Urgent and Emergency Care Review
- and the pharmacy role
If its
really
serious
I want
specialist
care
Keith Willett
Shaping Pharmacy Future
2014
Help me to help
myself and not
bother the NHS
Treat me as close
to my home as
possible please
If only they
could talk
to my GP?
UEC Review Vision
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:
•
www.england.nhs.uk
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
Current provision of urgent and emergency care services
>100 million calls or visits to urgent and emergency services annually:
Self-care and self
management
Telephone care
Face to face care
999 services
A&E departments
• 438 million health-related visits to pharmacies (2008/09)
• 24 million calls to NHS
• urgent and emergency care telephone services
• 300 million
consultations in
general practice (20010/11)
• 7 million emergency ambulance journeys
• 14.9 million attendances at major / specialty A&E
departments (2012/13)
• 6.9 million attendances at Minor Injury Units, Walk in Centres etc (2013/13)
Emergency admissions
3
• 5.3 million emergency admissions to England’s hospitals (2012/13)
UECR: The Why? – Care closer to home
www.england.nhs.uk
Helping people help themselves
Self care:
• Better and easily accessible information about self-treatment options
– patient and specialist groups, NHS Choices, pharmacies
• Accelerated development of advance care planning
• Right advice or treatment first time - enhanced
NHS 111 - the “smart call” to make:
• Improve patient information for call responders (SCR, care plan)
• Comprehensive Directory of Services
• Improve levels of clinical input (mental health, dental heath,
paramedic, pharmacist, GP)
• Booking systems for GPs, into UCC or A&E, dentist, pharmacy
5
NHS 111 Call Volume – front end to urgent care
Patients are predominately referred to lower urgency settings
National
Dispositions callers
(where callers are referred to)
11%
999 Ambulance
7%
A&E / UCC
GP OOH
62%
GP in hours
111
1%
Referral
Community service
Dental
7%
1%
Pharmacy
transfer
Caller
dials 111
Call handler
answers
Demographics
taken
www.england.nhs.uk
Pathways
triage 85%
21%
Clinician
takes
transfer
14%
6
Summary Care Record: Creating the records
• SCRs are an electronic record
containing key information from the
patient’s GP practice
• As a minimum SCRs contain
medication, allergies and
adverse reactions
• Improved functionality coming soon
to make it easier for GPs to create
SCRs with additional information for
those patients that need them most.
Close to
45m
2m
SCRs
created
(80%)
To find out more or enable SCR:
scr.comms@hscic.gov.uk
SCRs created
last month
or
@NHSSCR
Highly responsive urgent care service
close to home, outside of hospital
• Faster, convenient, enhanced service:
• Same day, every day access to general practice services, primary
care and community services
• Harness the skills and accessibility of community pharmacy
• 24/7 clinical decision-support for GPs, paramedics, community teams
from (hospital) specialists – no decision in isolation
• Support the co-location of community-based urgent care services
in Urgent Care Centres and Ambulatory Care centres.
• Develop 999 ambulances so they become mobile urgent community
treatment services, not just urgent transport services
8
Ambulance Services
• Transport  Treatment: Community-based provider of mobile
urgent and emergency healthcare, fully integrated within Urgent Care
Networks. Principles to underpin this transformation would include:
• Emphasis on supported treatment in community settings
• Single consistent triage system, DoS and universal referral rights
• Successful “hear and treat” - closer integration with 111, timely access to
relevant patient information and care plans, support of interdisciplinary
clinical hub (current low 3.4% high 10%)
• “see and treat”, inter-disciplinary working across traditional organisational
and professional boundaries, with guaranteed timely access to primary care,
mental health provision, social care and specialist clinical advice 24/7
(current low 27.4% high 51.5%)
9
• Development of the ambulance workforce, education programmes
coupled with changes to organisational culture, will be essential to long-term
success
Urgent Care Centres
• Community-based primary care facilities providing access to urgent
care for a local population.
• To encompass Walk-in Centres, Minor Injuries Units, “Darzi” Centres
etc, including those currently designated as “Type 3 A&E Departments”.
