Changing face of Unscheduled Care

1. Changing face of Unscheduled Care The Implementation of new roles within the Emergency Care Directorate across Pennine Acute Hospitals Jason Holland 10/06/2013

2. Drivers for change Nationally Increasing numbers of Emergency admissions Unsustainable spiralling cost of non elective tariffs 27% (1.5 million) of emergency admissions had zero day length of stay Locally Increased demand within A&E leading to consistently poor performance across all four sites against national targets Lengthy delays in patients receiving care Poor levels of patient experience when receiving care Difficulties recruiting middle grade Doctors in A&E Rising costs of locum Doctors. Capacity issues on the MEU leading to long delays for patients awaiting assessment “TIME TO CHANGE-A NEW WAY OF THINKING, A NEW WAY OF WORKING” Jason Holland 10/06/2013

3. The change In 2008 funding for 3 APIT’s and 5 TAP’s agreed and staff recruited in to post Business case for new Ambulatory Care Unit approved RAU pilot launched in early 2009 within the MEU footprint Supported by Acute Physician’s within the MEU Within 3 months 40% of all medical patients referred were seen by APIT’s TAP’s taking over many traditional roles of registered nurses and supporting APIT’s Established strong links and relationships with diagnostics and therapeutic staff Developing good working relationships with GP’s and on-call senior medics Promotion of service within MEU and A&E to maintain patient flow Jason Holland 10/06/2013

4. Barriers to change Lack of understanding of the roles from both Medical and Nursing fraternity Perceived as a threat to traditional roles Misuse of area by on-call managers out of hours to accommodate “inpatients” Misuse of staff during periods of staff sickness within the MEU Inappropriate referrals from A&E and on-call junior medics at peak busy times when bed pressures were present leading to capacity issues within the unit Recurrent funding Jason Holland 10/06/2013

5. The Roles; Assistant Practitioner & Advanced Practitioner • Clearly defined roles with new job specification and job description • Organisational support for role development once training completed • Recruitment of the “Right person” for the role is crucial • Crucial that academic and clinical support is always available • Assistant Practitioners can bridge the skills divide between untrained and trained staff • Advanced Practitioners; • Highly skilled • Experienced • Autonomous decision making at high levels • Multi-functional highly flexible workforce • Offer consistency • Transferable skills Jason Holland 10/06/2013

6. Results so far Service re-design in 2011 Integrated in to the A&E footprint Engaging with other specialities to provide a hub for ambulatory care provision in Advanced Practitioner led service Improvement over last 6 months in A&E access targets Assistant Practitioners working with ET+D to develop role further Developed an affordable and sustainable service which patients like and fits in with organisational needs Advanced Practitioners continue to engage with The University, offering spoke placements for APIT’s 8. Exceeding initial agreed targets; 95% discharge rate 1.2% re-admission rate Average LOS currently 1hr 30 min 100% compliance with discharge summaries for GP’s Ambulatory Care Pathways for ACS conditions developed and Implemented across Primary/Secondary Care Jason Holland 10/06/2013

7. The Future Continued engagement with NMCCG and local GP’s Ongoing professional development for staff within the NMTC to support MSc and Foundation Degree Recruitment of more APIT’s from Specialist Nurses roles and the multidisciplinary team to support long term conditions and improve patient outcomes. Development of more Ambulatory Care Pathways to ensure evidence based, standardised practice is maintained in order to reduce risk to patients Jason Holland 10/06/2013

8. QUESTIONS? Jason Holland 10/06/2013