1. Social services / Increase in Big rise in Migrants using A&E as
Social MH bottlenecks symptoms and electives primary care
admissions signs diagnosis Rise in use of
Not deprivation Across all Across all other services
linked – across the specialties diagnoses Increasing demand
Recent growth in
board for ambulances –
Admission Rise in Wales & NI
6.5% a year (32%
6 5% a year (32%
Aging population threshold short stay Around same cat A, ~30% cat C)
– 40% of rise lowered? admissions time as PbR, 60% of calls result in
MMC emergency journey
emergency journey
Avoidable
Avoidable
Appropriateness of
A i f
admissions
Rise in
Ri i 4‐hour (75% in cat C)
admission – who
makes the decision? potential – emergency
target not
driving Ambulance users more
33%?
Who gets 25% em admits
admissions nationall likely to be admitted
i likely to be admitted
to see the don’t qualify as A&E conversion Solutions:
patient acute inpat Long term Call: transfer to NHSD
rate increasing
first? GP or
first? GP or trend Attend: Trans to MIU
Attend Trans to MIU
A&E dr? Massive A&E: Primary care
Derby: 5% increase Are GPs aware involved in triage
variation in
in activity, 19% of all possible Reduce calls?
admission via
increase in cost
i i t routes?
t ?
Solutions
S l ti
GP by trust
Recording – definition of admission for Christmas eve – why
Cost £330m a year care provided ‐ HES admimeth not every day?

2. Oldest and 4 hour target: Last Crowding an international Patients changing – more
sickest wait 20 mins, 12/14% problem – other counties demanding
Improve flow:
Improve flow:
longest patients moved introducing time targets
Admission and somewhere GP costs might not be
GP t i ht t b
More junior doctors making
Avoid
Avoid
decisions in busy A&Es
discharge Target most stressful any cheaper than A&E
against rising demand
planning for nursing staff Major/minor patient stream
Clinical decision units
admissions:
Nurse led protocols
Cultural
Cultural Senior doctor triage
Senior doctor triage Fully integrated primary care with
F ll i t t d i ith
change in Improve exit
consultants
Models of
Improve flow common reception and operational
processes
Review of primary care and
emergency care to be Responses integration
integration
Avoid admission
Avoid admission
published by DH (tba) Consistent GPs as specialists
Real issue is not in the
Reduce attendance with primary
in acute teams
hospital – timely access
h it l ti l Patients confused by Out of
Patients confused by Out of Need co‐
to primary care
Insights –
interventions
care
Hours service change
d
located urgent
Social policy as a appropriate to Need clarity in promoting care centres
lever for changeg individuals urgent care services ‐
urgent care services ‐
Confusion about middle Incoherent “products” Clear governance lines
ground urgent care Social marketing being used Paramedic practitioners able
between first aid and as an effective tool to change to treat at scene – funding
g
serious emergencies behaviour discourages
Focus on easy to No one sure how many urgent care cases Middle mgnt fear of loss on
change groups should be seen by GPs, maybe 10‐30% tariff stifling innovation?