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Urgent care the current direction of travel

Outline. Types of urgent care bricks and mortar" - Out of hours (or all hours) - In hoursOpportunities for GPs - feasibility - advantagesWorking with other HCPs. . Patient safety. The firstdimension of quality must be thatwe do no harm to patients"Chapter 4

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Urgent care the current direction of travel

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    1. Urgent care – the current direction of travel Fiona Jewkes NHS Pathways and urgent care GP

    2. Outline Types of urgent care “bricks and mortar” - Out of hours (or all hours) - In hours Opportunities for GPs - feasibility - advantages Working with other HCPs

    3. “Patient safety. The first dimension of quality must be that we do no harm to patients” Chapter 4 - High Quality Care for all – NHS Next Stage Review Final Report, Lord Darzi 2008

    4. New thinking!! “Urgent care” - in hours and out of hours Heading towards competency based practice and outcomes Accreditation and revalidation Audit New GP training curriculum New sub speciality

    5. Deciding what is going to happen where… WE need to advise and influence PCTs to commission what’s right in our areas. DH “high level” – allows flexibility - Practice Based Commissioning Opportunity for shaping services so right for locality

    6. Bricks and Mortar Urgent care centres - co located at the front of EDs or ? as part of “Darzi” centres - standalone in the community - as part of Federations In hours, in GP surgeries – 80-90%

    7. In hours General Practice Primary Care Foundation Study (PCF) One size doesn’t fit all Study of 5 different areas Detailed study of how practices coped with urgent patients Lessons learnt by example

    8. PCF study components Telephone and IT Type of patient access – in person, on phone Receptionist training to triage Clinical response, type and time taken NO one answer – but many good ideas to try Lots and lots of examples

    9. PCF study- assumptions Response to request rapid as possible Patient initially defines urgency Capacity guidelines to meet demand Safety netting by person and system PCTs need to support change

    10. PCF suggestions Plan Do Study Act

    11. RCGP Audit tool for urgent care standards Good for demonstrating accreditation/ evidence for revalidation Objective evidence of competencies of ALL types of HCP from GP to call handler.

    12. A second class citizen? “Proper” GPs don’t do “out of hours”….. Youngest, least experienced doctors Locums from out of the area Doctors from abroad “flying in” to do sessions No doctors at all any more……. ….. In the highest risk branch of primary care…surely not?

    13. Who will work in urgent care? Nurse Practitioners ECP /community paramedics Pharmacists Other HCPs …….. And GPs – who must retain their “generalist” role

    14. Opportunities for GPs to deliver QUALITY in urgent care RCGP (2007) Most urgent care is in hours Vital the generalist GP stays involved and must be seen to lead the team New skill mix needs to SUPPORT GPs as GPs must support them – ECPs, nurse practitioners - teamwork Quality must be maintained

    15. Enhancing GP skills For current GPs – new opportunities to engage - PwSI – competencies have been worked out so will have measurable skills - acquisition will depend on prior knowledge and current practice - identification of needs locally and “matching” skills - courses where appropriate and necessary For GPs in training - more opportunity to “specialise”

    16. “GUIDANCE AND COMPETENCES FOR THE PROVISION OF SERVICES USING PRACTITIONERS WITH SPECIAL INTERESTS (PWSIS) URGENT AND EMERGENCY CARE” Department of Health

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