Showcasing Best Practice - Award Submissions Booklet

Award Submissions from UHUK Members

Introduction

Welcome to the showcase of Best Practice in Integrated Urgent Care

The following booklet supports the showcase event and gives the opportunity to see the various projects undertaken by members of UHUK, the federation of Urgent and Integrated care providers in the UK.

Project Categories:

• Innovation

Sponsored by Ummanu

• Partnership Sponsored by Lantum

• Patient Engagement Sponsored by One Advanced

• Health Inequalities

• Social Impact Projects

• Quality and Safety

Sponsored by Content Guru

Sponsored by RotaMaster

Sponsored by Lockton

Sponsored by:

Innovation Projects:

1. LCW Academy London Central West UCC

2. Patient Engagement and Satisfaction Survey Tool FCMS (NW) Ltd

3. 111 Clinical Support HUBs

6 Goals Urgent and Emergency Care Wales

4. Winter Home Visiting Service Suffolk GP Federation

5. SPA - System Innovation ShropDoc

6. Cornwall ARI Hubs Kernow Health CIC

7. Virtual Waiting Room

DHU Healthcare

Innovation Projects: LCW Academy

Introduction

The LCW Academy has been structured to address some of the recruitment and retention issues across the country in healthcare. The model focuses on the key needs in the primary and urgent care sector with a partnership to offer pathways in education and mentorship at postgraduate level.

The three pathways within the Academy are:

• Direct Entry - Graduate nurse or paramedic with at least two years’ experience post qualification.

• High Potential Development Scheme - Graduate nurse, paramedic or clinical pharmacist with at least four years’ patient facing experience post qualification and who will already have achieved level 7 qualifications prior to entry.

• Infinity Programme – A postgraduate nurse, paramedic or clinical pharmacist with significant work and academic history in a broad range of settings to include primary care.

Description of the LCW Academy

Whilst funded higher education programmes are not unique to employers, the Academy is an innovative programme to retain, promote and advance skills of existing employees via a bespoke programme of study.

At application stage, the candidate is assessed using a strict 45-minute process using a number of techniques to include reflection and awareness of the organisation's Vision and Values with a particular focus on:

- Clinical safety

- Personal resilience and academic aspirations

- Health equity, equality, diversity and inclusion

- Change management and clinical innovation <Back>

Innovation Projects:

LCW Academy

Development and Education

The process is intended to showcase the beginning of the expectations of level 7 Masters study and what the organisation expects of a senior clinician.

The expected outcome of successful candidates is a PgCert in Clinical Practice with the following core subjects:

• Clinical Reasoning

• Advanced patient assessment

• Triage and rapid assessment in Pre-hospital, Primary and Secondary Care

The candidate is able to choose additional subjects to complete the full complement of the PgCert.

The Results or impact

In September 2023, four candidates have been identified to be admitted to the Academy which will include clinical supervision and mentorship from existing senior clinicians.

Innovation Projects: Patient Engagement and Satisfaction Survey Tool

Outline

Reviewing post-treatment patient engagement and patient satisfaction questionnaires across our organisation showed there were issues. Cost was a factor with varying contracts lengths and prices among several different providers, even different costs for comparable contracts with the same providers. Consistency was an issue, different providers having different requirements and varying levels of quality and service provision. This incurred additional time and resources in dealing with multiple suppliers. The lack of timeliness to send out questionnaires was causing issues. Delays in sending (one supplier could only send weekly) meant patients were not always clear on what service they were giving feedback for. This was further compounded by not always being able to brand the surveys and therefore not have a clear Identity. Timeliness and identity were clearly factors in the low response rates we were seeing across most services.

Solution

After reviewing all the services in the market, it was felt that there wasn’t anything they could provide that was outside our inhouse skills. We mapped the ideal service delivery for questionnaires and commenced a small scale pilot. We were able to use tools which were already available to us, including SSRS, Microsoft Forms, Power Automate and Power BI. This allowed us to extract the patient information, create bespoke questionnaires, automate the sending to the desired schedule then process, analyse and communicate the responses. Following the successful pilot, we have rolled out this inhouse offering across all departments.

Innovation Projects: Patient Engagement and Satisfaction Survey Tool

Outcomes

We can now send surveys as quickly as each individual service requires, to within 15 mins of patient contact. We can fully brand or configure these questionnaires as desired (where known, we can cater for age groups, language, disabilities etc). The questions are more consistent and concise across the organisation. We have experienced a significant increase in response rates. The teamwork required to implement this new service has resulted in a general upskilling for the individuals involved. They have also increased engagement with the operational teams to deliver this project, which has had further unintended benefits. Additionally, there is an actual cost saving, given that the time and effort to setup and maintain this new process using existing software is far less than the previous monetary costs for the multiple contracts. In summary, we and our patients are getting an enhanced bespoke service with richer information, for less cost. This will allow us to further improve our services for our patients and communities.

Innovation Projects:

111 Clinical Support HUBs

Introduction

The Clinical support HUB team operates in three sites covering the whole of Wales. They consist of admin support, GPs and pharmacists.

Outline

They are nominated for their exceptional team working and the way they had to change the way they worked during the Adastra outage and BCI. As soon as we went into BCI the CSH team came up with a new way of working and put in two new roles in order to help improve the coordination and flow of patients through the 111 system and into urgent primary care. This has continued and the service now runs in a more coordinated way. Communication has improved between 111 and Out of Hours services. These new roles have improved patient flow and patient care.

The FAQ GP (flight controller GP) manages the CSH queues, they pull suitable calls from the 111 First Advise Queue and from the health board advise queues. They communicate with health boards and 111 throughout the shift and manage any issues that may arise.

There was also a HUB advice line (HAL) that was set up in BCI to give 111 call handlers a line to get GP advice on a call and add the GP to the call if needed for immediate advice at the first point of contact.

The CSH manage their areas - South East, South West and North but they are also able to flex their clinical staff to focus on health boards that maybe struggling with long waits for clinical advise. They have shown excellent team work and innovation.

Innovation Projects: Winter Home Visiting Service

Introduction

Suffolk GP Federation (the Fed) on behalf of the East Suffolk Primary Care Networks (PCN’s) providing and manage a home visiting service in conjunction with primary care during surgery operating hours 12pm to 6:30pm Monday to Friday.

Outline

The service supported 926 patients during the three month winter period, supporting primary care who are at capacity. The service provided visiting clinicians to patients in the community and at home on behalf on their own GP practice. This project also supports admission avoidance as a large proportion of these patients would have resulted in an 999 call out, thus providing a better patient outcome and keeping patients well within the community whilst still ensuring effective and safe patient care.

The success of this project enabled us to roll this out to the West of Suffolk PCN group who we also supported over the winter period.

Feedback from Practices

• Such a great service from the In-Hours home visiting support team. Being a rural practice stretching over three sites, this service was a crucial part in delivering a service for our patients. Please would you look at how this service now finishing will affect our rural surgeries as so many services we are seeing are being taken from the community. If the Fed had the staff cars and the need, why are we not looking at how we can keep it?

• This service has been brilliant. It has been a really big help to general practices, as doing a home visit tends to the most time-consuming element of patient care. Being able to ask the visiting service for help with a visit has taken pressure off the in-hours practice team and has often made what might otherwise have been very pressured days into much more manageable ones. I am sorry the service is stopping - was it just for winter help? Are there any plans for it to re-start at any point? My thanks to everyone involved in running it! <Home>

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Innovation Projects: SPA - System Innovation

Case Overview - System Innovation and ambition

The need for the Single Point of Access (SPA) project came following a review of data for local ambulance arrivals for ED Type1 and Type3 departments from April to September 2021, where the outcome has been coded as HRG VB08, 09 or 11z. The 3 lowest tariff codes, which are aligned to the lowest clinical need and intervention cases reported excluding attendances where haematology, microbiology and radiology tests have been performed, showed that activity increases throughout the 24-hour period.

The introduction of paramedic access via a single point to support decision-making throughout a 7-day period by a trusted clinical assessor would enable the impact to be measured.

The vision was to prevent avoidable admissions by extending the hours of the existing Care coordination service and supporting ambulance crews as well as GPs. Clinical decisions were made by ambulance crews to convey the patient to local acute trusts, the subsequent outcome was clinical and HRG coding based on the review of the patient within the department.

Therefore, at the point of decision made by the ambulance crew to convey, they would not know what the clinical coding outcome would be. Admissions by the new SPA system use trusted clinical assessors who are very familiar with the community service and have vast amount of experience in this area, preventing avoidable admissions.

A Care Coordination Centre (CCC) was originally set up to support GPs seeking access to Same Day Emergency Care (SDEC), direct admission to, or advice from, specialities at the local Acute Trust and referrals to community teams such as Rapid Response.

The service covered referrals from any community-based clinician across Shropshire, Telford and Wrekin (STW) Clinical Commissioning Group (CCG) area and avoids unnecessary conveyance to the Emergency Departments (EDs).

