Urgent and Emergency Care Strategy 2016/17 Delivering ......Urgent and Emergency Care Strategy 2013/14 – 2016/17 Delivering High Quality Urgent and Emergency Care Working together

Integrated UECPB Strategy: Final 15/10/2013 Page 1 of 113

Urgent and Emergency Care Strategy

2013/14 – 2016/17

Delivering High Quality

Urgent and Emergency Care

Working together to deliver sustainable high quality, safe, efficient and patient centred

Urgent and Emergency Care for all the people in Croydon


Date Version Discussed At

15/07/2013 Version 10 Major refresh for Urgent and Emergency pathways board

Draft (Circulated to Urgent & Emergency Care Board and Senior Management Team)

19/07/2013 Version 11 Addition of standards, tightening of direction

Draft

22/07/2013 Version 11.2 Draft (To be circulated to Urgent and Emergency Care Board and Senior Management Team and Clinical Network Leads for comments back 8

th August)

13/09/2013 Version 12 Incorporated comments from Senior Management Team / Urgent and Emergency Care Board / Clinical Leads

17/09/2013 Pre Final Version 12 Senior Management Team

17/09/2013 Pre Final Version 12 Urgent and Emergency Board

24/09/2013 Pre Final Version 12 CCG Governing Body

27/09/2013 Pre Final Version 12 Clinical Leads Group

02/10/2013 Pre Final 02102013 Urgent and Emergency Board for final Checks

15/10/2013 Final 15102013 Recommended sign off by Urgent and Emergency Care Board and CCG Governing Body


Contents

National Context ...................................................................................................................... 5 1.

1.1. Local Context .................................................................................................................... 6

1.2. Our Population Challenges ............................................................................................... 6

1.3. Our Service Challenges .................................................................................................. 12

1.4. Our priorities to improve our service challenges and meet the needs of our Population .. 13

Overall Strategic Aim ............................................................................................................. 14 2.

2.1. The overall Urgent and Emergency Care Strategy .......................................................... 16

Definition of Urgent and Emergency Care .............................................................................. 17 3.

3.1. Hyper-Specialist Emergency Care .................................................................................. 17

3.2. Emergency Care ............................................................................................................. 17

3.3. Urgent Care .................................................................................................................... 17

Current Landscape ................................................................................................................ 18 4.

4.1. Level 5 – Highly Specialised Services ............................................................................. 20

4.1.1. London Ambulance Service Conveyance to sites .................................................... 20

4.2. Level 4 – Emergency Departments ................................................................................. 21

4.2.1. ED Admission and Non-Admission Attendances ...................................................... 22

4.2.2. ED Attendances by HRG – CHS – 2012/13 ............................................................. 24


4.3. Level 3 – 24 hour Urgent Care Centres attached to ED. ................................................. 25

4.3.1. Virgin Urgent Care attendances – By Days .............................................................. 25

4.3.2. Virgin Urgent Care attendances - By Hours ............................................................. 26

4.3.3. 2012/13 Data Virgin Care – By Network .................................................................. 26


4.3.5. Ambulatory Care Pathways ..................................................................................... 27

4.4. Level 2a - Community (non-ambulatory patients) ............................................................ 28

4.5. Level 2b - Primary and Community (ambulatory patients) ............................................... 29

4.5.1. Minor Injuries at Parkway (MIA) and Purley (PUC) .................................................. 29

4.5.2. Attendances by Day of the Week ............................................................................. 29

4.5.3. Top Clinical Presentations ....................................................................................... 30


4.6. GP-Led Health Centre at Edridge Road with Walk In ...................................................... 31

4.6.1. Registered Patients ................................................................................................. 32

4.6.2. Walk-in Patients ....................................................................................................... 33

4.7. GP Practices ................................................................................................................... 33

4.7.1. GP Out-of-Hours ...................................................................................................... 34

4.7.2. 111 Directed Activity ................................................................................................ 34

4.8. Pharmacies ..................................................................................................................... 35

4.9. Level 1 – Self Care ......................................................................................................... 36


4.9.1. 111 Current Performance ........................................................................................ 36

4.9.2. 111 In-hours / Out-of-Hours ..................................................................................... 38

4.9.3. Percentage of 111 calls referred to LAS (including treat and transfer + 999

emergency Red ambulances) ................................................................................................ 39

Overall Activity ....................................................................................................................... 40 5.

5.1. Hours of the Day ............................................................................................................. 41

5.2. Days of the Week ........................................................................................................... 42

5.3. Out-of-Hours Total Activity .............................................................................................. 46

Improving Our Services ......................................................................................................... 47 6.

6.1. Whole System Pathway .................................................................................................. 48

6.2. Elderly Frail Pathway ...................................................................................................... 49

6.3. Children’s Pathway ......................................................................................................... 50

6.4. Whole System Service Provision .................................................................................... 51

6.5. Improving Quality ............................................................................................................ 52

Appendices ............................................................................................................................ 56 7.

7.1. Appendix A1: Urgent and Emergency Care Pathways Board Governance Structure ..... 56

7.2. Appendix A2: Urgent and Emergency Care Pathways Board Governance Membership 57

7.3. Appendix B1: NHS London Adult Emergency Care Commissioning Standards .............. 60

7.4. Appendix B2: London Urgent Care Operational Standards ............................................. 63

7.5. Appendix B3: Emergency Department Clinical Quality Indicators................................... 65

7.6. Appendix B4: National Quality Requirements OOH ....................................................... 66

7.7. Appendix B5: Social Care Performance Indicators - Hospital Discharge ........................ 67

7.8. Appendix B6: Quality and Performance Metric ............................................................... 68

7.9. Appendix C: Map of Top 6 ED’s by attendances ............................................................ 72

7.10. Appendix D: Map of UCC’s, MIU’s and Walk in Centre ............................................... 73

7.11. Appendix E: Ambulatory Care Pathways .................................................................... 74

7.12. Appendix F1: Virgin Care Urgent Care Centre Alternative Care Pathway .............. 75

7.13. Appendix F2: Purley War Memorial Hospital Urgent Care Centre Pathway ........... 77

7.14. Appendix F3: Parkway Emergency Minor Treatment Centre Care Pathway ................ 79

7.15. Appendix F4: Edridge Rd Community Health Centre Care Pathway ............................ 80

7.16. Appendix F5: SLAM Crisis & Home Treatment Team Care Pathway .......................... 82

7.17. Appendix G: GP Map ................................................................................................. 83

7.18. Appendix H: Map of Croydon Pharmacies .................................................................. 84

7.19. Appendix H1: Pharmacy First - Ailments included in the scheme: .............................. 85

7.20. Appendix I: Revised Urgent and Emergency Care Action Plan ................................... 86

7.21. Appendix J: GP and Pharmacy Opening Hours .......................................................... 93


National Context 1.

NHS England is leading on the development of a national framework for Urgent and Emergency

Care which will be available for Clinical Commissioning Groups in 2015/16. It is proposed that the

Framework will help Clinical Commissioning Groups commission consistent, high quality Urgent

and Emergency care services across the country and within the resources available.

To develop the Framework, NHS England is leading on the Urgent and Emergency Care Review

(High quality care for all, now and for future generations: transforming urgent and emergency care

services in England). In June 2013 the review has identified four emerging principles for an

improved Urgent and Emergency care system in England, these are:

1. Provision of consistently high quality and safe care, across all seven days of the week

2. Simple and guides good choices by patients and clinicians

3. Provision of the right care in the right place, by those with the right skills, the first time

4. Efficiency in the delivery of care and services

From these principles, 12 ‘system design objectives’ have also been outlined (table 1 below).

These are the suggested outcomes which should be delivered by any future urgent and emergency

care system:

No Design Objectives

1 Make it simpler for me or my family/carer to access and navigate urgent and emergency care services and advice.

2 Increase my or my family/carer’s awareness of early detection and options for self-care and support me to manage my acute or long term physical or mental condition.

3 Increase my or my family/carer’s awareness of and publicise the benefits of ‘phone before you go’.

4 If my need is urgent, provide me with guaranteed same day access to a primary care team that is integrated with my GP practice and my hospital specialist team.

5 Improve my care, experience and outcome by ensuring early senior clinical input in the urgent and emergency care pathway.

6 Wherever appropriate, manage me where I present (including at home and over the telephone).

7 If It's not appropriate to manage me where I present (including at home and over the telephone), take or direct me to a place of definitive treatment within a safe amount of time; ensure I have rapid access to a highly specialist centre if needed.

8 Ensure all urgent and emergency care facilities are capable of transferring me urgently and that the mode of transport is capable, appropriate and authorised.

9 Information, critical for my care, is available to all those treating me.


No Design Objectives

10 Where I need wider support for my mental, physical and social needs ensure it is available.

11 Each of my clinical experiences should be part of a programme to develop and train the clinical staff and ensure their competence and the future quality of the service is being constantly developed.

12 The quality of my care should be measured in a way that reflects the urgency and complexity of my illness.

Table 1: System Design Objectives

1.1. Local Context

The Urgent and Emergency Care Strategy represents a whole systems strategy that has been

developed with members of the Urgent and Emergency Care Pathways Board (UECPB).

The Board has recently refreshed its Terms of Reference and Membership so that it has new

senior representation from all organisations. (See Appendix A1 for Governance Structure and

Appendix A2 for membership).

The Urgent and Emergency Care Pathways Board recognises that demand for Urgent and

Emergency care services are predictable, based on activity trends and demographic changes. Hot

spots in demand for services at the main acute service provider Croydon University Hospital and,

in particular, in the Emergency Department is a symptom of the system not managing demand in

other service areas e.g. community health services, primary care and community social care.

The UECPB has prioritised 5 key areas and 14 key action areas, these are detailed within Section

1.4.

1.2. Our Population Challenges

Population as at March 2011 was 363,400, making Croydon the largest Local Authority in London.

Croydon's population has grown at a faster rate than the rest of England.

Over the last ten years Croydon has seen an increase of 28,300 people since the 2001 census

(335,100) which represents an 8.4% increase, 1.3 percentage points higher than the national

average. Croydon has an ethnically diverse population with a high proportion of both young and

elderly residents.

Croydon has the 5th highest proportion of children aged 0-19 years (26.9%) across all the London

boroughs. It is anticipated that the number of births will rise by around 10% over the next 5 years.

Older people aged 65 years and over make up 13.8% of the Croydon population and residents

aged 85 years and over make up 1.9%. These proportions are projected to increase to 16.27%


and 2.91% respectively by 2030. Croydon faces a significant future challenge as both the very

young and the very old require more care.

The analysis in Figures 1 and 2 show the projected attendances for future years based on the

assumption that the configuration of current services and rate of use of services by age group/ward

remains the same as in 2012/13. To cope with the projected demand our Urgent and Emergency

care services need to include different options of service delivery including an emphasis where

appropriate for people to manage their own care.

Figures 1 and 2 show a higher projected increase in attendances at CUH ED than for other Urgent

Care services over the next 10 years. This is owing to:

Higher population growth expected in Fairfield ward than other wards and residents in

Fairfield ward are more likely to use Croydon ED.

Users of alternative Urgent Care services to CUH ED such as Urgent Care Centres have a

younger age profile than users of CUH ED. The GLA projection shows growth in the

numbers of older people living in Croydon which will have a greater impact on CUH ED

than other Urgent Care services.

Figure 1: Projeced number of attendances at Urgent Care Services


Figure 2: Attendances at Urgent care Services in 2012/13 by age group

The projections in Figure 3,4 and 5 show projected Urgent Care activity to 2022/23, using 2012/13

data as a baseline and based on the underlying projected changes in the age structure and

deprivation levels in Croydon’s population. The forecasts use latest GLA population projections

and trends in the Index of Multiple Deprivation to project Urgent Care activity taking account of age

and deprivation changes in Croydon’s population.

The assumptions made in creating these projections should be noted when interpreting them:

The configuration of Urgent Care services is assumed to remain the same as 2012/13

The level of demand for Urgent Care services is assumed to vary only with regard to age

and deprivation and to remain at 2012/13 levels with regard to any other factors

At lower super output area level, Croydon is assumed to continue to become more deprived

or more affluent in comparison with the rest of England, at the same rate as between 2001

and 2008

The low scenario uses projections that are linked to housing development trajectories from

the Strategic Housing Land Availability Assessment (SHLAA).

The high scenario uses a trend-based projection that does not take dwellings into account.


Figure 3 shows a higher projected increase in attendances at CUH ED than for other urgent care

services over the next 10 years based on the high scenario.

Figure 3: Projection of Urgent Care Activity by type or Urgent Care Provider

Figure 4 shows that East Croydon and Mayday have the highest projections of Urgent care activity.

Figure 4: Projection of Urgent Care Activity by GP Network


Figure 5 shows that 55 – 64 years olds have the highest projected % increase of urgent care

activity (31%), followed by 75+ (30%) and 65 – 74 (22%).

Figure 5: Projection of Urgent Care Activity by age group


Long Term Conditions (LTCs) are a major cause of ill health and presenting cause for emergency

attendances and admissions. Figure 6 shows the projected number of long term conditions in

Croydon’s population, 2012-2021.

Figure 6 shows the projected number of long term conditions in Croydon’s population, 2012-2021

Figure 6: Source: Projections based on data from Croydon general practices

Figure 7 shows numbers of long term conditions by age and sex, showing that with older age the

number of conditions a person has increases.

Figure 7: Number of long term conditions by age and sex

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Num

ber

Year

Chronic kidney disease(total)

Chronic kidney disease(diagnosed)

COPD (total)

COPD (diagnosed)

Dementia (total)

Dementia (diagnosed)

Diabetes (total)

Diabetes (diagnosed)

Stroke/TIA (total)

Stroke/TIA (diagnosed)


The Urgent and Emergency Care Board recognises that we need to make changes to our services

to ensure that we can meet demand in the most appropriate and effective way. Within the strategy

there is an emphasis on self-care, primary care and community care access, effective utilisation of

the Urgent Care Centre and services within the ED departments.

Within our Health and Social Care Economy, Croydon has described 5 Levels of Urgent and

Emergency Care, with clear pathway routes to support these levels of care so that through a whole

systems approach, education and marketing, people will be seen in the right place, right time, first

time. These levels of care are supported also through 111 and LAS. Our self-care, prevention and

decision making strategy supports people keeping well and / or managing their long term condition

effectively.

Croydon has a number of service challenges that need addressing.

