single access model - past, present & future paul wilding - medical director nhs direct west...
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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
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Background
• Calderdale GP
• PENDOC
• NHS Direct West Yorkshire
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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%
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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
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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
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Single access model - past, present & future
• how did we get started? (3)
In summary:
• foundation for the future
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Single access model - past, present & future
• how has the model changed over time in unexpected ways?
• Increased coverage
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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
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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
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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
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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%
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Single access model - past, present & future
• How will the model look in the future?
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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Thank You!Thank You!