Briefing Paper: Urgent & Emergency Care
Author: Suzanne Hughes
Date: 27th February 2015
Audience: North West LETB and LWEGs
Version: 1.0
Introduction
The last 2 months has seen the Urgent and Emergency Care Programme move into implementation
phase with a variety of key projects commencing. This paper identifies these projects and describes
the next steps in to formalising the programme of work for the next 12 months.
HEI Innovation Fund
The HEI innovation Fund process has seen several successful bids put forward to support the Urgent
& Emergency Care programme. The process of evaluation started with each bid being reviewed by a
pair of internal and external reviewers who played the role of advocate and challenger to the bid.
The bids were then presented to a panel by the reviewer and a decision was made as to whether the
projects within the bid were approved, declined or required further information. After further
information, a final decision was reached and the following projects have been successful:
Project
Neighbourhood
Learning Network
Urgent Care
Paramedics
Emergency
Medical Technician
Enhanced Critical
Decision Making
Earlier
Intervention in the
home
Women’s Health in
the Home
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Description
The Neighbourhood Learning Network aims to facilitate the
integrated neighbourhood delivery team to develop key
knowledge, skills and behaviours to deliver effective care for
patients at risk of hospitalisation, with a particular emphasis
on supporting patients with frailty and dementia
The Urgent Care Practitioner will undertake routine medical
duties in circumstances that will enable the patient to be
treated appropriately in an appropriate setting, thereby
avoiding unnecessary utilisation of emergency and urgent
care services.
This development of the band 4 EMT workforce formally
recognises their complex role, whilst also giving them
opportunity to progress to level 5 study, and potentially gain
paramedic status.
This programme will facilitate the multi-disciplinary team,
responsible for the delivery of urgent and emergency care, to
develop the requisite leadership and decision making skills
and knowledge to lead, and shape care
Advanced Community Intervention Practitioner enabling
paramedics and nurses to provide a more focused assessment
and acute intervention in the home and providing nonmedical prescribing skills
Women’s Health Practitioners providing care and intervention
in the community reducing the number of attendances to
regional EDs and enhancing the experience of care for
HEI
Edge Hill
Edge Hill
Edge Hill
Edge Hill
JMU
JMU
Quality education for quality patient care, transforming our workforce
Health Education North West
Specialist
Practitioner
ED Pharmacist
Community
Pharmacist
Emergency
Medical Technician
Advanced
Community
Paramedic
ED Pharmacist
Community
Pharmacist
Mental Health
training for ED
staff
women and their families
A programme of study designed to empower a broad range of
community based, urgent, primary care, and social care
related workers to provide clients with alternatives to seeking
treatment at a hospital based emergency department; and
the provision of a collated e-health resources to aid the
healthcare clinician in assessing, treating, and /or signposting
clients to further care.
By providing clinical pharmacists with skills in diagnosis and
emergency care, we aim to provide emergency departments
with a prescribing workforce capable of implementing the
medicines optimisation agenda
While community pharmacists are competent to deal with the
common minor ailments, there is potential to expand the list
of conditions they can manage, treat and support. This would
include new diagnostic skills, ability to provide other
medicines under patient group directions and confidently
manage cases including follow up of patients
This development of the band 4 EMT workforce formally
recognises their complex role, whilst also giving them
opportunity to progress to level 5 study, and potentially gain
paramedic status.
Better use of skill mix in urgent care, prevention of A&E
admissions
Pharmacists can be employed within A&E settings to manage
people arriving with medicines supply issues, as well as
support management/treatment of minor ailments
Common ailments can be effectively and economically treated
in community pharmacy settings, plus emergency medicine
supply and vaccination service.
Improve understanding of mental health issues for existing
staff
Chester
Manchester
University
Manchester
University
North Lancs
& Cumbria
collaborative
North Lancs
& Cumbria
collaborative
North Lancs
& Cumbria
collaborative
North Lancs
& Cumbria
collaborative
North Lancs
& Cumbria
collaborative
The transformation team have also taken forward 2 initiatives put forward as part of Edge Hill’s HEI
Innovation bid for Person Centred Care and Care Home Staff Development.
All these projects are being developed and will be delivered in 2015/16. For further information on
the courses, please contact the HEI in the first instance or Suzanne.hughes@nw.hee.nhs.uk
National ED Pharmacist Pilot
HEE is supporting NHS England in the Urgent & Emergency Care Review by reviewing and
recommending various workforce solutions. One of these is looking at the role of the ED Pharmacist
and as such a project has been set up inviting LETBs to participate in a national pilot to further
evaluate the role. The project – the first of its kind in the UK – will aim to build upon research
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conducted in the West Midlands from April 2013 by Health Education West Midlands (in cooperation
with regional partners). This research identified a potential role for the pharmacist in areas such as
pre-discharge medicines optimisation in the Emergency Department (ED) and Acute Medicine Units,
as well as within Clinical Decision Teams in the undertaking of medicines-related and minor illnessfocussed clinical duties. Such duties are currently undertaken by junior medical staff, who face
significant demands on their time with emergency admissions.
Whilst the current skills of the Pharmacist were recognised as playing a part in the urgent and acute
setting, a skills gap relating to clinical diagnosis and “minors” (minor injury and minor illness)
treatment was identified. Clinicians who were involved in the 2013-14 West Midlands ED Pharmacy
project (see below) – including Emergency Medicine Consultants, Advanced Nurse Practitioners,
Junior Doctors, pilot Pharmacy teams and external stakeholders - proposed that offering clinical
skills training to the Pharmacist could allow for an effective mid-level, medicines-focused clinician;
able to practice as a prescribing Pharmacist, whilst also assisting in minors-focussed clinical duties in
urgent and acute care settings.
Health Education North West has been successful in being awarded 8 pilot sites. These are:


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




Wrightington, Wigan & Leigh NHS Foundation Trust
Central Manchester University Hospitals NHS Foundation Trust
Tameside Hospital NHS Foundation Trust
University Hospital of South Manchester NHS Foundation Trust
Warrington and Halton Hospitals NHS Foundation Trust
East Cheshire NHS Trust
East Lancashire Hospitals NHS Trust
Lancashire Teaching Hospitals NHS Foundation Trust
The 5 week pilot will run throughout March and early April and results will be shared once they have
been released.
Physician Associates
There has been a great deal of focus on the development of Physician Associate training provision
over the last few weeks. In partnership with the transformation team and the commissioning team,
the Urgent and Emergency Care Workforce programme has engaged with the HEIs to test out
market readiness for the provision of training and gain insight into developing fit for purpose
training for the North West.
There has been engagement across the North with colleagues in Yorkshire and Humber and the
North East to identify key principles in developing training provision including an agreed vision of the
role of Physician Associates, funding principles and defining the benefits of the role to complement
that of an Advanced Practitioner and Extended Scope Practitioner.
An event with HEIs and Employers will take place on 31st March 2015 at the Bolton Whites Hotel to
share the benefits of the role of the PA and facilitate the discussion between employers and
education providers to ensure what is developed meets the needs of service. To book onto the
event contact jessica.lord@nw.hee.nhs.uk
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International Recruitment
The LWEGs held in January demonstrated that short term solutions to urgent and emergency care
were a priority of which International Recruitment (IR) was seen as a primary way forward. HENW
would like to gain some further insight in recruitment issues and identifying spend on IR across the
North West. To this end, a letter will be sent out to all organisations (week commencing 23rd
February) from the LWEG Chair requesting information to enable HENW to identify how best they
can support employers in the region within their remit.
Project Development
The following projects are in development stage:
AHPs in ED
There is strong evidence that developing AHP workforce in accident & emergency enables the use of
their expert knowledge and skills to improve patient care and flow; preventing unnecessary
admissions, restoring function and enabling independent living. In partnership with the AHP
Network, the Urgent and Emergency Care programme is developing a pilot project to test out and
evaluate the role of AHPs in ED. Once the pilot has been finalised and approved, employers will be
invited to participate.
Competency Based Redesign Pilot
To ensure a frontline perspective is embedded into the project portfolio of the programme, a project
is being developed to enable a bottom up solutions approach to inform the programme. Using
service improvement methodology (lean, process redesign) and competency based workforce
redesign, the programme lead is looking for pilot sites to do a short piece of work to review urgent
care processes across a health system and redesign workforce based on skills to deliver that process.
Any interested health economy should contact Suzanne.hughes@nw.hee.nhs.uk
Leadership Forum
A survey has been sent out to decide the model of Leadership Forum the Urgent & Emergency Care
programme should adopt:



A 'transformation' group: encouraging spread and adoption, identifying innovation and best
practice, overseeing the implementation of the projects ensuring benefits are articulated and
realised. Members will be a mix of seniority and innovators across the system (professional
representation, employer representation, HEI representation)
A 'governance' board: ensuring the programme is fit for purpose and delivered to timescale.
Provide oversight of delivery and sense check emerging projects. Members will have seniority
and be representative of providers, commissioners and HEIs
A 'network': sharing good practice, providing coaching and advice, suggest ideas for the
programme implementation
Once the responses have been evaluated, a terms of reference will be drawn up and invites will be
sent out for participation. To participate in the survey, please click:
https://www.surveymonkey.com/s/QB9SBKV
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