1.3. Our Service Challenges

In delivering high quality Urgent and Emergency Care for all, we know that we face the following

challenges:

Bottom 10% of lowest satisfaction rates to see a GP quickly

Bottom percentile for patient experience at Croydon University Hospital for last 3 years

Rates for emergency admissions are higher when comparing Croydon with London

Boroughs. Croydon is close to the England average and the rate is increasing faster than

other local authorities.

Rates of emergency readmissions to hospital within 28 days of discharge is significantly

higher in Croydon than the national average

Variable performance in meeting the Emergency Department, 4 hour waiting target

Public are unclear about which services to best access and when

Public reliance on services, when self-care would have been more appropriate

Difficulties presented by the current Emergency Department and Urgent Care Department

infrastructure for example, original capacity not designed for current demand.

An integrated quality and performance metric (Appendix B6) has been developed which will

indicate potential risk factors to performance and will monitor improvements against our current

service challenges. Other standards that our plans have been aligned to include; London

Commissioning, London Urgent Care Operating Standards, Clinical Quality Indicators, Social Care

and Out of Hours standards (please see Appendix B1,B2,B3,B4 and B5). The quality and

performance metrics will be presented monthly to the Urgent and Emergency Care Pathways

Board where members will recommend immediate actions for improvement on negative trends.


1.4. Our priorities to improve our service challenges and meet the needs of our Population

The Urgent and Emergency Care Pathways Board have a whole systems agreed action plan to

improve our service challenges and meet the needs of our population. If we keep services the

same we will not cope with projected demand. The introduction of ambulatory care pathways offer

people the options and support to manage their own Long Term Condition other than an ED or

Urgent Care Centre attendance.

Our 5 key themes for our Recovery and Improvement plan are outlined in Figure 8 with the top 14

service actions to:

Improve self-care.

Improve system access.

Improve care and flow in hospital.

Appropriate flow on discharge and improving care options in the community.

Improving care/clarifying options when returning to the community.


Figure 8: Top 5 Priorities and 14 Service Actions

Overall Strategic Aim 2.

The overall aim of the Urgent and Emergency Care Strategy is to deliver high quality care in the

right place, right time, first time and work to manage demand and meet this demand as required.

To do this we understand that we need to emphasise a shift in current service use with more

Urgent Care delivered at Level 1 and 2 and 3. Our integrated action plan (Appendix I) works


towards this shift and will be regularly evaluated to ensure that the increase in service delivery at

level 1, 2 and 3 impacts positively on acute hospital demand. Our Prevention of Ill Health, Self-

Care and Shared Decision Making Strategy and Primary and Community Strategy will help to

facilitate this shift.


2.1. The overall Urgent and Emergency Care Strategy

The overall aim of the strategy seeks to improve appropriate access at each level of care, ensuring that people are seen in the right place, right time,

first time.

Figure 9: The Overall Urgent and Emergency Care Strategy


Definition of Urgent and Emergency Care 3.

3.1. Hyper-Specialist Emergency Care

There are three main Specialist Units that Croydon residents use if they suffer a stroke or a

complex major trauma. These units are located at King’s Hospital, St Georges and South London

Trust. Patients may be stabilised there before transfer on to their local hospital for further

treatment or rehabilitation. If a Croydon resident suffers a severe rapid onset mental health

condition, the main specialist unit is provided by The South London and Maudsley Mental Health

Trust (SLAM).

3.2. Emergency Care

Croydon residents use a range of local Emergency Departments for life-threatening conditions /

illness or injury. Emergency Departments assess and treat patients with serious injuries or

illnesses such as:

loss of consciousness

acute confused state and fits that are not stopping

persistent, severe chest pain

breathing difficulties

severe bleeding that cannot be stopped

The predominant Emergency Department used by Croydon residents is Croydon Health Services

(CUH) with King’s Hospital, St Georges and Epsom and St Helier Hospitals also used.

3.3. Urgent Care

Urgent Care is defined as the range of healthcare services available to people who need medical

advice, diagnosis and/or treatment quickly and unexpectedly. In practice this will mean that

people, whatever their urgent need, whatever the location, get the best care from the right person,

in the right place, at the right time, first time. The 111 service gives access to reassurance and

directs to services that can help. These services include; Urgent Care Centre at the front end of

Croydon Health Services (CUH), services providing out of hours care, GP Practices same day

appointments, Pharmacies (including minor ailments services), a walk in centre at Edridge Road, a

Minor Injury Unit at Parkway New Addington and an Urgent Treatment Centre at Purley. In

addition there is also a single point of access for social and community services for people who are

unable to leave their homes and which directs services as needed, for example rapid community

response.


Current Landscape 4.

In practice, Urgent Care services across Croydon are fragmented providing a confusing picture for Croydon residents on opening times, who the

service is for and what the services provide. For the most part, the default position is that Croydon residents use services located at Croydon Health

Services (CHS) e.g. Emergency Department, Virgin Care Urgent Care Centre, Edridge Road Walk-in Centre and GP Out-of-Hours where they know

that they will be seen and treated.

Figure 10: Current Landscape


Figure 11: Current Landscape

Integrated E&UC Strategy: Final 15/10/2013 Page 20 of 113

4.1. Level 5 – Highly Specialised Services

There are 3 main Specialist Units that Croydon residents use if they suffer a stroke or a complex

major trauma, these units are Kings Hospital, St Georges and South London Trust. Patients may

be stabilised there before transfer on to their local hospital. If a Croydon resident suffers a severe

onset mental health condition, the main specialist unit is South Maudsley Mental Health Trust

(SLAM).

(Awaiting validated data on use by Croydon residents of Hyper-acute Stroke Units and major

trauma).

4.1.1. London Ambulance Service Conveyance to sites

We know from 2012/13 London Ambulance Conveyance figures that 796 people were conveyed

with the following conditions:

Catheter Laboratory - 203

Major Trauma - 161

Hyperacute Stroke Unit – 432

Total - 796

Figure 12 shows the breakdown of where Croydon residents were conveyed to.

Figure 12: Level 5 LAS Conveyance


4.2. Level 4 – Emergency Departments

Figure 13 shows the total number of Croydon residents All ED attendances – All Trusts 2010/11,

2011/12, 2012/13 and 2013/14 (May YTD) and for CHS ED for the same years (Based on SUS

data). Appendix C shows the location of Level 4 Services. Please note for Figures 13 and 14 the

reduction in activity at CHS between 2011/12 and 2012/13 are attributable to the opening of Virgin

Care Urgent Care Centre.

Figure 13: Level 4 All ED Attendances

Figure 14 shows the annual costs for CHS and surrounding areas. Figure 15 shows the number of

ED attendances by age group.

2010/11 2011/12 2012/13 2013/14 YTD MAY

Total ED Costs – All Trusts £12,507,818 £14,214,272 £11,855,207 £2,043,767

Croydon Health Services ED – Cost £10,594,447 £10,840,724 £8,005,127 £1,408,744

Figure 14: ED Costs

2012/13 Attendances (Admitted) Attendances (Not Admitted) Total Admitted %

0-18 4,378 19,851 24,229 18

19-64 13,077 45,794 58,871 22

65-74 3,377 4,869 8,246 41

75-84 4,544 3,764 8,307 55

85+ 3,842 1,792 5,635 68

Total 29,218 76,070 105,288 28

Figure 15: ED Attendances by Age


4.2.1. ED Admission and Non-Admission Attendances

Figure 16 shows for 2010/11, 2011/12, 2012/13 and 2013/14 May YTD (Based on SUS data) the proportion of attendances admitted and not admitted

across All ED All Trusts.

Figure 16: ED Admission and Non Admission Attendances


Figure 17 and 18 show the total activity by network to all ED - it shows that Purley and New

Addington / Selsdon have the highest rates per 1000.

Figure 17: ED Attendances by Network

ED Attendances - All Ages as per 1000 of network population

MDY THN WSS NAS PRY ECR

ED all Attendances 252 253 263 339 273 267

Figure 18: ED attendances by Network

Key: MDY: Mayday, THN: Thornton Heath, WSS: Woodside and Shirley, NAS: New Addington

and Selsdon, PRY: Purley, ECR: East Croydon


4.2.2. ED Attendances by HRG – CHS – 2012/13

Figure 19: ED Attendances by HRG




4.3. Level 3 – 24 hour Urgent Care Centres attached to ED.

Appendix D shows a map of the locations of Level 3 and Level 2 services.

4.3.1. Virgin Urgent Care attendances – By Days

Total Attendances: 41,072

Figure 21: Virgin Urgent Care Attendances By Days


4.3.2. Virgin Urgent Care attendances - By Hours

Croydon CCG - 2012/13 – All Days – Hours Attended (Based on SUS data)

Figure 22: Virgin Urgent Care Attendances By Hours

4.3.3. 2012/13 Data Virgin Care – By Network

Total Attendances to Urgent Care Centre by Croydon residents 2012/13 - 38,539 (Please note that the difference in values is attributable to attendances not being assigned to a Network)

Figure 23: Virgin Urgent Care Attendances by Network



Figure 24 shows the number of patients taken to a Level 3 Co-located Urgent Care Centre. The

highest numbers are taken to Croydon University Hospital Virgin UCC followed by Princess Royal.

Figure 24: Level 3 UCC LAS Conveyance

4.3.5. Ambulatory Care Pathways

Ambulatory Care Pathways have been developed for people attending the ED and the Urgent Care

Centre at CHS. People will be directed to these pathways as appropriate (see Appendix E).


4.4. Level 2a - Community (non-ambulatory patients)

The main focus of the Primary and Community Strategy is to provide care closer to home and to

avoid (where clinically safe to do so), people attending ED and subsequently being admitted as an

emergency. Services in the community are planned to include Rapid Response Teams to people

at home or in Care Homes (see Figure 26 showing higher levels of non-elective admissions from

Purley and East Croydon network) and Case Management of people with complex needs including

people with unstable long term conditions. Members of the social and health infrastructure will be

able to access these services through a single point of assessment (SPA).

Figure 25: Level 2a Emergency Admissions

Usual Place of Residence

Usual place of residence all ages as per 1000 of network population

MDY THN WSS NAS PRY ECR

Care Home 3 4 4 3

7 6

Other Place of Residence 115 110 110 107 87 120

Figure 26: Usual Place of Residence

Key: MDY: Mayday, THN: Thornton Heath, WSS: Woodside and Shirley, NAS: New Addington

and Selsdon, PRY: Purley, ECR: East Croydon


4.5. Level 2b - Primary and Community (ambulatory patients)

4.5.1. Minor Injuries at Parkway (MIA) and Purley (PUC)

Table 2 shows activity for 2011/12 and 2012/13. Figures in brackets are Croydon registered

patients.

Overall Activity 2011/12 2012/13 2012/13 Cost Includes Premium

Cost per Case 2012/13 (Croydon Registered Activity)

MIU Parkway 7,546 (6,464) 7,013 (5,947) £914,000 £153.69

MIU Purley 6,907 (5,643) 6,755 (5,393) £864,000 £160.20

Table 2: MIA and PUC Activity

4.5.2. Attendances by Day of the Week

Figure 27: Attendances by Day of the Week


4.5.3. Top Clinical Presentations

Figure 28: PUC Top 5 Presentations 2012/13

Figure 29: MIA Top 5 Presentations 2012/13




4.6. GP-Led Health Centre at Edridge Road with Walk In

Year Total Registered Patients with Appointments

Total Walk-ins

2011-12 9,602 36,600

2012-13 12,865 35,774

Table 3: Edridge Road Activity


4.6.1. Registered Patients

Figure 31: Edridge Road Registered Patients with Appointments

Figure 32: Edridge Road Registered Patients with Appointments Trend

436 462 510 645

1009 878 852 821

992 960 852

1185

947 1038 1049

1436 1373 1386

1245 1228

1051 1095 1017 1048 1086 1095 1099

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4.6.2. Walk-in Patients

Figure 33: Edridge Road Walk in Patients

Figure 34: Edridge Road Walk-In Vs. Registered Patients

4.7. GP Practices

There are 61 practices (see Appendix G) signed up to Personal Medical Services. Most practices

offer extended hours and same day appointments. The emphasis within the Primary and

Community Strategy is to ensure that same day appointments are standardised across practices

and that networks regularly monitor the numbers of people attending ED and not admitted (see

Appendix J). In addition there is an emphasis for Urgent Care Centres to see by network if

responsiveness can be improved to avoid these attendances from happening.

3549 3194

3012 2957 2879 2694

2931 2912 2987 3035 3005 3445 3351 3426

3700 3323

3078 3041 3156 3075 3478

3249 2897

3303 2940

3321 3103

0

1000

2000

3000

4000

5000

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

De

c-1

1

Jan

-12

Feb

-12

Mar

-12

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

De

c-1

2

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Walk-In Patients

Walk-ins

0%

20%

40%

60%

80%

100%

Dat

e

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

De

c-1

1

Jan

-12

Feb

-12

Mar

-12

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

De

c-1

2

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

% split of Walk-In Vs. Registered Patients with Appointments

Reg Pts with Appointments Walk-ins


4.7.1. GP Out-of-Hours

GP out of hours is located at CHS. Figure 35 below shows for 2012/13 the numbers of patients

assessed by telephone advice, the numbers of people coming to base and the numbers of people

seen at home.

Figure 35: GP Out of Hours

4.7.2. 111 Directed Activity

Figure 36 shows the numbers of Out of Hours activity directed by 111 and the number of activity

non 111.

Figure 36: 111 directed activity


4.8. Pharmacies

There are 73 Pharmacies in Croydon, with all offering minor ailments advice (see Appendix H for

locations and Appendix H1 for a list of minor ailments as seen by participating pharmacies). Figure

37 shows that the number of consultations is highest in July.

Figure 37: Pharmacy First – Number of Consultations

Figure 38 shows for 1 month’s data (April) the top 4 ailments treated.

Figure 38: Pharmacy Top 4 Ailments


4.9. Level 1 – Self Care

Emphasis in the Prevention and Shared Decision making strategy is a move towards educating the

public to manage their own conditions.

Minor Injuries – Marketing campaigns and managing minor burns/stings etc

Long term conditions - Education around managing long term conditions

111 Reassurance – Croydon residents can call 111 for reassurance and advice on self-

treatment

4.9.1. 111 Current Performance

Total number of patients with a Croydon CCG GP NACs code for this period is 20,877

Data from Jan 2013 until the end of June

Data Source: South London Commissioning Support Unit

Figure 39: 111 Callers Split by Age Group


Figure 40: Top Symptom Groups Referred to ED

Figure 41: Top 10 Services 111 Callers Signposted To


4.9.2. 111 In-hours / Out-of-Hours

Figure 42: Croydon in and out of hours calls Feb to Jun 30

th


4.9.3. Percentage of 111 calls referred to LAS (including treat and transfer + 999 emergency Red ambulances)

Figure 43: LAS Calls Referred by 111 to 999


Overall Activity 5.