This provided a level of assurance that the extension of the service to a wider group of clinicians, specifically ambulance crews, would support the prevention of avoidable admissions. CCC has built up, since its inception in 2006, to manage, on average 2,100 cases per month.

Innovation Projects:

SPA - System Innovation

Shropdoc Single Point of Access (SPA)

Shropdoc Single Point of Access (SPA) is an engagement, triage and assessment service which supports Shropshire and Powys GPs as well as other Allied Health Professionals in providing easier access to hospital and community services and social care.

Our cross-organisation and cross-sector project - Single Point of Access -specifically reduces unplanned conveyance to ED by ambulance crews and relieves immense pressure on services across Shropshire.

The new and innovative system runs from 0830 to 2230 7 days a week, improving patient flow into acute services, avoiding the cluster of admissions at set times of the day.

The service with over 40 referral pathways, has managed around 19000 cases, of which 93% were referred to somewhere other than ED and 19% were managed into services for next-day appointments.

We are an established, innovative team of nurses and call handlers responsible for facilitating discharges into community settings. Adopting the trusted assessor model we signpost patients and health professionals to the appropriate setting utilising our knowledge base of local pathways working with the many services across Shropshire, Telford and Wrekin.

It also provides alternatives to hospital admissions and accident and emergency attendance by offering appropriate community or outpatient pathways to health and social care professionals across Shropshire & Powys. The service is staffed by nurse clinicians and non-clinical call handlers. Referrals are triaged and assessed based on the needs of the patient and aims to prevent unnecessary hospital admissions.

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Innovation Projects: SPA - System Innovation

Outcomes

The aim of the project was to provide, through a single point of access the most appropriate care for patients while avoiding the need to attend ED. The service's trusted clinical assessors support referring clinicians to find the most appropriate commissioned service in Shropshire, Telford and Wrekin.

This includes facilitating telephone conference calls between referrers and the receiving specialties for advice and guidance and importantly also includes signposting to alternative community-based pathways and directly booking patients onto ambulatory emergency care pathways such as DVT, TIA IV and antibiotics at home.

Improved patient care and improved experience is achieved by increasing the the clinicians able to refer to the SPA service:

• Ambulance crews

• Primary Care GPs and healthcare professionals (including during extended access on weekends and bank holidays)

• Community Care healthcare professionals

• Urgent Treatment Centres

• Minor Injury Units

• Regional Clinical Assessment Service (CAS)

• GP out of hours

The service requires the referring clinician to have made the initial clinical assessment either in person, or by telephone, on the day that the referral is made and referring clinicians are required to contact the CCC directly by phone, where their call will be warm-transferred to a CCC trusted clinical assessor for a clinical assessor. <Home>

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Innovation Projects: SPA - System Innovation

The improved outcomes achieved by the service include:

-Admission direct to a specialty Assessment area referral - Medical SDEC/Surgical SDEC/ Obstetrics and gynaecology/paediatrics/urgent ophthamology/Ear, nose and throat (ENT) and Maxillofacial surgery.

• Ambulatory Care Pathways - Deep Vein Thrombosis (DVT)/Transient Ischaemic Attack (TIA).

• Facilitate to Community Trust Pathways

• Community Hospital admission

• Out-of-hours GP home visit or base appointment

• Facilitated referral to STW's Integrated Community Service (ICS)

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Innovation Projects:

Cornwall ARI Hubs

Outline

During winter 2022, healthcare organisations received a notification that Group A Streptococcus (GAS) infections, including scarlet fever, invasive infections (iGAS) and severe pulmonary infections were higher than normal in England.

Cornwall saw a 237% increase in calls to 111 against predicted activity, with an associated elongation of call back time and high levels of abandonment, therefore causing a sustained, high level of clinical risk being held in both the front end of 111 and in the local Clinical Assessment Service (CAS).

Innovation

In response to this surge in demand, Cornwall 111 IUCS rapidly mobilised two surge clinics based in central locations within the county, but with the capability to become mobile if demand required through obtaining mobile infectious unit hubs. The aim of these clinics was to provide single points of access for patients presenting with symptoms of GAS infections, thus reducing pressure on other services within the system and allowing a pressure relief system to the front end of 111. In rapid fashion, an adapted call flow mechanism was implemented, with changed made to NHS Online allowing for an alternate Strep A pathways to be implemented with targeted comms to the Cornish population being sent across all relevant areas to engage with NHS 111 Online to capture these presentations. From here, calls would flow into a specifically set up and monitored Strep A list for triage and/ or referral to the 2 Strep A hubs. Referrals were also open to all healthcare professionals, such as primary care, ambulance crews on scene, emergency departments and MIUs, as well as accessible to patients via 111. <Home>

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Innovation Projects:

Cornwall ARI Hubs

Care and Quality

Over time, the scope of the hubs increased further to support pressures at the front end of 111 and General Practice. The Strep A hubs transitioned to infectious disease hubs managing Strep A, RSV, flu and an array of minor illness with continuing comms flowing.

Effectiveness

This partnership working between HUC and KHCIC saw a significant reduction in front end demand once mobilise and allowed patients with concerns to have rapid telephone triage after NHS Online assessment alongside 2 specific areas for face to face assessment. The rapid pilot was hailed as a success by the system and we are now in the process of creating a permanent surge capacity management hub initiative utilising this patient journey as a gold standard across the county. <Home>

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Innovation Projects:

Virtual Waiting Room

Outline

This opportunity aligned with our commitment to collaborate, and we have linked-up with an international telemedicine business offering remote healthcare platforms. They provide digital solutions across the world - and are currently supporting the healthcare needs of over 40 million people.

This company developed a virtual waiting room system with us (for telephone assessment and advice) that is designed to offer us a host of benefits, including the ability to:

• Free up valuable time for clinicians to spend with their patients – instead of spending it searching for telephone numbers and making multiple contact attempts

• Keep patients better informed about their likely waiting time for a call-back – setting expectations and reducing the frustration from ‘not knowing’, and in turn reducing concerns and complaints

• Enable timely re-assessment and re-prioritisation of clinical cases – if patients make a follow-up contact to share that their condition is worsening

In August 2023, after an eight month project development we marked our first successful patient interaction – when the first call to our Clinical Assessment Service (CAS) was directed through our new virtual waiting room system.

It marked the end of the project to get to this point, but was the start of the next steps in our journey. Colleagues in our CAS paved the way for a new way of working that will also be implemented in our Derbyshire urgent care services and could be adapted for other areas of the business.

It is a large-scale transformation that brings together collaboration and innovation for the benefit of our patients and people - in exactly the way our company strategy envisages. <Home>

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Innovation Projects:

Virtual Waiting Room

Outcomes

Every patient that uses the virtual waiting room receives a text messageasking them to answer a few questions. At the time of making this submission:

• 85% strongly agreed/agreed that they were happy with the number of text messages they received

• More than 90% strongly agreed/agreed helped them understand what was happening

• More than 90% strongly agreed/agreed said they understood what was happening when they received a phone call to connect them to a health care professional

• Around two thirds were happy with how long they waited to be connected to a healthcare professional once they received the phone call

These results show we are working more effectively, improving patient care, enabling teams to work well together so that our service and how we communicate improves. <Home>

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SHORTLISTED

Introduction

Partnership Projects:

Integrated ITK and Rapid Response Falls Service

We proudly nominate the partnership led by Kernow Health CIC (KHCIC) with Cornwall Ambulance Service, Lifeline and the South Western Ambulance Service NHS Foundation Trust (SWASFT) in the implementation of the Integrated ITK and Rapid Response Falls Service for Best Partnership. A video on this can be found here:

SHORTLISTED

Outline

Partnership Projects:

Integrated ITK and Rapid Response Falls Service

In Cornwall, historic challenges with ambulance response times have led to falls patients suffering ‘long-lies’, in many cases remaining on the floor 8 hours +. These vulnerable, often elderly patients often develop hypothermia, infection, pressure ulcers and in some cases develop embolic disease due to the length of time on the floor, resulting in significant morbidity and complex admissions

Innovation

This collaboration broke down inter-organisational clinical, governance, HR and technologic barriers with IUC clinicians gaining access to the live 999 queue, identifying falls patients and dispatching them to a specialist RRFS. Furthermore, improved capture of patients was gained through an agile relationship developed with Lifeline, where pendant alarm activations for falls are directly ‘hot transferred’ to the RRFS, avoiding 999.

Ambition

Despite already achieving high numbers of referrals and an 85%+ ‘discharge on scene’ rate, the RRFS has increased its scope to include patients with increasing illness and injury, with practitioners now delivering catheterisation, urinalysis, antibiotic administration, infusions and, through successful charitable fundraising of an advanced point-of-care-blood-testing device, advanced on-scene diagnostics.

