Key Contributors This strategy has been written by Porter, Senior Commissioning Support Officer, of England Commissioning Support Unit with and on behalf of County Durham and Darlington System Resilience Group Members whose representation is comprised of: NHS North Durham Clinical Commissioning Group (ND CCG) NHS Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) NHS Darlington Clinical Commissioning Group (DCCG) Durham County Council (DCC) Darlington Borough Council (DBC) County Durham and Darlington NHS Foundation Trust (CDDFT) North Tees and Hartlepool NHS Foundation Trust (NFHFT) Pharmaceutical Committee (LPC) City Hospitals Sunderland NHS Foundation Trust (CHSFT) East Ambulance Service NHS Foundation Trust (NEAS) County Durham Healthwatch Darlington Healthwatch Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) NHS 111 of England Commissioning Support Unit (NECS) NHS England Durham Police Authority Durham and Darlington Fire and Rescue Service All organisations will be inserted here in final version.
Contents Section Heading Page Number Foreword from of System Resilience Group 2 1.0 Executive Summary 5 2.0 Introduction 7 3.0 What Should Good Urgent and Emergency Care Look Like? 10 4.0 National and Local Context 14 5.0 Where Are We Now? 20 6.0 What Do We Want? Current Clinical Commissioning Group Priorities Urgent and Emergency Care Pathway Gaps 32 32 35 7.0 How Are We Going To Get There? High Level Action Plan 43 44 8.0 How Will We Measure Success? 53 9.0 Governance Structure 55 Appendix 1 Urgent Care Strategy 2014 – 2019 Plan on a Page 57 Appendix 2 Eight High Impact Interventions 58 Appendix 3 Local Performance and Activity Information 59 Appendix 4 Key National and Local Policy and Best Practice Documents 62 Appendix 5a Appendix 5a - Map of Current Services: Hospital Sites, Urgent Care Centres and GP Practices 64 Appendix 5b Appendix 5B – Map of Current Services: Community Pharmacies 65 Appendix 6 Glossary 66 Version Control Document History Date Amended by Amendment Document Version 0.5 10th October 2014 Anita Porter, Senior Commissioning Support Officer, NECS on behalf of the System Resilience Group Amendments to consultation draft.
Type of Service What is it for? Level of need How is it accessed? Hours of Operation North Durham Durham Dales, Easington and Sedgefield Darlington GP Practices Minor illness and injury Urgent and Non Urgent/ Routine Booked appointments Telephone appointments Home visits 8am to 6pm Monday to Friday 31 40 11 Extended GP Practices Opening Minor illness and injury Urgent and Non Urgent/ Routine Booked appointments Telephone appointments Home visits Hour of extended GP Practice opening vary Extended opening times vary between local GP Practices including appointments on Saturday mornings. South Durham Health: 10 x practices open Saturday 8.00 – 12.00 noon Durham Health: 5 x practices open Saturday 8.00am – 1.00pm Intrahealth: 1 practice open Saturday and Sunday 8.00am – 8.00 pm 1 practice open Saturday 8.00am – 1.00pm 1 practice open Saturday 9am – 12pm Most GP practices offer extended opening hours b but these vary between practices Pharmacies Minor illness and injury Urgent and Non Urgent/ Routine Advice and Information Walk-in Telephone advice and information Assessment 52 73 23 NHS 111 Minor illness and injury Urgent Advice and Information Telephone 24/7, 365 days of the year Regional Service Intermediate Care Plus Prevention of hospital admission and Non urgent Intensive community based interventions Single point of access for health and social care professionals 24/7, 365 days of the year Responsive Integrated Assessment Care Team Prevention of hospital admission and Non urgent Intensive community interventions Single point of access for health and social care professionals 24/7, 365 days of the year
Urgent and Emergency Care Transport Life Threatening Situations 5.25 The North East Ambulance Service provide emergency ambulances staffed with Paramedics and Emergency Care Assistants, responding to a wide variety of serious or life-threatening calls. Working alongside ambulance crews, a Rapid Responders Team also provide paramedic response to commence emergency treatment before the ambulance arrives on scene. 5.26 In some serious emergencies, you could also be treated by a medical team from the . The medical team on the helicopter includes an acute Consultant (for example, Anesthetists, Emergency Department Consultant) and a Paramedic who are skilled in treating patients who have serious traumatic injuries. Urgent Situations 5.27 At present transport is provided for doctors to visit patients at home and for patients who are unable to travel to the GP Practice or Urgent Care Service on their own. Non Urgent Situations 5.28 Non urgent transport is currently provided by the North East Ambulance Service’s Patient Transport Service. This planned service takes members of the public to and from their homes to outpatients' appointments, dialysis, chemotherapy, clinics, physiotherapy or non-urgent transfers between different hospitals. 