INTEGRATED URGENT AND EMERGENCY CARE IN GLOUCESTERSHIRE WORKSHOP 2nd December 2016

1. INTEGRATED URGENT AND EMERGENCY CARE IN GLOUCESTERSHIRE WORKSHOP 2nd December 2016

2. Purpose of the Workshop • To discuss and identify the benefits of further integration of elements of the urgent care system in Gloucestershire. • To share some of the work to date on the future model for urgent care in Gloucestershire. • To discuss opportunities in relation to the procurement of Primary Care Out of Hours, NHS 111 and an integrated Clinical Hub. • To obtain your views on the problems we need to address and the opportunities this presents.

3. Transforming Urgent and Emergency Care in England For those people with urgent but non-life threatening needs: • We must provide highly responsive, effective and personalised services outside of hospital, and • Deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families For those people with more serious or life threatening emergency needs: • We should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery

4. 5 key elements of change • Providing better support for people to self care • Helping people with urgent care needs to get the right advice in the right place, first time. • Providing highly responsive urgent care services outside of hospital so people no longer choose to queue in Emergency Departments • Ensuring that those people with more serious or life threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and a good recovery. • Connecting urgent and emergency care services so the overall system becomes more than the sum of its parts.

5. Public accessing Urgent and Emergency Care Out of Hours Community Teams Dentist 999 MIIU GHAC GP MIIU A&E GP 111 A&E Pharmacy Pharmacy Google NHS Choices ASAP GP website

6. Health Care professionals accessing support and advice Hot Advice Colleague Clinical Support Desk Single Point of Clinical Access GCare Adult Social care helpdesk Locality Hubs MiDOS Patients GP Mental Health helpdesk Health Care Professional line Out of Hours

7. Vision for Integrated Urgent and Emergency Care • To provide a more closely Integrated Urgent Care service which is simpleto access and navigate, in which organisations collaborate to deliver high quality, clinical assessment, advice and treatment and to shared standards and processes and with clear accountability and leadership. • To become straightforward for patients to access urgent care (Click and Call) • “Call” 999 for critical problems • “Call” 111 if Urgent advice is needed • In the future NHS111 on line will be an opportunity (Click). • To create an Urgent and Emergency care system that delivers the right care, first time for the majority of patients through a networked model 7 days a week. Sameday responsiveness is an expectation of the modern healthcare system. • To harness technological advancements to bring care closer to people homes • To provide better advice and support for self care, immediate telephone advice from a qualified clinical practitioner and a booked appointment in the right service when required. • To guide the patient to the correct level of care and to provide clarity as to which services are provided, where and when.

8. Integrated Urgent Care

9. “The Clinical Hub” • A ‘Clinical Hub’ offering patients who require it access to a wide range of clinicians, both experienced generalists and specialists. It will also offer advice to health professionals in the community, such as paramedics and emergency technicians, so that no decision needs to be taken in isolation. The clinicians in the hub will be supported by the availability of clinical records such as ‘Special Notes’, Summary Care Record (SCR) as well as locally available systems. In time, increasing IT system interoperability will support cross-referral and the direct booking of appointments into other services

10. The Gloucestershire emerging model Patient has Emergency or Urgent Care need NHS111 Own GP 111 Digital 999 Ambulance dispatched Social Care Clinical hub Virtual or Physical/ Multidisciplinary Team/Access to Directory of Service Dental Self Care Opportunity to directly book appointments Vol Sector Own GP Community Services Mental Health Urgent Care Centre Pharmacy

11. Urgent care centre –at least 12hours per day 7 days per week Access to the other key services such as mental health crisis, community based rapid response Integration between providers 111 and clinical virtual hub triage, local practices and walk in

12. NHS England IUC Metrics

13. I will be supported to help myself and not bother the NHS I will receive same day responsive care to my perceived Emergency or Urgent Care need I only have to tell my story once Benefits for patients The ambulance service were able to provide care to me in my own home I will be treated as close to my home as possible People will only access the Emergency Departments with serious or life threatening needs It will be simple for me to get the right advice in the right place first time It is efficient and effective and provides high quality care As I pass through the system it will be seamless in delivery It is simple to navigate around the system Decisions about my care will be taken with my full involvement I will be enabled to prevent development or deterioration of a condition that will affect my health and wellbeing

14. Care is provided by a full multidisciplinary team Care is provided by a full multidisciplinary team Benefits for Health Care Professionals The system is simple and guides good informed choices by patients, their carers and clinicians Promotes the appropriate and effective sharing of relevant patient information across and between My patients will be consistently provided with high quality and safe care It ensures effective utilisation of workforce and acknowledges and supports current challenges It provides access to the right care in the right place, by those with the right skills, first time Improves decision making through access to records

15. Group Session 1 What works well and what doesn’t? and What are the MUST Dos we should include in the new service specification?

16. Group Session 2 Describe the Clinical Hub model for Gloucestershire

17. Group Session 3 What are the significant obstacles we all face in delivering the Integrated Model?

18. Group Session 4 What are the standards we wish the Integrated Model to deliver?

19. High Level Procurement Timetable: Project A and Project B PQQ evaluation 17/02/17 - 03/03/17 Deadline for receipt of PQQ submissions 17/02/17 Dispatch ITT documents to shortlisted bidders 06/03/17 ITT Evaluation process 02/05/17 – 02/06/17 Contract Start Date 01/06/17 Formal Contract Award 04/07/17 Extraordinary GCCG Governing Body Meeting 22/06/17 Extraordinary GCCG Governing Body Meeting 12/01/17 Deadline for receipt of ITT submissions 25/11/16 ITT Evaluation process 25/11/16 – 23/12/16 Dispatch ITT documents to shortlisted bidders 31/10/16 PQQ evaluation 21/10/16 – 28/10/16 Deadline for receipt of PQQ submissions 21/10/16 Formal Contract Award 24/01/17 Advert placed 3/10/16 Engagement events – 02/12/16 & 14/12/16 Advert placed 09/01/17 Mobilisation / Contract Implementation Development of the specification in line with the Glos Urgent Care Strategy Mobilisation / Contract Implementation Contract Start Date 01/04/18