• A consistent nomenclature should be accompanied by a consistent
service, so that patients are clear about what they can expect from all
Urgent Care Centres
• To achieve this it is suggested that two important principles underpin
the development of Urgent Care Centres:
• access to a full range of urgent care services
• part of the Urgent Care Network
• Access to the clinical advice hub
10
Serious and life threatening
conditions – expertise and facilities
• Identify available services in hospital based
emergency centres
• Emergency hospital Centres* - capable of assessing and initiating
treatment for all patients
• Specialist Emergency hospital Centres* - capable of assessing and
initiating treatment for all patients, and providing specialist services
(direct, transfer or bypass) (- estimated 40-70 larger units)
• Emergency Care Networks
• Connecting all services together into a cohesive network so the
overall system becomes more than just the sum of its parts
• Strategic and Operational
11
Urgent Care Networks
• Networks would focus on:
• effective, pathways of care across boundaries for physical and mental
health irrespective of entry portal
• all patients managed to agreed pathways mutual trust in system
• no clinical decision made in isolation
• Networks would function at two levels:
1. Operational Urgent Care Networks would describe local communities of
clinicians (System Resilience Group) who work together to achieve the
best outcomes for patients within the urgent care system
2. Strategic Urgent Care Networks would operate over large populations
encompassing specialist provision, all severity and complexity, all
relevant stakeholders to plan, oversee and monitor network performance
12
Shape and structure of the new
system and key constituent parts…
www.england.nhs.uk
Progress update
• Continue to “build in public”
• 8 Work Programmes:
• WHOLE SYSTEM PLANNING AND PAYMENT,
COMMISSIONING AND ACCOUNTABILITY
• PRIMARY CARE ACCESS – NHSE strategy
• 111 service specification and standards
• DATA, INFORMATION AND CARE PLANNING
• COMMUNITY PHARMACIES – Call for Action
• EMERGENCY DEPARTMENTS and EMERGENCY
CARE NETWORKS
• AMBULANCE TREATMENT SERVICE
• WORKFORCE (HEE)
14
I
T
E
R
A
T
I
V
E
UECR: What – Big Tickets
www.england.nhs.uk
16
Progress: from design to delivery
• Implementation phase of the Review: Now convert the work
done so far into a national framework to guide commissioning of UEC
services: Update report
• Delivery Group own and describe the key national products from
the Stage 1 Report – give primacy to out-of-hospital
• Regional roadshows June-Sept 2014
• Working with System Resilience Groups, CCG and NHSE Ops
Teams as they develop 2 and 5 year operational and strategic plans
• Working through the NHS Commissioning Assembly to co-produce
commissioning guidance and specifications (throughout 2014/15)
• Release guidance, standards and outcome metrics for
Commissioners regarding UEC Networks, centres, and clinical
models and for Ambulance Services (after 5 year Forward View)
17
Consulting and testing
• Design to Delivery:
• NHSIQ mapping support/pilots testing ideas and models
(Integration Pioneers, PM Challenge, 111 pilots and 7DS early adopters)
• New Commissioning Standards for NHS 111:
• Clinician access to relevant patient’s medical and care information
• Access and treat to specific care plan where available
• Increased clinical advice to support call handlers
• to book appointments with urgent or emergency care providers
• Developing new system metrics – credible to public,
clinicians, providers and commissioners
18
Future payment options for UEC
•
Proposal suggests that the way forward could be a single, consistent
payment approach for every type of service in the system, made up of
3 elements and linked to quality metrics and part of 3-5 year
contracts:
• Core capacity element: substantial and fixed in-year, to reflect the
‘always on’ nature of urgent and emergency care:
• Facilities and service standards
• Volume-based and variable, to limit the impact of unpredictable
fluctuations in demand on individual providers across the system;
• Process measures – formative not summative
• Incentives and sanctions: Using provider-specific and system-wide
quality metrics as eligibility criteria for different rates of fixed and
volume-based funding, and as the basis for bonuses and penalties, to
support service change and promote quality improvement:
• Patient outcome measures (transfers of care, residence, PROMs)
• Patient safety and experience measures (mortality, SAEs, PREMs)
www.england.nhs.uk
The greatest challenges
1. Payment system reform
2. Information sharing
3. Workforce and skills shift
20
The role of pharmacy beyond winter pressures
Direct
Professional
care
Minor
Ailment
Service
Part of the
General
Practice
team
Supporting
999
dispatch
and
111 call
centre
Pharmacist
in A&E,
MAUs, ACS
Part of
Network
Clinical
Advice hub
Urgent and Emergency Care Review
I’m alive
cos I had
specialist
care
really fast
Progress:
DEFINITELY . . . . BUT
ONLY THROUGH YOU
It’s great to
share and learn
so much with
this group
I feel so much
better for not having
to go all the way to
hospital
It’s like
everyone
knows all
about me