Integrated Urgent Care – Delivery of the 8 key elements

Keith Willett, Medical Director, Acute Care

Integrated Urgent Care

Delivering a 24/7 service offering patients easy access to fully integrated urgent care services in which organisations collaborate to deliver an ‘all hours telephone, ‘clinical advice, assessment and treatment service’ through a single entry point – NHS 111.

8 key elements of an Integrated Urgent Care Service:1. A single call to NHS 111 get an

appointment Out of Hours2. Data sharing between providers3. Joint planning of capacity for NHS 111

and OOHs 4. Full availability of SCRs5. Shared care plans and patient notes 6. Ability to make appointments to in-hours

General Practice7. Joint governance across Integrated

Urgent Care8. Calls transferred to a clinical hub (Clinical

Assessment Service)9. Calls transferred to a clinical hub

Call flow with a Clinical Hub (Clinical Assessment Service)

Patient calls

NHS111

Patient is assessed

by a Health Advisor (using CDSS)

Some Patients passed to a

clinician for further assessment (using

CDSS)

Patient is Referred/Sign

-posted

Clinical Hub

5

Before After

Turning Expectation into Reality

Dr Vishen RamkissonEast of England Regional Clinical Lead for Integrated Urgent Care

What do we want and how do we get there? • 24/7 IUC hubs across England

• Multidisciplinary approach• Improved outcomes for mental health,

palliative, LTC patients and other high users • Reduced ED and Ambulance dispositions

• Funding & financial pressures• GP & clinical resource issues• Contracts on varying timelines• Multiple stakeholder involvement• Varying existing OOHs services• Multiple IT platforms

Integrated Urgent Care is not simply a case of….

EXISTING NHS 111

EXISTING GP OOHs

Opportunity to integrate a navigational service (NHS 111) with multiple treatment services including Urgent Primary Care

IUC CLINICAL HUB

• 24/7 senior clinical presence• Access to or direct presence of

specialist clinical advice (dental, MH, palliative care, pharmacy)

• Access to relevant patient records

• Up to date Directory of Services• Agreement for direct referralsOther routes

111Primary Care

Urgent Care

Self Care

Specialist Care

Social Care

Community Care

999

Key success factors in procurement• Develop clear local vision for Integrated

Urgent Care• Engage relevant stakeholders participation

in specification development • Understand and develop local

performance indicators to complement National KPIs prior to formal procurement

• Successful launch requires adequate mobilisation period circa 6 months with a phased launch of the different HUB components over a further 2-6 months

• Simultaneously strengthen existing NHS 111 Clinical Governance to include IUC Hubs and GP OOHs to assure patient safety and quality of service

Integrated Urgent Care

Gary CollierSenior Programme Lead – North East Urgent & Emergency Care Vanguard

Clinical Hub

• 2016/17 PilotsEmergency Department cliniciansParamedic ring backComplex elderly

• Continuing the 2015/16 PilotGreen Ambulance enhanced triage

2016/17 ED Pilot• 2 months – 500 patients 77% transfer!

Continuing the 2015/16 Pilot – Green Ambulance

• ‘Green’ ambulance enhanced clinical assessment

• Current impact circa 30% transfer to alternative disposition (some data issues)

Clinical Hub Expansion

Disposition proportions of a Clinical Hub

Interim Dispositions %

Transferred to a Clinical Advisor in NHS111 (Current) 22%

Speak to GP dispositions 8.1 %

Green ambulance assessment 3.75%

A&E referral assessment 4.8%

Streaming of mental health, pharmacy and dental calls 6.8%

Complex calls, refused disposition and pre-determined plan calls 6.7%

Patients > 80 years 6.2%

Patients < 5 years 2.15%

Total 61%

The North East IUC Model