The activity in Table 4 relates to all Croydon Resident activity to the following access points.

Overall Activity 2011/12 2012/13

Total Emergency Department activity across all Trusts e.g. CUH / St Georges / Kings for Croydon Residents 140,563 106,419

Total Emergency Department activity CUH 115,204 66,385 (55,144)

Co-located Virgin Care UCC at CHS - 52,287 (41,072)

WIC Edridge Rd 36,600 35,774

MIU Parkway 7,546 (6,464) 7,013 (5,947)

MIU Purley 6,907 (5,643) 6,755 (5,393)

Note: In brackets = Croydon Resident Activity 2012/13

Table 4: Overall Activity


5.1. Hours of the Day

Figure 44 shows 2012/13 overall activity by hours of the day for the following locations:

Hours of the Day: Attendances by Croydon residents to ED (CHS), UCC, MIU for Croydon CCG during 2012/13 (All Days)

Hours of Day /

Site

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Total All

Attend.

MAE 1,551 1,329 995 891 824 790 700 1,147 1,688 2,598 3,245 3,581 3,604 3,452 3,319 3,216 3,218 3,128 3,104 3,129 2,878 2,498 2,346 1,913 55,144

MEU 189 1248 607 294 54 400 1,285 209 28 1 1 4,316

MIA 420 204 1,505 777 744 615 666 579 410 27 5,947

PUC 6 386 530 560 549 509 440 438 474 536 441 397 127 5,393

VIR 924 685 544 510 399 435 498 824 1,468 2,373 2,609 2,542 2,538 2,454 2,301 2,269 2,332 2,440 2,544 2,629 2,525 2,143 1,774 1,312 41,072

Total 2,475 2,014 1,539 1,401 1,223 1,225 1,198 1,977 3,731 6,749 7,021 6,966 7,125 6,950 8,848 6,945 6,858 6,625 6,711 6,464 5,814 4,668 4,120 3,225 111,872

Figure 44: Hours of the Day

0

500

1000

1500

2000

2500

3000

3500

4000

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23

MAE

MEU

MIA

PUC

VIR

Main ED

Virgin

Parkway Purley Main Eye Unit


5.2. Days of the Week

Days of the Week: Attendances by Croydon residents for ED (CHS), UCC, MIU for Croydon CCG during 2012/13

Days Of Week / Site

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Grand Total

MAE 8,376 7,959 7,873 7,880 7,978 7,446 7,632 55,144

MEU 949 844 868 836 817 2 4,316

MIA 890 874 887 813 800 862 821 5,947

PUC 999 776 772 732 743 743 628 5,393

VIR 6,255 5,760 5,782 5,629 5,439 5,932 6,275 41,072

Grand Total 17,469 16,213 16,182 15,890 15,777 14,985 15,356 111,872

Figure 45: Days of the Week

Main A&E

Virgin

Parkway

Purley Main Eye Unit


CUH A&E attendances by hour of the day

Figure 46 shows all activity by hour of the day Croydon residents and Non-Croydon residents.

Figure 46: CUH ED Attendances by Hour of the Day 2012/13


AE Attendance Location 0 1 2 3 4 5 6 7 8 9 10 11

MAE - CUH - A&E 2,006

1,717

1,323

1,161

1,050

1,016

873

1,391

1,999

3,108

3,785

4,162

UCC - VIRGIN CARE 1,283

926

719

682

561

552

636

1,012

1,828

2,901

3,203

3,263

MEU - CUH - EYE UNIT 225

1,438

745

352

MIA - MINOR INJURIES PARKWAY

3

PUC - PURLEY URGENT CARE

7

477

662

692

679

AE Attendance Location 12 13 14 15 16 17 18 19 20 21 22 23

MAE - CUH - A&E 4,290

4,088

3,963

3,826

3,848

3,821

3,718

3,805

3,486

3,107

2,891

2,419

UCC - VIRGIN CARE 3,162

3,102

2,971

2,923

2,940

3,094

3,186

3,316

3,205

2,738

2,329

1,717

MEU - CUH - EYE UNIT 66

463

1,523

264

36

2

-

-

1

MIA - MINOR INJURIES PARKWAY

496

249

1,739

916

860

729

792

692

507

30

PUC - PURLEY URGENT CARE

648

587

563

576

651

552

505

156

Table 5: CUH ED Attendances by Hour of the Day 2012/13


CUH A&E attendances by day of the week

Figure 47 shows all activity by hour of the day Croydon residents and Non-Croydon residents.

AE Attendance Location Monday Tuesday Wednesday Thursday Friday Saturday Sunday

MAE - CUH - A&E 10,059 9,595 9,501 9,429 9,596 9,199 9,474

UCC - VIRGIN CARE 7,947 7,372 7,295 7,088 6,910 7,593 8,044

MEU - CUH - EYE UNIT 1,119 1,016 1,007 988 982 2 1

MIA - MINOR INJURIES PARKWAY 1,037 1,016 1,043 968 924 1,045 980

PUC - PURLEY URGENT CARE 1,230 966 994 932 911 939 783

Figure 47: CUH ED Attednacnes by Day of the Week – Croydon Residents and Non Croydon Residents


5.3. Out-of-Hours Total Activity

Out-of-hours Total Activity YR1 YR2 YR3

Speak to GP 22,100 19,500 18,400

Visit GP 17,751 17,751 17,751

Home Visit 5,259 5,259 5,259

Total Out of Hours 45,110 42,510 41,410

Table 6: Out of Hours Total Activity


Improving Our Services 6.

Our aim is to ensure that our pathways are seamless and that we work in an integrated manner.

The current system is fragmented with Walk-in Centres, Minor Injury Units and Urgent Care

Centres offering a variety of treatments and with a variety of opening times. This is a route cause

of the 6th service challenge we identified in section 1.3 service challenges.

London Ambulance Service redirect very few people to Walk-in-Centres and Minor Injury Units,

alternative care pathways are to be reviewed and additional alternative care pathways will be

developed to ensure that newly introduced community provision will be maximised. This work will

reduce pressures on our local Emergency Department and enable us to better respond to patient’s

needs. It will also help to reinforce the public health messages that there are alternatives to A&E.

Meeting the national time standard of 4 hours in the ED and local 4 hours standard in the co-

located UCC is a critical measure on whole system efficiencies which includes patient flows from

the ED back to Primary and or Community Services and from ED through to an inpatient spell and

discharge back to Primary and /or Community services. To achieve this, the health and social care

economy must be geared towards delivering a truly 7 day service, where patients can expect the

same response to the safe and timely management of their care that they receive on a Tuesday on

a Sunday. Delivering a 7 day service is a key measure of success against the third of our 5 key

themes which are identified in section 1.4 Our Priorities.

Ensuring the system has the right level of capacity at the right time of the day, is also vital to

meeting the national standard of 4 hours because it enables timely patient flow out of the ED and

into an inpatient setting. To achieve this the strategy has a focus around safe early discharge

which is highlighted in section 6.4 Whole system provision.

Figure 48 shows whole system pathways with the aim where appropriate of self-care at the end

point of a professional intervention. Alternative care pathways (See Appendix F) for most common

long term conditions have been developed to help support people to improve management of their

care and over time reduce the need to attend hospital services.

The integrated metrics will continually review the pathways at each level and set out actions to

mitigate any negative trends.


6.1. Whole System Pathway

Figure 48 shows the whole systems pathway for frail elderly adults and children. For further breakdown of services in each level for each client group

please see Figure 49 and Figure 50.

Figure 48: Whole System Pathway

KEY: S.C: SOCIAL CARE M.H: MENTAL HEALTH CHS: CROYDON HEALTH SERVICES (COMMUNITY) DAAT: DRUG AND ALCOHOL TREATMENT IB: INTERMEDIATE BEDS


6.2. Elderly Frail Pathway

Figure 49: Elderly Frail Pathway



6.3. Children’s Pathway

Figure 50: Children’s Pathway



6.4. Whole System Service Provision

Figure 51: Whole System Service Provision

Integrated U&EC Strategy: Final 15/10/2013 Page 52 of 113

6.5. Improving Quality

Quality is at the heart of everything we do; by adopting the pathways approach we will ensure that

our residents are seen at the right place, the right time, by the right person, first time.

Seamless integrated pathways will ensure that we can deliver consistent high quality care.

The Integrated Quality and Performance Metric indicators will ensure that we consistently meet

national and local standards. The Pathways Board will ensure that actions take place across the

whole system to reverse any negative trends.


Service Opening Hours and Improving Quality

Figure 52: Level 5 Improving Quality








Appendices 7.

7.1. Appendix A1: Urgent and Emergency Care Pathways Board Governance Structure

Chaired by the Assistant Clinical Chair, membership will include senior commissioner and provider representatives across the health and social care

system, relevant to the specific areas of responsibility, and other partners as appropriate. Members will need to have seniority within their

organisations in order to be able to take necessary decisions. Clinical representation is vital to the success of the UECPB and regular senior clinical

presence is required at each UECPB meeting.


7.2. Appendix A2: Urgent and Emergency Care Pathways Board Governance Membership

Representation from the following organisations will form the core membership of the Board and

will be accountable for delivery of the outputs:

Standing Accountable Members

Chair/Assistant Chair, Croydon - CCG

Director of Commissioning – Croydon CCG

Deputy Chief Executive / Chief Operating Officer – CHS

Primary Care Development Lead - CCG

Senior Representative - Local Authority

Senior Representative - SLaM

Ambulance Operations Manager – LAS

Community Pharmacy Advisor – CCG

Operations Lead Harmoni - NHS 111

Operations Manager - Virgin Care (UCC and OOH )

Senior Representative – Edridge Road

Primary Care Contracts Manager, NHS England

Senior Commissioning Manager, CSU

Local Pharmaceutical Committee

Local Medical Committee


Representation from the following organisations will form regular membership to the UECPB to

advise from their area of expertise and offer views of groups they represent:

Regularly Invited Members

Urgent Care Commissioner, Croydon - CCG

Senior Commissioning Manager, CSU

Clinical Governance Manager, CSU

ED Consultant, CHS

Paediatrics lead, CHS

Clinical Governance Lead NHS 111

Clinical Lead, Virgin Care

Clinical Lead, Edridge Road Community Health Centre

Local Pharmaceutical Committee

Local Medical Committee

Voluntary sector representation

Patient and Public Involvement Leads

Other organisational representatives may be co-opted onto the Board at such times as the UECPB

decide, given prevailing work streams and operational and strategic needs.


Membership of the Executive Committee

Representation from the following organisations will form the core membership of the Executive

Committee; this Committee will meet as Part Two of the UECPB as indicated when required.

(Terms of Reference in separate document)

Executive Team

CHS CHIEF EXECUTIVE

CCG CHIEF OFFICER

SLAM EXECUTIVE DIRECTOR

LBC EXECUTIVE DIRECTOR


7.3. Appendix B1: NHS London Adult Emergency Care Commissioning Standards

No. Commissioning Standards

1 All emergency admissions to be seen and assessed by a relevant consultant within 12 hours of the decision to admit or within 14 hours of the time of arrival at the hospital.

2 A clear multi-disciplinary assessment to be undertaken within 12 hours and a treatment or management plan to be in place within 24 hours (for complex needs patients see 23 and 24).

3 All patients admitted acutely to be continually assessed using a standardised early warning system (EWS). Consultant involvement is required for patients who reach trigger criteria. Consultant involvement for patients considered ‘high risk’ should be within one hour.

4 When on-take, a consultant and their team are to be completely freed from any other clinical duties or elective commitments.

5 In order to meet the demands for consultant delivered care, senior decision making and leadership on the acute medical/ surgical unit. To cover extended day working, seven days a week

6 All patients on acute medical and surgical units to be seen and reviewed by a consultant during twice daily ward rounds, including all acutely ill patients, directly transferred, or others who deteriorate.

7 All hospitals admitting medical and surgical emergencies to have access to all key diagnostic services in a timely manner 24 hours a day, seven days a week to support clinical decision making:

Critical – imaging and reporting within 1 hour

Urgent – imaging and reporting within 12 hours

All non-urgent – within 24 hours

8

All hospitals admitting medical and surgical emergencies to have access to interventional radiology 24 hours a day, seven days a week:

Critical patients – 1 hour

Non-critical patients – 12 hours

9 Rotas to be constructed to maximise continuity of care for all patients in an acute medical and surgical environment. A single consultant should retain responsibility for a single patient on the acute medical/ surgical unit. Subsequent transfer or discharge must be based on clinical need

10 A unitary document to be in place, issued at the point of entry, which is used by all healthcare professionals and all specialties throughout the emergency pathway.

11 Patients admitted for unscheduled care to be nursed and managed in an acute medical/ surgical unit, or critical care environment.

12 All admitted patients to have discharge planning and an estimated discharge date as part of their management plan as soon as possible and no later than 24 hours post-admission.



There should be a policy in place to access social services seven days per week. Patients should be discharged to their named GP.

13 All hospitals admitting emergency general surgery patients to have access to a fully staffed emergency theatre immediately available and a consultant on site within 30 minutes at any time of the day or night.

14 All patients admitted as emergencies are discussed with the responsible consultant if immediate surgery is being considered. For each surgical patient, a consultant takes an active decision in delegating responsibility for an emergency surgical procedure to appropriately trained junior or speciality surgeons. This decision is recorded in the notes and available for audit.

15 All patients considered as ’high risk’ to have their operation carried out under the direct supervision of a consultant surgeon and consultant anaesthetist; early referral for anaesthetic assessment is made to optimise peri-operative care. High risk is defined as where the risk of mortality is greater than 10%.

16 All patients undergoing emergency surgery to be discussed with consultant anaesthetist. Where the severity assessment score is ASA3 and above, anaesthesia should be provided by a consultant anaesthetist.

17 The majority of emergency general surgery to be done on planned emergency lists on the day that the surgery was originally planned. The date, time and decision maker should be documented clearly in the patient’s notes and any delays to emergency surgery and the reasons why recorded.

Any operations that are carried out at night should meet NCEPOD classifications and be under the direct supervision of a consultant surgeon.

18 All referrals to intensive care to be made from a consultant to a consultant. (Consultant involvement in referrals)

19 A structured process to be in place for the medical handover of patients twice a day. These arrangements to also be in place for the handover of patients at each change of responsible consultant/medical team. Changes in treatment plans should be communicated to nursing and therapy staff as soon as possible if they are not involved in the handover discussions.