Partnership Projects:

Integrated ITK and Rapid Response Falls Service

Effectiveness

The partnership has been remarkably effective. The service averages 300-350 calls per month, is on scene with the patient in 51 minutes (directly equivalent to the SWASFT Cat 2 mean response time even though RRFS does not travel on blue lights) and discharges over 85% of patients. This is compared to the SWASFT discharge on scene rate of 30%. Importantly, over 50% of activity now arises from outside the SWASFT ITK (from Lifeline, care homes, GPs etc.) reducing pressures on 999.

Care and Quality

The RRFS has just been rated as ‘Outstanding’ by CQC in recognition of this service. Alongside this, care and quality are palpable through the exceptional patient satisfaction feedback, excellent feedback from frontline workers across the partnership and the service has been positively highlighted as a marker of best practice in the Houses of Parliament.

Impact

The impact is substantial. The service not only addresses immediate patient needs but also improves system flow and reduces 999 operational pressures. August’s data, comparable to other months, demonstrates that 165 additional complex admissions were avoided as a result of this service.

Partnership Projects: OOH pilot project to Care Homes

Introduction

At IC24 our purpose is to provide responsive, safe, high-quality urgent healthcare at the right time, in the right place, supporting our patients to ensure they live their lives to the full.

We’re proud of our social enterprise status and our ability to provide our patients with access to health care 24 hours a day, 365 days a year.

We’re proud to have been providing NHS services for over 25 years. Across the whole of the UK, approximately 50% of ambulance call outs are unnecessary, and over nine million people are sent home from A&E having only needed advice. Our services are designed to relieve some of the pressure on the emergency care sector by assessing and helping patients and giving them the appropriate care they need.

We have a team of approximately 1,200 people working hard around the clock, providing a range of urgent care across Kent, Sussex, Essex, and Norfolk and Waveney.

Partnership Projects: OOH pilot project to Care Homes

Outline

IC24 has worked in collaboration with Care Homes and Norfolk and Waveney ICB to deliver an out of hours pilot project to Care Homes at the weekends. We identified a high volume of calls to our 111 service from Norfolk Care Homes which were resulting in unnecessary conveyances to hospital. This put a huge amount of pressure on the system and effects the ability to deliver services safely and effectively. The basis for the pilot was implementing remote technology to provide observations and support a more comprehensive clinical triage.

Assessing the help required in urgent situations was identified by Care Homes as a recurrent problem. Care Home staff reported they do not always feel confident in deciding who to call in an urgent situation or what information they need to provide. Many said they have felt scared and anxious when making an urgent call.

The three main reasons for requesting a clinical assessment are confusion, urinary problems, and cough/chest infection. When these symptoms are assessed and treated in a timely and person-centred manner there is a reduced risk of complications developing or requirement for hospitalisation.

Partnership Projects: OOH pilot project to Care Homes

Outline

IC24 has worked in collaboration with Care Homes and Norfolk and Waveney ICB to deliver an out of hours pilot project to Care Homes at the weekends. We identified a high volume of calls to our 111 service from Norfolk Care Homes which were resulting in unnecessary conveyances to hospital. This put a huge amount of pressure on the system and effects the ability to deliver services safely and effectively. The basis for the pilot was implementing remote technology to provide observations and support a more comprehensive clinical triage.

Assessing the help required in urgent situations was identified by Care Homes as a recurrent problem. Care Home staff reported they do not always feel confident in deciding who to call in an urgent situation or what information they need to provide. Many said they have felt scared and anxious when making an urgent call.

The three main reasons for requesting a clinical assessment are confusion, urinary problems, and cough/chest infection. When these symptoms are assessed and treated in a timely and person-centred manner there is a reduced risk of complications developing or requirement for hospitalisation.

Opportunity

We identified high volumes of unplanned care calls from our local care and nursing home populations, resulting in increased demand on services. Staff in the care homes reported that they may have had non-specific concerns about the residents several hours before needing to contact 111 or 999. However, they didn't feel the concerns had crossed a threshold to warrant an urgent call. This often led to increased conveyance into hospital for patients who had deteriorated.

Partnership Projects: OOH pilot project to Care Homes

Response

We identified the homes with the highest number of calls into 111 at weekends and spoke to staff about their experiences. They reflected that they might have felt more empowered to report lower acuity concerns to our clinicians if we had proactively contacted them, allowing our 111 clinical teams to triage patients and identify opportunities for early intervention to prevent deterioration. Through developing this pilot model, we have now integrated a 12-hour daily support via our Unscheduled Care Coordination Hub to 20 care homes in the region.

Results

The project has demonstrated that following clinical triage 83% residents were treated with home management, 14% had a home visit, 1.5% required an ambulance and 1.5% referred to Community Nursing.

The positive outcomes are reducing the detrimental effects on residents who suffer from deconditioning because of transfer and or a hospital stay.

Feedback from staff within the Care Homes has been very positive, they feel well supported to continue to care for the resident, giving confidence over the weekends and helping to avoid admissions. This is because they know there is a planned call with a clinician who can triage the resident and identify any interventions required. This also provides the resident, and their family, with the confidence that health needs are met in a comfortable and familiar environment. As such, the pilot is a good example of the benefit of bringing Health and Social Care closer together to ensure vulnerable people can be treated at the right time, in the right place and by the right person. It also ensures that any transfer to ED is a clinical decision and not a default position.

Partnership Projects: OOH pilot project to Care Homes

Results (continued)

In addition to the benefits to the individual, other benefits include:

• Additional support to care workers

• Enhanced risk and crisis avoidance

• Reduced transfer to ED via 999

• Reduced risk of requiring hospital admission

• Good resident experience

• Building trust and relationships between integrated Urgent Care Service and Care Homes

The feedback we’ve received directly from the care home residents has been very uplifting as they feel more confident when talking with health professionals and believe that their residents are getting quicker, more appropriate care. The resident’s experience has been positive as they feel like they are part of the care provision. One resident quoted as saying, ‘They brought the tablet to me, and I talked to a doctor. It was all very fancy. They gave me good advice to reduce the swelling on my eye’.

The pilot demonstrates the proactive nature of the service, and how partners/commissioners can work together to use digital tech to keep people well in their own settings, rather than being reactive. A strong partnership has been developed between the remote monitoring solution provider, the Digital Social Care Team, Care Home Staff and IC24.

Partnership Projects: Community Dermoscopy

Service

Introduction

In December 2022, a community dermoscopy service was introduced in east Suffolk for patients with skin lesions, delivered by experienced primary care clinicians and managed by Suffolk GP Federation. The service aims to improve the quality of secondary care referrals, reduce unnecessary hospital activity and provide care closer to home for patients.

Outcome

To date, 285 patients have attended of whom 68% have been discharged with reassurance. 31 patients have been referred on the two-week wait (2ww) pathway, supporting faster cancer diagnosis. There has been a 32% reduction in referrals to secondary care, associated cost savings and excellent patient feedback.

The service success was down to the successful collaboration of Suffolk GP Fed and the local ICB who innovatively funded the project through an existing service model allowing us to test and learn leading to improved outcomes and a better patient journey.

Partnership Projects: Advanced BI Platform

Introduction

Salford Primary Care Together was reviewing how we can best use data in an innovative way to help improve our efficiency. The dilemma was how we address rising demand, in a difficult operating environment, which all urgent health care providers continue to face.

Outline

We reviewed various business intelligence platforms and worked with a local primary urgent care provider (also a UHUK member – Mastercall) to review the advanced BI function that they were able to offer.

Working with colleagues from Mastercall and their BI teams has helped SPCT implement an advanced BI platform which has allowed us to evaluate data in much greater detail. The platform links with our clinical audit and rota software.

Outcome

As such we have been able improve efficiencies and minimise duplication. The BI platform also allows us to review clinician down time and productivity during sessions and has helped us identify which staff we need, where we need them and ensure that we minimise patient contacts during the patient journey, all whilst ensuring we maintain safety and quality.

Partnership Projects:

Anticholinergic Burden and Falls Assessment

Introduction

The Rossendale Minor Injuries Unit (RMIU) is part of a large non profitable organisation, FCMS (Fylde Coast Medical Services NW Ltd). Although RMIU are not part of the East Lancashire Hospital Trust, or Primary Care Networks (PCN), we have been successfully networking with both, over several years, to develop and implement standard operational procedures, to benefit care offered to the local community.

Outline

Over several months, RMIU has taken a huge step in networking with East Lancashire's Senior Medicines Optimisation Care Home Pharmacy Technician, who has won awards for her work in identifying patients who are at risk from Anticholinergic Burden in the > 65s. With her support, RMIU embarked on a patient improvement strategy, to develop a Standard Operational Procedure (SOP), that would align care within the 'patient incentive scheme' within the Primary Care Networks, which too, would help to identify patients who may be at risk from falls due to Anticholinergic Burden (ACB).

