Kingston Health on Call

1. Kingston Health on Call Wednesday 8th November 2006 7.45pm

2. Kingston Health on Call

3. An innovative partnership Taking the best of both organisations Building on five years of joint work A new model of call taking, segmented streaming and GP clinical assessment Enabling patient empowerment for choice and access to urgent care services with a multi-channel approach Cost effectiveness Strengths of partnership

4. Croydoc Strategic capacity Local service delivery Local integration Effective demand management Effective clinical sorting All hospital referrals 1.19% 999 + A&E referrals 0.26% Effective governance Safety & satisfaction record Staff ownership Responsive to change Strengths of partnership

5. Guiding principles

6. The Story so far…. Service since 29th March 2006 we have triaged 8133 Patients. We gave telephone advice to 3584 patients We have seen 3332 at the our base clinics We have visited 1217 patients

7. The story continued… Table with other referral types

8. Quality All patients will receive timely, high quality, safe, patient focused care. We will meet the national quality requirements We have robust governance structures Exemplary track record with patient feedback and complaints

9. Care Plans 1501 Care plans / treatment plans Offering continued care for patients Includes 914 Chronic Obstructive Pulmonary Disease (COPD) Patients

10. Compliments and Complaints We have received 4 letter of compliment from Patients We have received 3 letters of complaint all resolved at the first stage of the complaints procedure.

11. Steven Wibberly Call handling and streaming of calls

12. Guiding principles Patients should make one telephone call to access care out of hours Patients should receive the right care by the right person at the right time Patients should not have to repeat information Patients should be unaware of any ‘joins’ in the system Direction to A&E after GP assessment No duplication of work, effort or cost

14. GP assessment…

15. Activity Average 1200 calls per month Up to 120 call on Saturdays 20 – 30 calls on weekdays 2 – 3% abandonment

16. Out of Hours Training for GP Registrars Dr Fernandes

17. Out of Hours Training for GP Registrars- Dr Fernandes New Systems implemented Supernumerary Registrars Supervisors Joint induction in August Positive feedback Future Exposure to other areas and services Development of Kingston A&E (phase2) GPR numbers

18. CLINICAL AUDIT John Linney Clinical Audit Lead Croydoc

19. NATIONAL REQUIREMENT 4 NR 4 for OOH providers states Providers must regularly audit a random sample of patient contacts and appropriate action will be taken on the results of these audits. Regular reports of these audits will be made available to the contracting PCT. The sample must be defined in such a way that it will provide sufficient data to review the clinical performance of each individual working within the service. The audit must be led by a clinician with suitable experience in providing OOH care and, where appropriate, results will be shared with the multidisciplinary team that delivers the service. Providers must cooperate fully with PCTs in ensuring that these audits include clinical consultations for those patients whose episode of care involved more than one provider organisation.

20. NR 4 - ELEMENTS REGULAR audits to be undertaken SAMPLES [‘random’] must provide data for all individuals in the service LEAD clinician with ‘suitable experience’ REPORTS available to contracting PCT APPROPRIATE action to be taken based on results of audit

21. STAKEHOLDERS Patient - SERVICE RECEIVER GP practice - SERVICE USER PCT - SERVICE COMMISSIONER OOH organisation - SERVICE PROVIDER Duty doctor – SERVICE DELIVERER DOH – SERVICE OVERSEERS

22. Stakeholder expectations Patient [+ carers] – good, timely, sensitive care GP practice – ‘appropriate’ care PCT – satisfies NRs, no complaints, cost effective OOH organisation – good staff, supportive users + commissioners Duty doctors – pleasant working environment, supportive colleagues/staff DOH – all of the above + kudos for achieving

23. HOW TO VIEW NR 4 SCOT analysis Do we perceive as a THREAT … OR Do we respond to the CHALLENGE .. And use as an OPPORTUNITY .. To build position of STRENGTH

24. CROYDOC PROGRESS Committee Clinical audit [meningitis response] Clinical Governance [in house] Clinical audit [structured] IT reporting Clinical governance [multidisciplinary] Board

25. AUDIT CRITERIA Emergency assessment PMH recorded DH + allergies Diagnosis appropriate Effective decision-making based on clinical knowledge .. Based on critical appraisal of full info Empowering behaviour Outcome safe Outcome appropriate Warning instructions given [safety net] Documentation adequate Good prescribing

26. AUDIT DATA OUTCOMES Average total scores [anonymised] Average scores for each criterion [anon] Peer comparison graph for average scores Anonymised details for ‘Calls for reflection’ Individualised data [duty GPs] Total score + breakdown by criteria Personal ‘calls for reflection’

27. CHALLENGING CRITERIA ‘WIGGING’ [problems with tick boxes] Emergency assessment recorded Empowerment Decisions based on full info PMH + DH [allergies]

28. CMOs Wish list 1 [Update 44] To develop/use clinically valid info as tool for performance feedback [and for public information] To infuse .. a philosophy of regular assessment as .. mechanism to support practice improvement .. not to ‘catch out’ Recognition that doctors value most the opportunity to deliver high quality care

29. CMO Wish list 2 The need to recognise early the very small proportion of doctors whose practice is poor and address their needs fairly + effectively To build on successful track record of Royal Colleges et al in developing + assessing clinical standards To continue to maintain public confidence and trust in doctors with underpinning systems of quality/safety assurance

30. Routine clinical audit driving continuous professional development

31. CPD + AUDIT Annual appraisal [routine] ?part of GP appraisal ?carried within OOH organisation ‘Performance review’ Reactive [complaints, SUIs] Proactive [low average scores/ several CtRs]

32. Identifying the potential ‘poor performer’

33. CLINICAL AUDIT 7 Nov 06