20 Consultant-led communication and Information to be provided to patients and to include the provision of patient information leaflets.

21 Patient experience data is captured, recorded and routinely analysed and acted on. Review of data is a permanent item on board agenda and findings are disseminated.

22 All acute medical and surgical units to have provision for ambulatory emergency care.

23 Prompt screening of all complex needs inpatients to take place by a multi professional team which has access to pharmacy and therapy services, including physiotherapy and occupational therapy, seven days a week with an overnight rota for respiratory physiotherapy.

24 Single call access for mental health referrals to be available 24 hours a day, seven days a week with a maximum response time of 30 minutes.



25 Hospitals admitting emergency patients to have access to comprehensive 24 hour endoscopy services that has a formal consultant rota 24 hours a day, seven days a week.

26 All hospitals dealing with complex acute medicine to have onsite access to levels 2 and 3 critical care (i.e. intensive care units with full ventilatory support). All acute medical units to have access to a monitored and nursed facility.

27 Training to be delivered in a supportive environment with appropriate, graded consultant supervision

Table 7: NHS London Adult Emergency Care Commissioning Standards


7.4. Appendix B2: London Urgent Care Operational Standards

Governance

No Standard

1 Each urgent care service is to have a formal written policy for providing urgent care. This policy is to adhere to the urgent care clinical quality standards. This policy is to be ratified by the service’s provider board and reviewed annually.

2 All urgent care services are to be within an urgent and emergency care network with integrated governance structures. All urgent care services to participate in national and local audit, including the use of the Urgent and Emergency Care Clinical Audit Tool Kit to review individual clinician consultations.

Core Service

3 During the hours that they are open all urgent care services to be staffed by multidisciplinary teams, including: at least one registered medical practitioner (either a registered GP or doctor with appropriate competencies for primary and emergency care), and at least one other registered healthcare practitioner.

4 An escalation protocol is to be in place to ensure that seriously ill/high risk patients presenting to the urgent care service are seen immediately on arrival by a registered healthcare practitioner.

5 All patients are to be seen and receive an initial clinical assessment by a registered healthcare practitioner within 15 minutes of the time of arrival at the urgent care service.

6 Within 90 minutes of the time of arrival at the urgent care service 95 per cent all patients are to have a clinical decision made that they will be treated in the urgent care service and discharged, or arrangements made to transfer them to another service.

7 At least 95 per cent of patients who present at an urgent care service to be seen, treated if appropriate, and discharged in under 3 hours of the time of arrival at the urgent care service.

8 During all hours that the urgent care service is open it is to provide guidance and support on how to register with a local GP.

9 The service is to have a clear pathway in place for patients who arrive outside of opening hours to ensure safe care is delivered elsewhere.

10 Access to minimum key diagnostics during hours the urgent care service is open, with real time access to images and results: - Plain film x-ray: immediate on-site access with formal report received by the urgent care service within 24 hours of examination - Blood testing: immediate on-site access with formal report received by urgent care service within one hour of the sample being taken Clinical staff to have the competencies to assess the need for, and order, diagnostics and imaging, and interpret the results. [It is suggested that a cost-benefit analysis be undertaken by each service prior to implementation].

11 Appropriate equipment to be available onsite: - a full resuscitation trolley - an automated external defibrillator - oxygen - suction and - emergency drugs All urgent care service to be equipped with a range of medications necessary for immediate treatment.

12 Urgent care services to have appropriate waiting rooms, treatment rooms and equipment according to the workload and patient’s needs.


13 All patients to have an episode of care summary communicated to the patient’s GP practice by 08.00 on the next working day. For children the episode of care to be communicated to their health visitor or school nurse, where known and appropriate, no later than 08.00 on the second working day.

Staff competencies

14 All registered healthcare practitioners working in urgent care services to have a minimum level of competence in caring for adults, and children and young people (where the service accepts children), including: (a) Basic life support; (b) Recognition of serious illness and injury; (c) Pain assessment; (d) Identification of vulnerable patients At anytime the service is open at least one registered healthcare practitioner is to be trained and competent in immediate life support and paediatric immediate life support, where the service accepts children.

15 All registered healthcare practitioners working in urgent care services to have direct access to urgent referrals to specialist on-call services when necessary, and the right to refer those patients who they see within their scope of practice.

Supporting services

16 Urgent care services to have arrangements in place for staff to access support and advice from experienced doctors (ST4 and above or equivalent) in both adult and paediatric emergency medicine or other specialties without necessarily requiring patients to be transferred to an emergency department or other service.

17 Single call access for mental health referrals to be available during hours the urgent care service is open, with a maximum response time of 30 minutes.

Patient experience:

18 Patient experience data to be captured, recorded and routinely analysed and acted on. Data is to be regularly reviewed by the board of the urgent care provider and findings are to be disseminated to all staff and patients.

19 All patients to be supported to understand their diagnosis, relevant treatment options, ongoing care and support by an appropriate clinician.

20 Where appropriate, patients to be provided with health and wellbeing advice and sign-posting to local community services where they can self-refer (for example, smoking cessation services and sexual health, alcohol and drug services).

Training

21 Urgent care services to provide appropriate supervision for training purposes including both: - Educational supervision - Clinical supervision

22 All healthcare practitioners to receive training in the principles of safeguarding children, vulnerable and older adults and identification and management of child protection issues. All registered medical practitioners working independently to have a minimum of safeguarding training level 3.

Table 8: London Urgent Care Operational Standards


7.5. Appendix B3: Emergency Department Clinical Quality Indicators

No Indicator

1 Ambulatory care To reduce avoidable hospital admissions by improving the provision of ambulatory care. Recognise that not all A&E departments are able to fully clinically code attendances for these two specific.

2 Unplanned re-attendance rate Unplanned re-attendance at A&E within 7 days of original attendance (including if referred back by another health care professional).

3 Total time in the A&E department The median, 95th percentile and longest total time spent by patients in the A&E department, for admitted and non-admitted patients.

4 Left without being seen (LWBS) rate The percentage of people who leave the A&E department without being seen. (>5% is a problem, <3% is a problem)

5 Service experience Narrative description of what has been done to assess the experience of patients using A&E services and their carers, what the results were, and what has been done to improve services in light of the results. (Survey using NHS Surveys)

6 Time to initial assessment Time from arrival to start of full initial assessment, which includes a pain score and early warning score, for all patients arriving by ambulance

7 Time to treatment Time from arrival to see a decision making clinician (someone who can define the management plan and discharge the patient)

8 Consultant sign-off The percentage of patients presenting at type 1 and 2 (major) A&E departments in certain high-risk patient groups (adults with non-traumatic chest pain, febrile children less than 1 year old and patients making an unscheduled return visit with the same condition within 72 hours of discharge) who are reviewed by an emergency medicine consultant before being discharged

Table 9: Emergency Department Clinical Quality Indicators


7.6. Appendix B4: National Quality Requirements OOH

One

Performance reporting to PCT monthly

Two

Report OOH consultations to patient’s own GP practice by 08:00 next working day

Three

Regular exchange of up-to-date information about patients with predefined needs e.g. Palliative care

Four

Clinical audit of all who provide clinical service – (RCGP OOHs Clinical Audit Toolkit) (Urgent & Emergency Care Audit Toolkit 2011)

Five

Regular audit of patients’ experience of the service

Six

Complaints procedure

Seven

Capacity and contingency planning

Eight

Telephone answering requirements (Within 60s including a recorded message)

Nine

Telephone Clinical Assessment (30s, 20min, 60min)

Ten

Face-to-face Clinical Assessment (walk-ins)

Eleven

Patients must be treated by clinician best equipped to meet their particular needs

Twelve

Face-to-face consultations (Emergency – 1hr / Urgent – 2hrs / Routine – 6hrs)

Thirteen

Providing services for people with language difficulties, impaired hearing or impaired sight

Table 10: National Quality Requirements OOH


7.7. Appendix B5: Social Care Performance Indicators - Hospital Discharge

1.1 The Community Care (Delayed Discharges etc.) Act 2003 confirmed the responsibilities of

NHS Trusts and Local Authority Adult Social Services Departments in relation to the identification,

prevention and management of people whose discharge from hospital may be delayed due to

health or social care factors. Croydon Adult Social Services, which is part of the Department of

Adult Services, Health and Housing (DASHH), has long established policies and procedures in

place both at CUH and with out of borough hospitals to prevent or minimise the number of Delayed

Transfers of Care (DToC), and in recent years has achieved a consistently good level of

performance as evidenced by the national key performance indictor. The local authority’s

responsibilities in relation to hospital discharges of people who may be in need of social care

services are undertaken by teams of social workers and care managers. At CUH this is the Adult

Care Team (ACT) whilst the START service responds to the needs of Croydon residents in out-of-

borough hospitals.

1.2 The 2003 legislation required local health and social care economies to establish local

arrangements. It also established that hospital trusts which do not have an agreement in place can

apply financial penalties to the relevant Adult Social Services Department where it has been

agreed that the organisation is responsible for the failure to meet the statutory deadlines to ensure

that social care support arrangements are in place to enable discharge. When a delay occurs

because of a failure on the part of Adult Social Services to meet that deadline a coded delay is

agreed and formally recorded. Once a section 5.3 notice (Community Care (Delayed Discharges

etc) Act 2003) has been issued Adult Social Services has 24 hours (national standard) to complete

all social care discharge arrangements. In CUH it has been agreed that this period of notice is

extended to 48 hours before a social care coded delay is recorded. NHS providers and adult

social service departments are expected to reach agreement about which delays are recordable,

the reason for the delay and whether each one is a health or social care delay. In CUH the Head

of Hospital Avoidance and Adult Care Team Manager are responsible for reaching agreement on

recordable delays at CUH.

1.3 The performance of all NHS providers and Adult Social Services Departments are published

(as Delayed Transfer of Care data) by DH on a quarterly basis, with this being a national

performance indicator for the NHS and Local Authorities. This data includes all delays of Croydon

residents regardless of which hospital they were discharged from.

1.4 Whilst there are no specific quality hospital discharge KPI’s related to social care, the Local

Authority is required to undertake and report on nationally determined surveys of service users’

and carers’ experience of and satisfaction with social care services as part of the annual statutory

returns for the Adult Social Care Outcomes Framework.


7.8. Appendix B6: Quality and Performance Metric

Clinical Quality Indicators

ACTIVITY

111

111 in hours

111 out of hours

Numbers and Percentage of where diverted to:

Croydon OOH Emergency Dental Service

Croydon University Hospital ED

Croydon University Hospital UCC

Edridge Road

No DOS returned

Portland Medical Centre

Virgin Care GP for OOH - See GP

Virgin Care GP for OOH - Speak to GP

LAS

Number of category A incidents

Number of category C1 incidents

Number of category C2 incidents

Number of category C3 / C4 incidents

London Ambulance Service dispersals to Walk-in’s excluding ED:

Virgin Care

Edridge Road

Purley UCC

Parkway MIU

CHS

A&E 4 Hour Total Time in Department (All Types)

A&E 4 Hour Total Time in Department (Type 1)

Attendances (split UCC and ED)

Reattendance Rates

ED Admission and Non Admission Attendances


AMU beds turnover

AMU av LOS

Admissions avoided - AMU clinic

Admissions avoided - ACE

Admissions avoided - ACP

Discharges by 1pm (non-elective admissions only - shown as a Percentage of all non-elective admissions

Numbers of Medical Outliers

Numbers of Surgical Outliers

CUH: Daily hospital inpatient admission and discharge profile

7 day readmissions rates

28 day readmissions rates

SLAM

Numbers of Older people attendances and admission rates

Numbers of Adults attendances and admission rates

Out of Hours

Out of Hours Activity by face to face, home visit or telephone advice

Edridge Road

Overall Activity Walk-Ins

Overall Activity for Purley, Parkway, Virgin and ED

Overall Activity by Month (Croydon Registered and non Croydon residents):

ED

Virgin Care

Purley UCC

Parkway MIU

Primary Care and Pharmacy

Same Day Slots Available by Month (as of 17th Sep 2013):

Thornton Heath (536)

Mayday (3,032)

New Addington / Selsdon (1,820)

Woodside / Shirley (3,524)

Purely (3,284)

East Croydon (2,435)


Pharmacy Minor Ailment Consultation Activity

PERFORMANCE AND QUALITY

111

LAS

Category A percentage reached in 8 minutes

Cat C1 % within 20 mins

Cat C2 % within 30 mins

Ambulance Handover within 15 minutes

Ambulance Handover within 1 hour

CHS

A&E 4 Hours Waits 95% Target - All Types

CHS Breaches by Weekday

CHS A&E Attendances vs. Breaches by Arrival Hour

CUH (CHS): weekly 4 hr. emergency access performance by week, by patient flow groups

CUH (CHS): ED LoS distribution by patient flow group

UCC

Time Spent in UCC Handover and Streamed Adult Patients (>=16) 95th Percentile

Time Spent in UCC Handover and Streamed Paediatric Patients (>=16) 95th Percentile

UCC to CHS handover

London Borough of Croydon

Number of Domiciliary Care Packages

Delayed Transfer of Care

PATIENT EXPERIENCE

Emergency and Urgent Care Complaints

111 – Number of SIs/Complaints

LAS – Number of SIs/Complaints

Primary Care GP Practices – Number of SIs/Complaints

CHS – Number of SIs/Complaints

Virgin Care – Number of SIs/Complaints

Edridge Road – Number of SIs/Complaints

SLAM - Number of SIs/Complaints


LBC - Number of SIs/Complaints

Emergency and Urgent Care Patient Satisfaction Levels

111 – Patient Satisfaction

LAS – Patient Satisfaction

Primary Care GP Practices – Patient Satisfaction

CHS – Patient Satisfaction

Virgin Care – Patient Satisfaction

Edridge Road – Patient Satisfaction

SLAM - Patient Satisfaction

LBC - Patient Satisfaction

WORKFORCE

111 - Recruitment on Target / Vacancy Rates

LAS - Recruitment on Target / Vacancy Rates

Primary Care GP Practices - Recruitment on Target / Vacancy Rates

CHS - Recruitment on Target / Vacancy Rates

Virgin Care - Recruitment on Target / Vacancy Rates

Edridge Road - Recruitment on Target / Vacancy Rates

SLAM - Recruitment on Target / Vacancy Rates

LBC - Recruitment on Target / Vacancy Rates

Figure 57: Quality and Performance Metric


7.9. Appendix C: Map of Top 6 ED’s by attendances

Figure 58: Map of Top 6 ED’s by attendances


7.10. Appendix D: Map of UCC’s, MIU’s and Walk in Centre

Figure 59: Map of UCC’s, MIU’s and Walk in Centre


7.11. Appendix E: Ambulatory Care Pathways

Ambulatory Care Pathways allow patients who are safe to go home to be managed promptly as

outpatients, without the need for admission to hospital.