As RMIU see a significant amount of patients over the age of 65, we use strict assessment tools and pathways in the effective management of 'Silver Trauma'. By also using the Rockwood Frailty scale, this further identifies those patients >65, who could potentially suffer the catastrophic consequences of a simple fall from standing height alone, and it is recognised, the higher the frailty, the higher the risk of serious injury.

Partnership Projects:

Anticholinergic Burden and Falls Assessment

Outcome

As reducing falls is high on the agenda in the NHS, RMIU has combined all of the above, and developed a SOP, to identify patients >65, with a significant ACB score, incorporating the frailty status and the effects relatable to Silver Trauma. Should patients score significantly on such scores, RMIU can now relay this information back to GP's and/ or Clinical Pharmacists, aiming to trigger the consideration of a medicines review, thus helping to prevent falls and reduce hospital admissions.

To get 'buy in' from the PCN's and Clinical Pharmacists, networking has been a slow and tactful process, since it ran the risk of PCN groups feeling we could potentially increase their already busy workload.

With the perseverance of meetings, presentations, ICB approval, discussions with frailty teams and constant networking with the Senior Medicines Optimisation Care Home Pharmacy Technician, there has been a positive acceptance across East Lancashire with regards to RMIU's processes in helping to identify patients of 65 and over, who may be at risk from falling.

Partnership Projects: Falls Response Service

Introduction

The Falls Response Service (pilot) provided a lifting service post falls for all people over 18yrs who at the time of the call were deemed to be non-injured.

The GMUPCA (gtd Healthcare, Bardoc and Mastercall) pilot was provided in 5 areas (Manchester, Stockport, Salford, Rochdale and Bury) of Greater Manchester and operated 8am-8pm, 7 days a week.

Objectives

AIM

To provide one universal Falls Lifting service across GM for non-injured people

Covering: HMR, Bury, Manchester, Stockport and Salford

OBJECTIVE

• To improve response times for lifting non-injured people who have fallen in the 5 areas of GM

• Improve outcomes for people

• Reduce unnecessary ambulance call outs for non-emergency falls and conveyances to hospital

• Increase referrals to more appropriate services such as the Falls Prevention Team (proactive), Crisis response and Urgent care response teams and other community teams

Partnership Projects: Falls Response Service

The Challenge

Historically the process following a fall, especially in care home settings has been to contact the ambulance service. Many of which result in conveyance to hospital due to frailty and possible length of time the person is on the floor awaiting assistance (long lies).

Others are referred to a local ‘falls lifting’ service but the scope of the service cover across GM is varied and fragmented with different operating hours, processes and referral criteria.

It is estimated one third of adults over 65 who live at home will have at least one fall a year, but most falls do not result in serious injury. Many people who fall over at home and are unable to get up from the floor themselves do not have any injuries.

Falls are the single biggest reason for hospital admissions for older people. Falls are associated with significant mortality and morbidity. One significant aspect of falls is a "long lie". A long lie is when a person who has fallen spends a prolonged period of time on the floor because they are unable to get up. Literature defines a long lie as being on the floor for an hour or more.

Partnership Projects: Falls Response Service

Response

The service worked 7 days a week 8am-8pm and operated in partnership with NWAS taking direct referrals to reduce emergency ambulance responses in the identified areas.

The service initially took referral for people over 65years but after the first week this was reduced to include all non-injured fallers over the age of 18yrs to ensure we captured all appropriate adult cases.

The service also took direct referrals from care homes in Stockport.

Made referrals to the local falls prevention teams to ensure proactive work was undertaken to reduce the risk of future falls,

Referrals to urgent care response teams if required, for example lacerations requiring dressing,

Referrals to local safeguarding teams where the team identified safeguarding concerns,

Referrals to Out of hours and Pathfinder services and other community services if the person needed clinical review due to clinical concerns.

The falls response team involved whole system wide partnership working.

Future proposed developments

If the service had continued beyond the pilot the team were looking at expanding the service provision to include all care home residents in the 5 areas, developing direct electronic referrals from NWAS to the service into the Adastra system and expanding the cover to provide a pan GM offer.

Partnership Projects: Falls Response Service

Results

• More timely response reduced long lies. 100% on scene in < 1hr

• Proactive referrals to falls prevention teams

• Identified people who required an upgraded ambulance response. 11.5% of all referrals (225) as required ED review.

• Increased referrals and utilisation of community services

• Reduction in ED conveyances

• Identification of safeguarding/ social services concerns and referrals

• Empowerment and upskilling of staff 100% satisfaction.

• For each attendance that didn’t require an ambulance attendance, there is a cost saving of the difference between a Hear & Treat call (when the ambulance service take the call, but hand it to a third party, as in this case), and a See & Treat attendance (when they send a crew to the scene, but don’t take the patient to hospital). National reference cost data for 2021/22 suggests the average cost of a See & Treat attendance was £268.39, the potential ambulance cost saving was £205.49 per case.

Future scope is planned to include:

• referrals from all care home,

• expand the service to all GM,

• electronic referrals from NWAS

• electronic referrals to Falls prevention teams

Following a patient survey, the satisfaction was 100% across the following subject areas:

• Overall Satisfaction

• Individual communication needs were met

• Your dignity and respect were considered

• The treatment / advice received

• The explanation given about your condition

• The attitude of the lift responders

• The way the lift responders introduced themselves

Partnership Projects: Development of UTC in ED

Introduction

Suffolk GP Federation has run a GP service alongside the local ED department for a number of years.

When the plan to build a UTC at the hospital was announced, we offered to jointly manage and govern this space.

The project has been ongoing for the last 5 years with the planned opening date being May 2024.

Outline

To support this project we dedicated a team of staff to address the needs and planning of this massive project.

Specifically, since the end of COVID this work has increased.

We have undertaken a massive amount of data analysis so that the workforce plan could be written. We are on all working groups jointly with the hospital including IT, communications, equipment and pathways.

We are taking the lead on writing patient pathways so on the opening of the UTC with the aim that patients will be seen in the right place first time. This involves close working with our ED colleagues and other specialities across the hospital.

We recognise the largest issue working in partnership with another organisation revolves around relationships and culture. In response to this we have started to set up a series of workshops leading up to the opening of this service that will bring the two teams together to create optimum working environments and relationships.

Partnership Projects: Development of UTC in ED

Outcome

Working closely in this setting also has fostered a learning environment for all. ED have a greater understanding of the capabilities of primary care and our primary care clinicians are able to learn more in relation to acute medicine with the support of our ED colleagues when working in this setting.

We continue to support the hospital in additional ways such as increased staffing at times of industrial action and over bank holidays and have demonstrated that we are always willing to react to additional requests of support. Over the winter period we have proposed an additional service to support the paediatric ED recognising that this area comes under exceptional pressure at this time.

Our proactive approach to supporting ED is continually evident and working so closely with emergency care over these years has improved patient care and safety in this setting and created a really positive working environment that will hopefully results in a happy dynamic workforce in the new UTC.

Bringing primary care and emergency care together in this way has clearly improved patient outcomes, communication across these areas and led to positive relationship building.

We have moved from a "them and us"culture to a joined up co-responsive approach to addressing the demands in emergency care.

Partnership Projects: Short Term National Contingency Model

Introduction

Due to an unforeseen delay in mobilising a new contract the idea of a formalised approach for NHS111 contingencies was broached by with NHSE’s Integrated Urgent Care team. Nothing on such a scale had ever been commissioned so this service was designed as a trailblazer.

Through a collaborative process, an incremental short term national contingency model was agreed with NHSE.

It enabled patients to access services at times of high demand, support other NHS 111 providers as directed by the NHSE team and allowed us to utilise our on-going recruitment pipeline productively.

Outline

We put forward an ambitious mobilisation of this National Contingency solution of one month – with the aim of starting a service on November 1st 2022 through to February 28th 2023 on a 7am-11pm basis.

This new service required a very experienced and knowledgeable mobilisation team which consisted of 111 Directors, Operational & Clinical Leads, CQI, PA’s and Workforce Planning together with IT, HR, Analytics, Estates, PMO, Communications and Finance. Without everyone’s contribution this National support service would not have been a success.

Partnership Projects: Short Term National Contingency Model

Outcome

We collaborated exceedingly well and successfully as a team, with the NHSE Senior IUC Leadership Team, and three Ambulance Services.

We answered 156,000 patient calls through the contingency model over the four-month winter period.

91% of calls were answered within the 60 seconds performance target, with abandoned calls being only 1% (National target is less than 3%), a fantastic achievement.

The scale and success of this collaborative arrangement – through a nationally contracted model – has proved that we can provide a best practice service to enable support of the NHS system at times of high demand.

The partnership approach ensured that performance was very much geared to the provision of a quality service where patient experience was what mattered most. In addition the success of this innovation has enhanced our reputation.

