a whole system response,
with the core of responsiveness being
upstream not downstream:
Significant call centre capacity (as part of
operational resilience) and larger
workforce provides better ability to flex
CDSS and DoS allows wider distribution
of demand across UEC system making
use of all available services rather than it
presenting directly and unevenly at
frontline services
38
38
www.england.nhs.uk
39
Integrated Urgent Care:
8 key elements
In order to deliver the integrated urgent care model, bringing together
NHS111 and GP Out-of-hours services into a single entry point for
patients it is necessary to accelerate delivery of the following 8 key
elements to 20% of the population by March 2017:
• A single Call to get an appointment Out of Hours
• Data can be sent between providers
• The capacity for NHS111 and OOHs is jointly planned
• The SCR is available in the hub and elsewhere
• Care plans and patient notes are shared
• Appointments can be made to in-hours GPs
• There is Joint governance across urgent and Emergency Care
providers
• There is a Clinical Assessment Service (Clinical Hub) containing GPs
and other health care professionals
www.england.nhs.uk
The new strong 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 in the future 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
• You will receive a clinically appropriate response to 999 which may mean
you receive treatment advice by phone, in person by ambulance staff or
taken to hospital
• Care close to home (at home) unless need a specialist service
• Access to specialist care services (e.g. major trauma/stroke) will be through
a network that includes specialist hospitals in your wider area
40
www.england.nhs.uk
Delivery of Integrated Urgent Care is progressing across the country and in Transformation
Areas, with additional support being provided to accelerate delivery
National progress
• The CCG plan
for meeting
the 8 key
elements of
IUC by April
2017 is 20%
of the
population of
England. The
original audit
of CCGs in
January
indicated 22%
would meet
this
target. The
latest audit
suggests that
this is now
38% - an
improved
picture.
31%
1%
84%
51%
29%
22%
38%
45%
0%
35%
4%
95%
51%
36%
19%
54%
51%
0%
51%
45%
99%
82%
66%
58%
84%
86%
38%
0% 20% 40% 60% 80% 100%
70% F2F appts in one OOH call Q1
5% F2F in-hours appts in one call Q2
50% Info transfer to clinician Q3
50% Clinician SCR access Q4
Care Plan access Q5
GP 24x7 & 30% transfer to hub Q6
Joint capacity plan approved Q7
Review E2E and share actions Q8
All 8 key elements
Population of England resident in a CCG delivering Integrated Urgent Care in August 2016 and CCG estimating IUC delivery by April 2017
May IUC Delivery August IUC Delivery Estimated April '17 Delivery
www.england.nhs.uk
The Clinical
Advice Service
or ‘Clinical Hub’
www.england.nhs.uk
Clinical Assessment Service – what will it do?
• Improve patient experience &
outcomes,
• Helps the patient stay at home,
• Gives the patient confidence and
support to self care,
• Reduce pressure on emergency
pathways and services,
• Reduce unnecessary 999 dispatch,
• Reduce inappropriate conveyance,
• Shift activity to more planned
pathways,
• Reduce avoidable readmissions and
reattendances,
• Reduced system duplication and
delay,
• Saves the UEC system money.
www.england.nhs.uk
www.england.nhs.uk
• Can be a single location or multiple (may or may not be co-
located with other services)
• Will involve close organisational working
• Will use improved interoperable technology
Clinical Hub: what will it look like?
www.england.nhs.uk
System Fit
Access and
Integration
with local services
Shared patient
information and
care plans
Single Points
of
Access/Contact
Secondary Care
and
Mental Health
Social Care
and
Voluntary Sector
Community and
Primary Care
Emergency
Services
Clinical
Advisory
Service
See and Treat
Services
www.england.nhs.uk
Single Point of
Contact
Single Point of
Access
Care Coordination
Centre
Clinical Assessment Service – making it work for
you
Clinical
Advisory
Service
111 &
999
www.england.nhs.uk
Options for the implementation of Integrated
Urgent Care;
• Do Nothing;
• Sub regional model at logical scale; Sub
regional coordination with local “Plug ins”, or;
• Do it alone; CCGs provide Clinical hub.
Options
www.england.nhs.uk
• ‘111 has been done to’ local clinicians by ‘them over there’ (a quote from a group of local GPs talking about their commissioned NHS 111
service) – ‘Not invented here not welcome here’
• A race to the bottom in terms of price – always a balance between price and quality
• Crudely bolting together what we already had and hoping for something different 111+OOH = IUC (Not!)
• Letting contracts without robust clinical governance and financial due diligence - “past track record best predictor of future performance?”
Integrated Urgent Care Service Design is
not…
www.england.nhs.uk
Did I mention that 111 is just a
telephone number?
50
It’s not a provider and never will be!
www.england.nhs.uk
• What is your ‘commissioned end-point’ and are you clear of the practical steps to
take to get you there?’
Integrated Urgent Care Service Design -
some possible food for thought today…
• Which of the four elements of Integrated Urgent Care – Access, Assessment, Advice
and Treatment – can be done at scale and which need to be done more locally?
