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Rowley Regis and Tipton Pct Update on Emergency Services Re-Design And

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ROWLEY REGIS AND TIPTON PCT UPDATE ON EMERGENCY SERVICES RE-DESIGN AND GP OOH PLAN PROVISIONAL DRAFT 2 Philosophy and principles The nGMS contract will allow GPs to opt out of 24 hour responsibility. GPs opting out will no longer be required to provide or contract care for their registered patients between 6.30pm and 8am on weeknights and between 6.30pm on Fridays until 8am on Monday, nor on bank holidays. Instead PCTs will be required to provide or commission care for patients registered with opting out GPs. PCTs can offer GPs to opt out from April 2004, and must do so by December 2004. During 2002-3 the Sandwell/Heart of Birmingham health economy undertook an emergency care service re-design. The resulting service model includes both primary and secondary care in and out of hours. The model is part way through implementation. This document • sets out progress to date on implementing the model • provides more detail of how the model will be applied to provide out of hours care for patients registered with opted out GPs in Rowley Regis & Tipton PCT The out of hours plan adheres to the principles of the re-design and develops the sevice model detailed withinit. RR&T maintains its commitment to service re-design based on the principles outlined in the service re-design document (Feb 2003). In particular we are committed to • improving access to out of hours care • reducing waiting times • better patient pathways • integrated primary and secondary care services • improved practitioner satisfaction • reduced hospital admissions The model includes • new job roles/skill mix • opportunities for existing providers to fill these roles • fair tendering processes for service specifications which could be delivered by many providers • employed PCT staff • commissioned services • rationalisation of existing provision • use of both primary and secondary care emergency care capacity configured to meet demand appropriately • sign up by all partners The model does not include • replication of existing GP OOH services (unecessary (as no GP 24 hour responsibility) and costly) • destabilisation of existing OOH providers • overloading secondary care A&E services Progress on implementation of re-design model Access Given a change in the requirements placed on NHS Direct, access to the emergency care service will not be able to be via NHS Direct as a single point of access out of hours. Sandwell PCTs have joined the Birmingham and Solihull technical hub project. Meanwhile RR&T intend to go out to tender for call handling for opted out GPs. It is anticipated many existing providers may wish to do this including • Dudley Doc GP Co-operative • Primecare • Badger • NHS Direct • West Midlands Ambulance Trust It is also anticipated that such tendering could be done in conjunction with other PCTs. It is our view that our assumption about the capacity for call handling within the health economy is adequate, is still valid. Access arrangements for the hub at Sandwell Hospital remain as agreed and are detailed within the full business case for the Emergency Centre re-build at Sandwell Hospital (FBC) . Care Provided This remains as detailed in the re-design document and the FBC. Sandwell & West Birmingham Hospitals Trust has appointed 4 Physician Assistants (PAs) to work in its 2 A&E departments. RR&T PCT has appointed 2 Physician Assistants (PAs) to work half time each (1wte) in Sandwell Hospital A&E/Emergency Centre (see workforce) Dental services No change from current sevice as detailed in re-design document Spoke centres One spoke centre has opened at Rowley Hospital (September 2003) and another for Tipton is planned to open on 6th January 2004. There have been a number of variations from the anticipated model necessitated by local factors in Rowley. • Firstly, local GPs could not identify spare clinical capacity to staff the Rowley Centre, therefore an existing provider (Primecare) has been commissioned to provide a doctor in the centre from 12 noon to 6.30pm Tuesday to Friday (peak demand times identified by local practices). RR&T PCT has appointed 2 Physician Assistants (PAs) to work half time each (1wte) in the centre and are currently advertising for a GPwSI in emergency care to provide 3 sessions in the centre (see workforce). These staff should be in post before the end of this financial year. Primecare willthen reduce their input in a phased manner. The Tipton centre will initially also use Primecare but the existing multi-practice 1st wave PMS, Tipton Care Organisation (TCO) should mean reconfiguring existing capacity to staff the centre in part easier. Existing