Presentation given by Dr Rab McEwan Interim Chief Operating Officer Dorset County Hospital NHS Foundation Trust. At the Improving access to seven day services event, Southampton 25 March 2015

1. Dr Rab McEwan
Interim Chief Operating Officer
Dorset County Hospital NHS Foundation Trust
Seven Day Services
in West Dorset

2. West Dorset
Collaboration

4. Context
• Significant gaps in OOH and weekend
provision
– OOH primary and urgent care
– Cardiology services – Primary PCI
– Rapid assessment for frail elderly and ambulatory
assessment
• Low weekend mortality rates

5. Progress
• Self assessed against the NHS IQ Assessment tool
• Cluster workshop in November 2014 including all stakeholders
• Developed a seven day service mandate
• Integrated discharge service with social workers embedded
• Implemented a seven day ‘Acute Hospital at Home’ service
• The Alternative offer: discharging to assess for social care led by Dorset County
Council
• Extended support services over the weekend for pharmacy, imaging, and therapies
• Implemented a new ‘frail elderly’ care initiative focussed on over 65s who account
for 74% of the hospitals’ emergency bed days.
• A new catheter lab will come on stream in September 2015 moving from working
week to 24/7 primary PCI and cardiologist delivered care at weekends.
• Working with Commissioners, GPs, the Ambulance Trust, and local Community
Services to develop out of hospital urgent care and GP OOH services

6. Hub and spoke
model
Current community
hospital sites
Potential hub
Small practice <5
GP WTEs
Medium practice 5-8
GP WTEs
Large practice >8 GP
WTEs
Weymouth hospital is
the physical hub for a
network of GPs, providing:
– Urgent care,
minor injuries
Darzi walk-in
centre
– Diagnostics (both
routine and urgent)
– Intermediate care beds
– Consultant opinions
– Physiotherapy
– Occupational
Therapy
– Minor surgical
procedures (e.g., skin
lesions, IUD insertion)
– Potentially a
community
transfusion service,
IV antibiotics, etc
Innovation in staffing to include:
- 7 Day services pursuing all 10
clinical standards and
improving morbidity, patient
experience, length of stay,
readmission and demand for
emergency care.
– Common training for clinical
staff to ensure consistency of
skills and enable efficient
resource use
– Upskilling nurse practitioners
(e.g. increased mentoring)
– A rapid response integrated
care team linked to Acute
Hospital at Home
– A broader set of career
options for GPs and
potentially allied health
professions to boost
recruitment, retention and
satisfaction (e.g., ‘fellowships’
in specialties and rotation)
– Shared support services and
admin roles (e.g., a single
registrar and care coordinator)
– A shared pharmacist
Solutions for seven day services in OOH primary
and urgent care

7. Dorset County Hospital
second cath lab

8. Catheter Lab
• £3.5m development
• Move from inpatient stay to day case
• Primary PCI 24 / 7
• Cardiology consultant presence and intervention
7 days
• Electrophysiology and other sub-specialty
developments
• Improved access for rural population in West
Dorset

9. Challenges
• The standards are acute focussed
• Engaging other stakeholders
• Linking outcomes and standards
• Leverage on weekend mortality
• Costs and measuring cost effectiveness

10. Next steps
• Demonstrating and measuring success
through implementing major initiatives
• Skilled programme management to blend the
national and local agenda
• Collaboration to capture different
organisational priorities