• How are you aligning 999 and 111/IUC commissioning to transform the Ambulance
Service too?
• Can you afford to do this other than at scale?
• Where is your workforce to deliver this service – new or re-purposed?
• What financial or system impact modelling have you undertaken? How are you
going to assess the return on investment?
www.england.nhs.uk
From P to O via LA
Questions?
Integrated Urgent
Care
A Clinicians View
Dr Helen Thomas
National Medical Advisor for Integrated Urgent Care
November 2016
www.england.nhs.uk
IUC Clinical Assessment Service
CLINICAL NAVIGATOR
General Practitioners
Advanced Nurse Practitioners
Community Psychiatric Nurse
Dental Nurse
Pharmacist
Paramedics
Paediatric nurse
www.england.nhs.uk
Urgent care in Lincolnshire
• 7 points of entry for public and HCPs
• 6 providers
• 10 “services”
• Public confusion
• “hand off” between services
• Duplicated care (or lack)
• Default to 999 and/or A&E
• Potential for poor experience
• Inefficient use of scarce workforce
www.england.nhs.uk
Future Model for Urgent Care
• Single point of access (111/999)
• 24/7 Countywide Clinical Assessment Service (CAS)
• 24/7 Community Based Urgent Care (incl. Primary Care and
Integrated Care Teams)
• 24/7 Building Based Urgent Care
www.england.nhs.uk
Development of CAS
• March 2015 OOH – centralisation of calls requiring clinical
assessment (incl. 111 primary care; ambulance crews; palliative
care; community HCPs)
• Development of commissioner/provider alliance
• Phased implementation of:
o 999 Green 3&4 calls
o ED dispositions
o 111 Clinical Assessment
o Nursing/Care homes with high UC activity
• Development of 24/7 home visit service
• Development of pathways to support CAS outcomes
www.england.nhs.uk
Outcomes so far
• Formation of an alliance with LCHS and EMAS clinicians
working together
• 90% conversion of EMAS referrals to home management
• Reduction in home visits by 33%
• Reduction in PCC appointments by 20%
• No CAS related complaints
• ED 1hr dispositions 70% conversion to advice or PCC appt
• Established falls pathway utilising CFRs for rapid response and
follow up by social and health support
www.england.nhs.uk
Future development
• Link in to Primary Care – in hours appointments
• Broaden CAS expertise – Specialist “hot lines”; Pharmacy
input; Dental input; Mental Health
• Greater use of telemedicine for remote management
• ? Establish Urgent Care as a separate entity 24/7
• Further work around budgets and finance
www.england.nhs.uk
Indemnity
• Indemnity costs soaring especially OOH GPs and nurses
• Perception of increased risk as well as cost > disincentive to
work in urgent / OOH care
• England indemnity agreement 16/17 for GMS practices
• Winter schemes limited eg 111 work / some CCG areas
• Indemnity work streams include OOH services and non-
medical staff groups (pharmacists, paramedics)
• Continued calls for “crown indemnity”
• Underlying need for tort reform
www.england.nhs.uk
Clinical Governance of IUC CAS
• Use the best model available – NHS 111 and adapt to include
all providers working in the IUC hub
• Appoint local clinical lead for governance to lead with
sufficient experience, ability , respect and time
• Chair CAG , over see local governance reports and Sis
• Develop relationships with all key partners in the hub
• Work with regional IUC leads and attend regional IUC
meetings
• Lead on local engagement particularly with clinicians
www.england.nhs.uk
Clinical Assurance committee
www.england.nhs.uk
• Regular review of the ‘end-to-end’ patient journey, with the
involvement of other partner organisations, especially where
outcomes have proved problematic
• Provision of accurate, appropriate, clinically relevant and timely
data about the integrated urgent care service to ensure that it is
meeting these Commissioning Standards
• Regular reporting of Significant Events to stipulated guidelines
to ensure shared learning via the National Learning Log
• KPIs 11 and 12 to help with compliance
© 2016 National Association of Primary Care
Transforming Primary Care – the Primary Care Home
Improved health and
wellbeing
Improved quality of care
for in local
communities
Improved utilisation of
local health and social
care resources
1
2
3
www.england.nhs.uk
So what could be achieved if challenges
addressed?
• Enthusiastic teams truly working together to deliver high quality
care
• Cost effective primary care led integrated urgent care with low
escalation rates
• Services enabled to innovate, adapt and respond to local needs
and pressures
• Recruitment and education of the next generation of workforce
• Avoidable use restrained
ealth ducation ngland Developing the
future
Integrated
Urgent Care
Workforce
David Davis, National Lead,
IUC Workforce Development Programme
28 November 2016
www.england.nhs.uk
ealth ducation ngland
• Joint programme of work between NHS England
and
• Set up in April 2015 as a 3 year programme;
envisioned at December 2014 NHS 111 National
Workforce Workshop
NHS Integrated Urgent Care Workforce
Development Programme
68
www.england.nhs.uk
ealth ducation ngland
1 Creating a Sustainable
Workforce
2 Development of a Workforce
Blueprint
3 IUC Workforce Development
Programme
4 Competency Framework –
Early Adopter sites
5 NHS Workforce Investment
Fund
6 Flexible Multilevel Approach
to Wellbeing and Mental
Health
7 Clinical Assessment Service
(Clinical Hub)
69
Contents
www.england.nhs.uk
ealth ducation ngland Why should you care?
