Presentation by Mr Paul Goldsmith, Consultant General and Upper GI Surgeon, Manchester University Hospital Foundation Trust at the Emergency Laparotomy Collaborative, 13 November 2018 at Bolton Whites Hotel.

1. An Evolving Service
Paul Goldsmith
Consultant Surgeon MFT

2. Key Principles
• Creation of a General Surgery ‘Single Service’
• Streaming of patients across the sector according to their need
• Hub site at MRI - Patients from across the sector who may need
emergency surgery to prevent life threatening illness or injury, and those
who need complex elective surgery, will be streamed to the MRI hub.
• Robust escalation and de-escalation policies will be in place matched to
patient risk and the need to maintain local access to services
• Meets the HT & GM Quality and Safety standards

3. Key Principles
• Patients on integrated pathways, led by consultant decision making
• Workforce cover to meet the Quality and Safety standards to include:
• 24/7 senior surgical cover for both EDs to assess, triage and receive patients,
transferring patients to theatre where required.
• 24/7 emergency theatres and consultant surgeon cover in hub site (on site until
when?) to undertake emergency general surgery, supported by critical care, 24/7
consultant anaesthetic cover and recovery beds.
• On site surgical consultants at the non-hub site between 08:00 – 18:00. Out of
theatre hours, a surgical consultant will be on call.
• Low risk surgery at both sites supported by 24/7 critical care beds staffed by
Intensive Care Medicine (ICM) trained consultants.

4. General Model of Care – Wythenshawe Site

5. General Model of Care – MRI Site

11. Consultant Cover
• To qualify for the BPT, 80% of applicable patients (as
reported by NELA) must receive both:
• Consultant presence (proportion of high-risk patients
whose surgery was directly supervised by both a
consultant surgeon and a consultant anaesthetist)
• Critical care admission (proportion of high-risk patients
who were transferred directly to a critical care unit
from theatre).
• To qualify for the BPT, providers must have trust-wide
multidisciplinary care pathways in place.
• The base price is set at 90% of the BPT price.

12. Ambulatory Care
• The Surgical Ambulatory Care Model at MRI has been in operation for a
number of years and is co-located with the Medical Ambulatory Care
service. There is an ambulatory service currently in operation at
Wythenshawe (SACRU).
• SACRU provides a better patient experience; a reduced length of stay; a
lower cost per patient and avoids bed-based activity/admission avoidance
• Ambulatory care will be provided at both Trusts providing the same level
of service and functioning under the same governance arrangements,
policies and procedures.
• Aim to reduce the number of non elective admissions by having dedicated
Emergency General Surgeon(s) to assess, diagnose and operate on
patients who were previously being admitted to an inpatient bed.

14. The Team
• Advanced Nurse Practitioners
• Hot clinics
• Acute surgical assessment
• Minor procedures
• Physicians associates
• USS
• Physiotherapists/Occupational therapists
• Rapid assessment – home circumstances
• Care of the Elderly Physicians
• Frailty

15. The Goal
A team model in place that reflects the
emergency general surgery workload of the unit
and facilitates timely senior review

16. An Evolving Service
Paul Goldsmith
Consultant Surgeon MFT