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Developing Integrated Out Of Hours Services Making Healthcare Mutual

Developing Integrated Out Of Hours Services Making Healthcare Mutual. Thursday Programme. John Hutton-MP- Speech attached Mark Reynolds- Chair NAGPC David Carson- DoH Peter Hunt- Director MUTUO Cliff Mills- Solicitor Cobbetts Rick Stern- PCT CE Stephen Bellamy- GP

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Developing Integrated Out Of Hours Services Making Healthcare Mutual

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  1. Developing Integrated Out Of Hours ServicesMaking Healthcare Mutual

  2. Thursday Programme • John Hutton-MP- Speech attached • Mark Reynolds- Chair NAGPC • David Carson- DoH • Peter Hunt- Director MUTUO • Cliff Mills- Solicitor Cobbetts • Rick Stern- PCT CE • Stephen Bellamy- GP • Carolyn Clarke-Co-op Manager • Jane Harris- Nurse • Mike Dixon- Chair NHS Alliance

  3. Friday Programme • John Heyworth-President BAEM • Kathy Jones- London Amb Svc • Paul Jenkins- NHS Direct • Andy Lee- NHS Direct • Mo Girach- SELDOC CE • Bill Forsythe- PCT • John Davies -Tasmania

  4. DOH Key Issues David Carson

  5. The service will be taken over in exactly the same way it is run currently. Currently the service is a GP run co-operative that wishes to cease trading. Once we are ready to take over the operational running of this service. We would like to do this on 1.7.04. The service will then be directly managed by the PCT. It has two GPs working from 6.00 to midnight and then one GP working midnight to 8.00 am. There are two nurses working giving telephone triage and telephone advice to patient group directives set up by the GP co-operative. The two drivers that cover the evening shift double up as receptionists. There are two cars available to take GPs out to patients requiring visits. Both cars are fitted with mobile communications and computer connected to the one at the base.

  6. The midnight to 8.00am shift has one GP, one driver and one nurse working. This does occasionally mean that the nurse could be on the premises alone. We will be addressing this issue.It is hoped that the service will be expanded to include social care and community staff being available out of hours but we are very aware that these trained emergency care practitioners are not yet available. We are hoping to be able to send the most appropriate member of our out of hoursmultidisciplinary team to assist the patient. We envisage the cars being used to take other members of the multidisciplinary team out to patients. This will ensure that staff are not out visiting patients on their own.

  7. Key areas • Development Frameworks & Priorities • Sustainability and resilience • Quality • Staffing • Organisational competency • Provider integration • Risk management • Provider support

  8. Development Frameworks & Priorities • Everybody needs a system vision • Have we to much narrow thinking (Budgets, Service) • Excessive focus on facilities • Integrated services • Are PCTs running local agendas with little reference to whole system • Are commissioners operating in NHS provision safety zone without long term view • COOPs be patient • COOP Membership ? Change

  9. Sustainability and resilience 1 • Reality check now • Resilience need in call handling and face to face service • Underpinned by staffing and clinical management structures • Resilience will not be present as effectively in small services

  10. Sustainability and resilience 2 • Skill mix • Will take time • Who builds the teams (Will not just happen because they are in the same building) • Leadership needs the competency to deliver and develop the service • NHSD integration • Ambulance readiness

  11. Quality • Meet the standards now and all the time • Clear and will remain • Apply equally to PCT services • Will be monitored • All the standards will apply • Increasing clinical element • Success is not just seeing patients • But seen by appropriate member of staff • And appropriate quality treatment or advice

  12. Staffing • Need more skill mix • Support centrally • Attention needed to governance and team arrangements • Added value from access to senior staff (GPs) • The policy is that OOH doctors seeing providing primary services have to be on performers list • Recruitment • COOPs and Commercials shift your thinking • Yet to see more than a few adverts for OOH staff!

  13. Organisational competency • Leadership • Managerial and clinical management and leadership competency • Track record is important (lets use what we have properly!) • Capacity planning • Knowledge base

  14. Provider integration • Attention to governance and organisational interface • Joint ventures • OOH CAT C and NHSD Calls • Face to Face A&E , WICS, Community nursing • Have to have a provider to integrate • Are we loosing too many • Operational interface is vital

  15. Risk management • Hear a lot about risk • Shared risk is a reduced risk • Staffing fluctuations moderated by effective recruitment but also scale issue here • Financial risk

  16. Provider support • Mutual option • COOPs will need support • Do not underestimate the scale of provider change on both sides • Commissioning • Commercial providers need to share risk too and be attracted

  17. Summary • More to do • Mutual transfer another significant step • Real change in the way services are influenced and developed and owned • Many PCTs have worked out where and when and by which individual staff groups • Who makes sure it all works every day and night all the time is crucial • Take time to reflect and find the common ground with your PCTs

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