This was a proactive idea that came about as a result of an unexpected delay in another contract go live. Overall regional pressures in healthcare were addressed by working together, colleagues in other services were relieved of some of the pressures they were facing (which supported their wellbeing) and above all, our collective 111 patients received a high-quality service aligned to national standards.

Partnership Projects: ED Streaming Model

Introduction

NHUC is a community benefit society (CBS) that operates in partnership with the NHS. The organisation is clinically led, and its services are focused on delivering high-quality, innovative, and patient-centric care to the population of North & Mid Hampshire and Frimley.

Over the past few years, NHUC has undergone a significant expansion. As a result of this expansion, the organisation now operates from five clinical bases and runs nine discrete Same Day Care Services. Notably, NHUC has facilitated the establishment of the Frimley Park Hospital (FPH) ED streaming service in collaboration with the ICB and the Acute Trust. Additionally, the organisation has been pivotal in the development of other new services, including Aldershot Urgent Care Centre and Basingstoke Hospital ED streaming service.

Service Summary

In response to the growing demand and pressure on Urgent and Emergency Care services, we successfully collaborated with Frimley ICB and the Trust to introduce an ED streaming model at FPH in July 2022, aligned with the Fuller Stocktake vision. This model has proven to be highly effective, having served 11,116 patients to date. It is a testament to the exceptional leadership and teamwork between our organisation and the local Trust.

The implementation of an ED streaming service was predicated upon the findings of quantitative analysis of connected care. The analysis highlighted a cohort of ‘low need’ patients, who account for approximately 36% of daily ED attendances. Subsequently, the service aimed to alleviate ED pressures by streaming these patients away from the ED department. It is important to note that primary care appointments have also increased by 9% in the past year within Frimley ICS. Therefore, despite monumental efforts by primary care networks, there was an unmet demand overflowing to local ED departments. This further substantiated the need for the implementation of the Frimley Park Hospital (FPH) ED streaming service.

Partnership Projects: ED Streaming Model

Service Summary (continued)

The service operates from two clinical rooms located within the FPH ED. It is staffed by an administrator and two clinicians (GP/ACP model). The service is open seven days a week from 10:00 AM to 10:00 PM and primarily uses Adastra as its clinical platform. To ensure a seamless transition into our service, we have integrated the primary clinical system of the Trust, known as EPIC, as part of our service adaptation.

The clinical model was agreed in collaboration with the ICB, including the Chief Medical Officer and the Hospital Trust. Due to the nature of primary care, the scope of inclusion is broad and requires the clinician to be adaptive and skilled in rapid triage and diagnosis. In addition, with the reintroduction of 4-hour ED targets, a key aim of the service is to ensure the patient's journeys are tailored to the correct expert alongside supporting pressures on ED. To ensure the service remains aligned with its objectives, there are regular touchpoint meetings with FPH, our clinicians and patients to ensure implemented learning. Concerning the broader system, clinical interface committee meetings are carried out monthly with the main system partners ranging from Southeast Coast Ambulance Service (SECAM), Virtual Wards, and Primary Care providers.

It is noteworthy that the proportion of patients examined, treated, and discharged home has consistently increased over the course of the service and now has reached an average of 90%. Additionally, the percentage of patients returning to the Emergency Department has significantly decreased, with a reattendance rate of 3.8% in Q4 of 22/23. This is indicative of improved patient management and collaborative efforts. Furthermore, the service has the capacity to directly refer suitable patients to Same Day Emergency Care Services (SDECs) to alleviate pressure on the Emergency Department. When we take direct speciality referrals into account, our service consistently diverts over 95% of the patients seen by the service away from the ED department.

Partnership Projects: ED Streaming Model

Service Summary (continued)

As an organisation, we hold ourselves accountable to the highest standards of governance. This is demonstrated by employing a clinical audit system, Clinical Guardian, which enables us to regularly review 6% of clinical notes monthly. Furthermore, we gather valuable patient feedback using Patient Satisfaction Questionnaire (PSQ) cards with QR codes to an online survey. Our top priority is to provide exceptional patient care, as evidenced by the consistently positive feedback we receive from both patients and our partners in the broader healthcare system. Some highlights of anonymous patient feedback include:

‘Excellent patient care from start to finish’ and ‘Excellent service implementation’.

Our overarching ambition is to continue to support the ICB vision of ensuring patients have access to the right care, in the right place, in a timely way.

The Opportunity

This opportunity allowed us to work closely with the Frimley ICB as a provider service, strengthening our presence within the Frimley ICS footprint. Our innovation has been rewarded through the commissioning of the next iteration of FPH ED streaming in the form of an Urgent Care Centre. The key deliverable of this service is to contribute to the reduction of unscheduled care attendances at Frimley Park Hospital ED while providing equity of access.

Partnership Projects: ED Streaming Model

The Challenge

As with any new service, ensuring CQC compliance was a key challenge; this was especially true with the FPH ED streaming service due to the time constraints the service required to be operational. However, our organisation is experienced in expediting service commencement within short time frames and has assembled a leadership team distinguished by its agility and adaptability in meeting the system's demands.

The Results

The service remains operational, and in compliance with our established protocol, we provide quarterly reports to our system. We have provided treatment to over 11,000 patients since the inception of FPH ED streaming service. NHUC continues to provide exceptional support to the urgent care system by offering an ever-increasing range of services. Our unwavering commitment to our core values is reflected in this continued growth <Back>

Partnership Projects:

Healthcare Professionals

Awareness Campaign on Ectopic Pregnancy

Introduction

In 2022 LCW joined forces with leading charity ‘The Ectopic Pregnancy Trust’ to develop and deliver a new Quality Improvement Initiative: Healthcare Professionals Awareness Campaign on Ectopic Pregnancy.

Our vision is to raise vital awareness and provide tools to start important conversations. We recognise that ectopic pregnancy impacts many including the woman or pregnant person, their partner (if they have one), family members, friends, and colleagues. People affected are from all backgrounds and range of personal circumstances and we recognise that unscheduled care can often be the first contact for patients presenting with symptoms of this acute condition.

Outline

Along with a small number of acute trusts nationwide, we have been involved in the design and implementation of Biocards as well as educational material (including videos) produced by the charity. This aligns with the new updated Nice Guidelines on Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management published in August 2023.

Partnership Projects:

Healthcare Professionals

Awareness Campaign on Ectopic Pregnancy

Outcome

The Ectopic Pregnancy Biocard is an easy-to-use reference tool. It highlights signs of ectopic pregnancy and next steps for symptomatic women/people.

Our clinicians have been encouraged to keep the Biocard close by as a helpful reminder to bear in mind and consider the condition. It can be slotted into a lanyard holder. Made of durable plastic, it is hard-wearing and can be wiped clean.

Complimentary videos and further resources have been made available to our clinicians on our staff intranet and via The Ectopic Pregnancy Trust Pilot Website.

Think Ectopic - resources for pilot sites - The Ectopic Pregnancy Trust <Back>

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Patient Engagement Projects: Patient Experience and Engagement Team

Outline

Our patient feedback system has been transformed - moving from a manual process to an exciting new digital platform.

We have invested in patient experience software that allows our current patient surveys, along with the national Friends and Family Test to become fully automated. Text messaging and IVR (interactive voice response) calls will replace paper and postage - giving a range of our clinical services the opportunity to understand real time patient feedback, along with any themes and risks. The system includes the ability to produce information in Easy Read and in other languages as well.

Outcome

Saving colleagues' time and money spent on data collection and analysis, the project is effectively paying for itself - as well as realising other benefits including creating positive feedback messages to share with individuals and teams.

Most important of all, with both quantitative (numbers and statistics) and qualitative (descriptions and opinions) data collected, we now have valuable insights that we can use to drive improvements to patient care, safety, and experience.

NHS111, Urgent Care Services, Community Nursing and Home Visiting across all our counties are included in Phase one of the scope. Phase two will bring our GP and primary care services on board.

The Experience Platform is making a huge difference to how we seek-out and act on the comments we receive from our patients.

It provides our teams with a rich source of intelligence and data they can use to action improvement and change. Finding out from our patients what matters most to them improves care experiences and helps us to reach the highstandards we strive to deliver. For our people it provides an almost continuous feedback loop they can use to deliver the best possible outcomes.

Patient Engagement Projects: CMDU Service

Introduction

We are committed to engaging with patients to ensure we can identify areas for development, this is particularly evident on our CMDU service.

Outline

At the start of the patient’s journey, we will discuss our Friends and Family survey with them. Once the call ends, we send the patient a link to the survey for them to complete when they feel ready. At the end of each month, the survey results are collected, analysed, and shared with the appropriate managers for review and action. At the end of the quarter, a full report is produced highlighting any trends. In our latest report, 1265 patients used our CMDU service and 16 completed our survey. Of the 16 responses, 75% rated the service as “Very good”, 19% “Good” and one person rated it “Neither good nor poor”. When asked why they gave these ratings, we received comments such as:

“Very clear and reassuring”, “Excellent service all within 14 hours”, “Clear advice”, “Prompt.” and “Did all that could be expected.”