Patients presenting to CHS with the following conditions should be managed whenever possible

using the Ambulatory Care Pathways.

Figure 60: Ambulatory Care Pathways


7.12. Appendix F1: Virgin Care Urgent Care Centre Alternative Care Pathway

Service description: Croydon Urgent Care Centre, located at the front of the Emergency

Department at Croydon Health Services (CUH) is a GP-led urgent care centre that provides

treatment for patients with minor illness and minor injuries. The care is delivered by General

Practitioners, Nurse Practitioners, Emergency Care Practitioners, Staff Grade doctors and Nurses.

X-ray facilities are available on-site.

Virgin Care Urgent Care Centre

Categories of patients accepted

Ankle injury No deformity, able to weight bear with assistance of one person.

Bites and stings Animal or insect. No systemic reaction.

Burns and scalds Less than 3% in adults, less than 1% in paediatrics; no facial burns; no inhalation injury.

Digit injury No open injuries; no infection; no diabetic problems.

Earache

Elbow injury Must be non-displaced & have good distal pulse.

Eye conditions No penetrating injury or peri-orbital cellulitis.

Lower back pain No 'red flags', under 65 years of age.

Minor allergic reactions

Minor head injury GCS 15/15; no intoxicating substances; no current anti-coagulant therapy. No history of loss of consciousness.

Rib injury If no primary survey problems, must be due to trauma/injury, not non-traumatic presentation.

Skin complaints (incl. rashes)

Patient must be apyrexial; no non-blanching rashes; incl. impetigo, minor cellulitis and wound infections.

Sore throat Patient must be able to swallow; no drooling; no indications of quinsy; no trismus.

Upper respiratory tract infection (URTI)

Uncomplicated infections; flu-like symptoms; the latest version of the flu algorithm should be used in the assessment of these patients.

Urinary tract infection (UTI) Uncomplicated infections in female patients aged 12yrs and over only.

Vomiting With less than 4 hours history.

Wounds and lacerations Minor injuries only, scalp & facial wounds; excluding triangle of the face.

Wrist injuries No gross deformity, good distal perfusion.


Virgin Care Urgent Care Centre

Other

Gastrointestinal problems Diarrhoea, vomiting, constipation.

Head injuries Minor injuries only, scalp & facial wounds; excluding triangle of the face.

Musculo-skeletal Injuries

Injuries: Low impact, bony and non-injuries, bony injuries, i.e. sprains, strains, tendonitis, fractures, whiplash (without c-spine bony tenderness). Non-injuries: conditions of recent onset only.

Wounds & lacerations Grazes, lacerations requiring suturing.

Dental problems

RTC victims Minor injuries.

Table 11: Virgin Care Urgent Care Centre Alternative Care Pathway


7.13. Appendix F2: Purley War Memorial Hospital Urgent Care Centre Pathway

Service description: Purley War Hospital Urgent Care Centre is a nurse-led health centre that

provides treatment for patients with minor ailments and minor injuries. The care is delivered by

nurse practitioners and support nurses. X-ray facilities are available on-site

Purley War Memorial Hospital Urgent Care Centre



Bites and stings Animal or insect, no systemic reaction.

Burns and scalds Burns must not be full thickness and must cover less than 5% TBSA in adults and less than 3% TBSA in paediatrics. Minor facial burns but no neck or genitalia or inhalation injury.

Digit injury No open injuries. Infections will be seen even if patient is diabetic.

Earache



Lower back pain No 'red flags'.


Minor head injury No history of loss of consciousness, GCS 15/15; no intoxicating substances; no current anti-coagulant therapy.


Skin complaints (incl. rashes)

Patient must be apyrexial; no non-blanching rashes. Impetigo, minor cellulitis and wound infections will be seen.




Urinary tract infection (UTI)

Uncomplicated infections in female patients aged 12yrs and over only.


Wounds and Lacerations

Minor injuries only, scalp & facial wounds; Superficial grazes, lacerations requiring suturing apart from lacerations that cross the vermillion border of the lip or lacerations to the eyelids or those that obviously require plastics intervention or general anaesthetic or sedation as in very young children. Burns or scalds — see above excludes hands and feet.


Purley War Memorial Hospital Urgent Care Centre


Other

Gastrointestinal problems

Diarrhoea, vomiting. No constipation.

Head injuries Minor injuries only, scalp & facial wounds — see wounds and lacerations above.

Musculo-skeletal injuries

Injuries: low impact, non-displaced bony or non-bony injuries, i.e. sprains, strains, tendonitis, fractures, whiplash (without c-spine bony tenderness). Non-injuries: conditions of recent onset only

Table 12: Purley Wat Memorial Hospital Urgent Care Centre Pathway


7.14. Appendix F3: Parkway Emergency Minor Treatment Centre Care Pathway

Service description: New Addington Emergency Minor Treatment Centre is a nurse-led unit that

provides treatment for patients with minor ailments and minor injuries. The care is delivered by

doctors, nurse practitioners and support nurses. X-ray facilities are not available on-site.

New Addington Parkway Emergency Minor Treatment Centre



Bites and stings Animal or insect with no associated anaphylaxis.

Burns Burns must not be full thickness and must cover less than 5% TBSA in adults and less than 3% TBSA in paediatrics Minor facial burns but no neck or genitalia or inhalation injury.

Digit injury No open injuries. Infections will be seen even if patient is diabetic.



Minor head injury GCS 15, no LOC; no intoxicating substances; no current anti-coagulant therapy.

Rib injury If no primary survey problems, must be due to trauma /injury, not non-traumatic presentation.

Wounds Minor injuries only, scalp & facial wounds; excluding hands, feet & triangle of the face.


Other

Gastrointestinal problems

Diarrhoea, vomiting. No constipation.


Musculo-skeletal injuries

Injuries: Low impact, non-displaced bony or non- bony injuries, i.e. sprains, strains, tendonitis, whiplash (without c-spine bony tenderness). Non-injuries: conditions of recent onset only.

Wounds & lacerations

Superficial grazes, lacerations requiring suturing apart from lacerations that obviously require plastics intervention or general anaesthetic or sedation as in very young children. Burns or scalds — see above.

Non-traumatic neck pain

Adults only.

Distal limb injuries i.e. elbows to fingers, below to toes

Table 13: Parkway Emergency Minor Treatment Centre Care Pathway


7.15. Appendix F4: Edridge Rd Community Health Centre Care Pathway

Service Description: Edridge Rd Community Health Centre is a GP-led health centre provides

treatment for patients with minor ailments and minor injuries. The care is delivered by doctors,

nurse practitioners and support nurses. X-ray facilities are not yet available on-site.

Edridge Rd Community Health Centre



Bites and stings Animal or insect. No systemic reaction.

Burns and scalds Less than 3% in adults, less than 1% in paediatrics; no facial burns; no inhalation injury.

Digit injury No open injuries; no infection; no diabetic problems.

Earache



Lower back pain No 'red flags', under 65 years of age.


Minor head injury GCS 15/15; no intoxicating substances; no current anti-coagulant therapy. No history of loss of consciousness.


Skin complaints (incl. rashes) Patient must be apyrexial; no non-blanching rashes; incl. impetigo, minor cellulitis and wound infections.




Urinary tract infection (UTI) Uncomplicated infections in female patients aged 12yrs and over only.


Wounds and lacerations Minor injuries only, scalp & facial wounds; excluding triangle of the face


Other

Gastrointestinal problems Diarrhoea and constipation but heamodynamically stable.


Musculoskeletal and distal limb (i.e. elbows to fingers, below to toes) injuries

Injuries: low impact, non-displaced bony or non-bony injuries, i.e. sprains, strains, tendonitis, fractures, whiplash (without c-spine bony tenderness). Non-injuries: conditions of recent onset only.


Edridge Rd Community Health Centre

Wounds & lacerations Superficial grazes, minor lacerations requiring glueing, superficial burns or scalds <2% body surface area (excl. face, neck or genitalia).

Non-traumatic neck pain Adults only.

Family planning or sexual health complaints

Includes emergency contraception.

Table 14: Edridge Road Community Health Centre Care Pathway


7.16. Appendix F5: SLAM Crisis & Home Treatment Team Care Pathway

Service description: South London & Maudsley Foundation Trust provides care for patients with

mental health needs within the PCTs of Lambeth, Lewisham & Southwark.

Mental Health Liaison Teams are teams of mental health professionals based at A&E

departments within each PCT who assess people to determine if they need mental health

care and treatment, and refer them to clinical services.

They provide a 24 hour service to manage all psychiatric emergencies in A&E and inpatient

wards.

Can arrange for assessments under the Mental Health Act (1983)

Work closely with community-based mental health and substance misuse services to

provide mental health care and treatment.

Criteria for referral

Patients aged 18 years and over.

Patients who are a temporary or permanent resident of Lambeth, Lewisham & Southwark.

Categories of patients accepted Patients who:

All patients presenting with a mental health crisis.

Categories of patients not accepted Patients who:

Are medically unstable

Present with complications to the mental health issue including, alcohol or drug intoxication, injuries (accidentally sustained or as a result of self-harm), these would need to be medically cleared first.

Table 15: South London & Maudsley Crisis & Home Treatment Team Care Pathway


7.17. Appendix G: GP Map

Figure 61: GP Map


7.18. Appendix H: Map of Croydon Pharmacies

Note: This map does not show Fieldway Pharmacy and Fairview

Figure 62: Map of Croydon Pharmacies

Source Ordnance Survey, November 2010


7.19. Appendix H1: Pharmacy First - Ailments included in the scheme:


Acne Head lice

Athlete’s foot Headache

Back pain Indigestion

Cold sores Insect bites/stings

Conjunctivitis Mouth ulcers

Constipation Nappy rash

Contact dermatitis Scabies

Coughs & colds Sprains & strains

Cystitis Teething

Diarrhoea Threadworm

Earache Toothache

Ear wax Thrush

Fever Sore throat

Haemorrhoids (piles) Warts & verrucas

Hayfever & allergies

Table 16: Pharmacy First – Ailments included in the scheme


7.20. Appendix I: Revised Urgent and Emergency Care Action Plan

The Whole Systems Action Plan has been evolving with actions already completed to achieve sustainability. This Action Plan is as of September

2013 and includes Risk Summit Actions and the 14 Key Priority Service Actions.

CATEGORY PRIORITY RISK SUMMIT / BEST PRACTICE FLOW

ACTION LEAD ORG or BOARD TIMESCALE

Strategy & Governance Development of integrated Quality and Performance Dashboard incorporating London Standards / CQI Standards/ Social Care Standards

EUCB 23/10/2013

Strategy & Governance Review of Quality and Performance Dashboard at Monthly EUCB

EUCB 16/09/2013

Strategy & Governance Recommendation of Emergency and Urgent Care Strategy to Governing Bodies

EUCB 24/09/2013

Strategy & Governance Development of Demand & Capacity Plan inc Q3 & Q4 Whole System Plans

EUCB 23/09/2013

Strategy & Governance Finalise Emergency and Urgent Care Strategy for GB/Boards

CCG 23/09/2013

Strategy & Governance To complete Final Recovery and Improvement Plan

CCG TBC

Strategy & Governance To RAG Winter Checklist EUCB 16/09/2013

Strategy & Governance To RAG Demand and Capacity Checklist EUCB 16/09/2013

Strategy & Governance To finalise Demand and Capacity Plan to include Q3&Q4

EUCB 23/09/2013

1. Improving Self-Care Priority 1 For patients living with Long Term Conditions, the use of enhanced Case Management with the MDT in the community in order to achieve improved targeting of use of services.

CHS 01/10/2013

1. Improving Self-Care Priority 2 Targeted marketing campaign to educate the public about right service right time

CHS 01/10/2013

1. Improving Self-Care Social Care to appoint 8 social work staff including one team manager to be deployed to support MDT case management teams

LBC 01/10/2013




2. Improving System Access When Patients Realise Something Is Wrong

Risk Summit 10 Assessment of skill base in Primary Care for delivery of Urgent Care requirements for paediatric patients Scope of assessment process to be decided by UEPB and assessment undertaken. (RS1-R10)

CCG 31/07/2013


Risk Summit 11 Assessment of overall primary care capacity from 15.00 to 20.00 hrs to meet the needs of UC patients Review across networks as part of Primary and Community Care Strategy development and review of Purley and New Addington UCC provision. (RS1-R11)

CCG 31/07/2013


Risk Summit 12 Set up peer review process and framework for GP emergency referrals for follow up actions, benchmark existing process and ensure improvement framework overseen by GP Networks and UEPB Review to be commissioned by UEPB (RS1-R12)

CCG 30/09/2013


Risk Summit 14 Frail Elderly - Ensure national standards are applied as a minimum to the care of this patient group Assessment process against national standards to ensure parity with requirements (RS1-14)

CHS 30/09/2013


Priority 3 Community and Primary Care

Assessment of overall same day slots and demand for these slots and utlisiation by Network

CCG 31/10/2013



Strengthen real-time response and information through 111/DoS

CCG 01/11/2013

2. Improving System Priority 5 Single point of assessment activation of CCG 02/11/2013




Access When Patients Realise Something Is Wrong

Community and Primary Care

24/7 rapid response team



Review of LAS ACP’s and addition of increasing number of ACP’s to Community Services e.g. Rapid Response

LAS 31/10/2013


Paediatric Care - Check for requirement for additional actions to improve paediatric care across the system from primary into secondary provision. Review of paediatric care undertaken to ensure best possible provision ahead of winter 2013/14 (RS1-15)

CHS CCG

30/09/2013


Medicines management Increase uptake of Repeat dispensing, MURS and NMS to minimize inappropriate medication requests by patients to A&E and WIC as part of urgent care.

CCG 18/10/2013


Improved focus on dementia care and access to ICT to early identify people already using services

LB / CHS / CCG 01/12/2013


Review of existing ACP’s and increase % standards to disposal at other sites Primary Care / Edridge Road / Purley and Parkway

LAS 01/09/2013


Review of using exclusion criteria at Virgin UCC

LAS CHS

01/10/2013


Review of Primary Care Same Day slots availability and Opening Hours See 2.05

CCG 01/10/2013




3. Improving Care And Patient In ED / Hospital

Risk Summit 1 Mental health patients - Assessment processes in A&E to be risk stratified and responsiveness of service to be more aligned to need Success criteria for above to be drawn up and agreed (RS1)

CHS / SLAM 31/10/2013


Priority 7 Consultant cover at weekends

7 Day Working of Consultants in ED CHS


Priority 8 Consultant cover at weekends

7 Day Working of AHP's in ED CHS


Priority 9 7 Day Working / DTOC

7 Day Working of Care Managers Ward Specialities

LBC


Priority 10 7 Day Working

Recruitment campaign for band 6/7 ED nursing staff.

