Urgent and Emergency Care Programme
Suzanne Hughes, Urgent & Emergency Care Programme Lead
John Adams, Director of Post Graduate Hospital Training
Neil McLauchlan, Associate Head of Education & Commissioning
www.nw.hee.nhs.uk
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Urgent and Emergency Care Programme
Background & Programme Development
Suzanne Hughes, Urgent & Emergency Care Programme Lead
www.nw.hee.nhs.uk
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Strategic Context
• HEE Strategic Framework 2014-19
– Kings Fund recommending fewer centres
– Supporting care at or closer to home
– Adaptable skills in Emergency Care
• HEE Mandate 2014-15
– Tackling historic shortages in emergency medicine
– Upskilling and training paramedics to deliver more treatment in the
community and deliver onsite triage and treatment in emergencies
• HEE Business Plan 2014-15
– Additional emergency medicine trainees and consultants
– Focus on NHSE and CCGs service policies, pathways or settings of
care (Transforming Primary Care, 24/7 services and Emergency
Medicine)
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Strategic Context
• NHS 5 Year Forward View report
– More appropriate use of primary care, community mental health teams, ambulance services,
and community pharmacists
– Developing linked or networked hospitals – linking emergency centres with specialist
emergency centres
– Access to 7 day services where this makes a clinical difference to outcomes
– Proper funding and integration of mental health crisis services, including liaison psychiatry
– A strengthened clinical triage and advice service
– New ways of measuring the quality of urgent and emergency services
• NHS England Urgent & Emergency Care Review
– Supported by HEE through EMWIG (Emergency Medicine Workforce Implementation Group)
with specific projects on Medical Workforce, Physician Associates, Advanced Clinical
Practitioners, Paramedics and Pharmacists
– Distinguishes between those with urgent but non threatening needs (care outside of hospital
as close to peoples homes as possible) and those with a more serious or life threatening
emergency needs (treated in centres with the very best expertise and facilities)
– Two levels of hospital based emergency centres (Emergency Centres and Specialist (Major)
Emergency Centres) supported by a wide range of primary and community urgent care
support services
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Operational Impact
• Major issues across the whole workforce and
not just medical
• National issue – decades of targets and
pressure
• Recruitment & retention issues
• Reliance on locums and agency
• Impact on theatres, critical care, ICU, HDU,
A&E an EM
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Workforce Plans by LWEG
Cumbria and Lancashire
• Vacancies Emergency Medicine
Middle Grades and Consultants;
development of nurse consultants
• A&E and unscheduled care nurse
shortages: recruitment & retention,
% international recruitment, % newly
qualified workforce
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Workforce Plans by LWEG
Greater Manchester
• Vacancies Emergency Medicine
Middle Grades and Consultants;
reliance on locum cover; looking to
international recruitment
• Complex care recruitment issues;
development of advanced
practitioners
• Impact of Healthier Together on the
location and number of specialist and
generalist centres
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Workforce Plans by LWEG
Cheshire & Merseyside
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• Theatre workforce – shortage of
skilled staff nurses in ED, Critical
Care, Coronary Care and Theatres
• Newly qualified nurses filling most
band 5 vacancies posing a risk to
specialist areas
• Remodelling emergency care where
possible and considering wider
workforce in service transformation
• Impact of downgrading critical care
advanced training posts
• Paediatric ED workforce issues
• High % international recruitment
make stability of service difficult
Programme Development
• Establish current baseline of issues
• Develop suite of solutions through engagement,
pilot work and evidence based practice
• Develop a Leadership Forum to guide, challenge
and provide expertise to the development and
delivery of the programme
• Develop a portfolio of projects dedicated to
delivering the vision and blueprint of the future
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Investment
• Forerunner Funds:
– Lancashire economy clinical portfolio careers to recruit and retain medics
and clinical staff across urgent, emergency, intensive, critical, unscheduled
and other care sectors
– North Lancashire to develop and deliver a programme of education across
to support Primary Care Development by addressing identified skills gaps
within General Practice staff, supporting future sustainability and
maximising workforce development.