It is possible that we only receive a 1% response rate because of the unique way we deliver our CMDU service, where we discuss the decision-making process with patients and give answers in real time. For example, if a patient cannot receive treatment, a clinician will speak with them to clearly explain why. From experience, we know that many patients express concern when they cannot receive treatment, and this process allows resolution to be achieved in real time.

Patient Engagement Projects: CMDU

Service

Outcome

We recognise that sometimes patients prefer more formal channels. Therefore, in addition to the opportunities above, we also have a complaints and compliments process. If a patient chooses to do so, they can contact our Clinical Governance and Quality Team via email, phone or in writing with details of the concerns they would like us to investigate. They can also use our feedback form on the “contact us” page on our website.

All patient feedback is shared as learning through internal channels such as team message boards and clinical discussion groups. This enables the team, the lead GP and the CMDU Service Manager to adapt and adopt any best practice.

Providing all these engagements methods allows us to support patients during all stages of their journey on our CMDU service, ensuring that their views are obtained and any areas for actionable improvement are identified, acted upon and reported back to patients where possible.

Sponsored by:

Addressing Health Inequalities Projects:

1. Homeless Inclusion Service

Salford Primary Care Together

2. 111 Action Card for Asylum Seekers London Central West UCC

3. Trailblazer positive ageing pilot service FCMS (NW) Ltd

4. Very Important Invitation ProjectCervical Screening

5. Health Matters - service for vulnerable patients

6. Providing Medication and Treatment to Vulnerable patients with COVID

7. Goal 2 Palliative and End of Life working group

Suffolk GP Federation

Cumbria Health on Call

DHU Healthcare

6 Goals Urgent and Emergency Care Wales

Addressing Health Inequalities Projects:

Homeless Inclusion Service

Introduction

Salford Primary Care Together delivers an inclusion service across Salford targeting the most vulnerable patients. Our aim is to remove barriers to accessing health care; we can register patients who have no fixed abode with links to Salford. This includes people who are rough sleeping, sofa surfing, staying in emergency or temporary accommodation such as hostels, hotels, B&Bs. Our current case load is over 400 patients.

Outline

The inclusion team is comprised of expert staff including a service lead, 2 health care navigators, GPs and ANPs, nursing and HCA support.

The team also have a base at the acute trust and work closely with our care navigators at the Urgent Treatment Centre. This enables our care navigators and clinical staff to identify the most vulnerable patients or those experiencing homelessness and escalate these to the inclusion service.

The inclusion service can register the patient under their care, to provide the support they need following an ED / UTC attendance. We also provide hospital in-reach for patients who have already been admitted to hospital. Our in reach and front door work receives on average 36 referrals a month.

Addressing Health Inequalities Projects:

Homeless Inclusion Service

Outline (continued)

Our in-reach teams also link in with embedded Housing Officers at SRFT, Ward and Emergency Avoidance. We provide expert advice and clinical advocacy around homeless and inclusion health issues (such as substance misuse and substitute prescribing) for inpatients, improving care and treatment outcomes. This includes ensuring patients with complex needs are able to engage with health and other services through holistic inpatient support and care, thereby reducing rates of early self-discharge. We help homeless patients find somewhere safe and appropriate to stay on discharge, taking into account their needs around health, care and general support, support patients with financial issues, welfare entitlement and to access specialist legal help where possible and ensure patients are registered with a GP for ongoing care.

The service also offers a drop clinic at a local charity, with no documents required to register. Our outreach also includes street walks alongside the Salford RSI team, accommodation and bedding sites visits, joint visits with Salford Dual Diagnosis and Rough Sleeper Drug and Alcohol Team, hostels, women’s center and out of hospital accommodation.

We also offer a WhatsApp contact number so inclusion patients can contact the team for non-urgent queries realising that not all patients would have the credit to make outgoing calls but can contact in area with Wi-Fi facilities.,

Addressing Health Inequalities Projects: 111 Action Card for Asylum Seekers

Introduction

The NHS 111 service is under huge demand nationally. In June 2023, an NHS publication reported 1.55 million calls answered by 111 in April 2023, which is an average of 51.7 thousand a day .

LCW commits to putting patients first and aims to ensure quality and safe care whilst addressing inequalities.

Outline

In April 2023 during a clinical meeting, it was identified that we were receiving calls from public places whereby the Operational team and Clinical Navigator were unable to identify correct demographics. The 111 Health Advisor assessment was taking extended periods of time which meant care could be delayed. We investigated the pattern and origin of these cases. We identified that these patients were from public places and in particular hotels. Further investigation revealed patients were likely to be asylum seekers and most needed a translation service.

These cohorts of patients presented with language difficulties, poor medical and drug history which could result in a patient experience which did not align with the organisation's mission to give the best possible care.

Addressing Health Inequalities Projects:

111 Action Card for Asylum Seekers

Outcome

The Clinical Lead produced an ‘action card’ to facilitate the journey of these patients to enable the Health Advisor to provide a high quality NHS 111 Pathways assessment. This was a collaborative approach with both the operational and clinical team and circulated to all NHS 111 staff.

The aim of the action card was for the 111 Health Advisor to be given support throughout the initial call and provide immediate assistance if there was any doubt about a symptom or disposition (outcome). The objective is to offer equity in care without any hindrance as a result of patients demographic.

Addressing Health Inequalities Projects:

Trailblazer positive ageing pilot service

Introduction

Across Lancashire & South Cumbria (L&SC) there are several older adults with mental health needs (especially dementia) who don’t always receive the right care, at the right time, in the right place to age positively and experience good mental health and wellbeing. Arguably this contributes to and exacerbates significant pressures facing Older Adult Mental Health Services around assessment and review functions including an increasing complexity. This is demonstrated through a 22% increase in the number of people requiring 1:1 support and an overall increase in annualised costs of 19% from 2019/20.

Outline

FCMS supported in addressing the challenges that faced the service user, their family and the system, around avoidable admissions, reducing length of stay, delayed discharge, and repatriation of those who are in out of area placements.

We hoped that that this new model would provide truly personalised care that meets need and will provide positive outcomes for the individual and their family. In turn, this will provide efficiencies and create flow across the system through the prevention of avoidable admissions, reduction in length of stay and delayed discharges (addressing issues relating to non-medical right to reside/ ‘hospital complete’), and repatriation of those who are in out of area placements.

Trailblazer positive ageing pilot service

Addressing Health Inequalities Projects:

Very Important Invitation

Project - Cervical Screening

Introduction

Cervical screening is a vital preventive measure for detecting early signs of cervical cancer and reducing mortality rates. It emphasises the importance of early detection through regular screening, which can significantly improve treatment outcomes and survival rates. However, disparities in access to cervical screening services create health inequalities, particularly affecting lowincome individuals, racial and ethnic minorities, and those with limited healthcare access.

Outline

The Suffolk GP Federation, a not-for-profit community interest company has been funded by the Suffolk and North East Essex Integrated Care Board (SNEE ICB), to operate The Very Important Invitation Project. This project aims to address health disparities in cervical screening in Suffolk, aligning with the objectives of the NHS Long Term Plan. It provides training sessions to clinical and non-clinical staff members from all fifty-six GP practices in the county, focusing on best practices for cervical screening and addressing barriers related to health inequalities.

In England, women and individuals with a cervix, including non-binary and transgender patients, are eligible for cervical screening from the age of 25. Routine invitations are sent every three years between the ages of 25 and 49, and every five years between the ages of 50 and 64. However, approximately one third of patients do not attend when invited.

Addressing Health Inequalities Projects:

Very Important Invitation

Project - Cervical Screening

Outline (continued)

The project covers diverse areas, including urban, rural, and coastal regions, some of which experience high levels of poverty. It acknowledges these barriers and collaborates with primary and secondary care, community-based organisations, and charities to reach underserved groups. Social media platforms are also utilised to expand the project's reach. Additionally, Suffolk GP Federation's extended access service, GP+, provides appointments in the evenings, weekends, and bank holidays across nine different sites, ensuring accessibility for all individuals registered with a GP practice in Suffolk. An appointment booking request system through the project's website facilitates contact and booking into GP+ clinics.

Aims

The project aims to meet the specific needs of the local population and provide a valuable service to those who may not otherwise engage with the national cervical screening program or the healthcare system in general. It aligns with the NHS Long Term Plan's goal of diagnosing 75% of cancers at stage one or two by 2028.

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

Introduction

Cumbria Health, formerly Cumbria Health on Call (CHoC), places the patient, their family and their community at the heart of everything we do.

We are an award-winning organisation, the first out-of-hours organisation in the country to be rated as outstanding by the CQC. We are a not for profit primary and urgent care provider operating in the North of England. We operate an out-of-hours primary care service for 68% of the week and our inhours services help to ensure patients have access to the best possible care. As well as providing out-of-hours urgent care, we also manage 6 General Practices and a number of daytime services.