CHS 01/09/2013


Workforce: Skill mix Delivery of training to support 2-tier working

LAS 05/08/2013


Workforce: The LAS has started a review of rosters far all operational staff, which has a 3 month time line and will be completed in Jan 2014 for implementation around March April 2014

LAS 01/04/2014


Efficiencies: Recruitment of additional staff within the Clinical Hub to the new role which is targeted to deliver hear and treat

LAS 31/12/2013


Efficiencies: New response model to be implemented when workforce and modernisation programme is completed.

LAS 01/04/2014

3. Improving Care And Local Pharmaceutical Service Contacts CCG 31/10/2013




Patient In ED / Hospital Review Edridge RD Pharmacy linked to the WIC and Mayday Pharmacy close to Croydon University Hospital are under review


Data accuracy for ambulance handover is impaired by availability and use of CAD in all receiving locations

LAS 10/09/2013


Maximise the potential for Urgent Care to manage ambulance arrivalsthrough use of exclusion criteria

CHS/LAS/CCG 01/10/2013


To improve the efficiency of handover by redesign the majors process to minimise delays, using learning from the RATT implementation.

CHS 30/06/2013


ED IT system does requires complete overhaul to enable visual shop floor management

CHS 26/08/2013


Adult Emergency Care Standards (AECS) Standards

CHS 01/10/2013


Developing a full capacity protocol - Current escalation response does not contain and de-escalate pressure quickly. ED can be compromised with regard to flow and safety but the hospital does not change tempo and respond accordingly.

CHS 23/09/2013


Develop internal professional standards - to define the expectations of how specialties will support one another to enable safe and timely decision making and flow

CHS 01/07/2013


There is a lack of intelligent performance data by specialty and site level to inform decision making / performance management.

CHS 01/10/2013


Board rounds - Project Initiation Document completed Implementation plan complete -

CHS 31/07/2013




coveringgood ward based practice such as EDD, clinical criteria for discharge, daily / twice daily senior review, managing delays and escalation


The plans for ED represent a once in a generation opportunity to provide a clinical environment which will support the clinicians in providing first class care. Networking with EDs who have rebuilt there environments would support the development learning wise.

CHS 21/10/2013


Review of ED Psychiatric Liaison and adult mental health liaison and Drugs and Alcohol onward signposting and service availability

CCG 21/10/2013

4. Appropriate Flow For Patients Leaving Hospital


7 Day Working of AHP's Ward Specialities CHS



7 Day Working of Care Managers Ward Specialities

LBC



Service to be profiled on DOS in NHSP new release and a LOP developed to enable referrals through to service when appropriate At every opportunity 111 needs to be involved in processes out of hospital eg advising EVERY patient who attends ED/ is discharged from hospital / Has TTas needs encouragement to call 111 if their condition deteriorates Frequent flyers need special patient notes on 111 system to support 111 in managing these patients rather than sending them in

111 27/10/2013

4. Appropriate Flow For Acute Pharmacy Croydon University CCG 18/10/2013




Patients Leaving Hospital Hospital Medicines discharge work steam review


Support for Continuing Care Assessment CHS 01/10/2013


Develop case for Discharge Coordinators CHS 01/08/2013


To review the discharge policy and procedures to review how can be more integrated with whole systems

CHS 01/11/2013

5. Improving Care Clarifying Options When Returning To The Community


The CCG will procure 12 Intermediate Care Beds which will be able to support step up / step down community based facilities supported by the community teams, thus preventing or reducing an acute hospital admission.

CCG 01/10/2013

5. Improving Care Clarifying Options When Returning To The Community

Develop the Single Point of Assessment service such that access to social and community care services are enhanced through appropriate sign-posting and will enable a clinical face to face assessment within 2 hours.

CHS 01/10/2013

Table 17: Revised Urgent and Emergency Care Action Plan


7.21. Appendix J: GP and Pharmacy Opening Hours

PLEASE NOTE: Within this section (Appendix J) data relating to GP Opening hours and GP Same Day slots is still being verified and further data

collected to complete the same day slot analysis.

Mayday

Table 18: Mayday GP Opening Hours

Nacscode Practice Mon Open Mon Close Tues Open Tues Close Wed Open Wed Close

H83009 NORBURY HC 08:30 19:00 08:30 19:00 08:30 19:00

H83042 LEANDER ROAD 08:30 18:00 08:30 18:00 08:30 18:00

H83051 THORNTON ROAD 08:00 18:30 08:00 20:00 08:00 20:00

H83625 BROUGHTON CORNER 09:00 18:30 09:00 20:00 09:00 20:00

H83017 BRIGSTOCK MP 08:00 20:00 08:00 20:00 08:00 18:30

H83020 EVERSLEY MC 08:30 18:30 08:30 18:30 08:30 18:30

H83608 BRIGSTOCK 08:15 20:00 08:15 19:00 08:15 17:45

H83021 LINDEN LODGE (LONDON ROAD) 08:30 20:00 08:30 18:30 08:30 18:30

H83011 NORTH CROYDON 08:00 18:30 08:00 18:30 08:00 18:30

H83624 FAIRVIEW MC 08:00 20:00 08:00 18:30 08:00 14:30

H83634 VALLEY PARK SURGERY 08:30 18:30 08:30 18:30 08:30 13:30

Nacscode Practice Thurs Open Thurs Close2 Fri Open Fri Close Sat Open Sat Close

H83009 NORBURY HC 08:30 19:00 08:30 19:00

H83042 LEANDER ROAD 08:30 18:00 08:30 18:00

H83051 THORNTON ROAD 08:00 20:00 08:00 18:30 09:00 11:00

H83625 BROUGHTON CORNER 09:00 18:30 09:00 18:30

H83017 BRIGSTOCK MP 08:00 20:00 08:00 18:30

H83020 EVERSLEY MC 08:30 18:30 08:30 18:30

H83608 BRIGSTOCK 08:15 19:00 08:15 19:00

H83021 LINDEN LODGE (LONDON ROAD) 08:30 18:30 08:00 18:30

H83011 NORTH CROYDON 08:00 19:30 08:00 19:30

H83624 FAIRVIEW MC 08:00 18:30 08:00 18:30

H83634 VALLEY PARK SURGERY 08:30 13:30 08:30 18:00


GP Same Day Slots

Table 19: Mayday GP Same Day Slots

Nacscode Practice Mon Tue Wed Thu Fri Sat

H83009 NORBURY HC 70 60 60 60 60

H83042 LEANDER ROAD

H83051 THORNTON ROAD AM: 27

PM: 15

AM: 27

PM: 15

AM: 27

PM: 15

AM: 27

PM: 15

AM: 27

PM: 15 12

H83625 BROUGHTON CORNER 27 27 27 27 27

H83017 BRIGSTOCK MP

H83020 EVERSLEY MC

H83608 BRIGSTOCK 10 to 15 10 to 15 10 to 15 10 to 15 10 to 15

H83021 LINDEN LODGE (LONDON ROAD)

H83011 NORTH CROYDON 25 13 14 10 16

H83624 FAIRVIEW MC

H83634 VALLEY PARK SURGERY 5 5 5 5 5


Pharmacy Mon Tue Wed Thu Fri Sat Sun Bank Holiday

SUPERDRUG PHARMACY 1491-1493 LONDON ROAD, SW16 3LU

09:00-18:00 09:00-18:00 09:00-18:00 09:00-18:00 09:00-18:00 09:00-18:00 Closed Closed

SAINSBURY’S PHARMACY 2 TRAFALGAR WAY, CR0 4XT

07:00-23:00 07:00-23:00 07:00-23:00 07:00-23:00 07:00-23:00 07:00-22:00 10:00-16:00 Closed

PYRAMID PHARMACY 1351 LONDON ROAD, SW16 4BE

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-18:00 Closed Closed

PARADE PHARMACY 299A THORNTON ROAD, CR0 3EW

09:00-13:00 14:00-18:30

09:00-13:00 14:00-19:00

09:00-13:00 14:00-19:00

09:00-13:00 14:00-19:00

09:00-13:00 14:00-18:30

09:00-13:00 Closed Closed

MAYDAY COMMUNITY PHARMACY 514 LONDON ROAD, CR7 7HQ

09:00-22:00 09:00-22:00 09:00-22:00 09:00-22:00 09:00-22:00 09:00-22:00 09:00-22:00 Open

DAY LEWIS PHARMACY 1102 LONDON ROAD, SW16 4DT

09:00-13:00 14:00-18:30

09:00-13:00 14:00-18:30

09:00-13:00 14:00-18:30

09:00-13:00 14:00-18:30

09:00-13:00 14:00-18:30


DAY LEWIS PHARMACY 2 PETERWOOD WAY, CR0 4UQ

09:00-17:00 09:00-17:00 09:00-17:00 09:00-17:00 09:00-17:00 Closed Closed Closed

DAY LEWIS PHARMACY 506 LONDON ROAD, CR7 7HQ

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-13:00 Closed Closed

CRANSTON LTD 951 LONDON ROAD, CR7 6JE


BOOTS VALLEY PLAZA RETAIL PARK, CR0 4YJ

09:00-23:59 09:00-23:59 09:00-23:59 09:00-23:59 09:00-23:59 09:00-23:59 11:00-17:00 Closed

BRIGSTOCK PHARMACY 141 BRIGSTOCK ROAD, CR7 7JN

09:00-18:00 09:00-18:00 09:00-18:00 09:00-18:00 09:00-18:00 09:00-12:00 Closed Closed

BIDS CHEMIST 1495 LONDON ROAD, SW16 4AE

09:00-17:30 09:00-17:30 09:00-17:30 09:00-17:30 09:00-17:30 09:00-13:00 Closed Closed

ALPHAMED LTD 324-340 BENSHAM LANE, CR7 7EQ


Table 20: Mayday Pharmacy Opening Hours


Thornton Heath

Table 21: Thornton Heath GP Opening Hours


H83037 AUCKLAND SURGERY 08:00 18:30 08:00 18:30 07:15 13:00

H83010 SOUTH NORWOOD HILL MC 08:00 18:30 08:00 18:30 08:00 18:30

H83005 UPPER NORWOOD GRP PRAC 08:00 18:30 08:00 18:30 08:00 18:30

H83041 SOUTH NORWOOD MC 09:00 19:00 09:00 19:00 09:00 14:00

H83609 MERSHAM MC 08:00 18:30 / 20:00 08:00 18:30 / 20:00 08:00 18:30 / 20:00

H83622 SOUTH NORWOOD MP 09:00 19:00 09:00 19:00 09:00 14:00

H83053 PARCHMORE MC 08:00 18:30 08:00 18:30 08:00 18:30

H83022 THORNTON HEATH HC 08:30 18:30 08:30 18:30 08:30 18:30

Nacscode Practice Thurs Open Thurs Close Fri Open Fri Close Sat Open Sat Close

H83037 AUCKLAND SURGERY 08:00 18:30 08:00 18:30 08:30 10:15

H83010 SOUTH NORWOOD HILL MC 08:00 18:30 08:00 18:30

H83005 UPPER NORWOOD GRP PRAC 08:00 18:30 08:00 18:30 09:00 11:00

H83041 SOUTH NORWOOD MC 09:00 18.30 09:00 18:30

H83609 MERSHAM MC 08:00 18:30 / 20:00 08:00 18:30 / 20:00

H83622 SOUTH NORWOOD MP 09:00 18:00 09:00 18:00

H83053 PARCHMORE MC 08:00 18:30 08:00 18:30

H83022 THORNTON HEATH HC 08:30 18:30 08:30 18:30 08:30 12:00


GP Same Day Slots

Table 22: Thornton Heath GP Same Day Slots


SUPERDRUG PHARMACY 1 - 2 COTFORD PARADE, CR7 7JG

08:30-19:00 08:30-19:00 08:30-19:00 08:30-19:00 08:30-19:00 08:30-19:00 10:00-16:00 Closed

SAINSBURY PHARMACY 66 WESTOW STREET, SE19 3RW

07:00-23:00 07:00-23:00 07:00-23:00 07:00-23:00 07:00-23:00 07:00-22:00 11:00-17:00 Closed

SAINSBURY PHARMACY 122 WHITEHORSE LANE, SE25 6XB

08:00-21:00 08:00-21:00 08:00-21:00 08:00-21:00 08:00-21:00 07:30-20:00 10:00-17:00 Closed

THOMPSONS CHEMIST 86-88 BEULAH ROAD, CR7 8JF

08:30-18:30 08:30-18:30 08:30-18:30 08:30-13:00 08:30-18:30 08:30-13:00 Closed Closed

THORNTON HEATH PHARMACY 27 HIGH STREET, CR7 8RU

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-13:00 Closed Closed

WILKES CHEMIST 105 PARCHMORE ROAD, CR7 8LZ

09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-13:00 Closed Closed

LLOYDS PHARMACY 130 CHURCH ROAD, SE19 2NT

08:30-19:00 08:30-19:00 08:30-19:00 08:30-19:00 08:30-19:00 09:00-12:00 Closed Closed