5.29 This service covers Teeside, South Tyneside, North Tyneside and Northumberland as well as County Durham and Darlington and undertakes over a million journeys every year. Crews are trained as ambulance care assistants with specialist knowledge of comprehensive first aid, driving skills and patient moving and handling techniques. Some GP Practices organise their own non urgent patient transport directly outwith this service. 5.2 Emergency and Urgent Care Transport Type of Service What is it for? of need How is it accessed? Hours of Operation Coverage 999 Emergency Ambulance Great North Air Ambulance conditions Emergency Telephone 24/7, 365 days of the year Regional Urgent Care Transport Minor illness or injury Urgent By professionals who need to arrange urgent transport for their patients 24/7, 365 days of the year County Durham and Darlington Patient Transport Service Minor illness or injury Routine appointments Hospital Discharge Non urgent By professionals who need to arrange urgent transport for their patients 24/7, 365 days of the year Regional
High Level Action Plan This Action Plan will be reviewed monthly by the System Resilience Group to monitor progress and updated annually during the life of the strategy. The implementation of the actions identified below will in the main be the overall responsibility of the County Durham and Darlington System Resilience Group. However, those that are the overall responsibility of the regional Urgent and Emergency Care Network have been highlighted. Those actions that are also aligned to the delivery of NHS England’s 8 High Impact Interventions have also been clearly identified. Reference Action Lead Commissioner Lead Provider/s Governance Lead Fit with 8 High Impact Interventions Objective 1: People are central to designing the systems and are at the heart of decisions being made 1.1 All System Resilience Group commissioners and providers will ensure that appropriate public, patient and clinical engagement and consultation takes place in the delivery of strategy actions to make sure people are able to input their views into the development of local urgent and emergency services in line with the strategy vision Clinical Commissioning Groups Local Authorities All SRG Providers System Resilience Group Objective 2: Patients will experience a joined up and integrated approach regardless of the specific services they access 2.1 Review current provision appropriate and develop an 'integrated service' for NHS 111 and in and out of hours primary care across the Urgent and Emergency Care Network All Regional System Resilience Groups All relevant providers Urgent and Emergency Care Network 2.2 Review and develop local arrangements for enabling GP Practices to provide extended hours/additional capacity and increased access opportunities providing a responsive service to both primary and urgent needs 7 days a week Clinical Commissioning Groups GP Federations System Resilience Group 2.3 Review, research and develop community based urgent care clinical hub arrangements within primary and urgent care, ensuring appropriate fit with the Urgent and Emergency Care Network ‘integrated service’ Clinical Commissioning Groups All relevant providers System Resilience 2.4 Develop robust links with the Frail Elderly pathway to ensure each care home has effective arrangements with primary care, pharmacy and falls services for prevention and response training, to support management falls without conveyance to hospital where appropriate Clinical Commissioning Groups Local Authorities All relevant providers System Resilience Group
4.3 Further develop the range of primary and secondary care clinical support to care homes and people within their own homes to make sure everyone has responsive, timely and effective health and social care interventions to avoid a hospital admission where appropriate and support people with timely safe hospital discharge 7 days a week Clinical Commissioning Groups All relevant providers System Resilience 4.4 Clarify the scope of the Emergency Medication Service following evaluation and training and education of health and social care staff in the proper use of inhalers as a preventative measure Clinical Commissioning Groups Community Pharmacies System Resilience Group 4.5 Clarify the of the Minor Ailments service in light of availability of real time data Clinical Commissioning Groups Community Pharmacies System Resilience Group 4.6 Improve the skills of health and social care staff to ensure the consistent application of medication reviews for frail elderly people Clinical Commissioning Groups Local Authorities All relevant providers System Resilience Group 4.7 Develop responsive children's community services that are integrated with urgent and emergency care services. This includes increasing specialist community paediatric capacity to help further support children and their families at home with acute and chronic disease management Clinical Commissioning Groups County Durham and Darlington NHS Foundation System Resilience 4.8 Ensure special patient notes are up to date and available for paramedics to contact local clinical support for vulnerable patients Clinical Commissioning Groups North East Ambulance Service System Resilience Group 4.9 Develop intermediate care services in line with the outcome of local reviews Local Authorities County Durham and Darlington NHS Foundation Trust System Resilience Group