We have strengthened our profile and are helping to shape healthcare and practice in many important areas, such as providing in-hours services and supporting the digital health economy including sourcing funding to enhance digitally enabled services and increase the current capacity for remote monitoring.

With a significant focus on investment in action to address social inequalities and patients who are vulnerable and isolated. We are involved in tackling the significant causes of ill health promoting a healthy lifestyle as a preventative measure for our communities whilst strengthening partnerships with both local and county councils to achieve our goals of reducing health inequalities.

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

Outline

We operate a ‘Health Matters’ service which involves working with third sector organisations to enhance access for those who may have chaotic lifestyles, homeless, health and addiction problems. The purpose of the service is to host these sessions in community, easy to reach locations, perhaps where they’re attending already, rather than expecting them to follow the often difficult access to healthcare, which is even harder for those who may be homeless and/or vulnerable.

Patients accessing the service can have a full health check which are carried out by GPs, ANPs and Mental Health Nurses. The team provide physical health checks, cholesterol and diabetic blood checks using near point testinginformation is recorded in EMIS patient records. This includes general health and wellbeing conversations, advice support and signposting and can address urgent health needs. This service provides a means for everyone to have access to some form of healthcare.

The staff involved in these community projects have been totally committed to offering the best possible consultations for all patients involved, treating everyone with warmth and kindness; non-judgemental in their approach; aiming to give information about accessing healthcare and overcoming the many barriers all patients face whether this be asylum, homelessness, health and addiction problems.

Patient’s attending Health Matters clinics are appreciative of these clinics as it allows them to receive advice and guidance that they perhaps would not have been able to access if this provision wasn’t available.

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

The Challenge

Cumbria brings unique challenges for a primary health care provider. It is the most rural county in England, with an area of 6,768sq km and a population of approx. 528,000 across a varied and testing landscape. It has strong and diverse communities, which have shown great resilience in recent years.

There are clear pockets of deprivation linked to low income and skills, particularly in some urban areas. The more rural areas often have difficulty in accessing services. An ongoing issue throughout Cumbria is access to healthcare. This is often due to the rurality as mentioned above, transport and GP practices are running at full/over capacity.

A group that are particularly affected by these issues are the homeless, people with health and addiction problems and people with chaotic lifestyles. Healthcare services can be even harder for this group to access than normal. Many people that are homeless or have addiction problems don’t access healthcare services at all.

This was an opportunity for CHoC to provide a tailored healthcare service for these groups of people to give them the easier access and the confidence to attend an appointment to get their health concerns addressed.

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

Response

Our Head of Nursing is at the forefront to ensuring Cumbria Health help to tackle these health inequality issues and works hard to plan and deliver core services which are key to the success of providing high-quality care. She has links with a community church who provide a 2 course hot meal free of charge and a safe warm place for conversation & company in a café style environment.

The first project started with offering health checks for guests alongside this ‘mealbank’ provision – these health checks include vital signs, height & weight, near point testing of cholesterol &HbA1c (diabetes check), along with lifestyle questionnaires, advice and signposting.

Following the success of this, this expanded to become the ‘Health Matters’ service by working with third sector organisations.

The Health Matters service provision is provided at 4 community locations across Carlisle and we have 4 clinics at the following locations:

• Women and family hostel

• Men’s hostel

• Gateway for Women, a women-only safe space

• Healthbank, free hot two course meal in a warm and welcoming space (for everyone)

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

Response (continued)

The health matters service offers a physical health check and cholesterol and diabetic blood checks using near point testing. The appointment gives the patients an opportunity to raise any health concerns, have general health and wellbeing conversations, advice, support and signposting and also to address urgent health concerns. These appointments are offered at community, easy to reach locations and in some cases are hosted at locations where the patients are already attending. This not only makes access easier for patients but gives them the confidence to attend as they don’t have to go down the route of finding access to the already difficult access to healthcare services. We believe this service tackles all the issues at hand within the appointment.

All information from appointments is recorded in EMIS patient records so the patient’s own GP can access this if needed.

Cumbria Health was able to work strategically with partners to provide a service which works to prevent illness and tackle health inequalities, becoming more involved in tackling the significant causes of ill health promoting a healthy lifestyle as a preventative measure for our communities.

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

Results

Patient’s attending Health Matters clinics are appreciative of these clinics as it allows them to receive advice and guidance that they perhaps would not have been able to access if this provision wasn’t available.

We have received very positive feedback from the men’s hostel especially with input from mental health nurse to support residents and staff. Some examples of key achievements and positive outcomes include:

• One gentleman presented with a history of black stools and in conjunction with his own GP, we arranged for him to have bloods and an endoscopy. This individual would not have attended his own GP Practice, but by bringing the service to him he received the investigations he required and was very happy with how this was managed.

• An IV user with cellulitis in the lower leg presented to the clinic where our clinician provided oral antibiotic treatment. This individual was initially reluctant to see the Health Matters service, let alone attend their own GP Practice. This highlights the benefit of the service; the patient did agree to being seen by the service and appreciated the care and treatment given.

• These case studies really show the difference the health matters service was able to make to patients’ lives. Both patients would have not attended a GP practice to get help with their health concerns and would have suffered with these instead.

Addressing Health Inequalities Projects:

Health Matters - service for vulnerable patients

Results (continued)

At the Gateway for Women we now provide group sessions covering subjects such as weight management, contraception, sexual health, healthy eating etc. These are followed with BP checks or diabetic blood checks relevant to the topic.

Due to success in this service so far, we have been approached by the local Foodbanks to deliver a similar service at their locations.

The focus and drive is to take health care to where people actually are, which is especially important when they are marginalised/experience health inequalities; rather than expecting them to navigate the health care system.

Addressing Health Inequalities Projects:

Providing Medication and Treatment to Vulnerable patients with COVID

Introduction

Throughout the COVID-19 pandemic members of our communities who were considered at greater risk from the illness were required to shield to reduce the risk of complications, serious clinical intervention, and hospitalisation. When others were returning to a more ‘normal’ life many of these vulnerable adults experienced the opposite, leading to inequality in their everyday life as a result of their on-going health conditions.

Outline

In two of the geographies we serve and with the backing of commissioners, we have been able to expand a clinical service that provides treatment to reduce the risk of serious illness that can arise amongst vulnerable people testing positive for Covid-19.

When it started in 2022, it was the first time in the UK that such medication was available outside of a hospital setting. Now this essential and potentially lifesaving initiative is also accessible digitally which means that if an ‘at risk’ individual tests positive for COVID all they have to do is fill in a short online form and they are contacted and assessed by a clinician to discuss treatment options. <Back>

Addressing Health Inequalities Projects:

Providing Medication and Treatment to Vulnerable patients with COVID

Outcome

We are now much better at recognising who will benefit the most from this form of treatment so the digital application is available to all and means we can provide care in a more timely manner. The patient doesn’t have to wait in a queue, be referred or triaged; if they have underlying health conditions, the form comes straight through to us and we can contact the patient promptly.

Although the World Health Organisation has downgraded Covid-19 it is still a concern for those with long term conditions. We have been able to ensure that these vulnerable patient groups have access to the most impactful antivirals, known as nMABS (Neutralising Monoclonal Antibodies).

The treatment is provided at home or in GP surgeries and out of hours clinics. It reduces the barriers that vulnerable patients may have previously experienced during the pandemic and allows them to get on with their life, with the knowledge that additional care and treatment is available if they need it.

Addressing Health Inequalities Projects:

Palliative and End of Life working group

Introduction

The Goal 2 Palliative and End of Life working group is chaired by 111 Clinical Lead Pharmacist Alex Gibbins. The group consists of clinical leads from 6 goals of urgent and emergency care, urgent primary care, WAST and palliative care.

Outline

The Project Initiation Document describes, ‘timely and efficient access to Urgent Care, Advice & Support for patients with life limiting conditions, in the last weeks and days of life’.

One of key policy priorities for the Six Goals National Programme is to ‘establish a palliative care pathway, helping people with life-shortening illness to access a specialist 24/7 after dialling 111’. With the policy directive clearly defined, there is a need to further develop 111 services with an enhanced clinical pathway to address the needs of specific patient populations with palliative and end of life (PEOL) care needs.

Outcome

The group is looking at a way of getting palliative care patients and carers access to a single point of access of care in a timely way for assessment, reassurance, advise and coordination of care. This improvement will ensure end of life and palliative patients would be able to access advise and care with minimal delay. The group has a clear project plan and is innovative in ways to ensure this patient group gets improved care without delay.

