Single access model - past, Single access model - past, present & futurepresent & future

Paul Wilding - Medical Director NHS Direct Paul Wilding - Medical Director NHS Direct West YorkshireWest Yorkshire

Background

• Calderdale GP

• PENDOC

• NHS Direct West Yorkshire

NHS Direct nurse triage

Patient calls

PENDOC controller

General practitioner review

GP telephone advice46%

Home visitPCC

appointment

Nurse tel. advice

999/A&E

21%

52%

33%

43%

5%

Single access model - past, present & future

• how did we get started? (1)

• clinical leadership

• coincidence - opportunity seized

• mutual commitment to partnership working

• shared objectives - seamless patient centered high quality care, demand management

Single access model - past, present & future

• how did we get started? (2)

• progressing a good idea - single number access to multi-disciplinary OOH care

• clear benefits to patients and all stakeholders “pushing against an open door”

•resources - central and local

Single access model - past, present & future

• how did we get started? (3)

In summary:

• foundation for the future

Single access model - past, present & future

• how has the model changed over time in unexpected ways?

• Increased coverage

Single access model - past, present & future

• how has the model changed over time in unexpected ways?

• PENDOC coverage

1999 47 GPs 85,000 patients

2003 250 438,000

Single access model - past, present & future

• how has the model changed over time in unexpected ways?

• clinical governance outputs – audit, performance & risk management

• co-location of ambulance control

Single access model - past, present & future

• how has the model changed over time in unexpected ways?

• mental health

• NHS CAS - wider role out stalled, call-times and triage outcome

• single telephone assessment

• call-streaming

NHS Direct nurse triage

Patient calls

PENDOC controller

General practitioner review

GP telephone advice46%

Home visitPCC

appointment

Nurse tel. advice

A&E & Others

21%

52%

33%

43%

5%

Single access model - past, present & future

• How will the model look in the future?

1

Dedicated Calderdale & KirkleesOOH Number + 999

WYMAS PCC/ NHSD WY

Prioritisation by PCA`s usingIntegrated Privatisation System

Nurse / Allied HealthCare Professional Triage

Cat A

Alternative responsesincluding HCR

Same Day

Nurse Triage & GP AssessmentAt C&K Primary OOH Centre

Home Visit / HCRHome Care / Advice

Referral to otherOOH Agency

Next Day

OOHCentre

OOHCentre

OOHCentre

OOHCentre

Pre

-defi

ned

call

s s

tream

ed

to

OO

H p

rov

ider

A&E

Single access model - past, present & future

• What else was unexpected?

• pace of NHS policy initiatives

• Carson Review, REC

• (GMS GP Contract)

• sense of urgency – PCT OOH funding time bomb

Single access model - past, present & future

• How did the development broaden out?

• dental services, community nursing

• leadership - managerial & clinical

• communication & marketing

• extension to in-hours cover

Single access model - past, present & future

• How did the development broaden out?

• by accessing local expertise e.g. palliative care

• to create a special patient pathway

Single access model - past, present & future

• How can we grow connections with other parts of the system in the future?

• dedicated unscheduled care provision by all agencies across the 24 hour divide

• technology – EPR (and compliance with with confidentiality requirements)

Single access model - past, present & future

• How are we overcoming professional boundaries and traditional roles?

• communicating the vision of a multi-disciplinary OOH workforce and telephone triage service

• managing sensitivities e.g. GPs

• attracting new investment – Developing NHS Direct

Single access model - past, present & future

• How did we overcome professional boundaries and traditional roles?

• extension to in-hours cover

• GPs benefiting from locality “NHS” provision

• towards a 24x7 emergency access model

Single access model - past, present & future

• How can we overcome professional boundaries and traditional roles in the future?

• working with the wider NHS e.g. MA Changing Workforce Programme, NHS Direct

Single access model - past, present & future

• How can we overcome professional boundaries and traditional roles in the future?

• by a delivering safe & effective service

• acknowledging different attitudes to risk/uncertainty

• be pragmatic e.g. selected caseload

SummarySummary

• pole position for progressing a regional approach towards a single access pathway to emergency/ unscheduled care• manager/clinician partnership• all agencies must be engaged • Primary Care must assume a leading role in Emergency Care Networks

Thank You!Thank You!