70
www.england.nhs.uk
ealth ducation ngland
ealth ducation ngland
Getting the right ingredients for
successful Integrated Urgent Care
Creating a Sustainable
Workforce
www.england.nhs.uk
ealth ducation ngland
• Creating a workforce blueprint
• Enabling transformation change
• Developing and supporting frontline colleagues
• Enhancing safety and satisfaction
• Engaging with the Inter-Professional Advisory
Group (IPAG)
72
www.england.nhs.uk
ealth ducation ngland Development of Workforce Blueprint
• What are the components?
• Job descriptions and competencies
• Identifying training and education
requirements
• Accreditation
• Apprenticeships
• Career Framework
73
ealth ducation ngland
www.england.nhs.uk
ealth ducation ngland
Creating the land of opportunity…
74
www.england.nhs.uk
ealth ducation ngland
• To:
Increase the clinical capability and support within NHS 111 services
Increase hear & treat
Manage problems with staff attrition and high turnover
Decrease ambulance and ED dispositions
Support development of optimal NHS 111 / IUC
call centre workforce
75
www.england.nhs.uk
ealth ducation ngland NHS 111 Competency Framework
Effective Workforce Solutions commissioned by Health
Education England is working with two NHS 111
Providers, DHU & Care UK to:
• Identify and develop work activities and
associated competencies of roles
• Map these to the right behaviours and skills
• Create a development roadmap
• Create a workforce with optimal capabilities to
meet patients’ needs
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ealth ducation ngland
www.england.nhs.uk
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ealth ducation ngland What is a Competency?
A competency is the capability to apply or use
a set of related knowledge, skills, and abilities
required to successfully perform "critical work
functions" or tasks in a defined work setting.
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Calderdale Framework – 7 stages
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• The aim of the Early Adopters sites is to support the establishment
of a Career Framework focussed on staff operating at Skills for
Health levels 2 to 7
• 8 Early Adopter sites (NHS 111 providers, including the two already
working with EWS – DHU and Care UK), selected by a panel, YAS,
NWAS, HUC, VOCARE, IOW, PELC
• Currently validating and testing out the draft competencies, job
descriptions and supporting the development of training and
education of the NHS Integrated Urgent Care / NHS 111 call centre
workforce
• Began October 2016 and running until March 2017
• Late 2017 / 2018 roll out of materials to other organisations
Competency Framework
Early Adopter sites
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NHS Workforce Investment Fund
Phase 1:
• Launched December 2015 - 19 pilot, test or evaluation projects were
funded.
• Objective - to obtain evidence, information and examples to support the
development of local services, inform outputs of programme and increase
quality, patient safety and best practice for a sustainable future service.
Phase 2
• Launched November 2016
• Projects to focus on:
• Integrated Urgent Care - introduction of Clinical Assessment Service
(Clinical Hubs) / Patient perspective / New workforce models / Mental
health competencies / Recruitment and Retention / Workforce
governance and oversight / Integration across U&EC / Projects which
build on pilot from Workforce Investment Fund phase 1.
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Flexible Multilevel Approach to Wellbeing and Mental Health
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Commissioning standards
Organisational commitment
Executive management buy-in
Line management capability
Workforce knowledge and skills
MHFA
WIF
Phase1
MIND
Blue Light
Mindfulness Resilience
training
Mentoring
Coaching
Debrief
s
Supervision
Skills for
Care
PHE
Toolkit
Transformational
Leadership
Commissioning
Standards
Conscious
commitment
EAP
NHS Digital
programme
• Explicit commitment at all levels within organisation
• Flexibility of approach to address diverse needs within organisations
• Discreet programmes of work provide strong impetus for improving Mental Health and Wellbeing at work.
However the practices they deliver can only be embedded through ongoing support and initiatives
WIF
Phase2
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ealth ducation ngland Extended scope of programme - Clinical
Assessment Service (Clinical Hub)
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Key areas to focus on:
• Skills and competencies
• Good workforce governance
• Resourcing models for the ‘new’ workforce
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How do you buy eggs…
…price or quality or chicken welfare?
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ealth ducation ngland Contact:
IUC Sketch Link
www.england.nhs.uk
David Radbourne
Moving into
Action
Regional Director of Assurance and
Delivery, NHS England South
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LUNCH BREAK 13:00-13:30
Workshops
Session 1 - 13:30-14:15
Session 2 - 14:30-15:15
Main Room Channel Shift
Voysey Room Vanguard Experience and
Implementing IUC – Shared
Experience
Arnold Room Dorset’s Journey to Delivering an
Integrated Clinical Hub
Emerson Room Fire as a Health Asset
Herschel Room Telemedicine Service
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David Radbourne
Closing remarks
Regional Director of Assurance and
Delivery, NHS England South