Sponsored by:

Social Impact Projects:

2. Social Impact Committee DHU

1. Community Fund: A Commitment to Social Impact BrisDoc

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Introduction

Social Impact Projects:

Community Fund: A Commitment to Social Impact

Since its inception in 2015, BrisDoc’s Community Fund has invested over £1 million in addressing health inequalities, both locally and globally. Uniting staff around the shared vision of aiding disadvantaged groups, the fund has flourished as a versatile platform to champion health-related charities through financial backing and hands-on volunteering.

Local Health Initiatives:

This year, we've made remarkable strides in supporting local health charities.

Highlights include:

• Collaborating with ‘Emmaus’ to refurbish a 3-bedroom house for a homeless family and partnering with ‘Help Bristol Homeless’ to fund a short to medium stay shipping-container apartment.

• Supporting ‘Bridges in the Community’ with a coaching programme for asylum seekers and ‘Greif Encounters’ with funds and staff volunteering for workshops for bereaved children.

• Contributions to: SARI to support counselling sessions for victims of racial abuse, Bristol Drugs Project's ‘Recovery Music Programme’, and Beloved’s initiatives for sex workers to create a safe environment to get away from dangerous situations.

• Ongoing efforts include food bank donations, seaside trips for refugee children, provision of 50 Christmas dinners for the homeless, dental-nurse funding in Bristol's Homeless Health Service, and annual sponsorship of a hospital consultant to work as a critical-care on-call responder for lifesaving roadside medical assistance.

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Social Impact Projects:

Community Fund: A Commitment to Social Impact

International Charities:

22/23 has seen our continued support for several oversees project:

• One of our most ambitious projects has been in Uganda, financing the build of a brand-new health clinic in one of the poorest districts of Kampala. This year, over £35K has been contributed to the “Wellsprings Project” with our overall total reaching £270,000. We have also facilitated staff volunteering trips to support the clinic's operation by sharing our expertise, knowledge, and experience.

• Continued support for Casa De-Esperanza in Mexico, aiding young boys in escaping the influence of drug cartels.

Co-owner Fund Matching:

We've matched £6.7K raised by co-owners for charities in the past year.

Future Commitments:

BrisDoc’s target is to continue distributing 10% of its operating surplus to the Fund annually.

In summary:

Our mission is to provide "Patient Care by people who care”. Our Community Fund, led by our Employee Co-owners, very much encapsulates that spirit. It has become a key element of our organisational pledge to manifest a positive “Social Impact”, one of our five core values. The fund exemplifies our continuous striving for a healthier community and world, underscoring our pursuit of excellence and compassion in healthcare delivery.

Social Impact Projects: Social Impact Committee

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Introduction

DHU Healthcare has overhauled our approach to Citizenship this year - setting out a plan that is maximizing the benefits and value of social responsibility, particularly in the way we support great causes and charitable endeavours.

Outline

Through the launch of a new social impact committee, we're involving our people in our environmental, social and governance (ESG) goals – to demonstrate that being a community interest company is more than ‘words on paper’ but really is about the actions we take in support of the geographies we look after.

Our annual people survey put speaking up right at the heart of its aims as a starting point. We encouraged colleagues to ‘have their say’ about what it feels like to be part of our company by donating £10 for every returned survey. With a 51% response rate, more than £11000 was shared between charities Refuge, Childline and MIND, each of which also urge others to ‘be brave’ and to use their voice to speak out and seek help.

We’ve setting aside around 1% of our turnover – around £100,000 – to allow our colleagues to bolster the sponsorships, charity events and community causes they are personally supporting. We’re offering ‘matched funding’ to help spur them on that little bit further! We’re also developing volunteering through work-related events, helping people to support communities with DIY projects, clean-ups and health awareness.

Our approach to social responsibility is designed to give everyone the opportunity to get involved by becoming an ambassador for our company. People are wearing our Citizen badges with pride and know they are making a difference.

Quality and Safety Projects:

Quality and Safety Projects: Shift Lead Clinician Demand Management Initiative

Outline

The Cornwall 111 IUCS has introduced an innovative initiative combining a new Shift Lead Clinician (SLC) role, an intelligent auto-populating demand management matrix and a set of streamlining protocols which come together to form the ‘Shift Lead Clinician Demand Management Initiative’.

Innovation and Ambition

Having successfully launched the SLC role last year, this continuously ambitious initiative was driven further by the development of an auto-populating dashboard, with an algorithm that informs the clinician and shift managers in a live fashion what level of escalation the service is currently within and the associated actions (taken from our Demand Management Plan) to initiate. Alongside this, innovative auto-dispatching protocols are embedded within the dashboard, delegating authority to the clinicians to undertake streamlined functions such as ‘straight to home visit/ treatment centre’ ‘patient deferral protocols’ and linking to auto-populated GoodSAM templates to send to patients.

Quality and Care

Having designated SLC empowers clinical colleagues, provides peer-to-peer education and enables prompt, clinically led management of a service in escalation. With the addition of our auto-populating demand management matrix and streamlining protocols, clinicians know exactly where the service is from an escalation perspective, patients have demonstrably received more streamlined journeys and have been seen in clinics and home visits in a more rapid fashion or alternatively have had their presentations managed remotely with senior oversight.

Quality and Safety Projects: Shift Lead Clinician Demand Management Initiative

Effectiveness and Impact

The combination of a SLC alongside the dashboard and protocols has led to a 62% downgrade rate on patients provisionally booked into a home visit of clinic appointment, a 93% downgrade rate on clinical validation calls and a 20% increase in the efficient handling of high-priority cases such as End-of-Life patients and Health Care Professionals on Scene, thereby enhancing patient safety and improving operational effectiveness. The service has been able to continually de-escalate from challenged positions and recover in a much more rapid fashion from large surges in activity and, most importantly, frontline workers hugely value the initiative.

The future of this model hopes to incorporate artificial intelligence, linking the demand management plan to messaging systems and pre-recorded actions and templates. Thus, demand will be monitored by AI (alongside the autopopulating demand management matrix) and clinicians will automatically receive delegated actions to manage demand whilst patients will receive prescripted messages via text.

Quality and Safety Projects: Quality Improvement Project

Introduction

IC24 carried out a Quality Improvement Project to improve the process of providing care within our NHS 111 service.

This specifically focused on our palliative care patients who, following an NHS Pathways assessment, were deemed to need to speak to a clinician immediately.

By reducing waste activity in this way, it fulfils our purpose of providing responsive, safe, high-quality urgent health care at the right time, in the right place, supporting our patients to ensure they live their lives to the full.

Outline

A quantitative data review showed there were delays within our care pathway for palliative patients due to duplicate clinical assessments.

• Anecdotal feedback highlighted mapping created additional waits and delays and was not achieving the intended aims.

• The process increased responsibility on the Health Advisor (HA) as there was an expectation that when they reached a palliative care disposition, they performed extra steps to highlight the call as urgent.

Outcome

Data identified that 77% of patients were assessed by a 111 Clinical Advisor where then transferred to a Clinical Advisory Service (CAS) Clinician for further assessment.

We gained feedback from our clinicians who expressed that they did not always feel confident in dealing with palliative care needs due to their complexity. <Home> <Back>

Quality and Safety Projects: Improving Quality and Safety through Audits

Introduction

As an OOH provider we are contractually obliged to perform a 1% audits on all our clinicians. In the past this has been quite a manual process and did not result in any obvious improvement to quality or safety. Though we tried several different approaches to managing audit results we did not find an effective approach.

Outline

At the end of last year we engaged with an organisation who could provide us with auditing software.

We have now been utilising this for the last 10 months.

In addition to auditing clinical consultations we also audit prescribing of antibiotics and other high risk medications.

We have a team of auditors working across our services.

On a monthly basis we have an audit review meeting. This is attended by the clinical leadership team and the governance team.

We are able to review any cases of concern relating to documentation, prescribing and clinical management. We also highlight examples of best practice too.

From this review we then take an individual approach to each case tailoring the actions to the individual and the specific issue. We are able to offer specific support to clinicians to help them improve their practice resulting in improved quality and safety.

Quality and Safety Projects: Improving Quality and Safety through Audits

Trends can be identified which lead to organising education events that address those identified learning needs. All staff are invited to these creating a great learning environment.

We are able to set higher level audits for new staff so we can pick up any issues early and also have higher level audits set on groups of clinicians that we feel need it. These would include those who work solely at night, for example.

The individual feedback to clinicians has been received well and their has been a notable improvement across all services in audit results.

Outcome

The number of cases required to be reviewed at the monthly meeting has decreased demonstrating the general improvement.

The introduction of this approach has not only improved audit results but has been really beneficial for the clinical leaderships team. Having the ability to discuss issues as a whole team has also created a great learning environment for them. Being able to learn from our peers and those working in the service has been an unexpected consequence of this process.

Auditing has changed from being a chore to a worthwhile and effective process with all involved gaining something from it but most importantly improved quality and safety and gives the clinical leadership greater confidence that, we are providing a high quality service.

Feedback from our clinicians has all been positive and it feels like our approach has felt very supportive and has improved relationships across the services.