High Intensity User

ProjectAn innovative initiative, one of the first of its kind in

the country

Boena Zeneli06 December 2018

To ensure that ‘High Intensity Users’ – those who engage with

urgent & emergency services inappropriately, are supported

to access the right care, in the right place at the right time.

To thereby, meet unmet patients needs and improve

patients’ and staff’ experiences and to create capacity and

make financial savings.

Our ambition

The number of ambulances dispatched, A&E attendances and

admissions all decreased on average by 36%

Patient receive the right health care and the clinical as well as

non clinical needs are met

Staff are happier and better supported to make complex decisions

Potential savings of £48,230 were identified for the pilot. For the

expanded project, average savings per patient of £2,613.56,

with a total saving of £122,837.32

Outcome

The pilot began in 2015 with a focus on three patients, and

due to its success, a larger scale project was agreed

This expanded project has resulted

in significant achievements. Over

a period of 12 months, 5 HIUs have

called the Ambulance service 1,196

times between them but our project enabled the Ambulance

Service to only send an ambulance on 199 occasions

Impact and Involvement

By discussing HIUs via our multi-disciplinary team

approach (MDT) in a holistic way, we have improved

integration across the health economy, including: acute,

ambulance, mental health, community, 111 and OOH services

In addition, there is regular collaboration with social care,

voluntary services, the police and the borough councils

Both behavioural changes among HIUs and financial savings

as well as better working environment have led to a more

efficient and effective service for the patients we serve

Impact and Involvement cont…

How we learned and shared

our experience

We consulted for advice with a number of organisations including the

London Ambulance Service and learned from Blackpool CCG model

We have helped Ipswich and East Suffolk and West Suffolk CCGs who

are part of our STP footprint

We have been contacted by Mid Essex CCG, Bromley CCG, West Essex

CCG, Chiltern CCG and Aylesbury CCG who have appreciated our help

We have also published an article on NHSI (Academy of Fabulous Stuff),

presented for EdgeTalks,

We have been contacted by our local Right Care lead and asked to share

our work as an example of best practice nationally

Information governance and data sharing agreements

Being restricted, due to IG, to have all partners in one room

Meaningful and continuous engagement

from providers

Sustainability and taking the ownership

of the move to Business as Usual phase

The challenges so far

What our MDT members say

about the project

“Without collaborative, multi-disciplinary working, we cannot expect to

deliver patient-focused, cost effective services that allow us to maximise

resources where they are needed most…”

East of England Regional Clinical Coordinator Paramedic

“If it stopped, I would not have access to provide better quality care for my

patients. There would be no integration at all between primary and

secondary care and it would be very difficult to support these patients…’’

GP Practice Matron

“We have made a difference to patients who are now not HIUs due to our

regular communication…I do feel that it would negatively impact our

patients if the group were to disband…”

Deputy Clinical Director, East of England Out of Hours Service

The HIU project has proved that it works and that the impact for Patients, staff and the economy as a whole are significant

The susses of this project has been recognised by

the HSJ Awards in the category of ‘Improvement

in Emergency and Urgent Care’ therefore,

considered to be a ‘best practice’ and would serve

other organisations nationally

Currently we are looking at how we make this business as usual, first locally and then across our STP

Looking also at expanding the scoping into children's services

Conclusions and the Future…

HSJ Awards 2018 Finalist

www.greenbrook.nhs.uk

Next steps in transforming urgent and emergency care services6th December 2018

Integrated, primary care led, urgent treatment centres

www.greenbrook.nhs.uk 12

Well-run, integrated, primary care-led UTCs can bring significant benefits for patients and commissioners

50-60% fewer patients in A&E

Significantly improved performance compared to A&E

Better experience for patients

Much lower costs per patient for commissioners

www.greenbrook.nhs.uk 13

1

2 Clinical assessment and navigation of all A&E walk-in patients within 15 mins of arrival

Ability to influence future

patient behaviour – Patient

Champions lead the way

4

3 Special urgent primary care approach allows UTC to keep more acute patients out of ED -only limited use of blood tests

5

Integrated with other local services that can better look after patients

6

Excellent primary care led UTCs share 6 key features

Patients see the clinician that can discharge them home first - rather than at the end of the process

The UTC is the front door to A&E – no other way in

www.greenbrook.nhs.uk 14

PRIMARY CARE-LED UTC & OUT OF

HOURS

Community Pharmacies

Mental Health

Drug and Alcohol Service

Community Services

Social Services

Community Dentistry

Integration and partnership working are crucial for successful urgent care systems

General Practice and GP hubs

Emergency Dept. & Specialities

www.greenbrook.nhs.uk 15

Successful integration and partnership working lead to a virtuous circle in urgent care

Integrated governance leads to safer services

Patients in the right place leads to improved patient flow

Partnership working leads to better use of scarce workforce

Education and signposting over time leads to lower demand