The new 24-7 functionally integrated access to urgent care standards Delivered by Prof Keith Willett Day Two, Pop-up University 6, 11.00

1. Integrated Urgent Care
– Delivery of the 8 key elements
Keith Willett, Medical Director, Acute Care

2. Integrated Urgent Care
Delivering a 24/7 service offering patients easy access to fully integrated
urgent care services in which organisations collaborate to deliver an ‘all hours
telephone, ‘clinical advice, assessment and treatment service’ through a
single entry point – NHS 111.

3. 8 key elements of an Integrated Urgent Care Service:
1. A single call to NHS 111 get an appointment Out of Hours
2. Data sharing between providers
3. Joint planning of capacity for NHS 111 and OOHs
4. Full availability of SCRs
5. Shared care plans and patient notes
6. Ability to make appointments to in-hours General Practice
7. Joint governance across Integrated Urgent Care
8. Calls transferred to a clinical hub (Clinical Assessment Service)
9. Calls transferred to a clinical hub

4. Call flow with a Clinical Hub (Clinical Assessment Service)
Patient
calls
NHS111
Patient is
assessed
by a Health
Advisor
(using
CDSS)
Some Patients
passed to a
clinician for further
assessment (using
CDSS)
Patient is
Referred/Sign
-posted
Clinical Hub

5. 5
Before After

7. Turning Expectation into Reality
Dr Vishen Ramkisson
East of England Regional Clinical Lead for Integrated
Urgent Care

8. What do we want and how do we get there?
• 24/7 IUC hubs across England
• Multidisciplinary approach
• Improved outcomes for mental health,
palliative, LTC patients and other high users
• Reduced ED and Ambulance dispositions
• Funding & financial pressures
• GP & clinical resource issues
• Contracts on varying timelines
• Multiple stakeholder involvement
• Varying existing OOHs services
• Multiple IT platforms

9. Integrated Urgent Care is not simply a case of….
EXISTING NHS
111
EXISTING GP
OOHs

10. Opportunity to integrate a navigational service (NHS 111) with multiple
treatment services including Urgent Primary Care
IUC CLINICAL HUB
• 24/7 senior clinical presence
• Access to or direct presence of
specialist clinical advice (dental,
MH, palliative care, pharmacy)
• Access to relevant patient
records
• Up to date Directory of Services
• Agreement for direct referralsOther routes
111
Primary Care
Urgent Care
Self Care
Specialist Care
Social Care
Community Care
999

11. Key success factors in procurement
• Develop clear local vision for Integrated Urgent Care
• Engage relevant stakeholders participation in specification development
• Understand and develop local performance indicators to complement
National KPIs prior to formal procurement
• Successful launch requires adequate mobilisation period circa 6 months
with a phased launch of the different HUB components over a further 2-6
months
• Simultaneously strengthen existing NHS 111 Clinical Governance to
include IUC Hubs and GP OOHs to assure patient safety and quality of
service

12. Integrated Urgent Care
Gary Collier
Senior Programme Lead – North East Urgent & Emergency
Care Vanguard

13. Clinical Hub
• 2016/17 Pilots
Emergency Department clinicians
Paramedic ring back
Complex elderly
• Continuing the 2015/16 Pilot
Green Ambulance enhanced triage

14. 2016/17 ED Pilot
• 2 months – 500 patients
77% transfer!

15. Continuing the 2015/16 Pilot –
Green Ambulance
• ‘Green’ ambulance enhanced clinical assessment
• Current impact circa 30% transfer to alternative disposition (some data
issues)

16. Clinical Hub Expansion

17. Disposition proportions of a Clinical Hub
Interim Dispositions %
Transferred to a Clinical Advisor in NHS111 (Current) 22%
Speak to GP dispositions 8.1 %
Green ambulance assessment 3.75%
A&E referral assessment 4.8%
Streaming of mental health, pharmacy and dental calls 6.8%
Complex calls, refused disposition and pre-determined plan calls 6.7%
Patients > 80 years 6.2%
Patients < 5 years 2.15%
Total 61%

18. The North East IUC Model