6.4 Monitor progress in the two year reduction trajectory for See, Treat and Convey activity and associated increases in Hear and Treat and See and Treat activity; Clinical Commissioning Groups North East Ambulance Service Urgent and Emergency Care Network 6.5 Reduce inappropriate and increase appropriate referrals to ambulatory care within County Durham and Darlington hospitals Clinical Commissioning Groups County Durham and Darlington NHS Foundation Trust System Resilience Group 6.6 Make sure Crisis and Liaison support for children and adolescents with mental health needs is sufficient and effective across County Durham and Darlington Clinical Commissioning Groups Tees Esk and Wear Valleys NHS Foundation Trust System Resilience Group 6.7 Make sure that clinical and referral pathways into recovery services for both adults and young people with an alcohol dependency are sufficiently robust and effective across County Durham and Darlington Local Authorities Relevant community support services System Resilience Group 6.8 Review and expand Community Mental Health Services across County Durham and Darlington to support people in mental health crisis including people with dementia, and providing a patient centred response Clinical Commissioning Groups Tees Esk and Wear Valleys NHS Foundation Trust System Resilience Group 6.9 Make sure that the NHS Pathways Directory of Service for County Durham and Darlington is comprehensively populated with up to date and accurate information to promote easier and faster access to appropriate services across health and social care Clinical Commissioning Groups All SRG Providers System Resilience Group Objective 7: The patient will not experience any unnecessary delay in receiving the most appropriate care 7.1 Ensure that Rapid Assessment and Treat is in place to support patients in Accident and Emergency and Medical Assessment Units to receive safer and more appropriate care as they are reviewed by senior doctors Clinical Commissioning Groups County Durham and System Resilience Group
North East Ambulance Service 7.6 Make sure that the Ambulatory Care Service provided by County Durham and Darlington NHS Foundation Trust has sufficient capacity to manage appropriate demand Clinical Commissioning Groups County Durham and Darlington NHS Foundation Trust System Resilience Group 7.7 Ensure consistent achievement of maximum four-hour wait in Accident and Emergency from arrival to admission, transfer and discharge at 95% as a minimum Clinical Commissioning Groups All Acute Trusts reporting to the System Resilience Group System Resilience Group 7.8 Use collated primary, urgent and emergency care demand levels to help understand fluctuations in overall levels of demand across the whole system, particularly surge activity Clinical Commissioning Groups GP Federations Urgent Care Service Providers Acute Trusts Urgent and Emergency Care Network 7.9 Continue to develop and improve initiatives that reduce acute bed length of stay, particularly for people aged 75 and over Clinical Commissioning Groups County Durham and Darlington NHS Foundation Trust System Resilience Group 7.10 Review and evaluate the implementation, management and effectiveness of the Regional Flight Deck Clinical Commissioning Groups North East Ambulance Service Urgent and Emergency Care Network
7.11 Review and evaluate the implementation, management and effectiveness of the Regional Divert Policy Clinical Commissioning Groups North East Ambulance Service Urgent and Emergency Care Network 7.12 Review and evaluate the implementation, management and effectiveness of the North Durham Local Divert Policy North Durham Clinical Commissioning Group North East Ambulance Service System Resilience Group 7.13 Complete a full review of the Patient Transport Service and discharge transport services and implement any agreed recommendations to make sure that services are able to meet demand, are robust and cost effective Clinical Commissioning Groups North East Ambulance Service Urgent and Emergency Care Network 7.14 Work to better understand the bottlenecks and pressures throughout the urgent and emergency care pathway and the most effective approach to alleviate these pressures, possibly through the use of NHS England’s Data Intelligence Tool Clinical Commissioning Groups All SRG Providers System Resilience 7.15 Ensure that the mental health acute care pathway processes are as efficient as possible to make sure patients receive a timely response and improve patient experience Clinical Commissioning Groups Tees Esk and Wear Valleys NHS Foundation Trust System Resilience Group 7.16 Expand the current Mental Health Acute Liaison Service in A&E to 24/7 coverage Clinical Commissioning Groups Tees Esk and Wear Valleys NHS Foundation Trust System Resilience Group 7.17 Ensure that the re-configuration of Accident and Emergency Departments in both Darlington Memorial Hospital and University Hospital of North Durham include the integration of children’s care that is also sufficiently resourced Clinical Commissioning Groups County Durham and Darlington NHS Foundation Trust System Resilience