KLUB PHARMACY LTD 10 CROWN POINT PARADE, SE19 3NG

09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-14:30 Closed Closed

DAY LEWIS PHARMACY 283 SOUTH NORWOOD HILL, SE25 6DP

09:00-13:00 14:00-18:00

09:00-13:00 14:00-18:00

09:00-13:00 14:00-18:00

09:00-13:00 14:00-18:00

09:00-13:00 14:00-18:00


DAY LEWIS PHARMACY 3 HIGH STREET, SE25 6EP

09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-16:30 Closed Closed

Table 23: Thornton Heath Pharmacy Opening Hours


H83037 AUCKLAND SURGERY 12 12 16 12 12

H83010 SOUTH NORWOOD HILL MC 15 to 20 15 to 20 15 to 20 15 to 20 15 to 20

H83005 UPPER NORWOOD GRP PRAC 20 20 20 20 20

H83041 SOUTH NORWOOD MC 3 3 3 3 3

H83609 MERSHAM MC 10 10 10 10 10

H83622 SOUTH NORWOOD MP 6 4 2 3 5

H83053 PARCHMORE MC

H83022 THORNTON HEATH HC 6 6 6 6 6 6


Woodside / Shirley

Table 24: Woodside / Shirley GP Opening Hours


H83033 ASHBURTON PARK 08:00 19:30 08:00 18:30 08:00 13:00

H83029 HARTLAND WAY 08:00 18:30 08:00 18:30 08:00 18:30

H83035 SOUTH WAY 08:00 19:00 08:00 20:00 08:00 19:00

H83025 WOODSIDE 08:00 18:30 08:00 18:30 07:30 20:00

H83030 SPRING PARK 08:30 18:30 08:30 13:00 08:30 20:30

H83008 THE ADDISCOMBE 08:00 17:00 08:00 17:00 08:00 19:00

H83039 STOVELL HOUSE 08:15 20:00 08:15 19:00 08:15 19:00

H83626 WOODSIDE 08:30 18:30 08:30 18:30 08:30 20:00

H83001 PORTLAND 08:00 20:00 08:00 20:00 07:30 18:30

H83043 SHIRLEY MEDICAL CENTRE 08:00 18:30 08:00 18:30 08:00 18:30


H83033 ASHBURTON PARK 08:00 19:00 08:00 18:30

H83029 HARTLAND WAY 08:00 18:30 08:00 18:30

H83035 SOUTH WAY 08:00 15:30 08:00 19:00

H83025 WOODSIDE 08:00 18:30 08:00 18:30

H83030 SPRING PARK 08:30 18:30 08:30 18:30

H83008 THE ADDISCOMBE 08:00 17:00 08:00 17:00

H83039 STOVELL HOUSE 08:15 19:00 08:15 19:00 09:00 (Last Sat of Month) 11:00

H83626 WOODSIDE 08:00 18:30 08:00 18:30

H83001 PORTLAND 08:00 18:30 08:00 18:30 09:00 11:00

H83043 SHIRLEY MEDICAL CENTRE 08:00 18:30 08:00 18:30


GP Same Day Slots

Table 25: Woodside and Shirley Same Day Slots


H83033 ASHBURTON PARK 10 10 10 10 10

H83029 HARTLAND WAY 38 25 20 28 23

H83035 SOUTH WAY 39 40 34 30 39

H83025 WOODSIDE 25 25 25 25 25

H83030 SPRING PARK

H83008 THE ADDISCOMBE 4 to 6 4 to 6 8 4 to 6 4 to 6

H83039 STOVELL HOUSE 15 to 30 15 to 30 15 to 30 15 to 30 15 to 30

H83626 WOODSIDE AM: 3 Queries +

3 Emergency. Apt.

PM: 5 Emergnecy

Apt.

AM: 3 Queries +

3 Emergency. Apt.

PM: 3 Emergnecy

Apt.

AM: 3 Queries +

3 Emergency. Apt.

PM: 3 Emergnecy Apt.

AM: 3 Queries +

3 Emergency. Apt.


AM: 3 Queries +

3 Emergency. Apt.


H83001 PORTLAND 70 70 70 70 70

H83043 SHIRLEY MEDICAL CENTRE 14 14 14 14 14



TESCO STORES LIMITED 32 BRIGSTOCK ROAD, CR7 8RX

08:00-21:00 08:00-21:00 08:00-21:00 08:00-21:00 08:00-21:00 08:00-21:00 10:00-16:00 Closed

MC COIG PHARMACY 143 WICKHAM ROAD, CR0 8TE

09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-13:00 Closed Closed

MONA PHARMACY 246 WICKHAM ROAD, CR0 8BJ

09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-13:00 Closed Closed

LLOYDS PHARAMACY 156 PORTLAND ROAD, SE25 4PT

08:00-22:30 08:00-22:30 08:00-22:30 08:00-22:30 08:00-22:30 08:00-22:30 09:30-22:30 Closed

LARCHWOOD PHARMACY 215 LOWER ADDISCOMBE ROAD, CR0 6RB

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-18:00 Closed Closed

GREENCHEM 20 BYWOOD AVENUE, CR0 7RA

09:00-13:00 14:00-18:30

09:00-13:00 14:00-18:30

09:00-13:00 09:00-13:00 14:00-18:30

09:00-13:00 14:00-18:30


GREENCHEM 15 BROOM ROAD, CR0 8NG

09:00-13:00 14:00-19:00

09:00-13:00 14:00-19:00

09:00-13:00 09:00-13:00 14:00-19:00

09:00-13:00 14:00-19:00

09:00-13:00 14:00-19:00

Closed Closed

FISHERS ENMORE PHARMACY 1 ENMORE ROAD, SE25 5NT

08:00-22:00 08:00-22:00 08:00-22:00 08:00-22:00 08:00-22:00 08:00-18:00 11:00-13:00 Closed

BOOTS 257 LOWER ADDISCOMBE ROAD, CR0 6RD

09:00-17:30 09:00-17:30 09:00-17:30 09:00-17:30 09:00-17:30 09:00-17:30 Closed Closed

ADDISCOMBE PHARMACY 302 LOWER ADDISCOMBE ROAD, CR0 7AE

09:00-18:00 09:00-18:00 09:00-17:30 09:00-18:00 09:00-18:00 09:00-13:00 Closed Closed

SHIRLEY PHARMACY 175 SHIRLEY ROAD, CR0 8SS

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-17:00 Closed Closed

Table 26: Woodside / Shirley Pharmacy Opening Hours


New Addington / Selsdon

Table 27: New Addington / Selsdon GP Opening Hours


H83028 PARKWAY 08:00 19:15 08:00 18:30 08:00 18:30

H83049 HEADLEY DRIVE 08:00 18:30 08:00 20:00 08:00 13:30

H83004 FARLEY ROAD 08:00 18:30 08:00 20:00 08:00 20:00

H83027 PARKWAY 08:00 19:00 08:00 18:30 08:00 18:30

H83014 QUEENHILL 08:00 18:30 08:00 18:30 08:00 20:00

H83046 FIELDWAY 08:00 20:00 08:00 18:30 08:00 19:30

H83018 SELSDON PARK 08:00 19:30 08:00 18:30 08:00 19:30

H83006 PARKWAY 08:00 20:00 08:00 20:00 08:00 20:00


H83028 PARKWAY 08:00 19:15 08:00 18:30

H83049 HEADLEY DRIVE 08:00 18:30 08:00 18:30 09:00 12:00

H83004 FARLEY ROAD 08:00 18:30 08:00 18:30 08:30 11:30

H83027 PARKWAY 08:00 19:00 08:00 18:30

H83014 QUEENHILL 08:00 20:00 08:00 18:30

H83046 FIELDWAY 08:00 18:30 08:00 18:30

H83018 SELSDON PARK 08:00 18:30 08:00 18:30

H83006 PARKWAY 08:00 18:30 08:00 18:30 09:00 12:00


GP Same Day Slots

Table 28: New Addington and Selsdon GP Same Day Slots


BOOTS 1 CENTRAL PARADE, CR0 0JB

08:00-20:00 08:00-20:00 08:00-20:00 08:00-20:00 09:00-20:00 09:00-17:00 Closed Closed

LLOYDS PHARMACY 123 ADDINGTON ROAD, CR2 8LH

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-13:00 Closed Closed

LLOYDS PHARMACY 97 ADDINGTON ROAD, CR2 8LG

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-13:00 Closed Closed

HARRIS CHEMIST LTD 3 CROSSWAYS PARADE, CR2 8JJ

09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-19:00 09:00-17:30 Closed Closed

GOLDMANTLE PHARMACY 2 FORESTDALE CENTRE, CR0 9AS

09:00-19:30 09:00-19:30 09:00-19:30 09:00-19:30 09:00-19:30 09:00-18:00 09:00-15:00 Closed

FIELDWAY PHARMACY 3 WAYSIDE, CR0 9DX

08:30-20:00 08:30-18:30 08:30-18:30 08:30-19:30 08:30-18:30 10:00-14:00 Closed Closed

DOUGANS CHEMIST 114 HEADLEY DRIVE, CR0 0QF

09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-18:30 09:00-13:00 Closed Closed

DAY LEWIS PHARMACY 150 ADDINGTON ROAD, CR2 8LB

09:00-12:00 13:00-18:00

09:00-12:00 13:00-18:00

09:00-12:00 13:00-18:00

09:00-12:00 13:00-18:00

09:00-12:00 13:00-18:00

09:00-12:00 13:00-17:30

Closed Closed

AUMEX PHARMACY 43-44 CENTRAL PARADE, CR0 0JD

08:00-19:00 08:00-19:00 08:00-19:00 08:00-19:00 08:00-19:00 09:00-17:30 Closed Closed

Table 29: New Addington / Selsdon Pharmacy Opening Hours


H83028 PARKWAY 12 8

H83049 HEADLEY DRIVE 20 20 20 20 20

H83004 FARLEY ROAD 30 30 30 30 30

H83027 PARKWAY 18 18 18 18 18

H83014 QUEENHILL 6 same day apt

per clinician

6 same day apt

per clinician

6 same day

apt per clinician

6 same day apt

per clinician

6 same day apt

per clinician

H83046 FIELDWAY 80 80 80 80 80

H83018 SELSDON PARK 25 25 25 25 25

H83006 PARKWAY 35 35 35 35 35


Purley

Table 30: Purley GP Opening Hours


H83620 COULSDON 08:00 18:30 08:00 20:30 08:00 18:30

H83013 OLD COULSDON 07:00 19:30 07:00 19:30 07:00 19:30

H83052 BRAMLEY AVENUE 08:30 18:30 08:30 19:30 08:30 13:30

H83024 THE WOODCOTE GROUP 08:00 18:00 08:00 20:00 08:00 20:00

H83616 PURLEY 08:00 19:30 08:00 18:30 07:30 18:30

H83015 PARKSIDE GROUP 08:30 18:30 08:30 18:30 08:30 18:30

H83016 KESTON HOUSE 08:00 18:30 07:00 18:30 07:00 18:30

H83048 DOWNLAND 08:30 19:30 08:30 19:30 08:30 14:00

H83050 THE MOORINGS 08:00 18:30 08:00 18:30 08:00 19:30


H83620 COULSDON 08:00 18:30 08:00 18:30

H83013 OLD COULSDON 07:00 19:30 07:00 19:30

H83052 BRAMLEY AVENUE 08:30 18:30 08:30 18:30

H83024 THE WOODCOTE GROUP 08:00 20:00 08:00 18:00 09:00 11:30

H83616 PURLEY 08:00 18:30 08:00 18:30

H83015 PARKSIDE GROUP 08:30 18:30 08:30 18:30

H83016 KESTON HOUSE 07:00 18:30 08:00 20:00

H83048 DOWNLAND 08:30 19:00 08:30 19:00

H83050 THE MOORINGS 08:00 19:30 08:00 18:30


GP Same Day Slots

Table 31: Purley GP Same Day Slots


H83620 COULSDON 25 to 30 25 to 30 25 to 30 25 to 30 25 to 30

H83013 OLD COULSDON AM: 22 per GP

PM: 4

Nurse AM: 14

Nurse PM: 3

AM: 22 per GP

PM: 4

Nurse AM: 14

Nurse PM: 3

AM: 22 per GP

PM: 4

Nurse AM: 14

Nurse PM: 3

AM: 22 per GP

PM: 4

Nurse AM: 14

Nurse PM: 3

AM: 22 per GP

PM: 4

H83052 BRAMLEY AVENUE 13 13 7 14 13

H83024 THE WOODCOTE GROUP 36 36 36 36 36

H83616 PURLEY 32 14 15 13 18

H83015 PARKSIDE GROUP

H83016 KESTON HOUSE 44 31 28 28 28

H83048 DOWNLAND

H83050 THE MOORINGS 26 22 23 23 21



RIDDLESDOWN PHARMACY 104 LOWER BARN ROAD, CR8 1HR

09:00-13:00

14:15-17:00

09:00-13:00

14:15-17:00

09:00-13:00

09:00-13:00

14:15-17:00

09:00-13:00

14:15-17:00

09:00-13:00

Closed Closed

OLD COULSDON PHARMACY 217 COULSDON ROAD, CR5 1EN

09:00-13:00

14:15-18:00

09:00-13:00

14:15-18:00

09:00-13:00

14:30-18:00

09:00-13:00

14:15-18:00

09:00-13:00

14:15-18:00

09:00-13:00

Closed Closed

ORION PHARMACY 939 BRIGHTON ROAD, CR8 2BP

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-14:00

Closed Closed

VALLEY PHARMACY 209 CHIPSTEAD VALLEY ROAD, CR5 3BR

09:00-19:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-18:00

09:00-13:00

Closed Closed

TESCO PHARMACY 8 PURLEY ROAD, CR8 2HA

08:00-22:00

08:00-22:00

08:00-22:00

08:00-22:00

08:00-22:00

08:00-22:00

11:00-17:00

Closed

MAKEPEACE AND JACKSON 7 STATION PARADE, SANDERSTEAD ROAD, CR2 0PH

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-13:00

Closed Closed

ANDREW MCCOIG PHARMACY 367 BRIGHTON ROAD, CR2 6ES

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-13:00

Closed Closed

MEDIPHARM PHARMACY 37 LIMPSFIELD ROAD, CR2 9LA

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-13:00

Closed Closed

LLOYDS PHARMACY 337 LIMPSFIELD ROAD, CR2 9BY

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-18:00

09:00-17:30

Closed Closed

INFO HEALTH PHARMACY 28 CHIPSTEAD VALLEY ROAD, CR5 2RA

09:00-19:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-17:30

Closed Closed

HOBBS PHARMACY 12 GODSTONE ROAD, CR8 5JE

09:00-18:00

09:00-18:00

09:00-13:00

09:00-18:00

09:00-18:00

Closed Closed Closed

HOLMES PHARMACY COULSDON ROAD, CR5 1EH

08:30-13:00

14:00-17:30

08:30-13:00

14:00-17:30

08:30-13:00

14:00-16:30

08:30-13:00

14:00-17:30

08:30-13:00

14:00-17:30

08:30-13:00

Closed Closed

FOXLEY LANE PHARMACY 32 FOXLEY LANE, CR8 3EE

08:00-19:00

08:00-19:00

08:00-20:30

08:00-19:00

08:00-19:00

09:00-18:00

Closed Closed

DAY LEWIS PHARMACY 45 ELMFIELD WAY, CR2 0EJ

09:00-13:00

09:00-13:00

09:00-13:00

09:00-13:00

09:00-13:00

09:00-13:00

Closed Closed


14:00-17:30

14:00-17:30

14:00-17:30

14:00-17:30

14:00-17:30

BOOTS 15 HIGH STREET, PURLEY, CR8 2AF

09:00-17:30

09:00-17:30

09:00-17:30

09:00-17:30

09:00-17:30

09:00-17:30

Closed Closed

BOOTS 118-120 BRIGHTON ROAD, CR5 2ND

09:00-17:30

09:00-17:30

09:00-17:30

09:00-17:30

09:00-17:30

09:00-17:30

Closed Closed

ZINA CHEMIST 76-78 GODSTONE ROAD, CR8 5AA

09:00-19:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-13:00

Closed Closed

Table 32: Purley Pharmacy Opening Hours


East Croydon

Table 33: East Croydon GP Opening Hours


H83623 SOUTH CROYDON 08:00 18:30 08:00 18:30 08:00 13:30

H83012 ST.JAMES'S CENTRE 08:00 18:30 08:00 18:30 08:00 13:00

H83034 THE WHITEHORSE 08:00 18:30 08:00 18:30 08:00 18:30

H83002 HEATHFIELD SURGERY 08:30 18:30 08:30 18:30 08:30 13:00

H83007 VIOLET LANE 08:00 18:30 08:00 18:30 08:00 20:30

H83611 SELHURST CENTRE 09:00 18:30 09:00 18:30 09:00 13:00

H83044 EAST CROYDON CENTRE 08:00 18:30 08:00 20:00 08:00 18:30

H83031 HALING PARK 08:00 18:30 08:00 18:30 08:00 18:30

H83019 FRIENDS ROAD 08:00 18:30 08:00 18:30 08:00 18:30

H83627 BIRDHURST 08:30 18:30 08:30 18:30 08:30 13:00

Y02962 EDRIDGE ROAD 08:00 20:00 08:00 20:00 08:00 20:00

H83023 MORLAND ROAD 08:00 20:00 08:00 18:30 08:00 18:30

H83631 GREENSIDE 08:00 18:30 08:00 19:30 08:00 18:30

Nacscode Practice Thurs Open Thurs Close Fri Open Fri Close Sat Open Sat Close Sun Open Sun Close