– Royal Manchester Children’s Hospital and North West & North Wales
Paediatric Transport Team (NWTS) to improve paediatric trauma care
through targeted onsite simulation and crisis checklist implementation – “a
child and hospital centred Paediatric Trauma Program”
• HEI Innovation Fund
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Urgent and Emergency Care Programme
Medical Workforce in Emergency Medicine
John Adams, Director of Post Graduate Hospital Training
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Emergency Physician (retired)
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The annual headlines on A&E pressures are becoming almost a
winter tradition. Solving this deep-rooted problem extends far
beyond the front door of local emergency departments.
A&E and ambulance services are the 24-hour frontline part of
this system – and get this scrutiny as the most recognisable
“brand”, but we ignore at our peril the role that community
nurses, pharmacists, walk-in centres and GPs can play in
delivering a sustainable and consistent urgent care service.
David Colin-Thome
www.nw.hee.nhs.uk
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Guardian 27 Nov 2014
A&E figures 'show NHS in winter crisis’
Daily Telegraph
More patients wait on trolleys as crisis looms
in A&E units
The Times
Record number of A&E patients kept in
hospital... and overcrowding crisis sees fourhour waits double in a year
Daily Mail
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The Issues
• Address current staffing shortfall
• Make EM a specialty which is professionally
satisfying ( and NW the place to be )
• Facilitate entry into EM
• Retain the work force
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National Initiatives
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National initiatives
• Run through training in EM
• Increase the intake to ACCS(EM)
– 12 additional starters in 2014
• Recognition of transferable competences
– Defined route of entry (DRE-EM)
• HEE/CEM overseas development programme
– Work, learn and return
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HENW initiatives
• PG dean paper to LETB (Dec 2013)
• Training leads meeting (April 2014)
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HENW initiatives
•
•
•
•
Reduce long hours of duty and long duty runs
Support development of non training grades
Recruitment of non training grades
Develop a culture of patient focussed diagnosis
and management
• Review the quality of ACCS placements and
promote those that offer a learning culture
• Support for trainees at CT3 , a key transition point
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HENW initiatives
• Facilitate a break in training
– Run through with OOP may help
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Urgent and Emergency Care Programme
Non-Medical Workforce Solutions
Neil McLauchlan, Associate Head of Education & Commissioning
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Short Term Solutions
• CPD Strategy to support and develop existing and facilitate the
flexibility of the wider workforce
• Leadership Development – commission a programme to support
leadership capacity and capability for emergency care.
• Paramedics - review current education provision to ensure it is fit for
future role requirements
• Mental Health training for non-mental health staff
• Physical health, and long term conditions training, for mental health
practitioners
• Utilise the flexibility offered by the Advanced Practitioner Programme
to fast track staff to gain specialist skills and competencies
• Increase in Primary Care Nursing, 30 CSP plus implementation of new
foundation programme and 11% increase in District Nursing
• Actively support and invest in return to practice campaign
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Medium Term Solutions
• Advanced Practitioners – increase by 20% to 136 to enable development of
emergency care practitioners and other advanced practitioner roles
• Piloting a programme for training Physician Associates
• Piloting a new training programme for 10 sonographers
• Scope the wider workforce including AHPs and paramedics supporting
Urgent and Emergency Care Departments.
• Emergency Care Pharmacists – pilot the development of a specialist
pharmacy role
• For existing staff the funding for CPD will allow access to specialist
education and training including:
• Continued funding for the Critical Care Institute in Greater Manchester for
staff working in critical and high dependency care settings including the
AIM programme.
• Develop a workforce transformation and competency framework for
urgent and emergency care supporting transferability
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Long Term Solutions
• Nursing – an increase of 125 Commissions representing a 7.2%
increase since 2012/13 to give 3,322 commissions in 2015/16
• Operating Department Practitioners – increase by 10% (20) to 219
• Maintenance of the dual direct and technician entry to Paramedic
training with NWAS
• Increases in Healthcare Science at STP and PTP to support diagnostic
capacity
• Continue to closely monitor and performance manage improvement
in student retention to increase outturn
• Ensure initiatives design to enhance commissioning support
emergency medicine including, pre-degree year of care,
• Widening Participation Strategy, Care Certificate, TEL
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Any Questions?
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