Out of Hours Medical Services

AGENDA ITEM

BOURNEMOUTH & POOLE TEACHING PRIMARY CARE TRUST 6

BRIEF 1. INTRODUCTION

1.1 The Bournemouth and Poole Primary Care Trust jointly with Dorset Primary Care Trust and Somerset Primary Care Trust commission the Dorset & Somerset Urgent Care Service with South West Ambulance Services NHS Trust to provide out of hours medical services for our population.

1.2 Within the Bournemouth and Poole Teaching PCT there are two Local Treatment Centres to provide face to face care for those who are able to attend. The service also provides home visits and telephone advice for appropriate patients.

1.3 The Local Treatment Centre is based in the out patient area near the A&E Department in Poole. There is no walk in centre in Poole.

1.4 The out of hours service is provided between 18.00 hrs and 08.00 the next day during weekdays and over 24 hours at weekends and Bank Holidays.

2. PERFORMANCE - POOLE

2.1 Activities: November 07 December 07 January 08

Number of patient contacts during month 1,068 1,703 1,602 13% 23% % Calls given advice only 17% Advice only call rate %: Weekday evenings 8% 7% 6% & all overnights 23% 29% Weekend days & bank hols 33% % Patients seen at Treatment Location 68% 66% 65% 21% 11% % Patients visited at home 15% 2.2 Dorset & Somerset Urgent Care Service Performance against National Requirements: Compliant Within 5% of target Partially Compliant 5-10% short of target

Not compliant More than 10% short of target

November 07 December 07 January 08 Total activities for Dorset & Somerset Urgent Care Service 15,386 22,013 16,461

Providers must report regularly to PCTs on their compliance with the Quality Requirements Monthly Monthly Monthly

Providers must send details of all OOH consultations to the practice where the patient is registered by 08:00 the 92% 80% 94.2% next working day

Providers must have systems in place to support and encourage the regular exchange of information between all Special notes flagging Special notes flagging Special notes flagging those who may be providing care to patients with predefined needs (including eg patients with terminal illness) system in place system in place system in place

Providers must regularly audit a random sample of patient contacts. The sample must be defined in such a way 120/ Quarter 120/ Quarter 120/ Quarter that it will provide sufficient data to review the clinical performance of each individual working within the service.

Providers must regularly audit a random sample of patients' experiences of the service (eg 1% per quarter). Quarterly Survey Quarterly Survey Quarterly Survey

Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints Complaints 13 Complaints 10 Complaints 4 procedure. Incidents 20 Incidents 27 Incidents 6

Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for Compliant Compliant Compliant their contracted service.

Initial telephone call: % % %

No more than 0.1% of calls engaged 0 0 0 No more than 5% calls abandoned 3.7 7.5 2.5

Time taken for initial call to be answered by a person. % % %

All calls answered within 60 seconds after introductory message of 30 seconds 86.8 79.3 91.3

Telephone clinical assessment: % % % All immediate life threatening conditions passed to the ambulance service within 3 minutes. 100 100 100

Definitive clinical assessment. Target: Urgent calls started within 20 mins, other calls started within 60 minutes U % L U% U % L U% U % L U% Monthly Average 64 79 68 75 77 87 Weekday Average 66 89 68 85 75 92 Saturday Average 60 67 68 73 80 81 Sunday Average 68 82 68 82 79 87 Bank Hols Average - - 73 82 86 92 Face-to-face clinical assessment: (a) Identification of immediate life threatening conditions All immediate life threatening conditions passed to the ambulance service within 3 minutes. 100% 100% 100%

Definitive clinical assessment (of patients presenting at treatment location): All definitive clinical assessment for urgent calls started within 20 minutes 100% 100% 83% All definitive clinical assessment for other calls started within 60 minutes 100% 100% 90%

Outcome. At the end of the assessment, the patient must be clear of the outcome Compliant Compliant Compliant

Providers must ensure that patients are treated by the clinician best equipped to meet their Compliant Compliant Compliant needs in the most appropriate location.

Face-to-face consultations (whether in a centre or in the patient's place of residence) must Base Visits Base Visits Calls Base Visits be started within the following timescales, after the definitive clinical assessment has been Calls Calls Calls Calls Calls completed: Emergency: Within one hour. Urgent: Within two hours. Less urgent: Within six hours. % % % % % % Number of emergency consultations commenced within one hour 60 75 62 83 76 75 Number of urgent consultations commenced within two hours 87 79 81 75 91 79 Number of less urgent consultations commenced within six hours 98 96 97 94 98 97

Patients unable to communicate effectively in English will be provided with an interpretation compliant compliant compliant service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight.

Additional capacity to manage increased peak time demand

2.3 Dorset and Somerset Urgent Care Service is invested in additional staff at peak times during the winter holiday period to maintain performance. It has been agreed between the service and the commissioners that the service will continue to manage peak time demand to aim to meet all national requirements. This will be readdressed after the additional opening hours for General Practice is implemented as agreed nationally.

2.4 Dorset and Somerset Urgent Care Service is the most efficient provider of the out of hours service within the South West region.

3. JOINT WORKING

3.1 The Dorset and Somerset Urgent Care Service is managed by the South West Ambulance Service NHS Trust. The St Leaonard’s Call centre has been developed by South West Ambulance Service NHS Trust to accommodate Emergency Ambulance Service, Dorset and Somerset Urgent Care Service (Out of Hours Service), Patient Transport and NHS Direct in the same room with facility to triage and provide telephone advice, despatch emergency ambulance or direct the patient to the appropriate service.

3.2 The Dorset and Somerset Urgent Care Service and Accident & Emergency Departments have agreed protocols to refer appropriate patients to each other so that the patent receive the most appropriate care easily and in good time.

4. WORKFORCE

4.1 The medical rota to provide Out of Hours service is staffed mainly by local General Practitioner. Extended Care Practitioner provides clinical support to appropriate patients in the Local treatment Centre and during home visits. A Nurse Practitioner is also employed to provide clinical care in the Poole Local Treatment centre. Medical support is always provided where needed to support the non medical staff.

5. SERVICE DEVELOPMENT

5.1 The Bournemouth and Poole Teaching Primary care Trust is working with local General Practitioners to achieve the government requirement for longer opening of General Practice surgeries. This is likely to have impact on Out of Hours Service.