H83623 SOUTH CROYDON 08:00 19:30 08:00 18:30

H83012 ST.JAMES'S CENTRE 08:00 18:30 08:00 18:30 08.00 12.30

H83034 THE WHITEHORSE 08:00 18:30 08:00 18:30

H83002 HEATHFIELD SURGERY 08:30 18:30 08:30 18:30

H83007 VIOLET LANE 08:00 20:30 08:00 18:30

H83611 SELHURST CENTRE 09:00 18:30 09:00 18:30

H83044 EAST CROYDON CENTRE 08:00 18:30 08:00 18:30 09:00 (Every 4th Week) 12:00

H83031 HALING PARK 08:00 18:30 08:00 18:30 08:00 09:45

H83019 FRIENDS ROAD 08:00 18:30 08:00 18:30

H83627 BIRDHURST 08:30 18:30 08:30 18:30 08:00 11:00

Y02962 EDRIDGE ROAD 08:00 20:00 08:00 20:00 08:00 20:00 08:00 20:00

H83023 MORLAND ROAD 08:00 18:30 08:00 18:30

H83631 GREENSIDE 08:00 19:30 08:00 18:30


GP Same Day Slots

Table 34: East Croydon GP Same Day Slots


H83623 SOUTH CROYDON 5 to 6 5 to 6 5 to 6 5 to 6 5 to 6

H83012 ST.JAMES'S CENTRE 16 14 7 14 14 5

H83034 THE WHITEHORSE

H83002 HEATHFIELD SURGERY 6 6 6 6 6

H83007 VIOLET LANE 84 84 124 136 112

H83611 SELHURST CENTRE 6 same day apts

68 mins for

emerg. Apts

6 same day apts

68 mins for

emerg. Apts

6 same day apts

68 mins for

emerg. Apts

6 same day apts

68 mins for

emerg. Apts

6 same day apts

68 mins for emerg. Apts

H83044 EAST CROYDON CENTRE 240 + 60 add

ons at the end of

surgery

240 + 60 add

ons at the end of

surgery

240 + 60 add

ons at the end

of surgery

240 + 60 add

ons at the end of

surgery

240 + 60 add ons at the

end of surgery

H83031 HALING PARK

H83019 FRIENDS ROAD 6 to 8 6 to 8 6 to 8 6 to 8 6 to 8

H83627 BIRDHURST 6 6 6 6 6

Y02962 EDRIDGE ROAD

H83023 MORLAND ROAD 40 40 40 40 40

H83631 GREENSIDE AM: 9

PM: 4

AM: 9

PM: 4

AM: 9

PM: 4

AM: 9

PM: 4

AM: 9

PM: 4



ST CLARE CHEMIST GEORGE STREET, CR0 1LG

08:00-18:30

08:00-18:30

08:00-18:30

08:00-18:30

08:00-18:30

09:00-18:30

Closed Closed

SHIVAS PHARMACY 300 LONDON ROAD, CR0 2TG

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-13:00

Closed Closed

SELHURST PHARMACY SE25 5QL, 8 SELHURST ROAD

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

Closed Closed Closed

SWAN PHARMACY 119 SOUTH END, CR0 1BJ

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-13:00

Closed Closed

LLOYD GEORGE PHARMACY 63 WHITEHORSE ROAD, CR0 2JG

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-17:30

Closed Closed

KENT CHEMIST 66 CHURCH STREET, CR0 1RB

08:30-18:00

08:30-18:00

08:30-18:00

08:30-18:00

08:30-18:00

09:00-15:00

Closed Closed

FAIRVIEW PHARMACY EDRIDGE RD COMMUNITY HEALTH CENTRE, CR9 1PJ

08:00-20:00

08:00-20:00

08:00-20:00

08:00-20:00

08:00-20:00

08:00-20:00

08:00-20:00

Open

CROYCHEM LTD 38 LOWER ADDISCOMBE ROAD, CR0 6AA

09:00-20:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-19:00

09:00-14:00

Closed Closed

CROYDON PHARMACY 44 SOUTH END, CR0 1DP

07:00-22:00

07:00-22:00

07:00-22:00

07:00-22:00

07:00-22:00

07:00-22:00

09:00-20:00

Closed

BOOTS 77 GEORGE STREET, CR0 1LD

07:00-19:00

07:00-19:00

07:00-19:00

07:00-19:00

07:00-19:00

10:00-18:00

Closed Closed

BOOTS 12-18 THE MALL, WHITGIFT CENTRE, CROYDON, CR9 1SH

08:00-19:00

08:00-19:00

08:00-19:00

08:00-20:30

08:00-19:00

08:00-19:00

11:00-17:00

Closed

BARKERS CHEMIST 105 CHURCH STREET, CR0 1RN

08:30-18:00

08:30-18:00

08:30-18:00

08:30-18:00

08:30-18:00

08:30-18:00

12:00-16:00

Closed

A-Z PHARMACY 20 LONDON ROAD, CR0 2TA

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:00-18:30

09:30-18:00

11:00-17:00

11:00-17:00

ALLCORN CHEMIST 197 ST.JAMES ROAD, CR0 2BZ

09:00-18:30

09:00-18:30

09:00-17:30

09:00-18:30

09:00-18:30

09:00-13:00

Closed Closed


SUPERDRUG PHARMACY WHITGIFT CENTRE, CR0 1US

08:30-15:00 15:30-18:30

08:30-15:00 15:30-18:30

08:30-15:00 15:30-18:30

08:30-15:00 15:30-20:00

08:30-15:00 15:30-19:00

08:30-15:00 15:30-19:00

11:00-17:00

Closed

Table 35: East Croydon Pharmacy Opening Hours


Contents of Figures

Figure 1: Projeced number of attendances at Urgent Care Services .............................................. 7

Figure 2: Attendances at Urgent care Services in 2012/13 by age group ....................................... 8

Figure 3: Projection of Urgent Care Activity by type or Urgent Care Provider ................................. 9

Figure 4: Projection of Urgent Care Activity by GP Network ........................................................... 9

Figure 5: Projection of Urgent Care Activity by age group ............................................................ 10

Figure 6: Source: Projections based on data from Croydon general practices ............................. 11

Figure 7: Number of long term conditions by age and sex ............................................................ 11

Figure 8: Top 5 Priorities and 14 Service Actions ......................................................................... 14

Figure 9: The Overall Urgent and Emergency Care Strategy ....................................................... 16

Figure 10: Current Landscape...................................................................................................... 18

Figure 11: Current Landscape...................................................................................................... 19

Figure 12: Level 5 LAS Conveyance ............................................................................................ 20

Figure 13: Level 4 All ED Attendances ......................................................................................... 21

Figure 14: ED Costs ..................................................................................................................... 21

Figure 15: ED Attendances by Age .............................................................................................. 21

Figure 16: ED Admission and Non Admission Attendances ......................................................... 22

Figure 17: ED Attendances by Network ....................................................................................... 23

Figure 18: ED attendances by Network ........................................................................................ 23

Figure 19: ED Attendances by HRG............................................................................................. 24


Figure 21: Virgin Urgent Care Attendances By Days .................................................................... 25

Figure 22: Virgin Urgent Care Attendances By Hours .................................................................. 26

Figure 23: Virgin Urgent Care Attendances by Network ............................................................... 26

Figure 24: Level 3 UCC LAS Conveyance ................................................................................... 27

Figure 25: Level 2a Emergency Admissions ................................................................................ 28

Figure 26: Usual Place of Residence ........................................................................................... 28

Figure 27: Attendances by Day of the Week ................................................................................ 29

Figure 28: PUC Top 5 Presentations 2012/13 .............................................................................. 30

Figure 29: MIA Top 5 Presentations 2012/13 ............................................................................... 30


Figure 31: Edridge Road Registered Patients with Appointments ................................................ 32

Figure 32: Edridge Road Registered Patients with Appointments Trend ...................................... 32

Figure 33: Edridge Road Walk in Patients .................................................................................... 33

Figure 34: Edridge Road Walk-In Vs. Registered Patients .......................................................... 33

Figure 35: GP Out of Hours ......................................................................................................... 34

Figure 36: 111 directed activity .................................................................................................... 34

Figure 37: Pharmacy First – Number of Consultations ................................................................ 35

Figure 38: Pharmacy Top 4 Ailments ........................................................................................... 35

Figure 39: 111 Callers Split by Age Group .................................................................................... 36

Figure 40: Top Symptom Groups Referred to ED.......................................................................... 37

Figure 41: Top 10 Services 111 Callers Signposted To................................................................. 37

Figure 42: Croydon in and out of hours calls Feb to Jun 30th ......................................................... 38

Figure 43: LAS Calls Referred by 111 to 999 ............................................................................... 39

Figure 44: Hours of the Day ......................................................................................................... 41


Figure 45: Days of the Week ........................................................................................................ 42

Figure 46: CUH ED Attendances by Hour of the Day 2012/13 ..................................................... 43

Figure 47: CUH ED Attednacnes by Day of the Week – Croydon Residents and Non Croydon

Residents ...................................................................................................................................... 45

Figure 48: Whole System Pathway .............................................................................................. 48

Figure 49: Elderly Frail Pathway .................................................................................................. 49

Figure 50: Children’s Pathway ..................................................................................................... 50

Figure 51: Whole System Service Provision ................................................................................. 51

Figure 52: Level 5 Improving Quality ............................................................................................ 53





Figure 57: Quality and Performance Metric .................................................................................. 71

Figure 58: Map of Top 6 ED’s by attendances ............................................................................. 72

Figure 59: Map of UCC’s, MIU’s and Walk in Centre .................................................................... 73

Figure 60: Ambulatory Care Pathways ......................................................................................... 74

Figure 61: GP Map ....................................................................................................................... 83

Figure 62: Map of Croydon Pharmacies ....................................................................................... 84


Contents of Tables

Table 1: System Design Objectives................................................................................................ 6

Table 2: MIA and PUC Activity ..................................................................................................... 29

Table 3: Edridge Road Activity ..................................................................................................... 31

Table 4: Overall Activity ............................................................................................................... 40

Table 5: CUH ED Attendances by Hour of the Day 2012/13 ........................................................ 44

Table 6: Out of Hours Total Activity .............................................................................................. 46

Table 7: NHS London Adult Emergency Care Commissioning Standards .................................... 62

Table 8: London Urgent Care Operational Standards .................................................................. 64

Table 9: Emergency Department Clinical Quality Indicators ......................................................... 65

Table 10: National Quality Requirements OOH ............................................................................ 66

Table 11: Virgin Care Urgent Care Centre Alternative Care Pathway ........................................... 76

Table 12: Purley Wat Memorial Hospital Urgent Care Centre Pathway ........................................ 78

Table 13: Parkway Emergency Minor Treatment Centre Care Pathway ....................................... 79

Table 14: Edridge Road Community Health Centre Care Pathway .............................................. 81

Table 15: South London & Maudsley Crisis & Home Treatment Team Care Pathway .................. 82

Table 16: Pharmacy First – Ailments included in the scheme....................................................... 85

Table 17: Revised Urgent and Emergency Care Action Plan ....................................................... 92

Table 18: Mayday GP Opening Hours .......................................................................................... 93

Table 19: Mayday GP Same Day Slots ........................................................................................ 94

Table 20: Mayday Pharmacy Opening Hours ............................................................................... 95

Table 21: Thornton Heath GP Opening Hours ............................................................................. 96

Table 22: Thornton Heath GP Same Day Slots ............................................................................ 97

Table 23: Thornton Heath Pharmacy Opening Hours ................................................................... 97

Table 24: Woodside / Shirley GP Opening Hours ......................................................................... 98

Table 25: Woodside and Shirley Same Day Slots ........................................................................ 99

Table 26: Woodside / Shirley Pharmacy Opening Hours ............................................................ 100

Table 27: New Addington / Selsdon GP Opening Hours ............................................................ 101

Table 28: New Addington and Selsdon GP Same Day Slots ...................................................... 102

Table 29: New Addington / Selsdon Pharmacy Opening Hours .................................................. 102

Table 30: Purley GP Opening Hours .......................................................................................... 103

Table 31: Purley GP Same Day Slots ........................................................................................ 104

Table 32: Purley Pharmacy Opening Hours ............................................................................... 106

Table 33: East Croydon GP Opening Hours ............................................................................... 107

Table 34: East Croydon GP Same Day Slots ............................................................................. 108

Table 35: East Croydon Pharmacy Opening Hours .................................................................... 110

Documents

Urgent and Emergency Care Strategy 2016/17 Delivering ......Urgent and Emergency Care Strategy 2013/14 – 2016/17 Delivering High Quality Urgent and Emergency Care Working together