business support has been identified from practices and PCT business support team to provide • reception and appointment booking function • receiving and transfering clinical/patient information Currently the Rowley Centre offers same day appointments to patients requesting a same day appointment with a GPat their usual GP practice. Full details of patient pathways and operational policies are available from the PCT (contact: Maeve Boyle). The centre has been named Rowley GP referral unit. The centre does not currently receive minor cases from ambulances, nor incorporate walk in centre or NHS Direct access point. These ideas may be revisited later. How do we know it’s working? Primary care access targets achieved (ahead of schedule) Patient evaluation positive All practices using the centre Prescribing monitored Regular feedback from practices incorporated into service development Partnership with Primecare ongoing Practitioners supported Successful recruitment of centre staff Workforce • PCT staff identified to meet staffing requirement to deliver re-designed model in Sandwell Hospital Emergency Centre (day time service) PA 2 x0.5wte £40k GPwSI x0.3wte £20k RRT local priority money • Staff identified to provide spoke centre service Rowley Centre PA 2 x0.5wte £40k GPwSI x0.3wte £20k ANP x1.0wte £40k A&C x1wte £20k Tipton Centre £144k (see workforce plan for breakdown) • OOH Sandwell Hospital GP x5 sessions Monday to Friday 6.30pm to 11.30pm (Primecare GP from Sandwell Centre which will be closed during these times). • OOH Rowley Centre 1.3wte GP/PA/equivalent business support security staff RRH Tipton centre will not be open at night Finance Revenue costs for the Sandwell Hospital emergency centre included in LDPs (3xSandwell PCTs) PCT staff needed to work in Emergency centre to deliver re-designed model of care identified and funded through RRT PCT local priorities funding. Next steps for the spoke centres Plans currently being developed • Open on Mondays 12noon to 6.30pm (identification of physical capacity within Rowley Hospital ongoing) • Undertake urgent home visits for practices during current opening hours (plans being developed including pilot with one practice using Primecare doctors. Future includes PCT employed GP (0.5wte) to undertake some visits (see workforce) • PCT home visiting service to be developed using access funding and administered from Rowley Centre by existing business support staff. • GP OOH service based on Rowley Centre ROWLEY REGIS & TIPTON GP OOH SERVICE Proposed service model Time scales The PCT intends to offer its GPs an opt out as soon as practicably possible after 1st April 2004. Call handling The PCT will go out to tender for a call handling service to take all out of hours calls from patients registered with RR&T GP practices. The service will be required • Monday to Thursday 6.30pm to 8am the following morning • Friday 6.30pm to Monday 8am • Bank Holidays 8am to 8am the following morning The service will need to be • compliant with Carson standards • currently acredited • able to triage to all providers (GP centre, Sandwell emergency centre, community nursing service, ambulance service, rapid response team, crisis intervention team etc) • able to link with technical hub project A tender specification will be developed (in conjunction with other PCTs if appropriate). Face to face consultations These will be provided at Rowley Centre for patients triaged to require such care 6.30pm to 11.30pm Monday to Friday 8am to 5pm Saturday, Sunday & Bank Holidays At other times face to face consultations will be provided in Sandwell Emergency Centre at Sandwell Hospital or other centre (eg DDoc Centre at Russels Hall) determined by the provider of the service and patient choice. Home visits A tender specification for home visits will be developed covering times not included in the development of the daytime service at Rowley Hospital. The specification would include • provision of visiting service for patients triaged to require a home visit • skill mix of staff providing visits • working around specific protocols for out of hours visiting • collaborative working with other agencies visiting out of hours eg ambulance, rapid response etc Finance Finance has been worked out for each practice using the BMA ready reckoner, giving a global figure of around £9k per GP for the PCT to provide the service described above. (Financial breakdown available from Richard Price Process OOH subgroup of EC network Has met. A broad strategic overview document containing common principles all can sign up to (agreed at director level for 4 PCTs). Principles will be reported back to EC network and through partnership forums. The intended outcome is sign up across socual care and other partners. Model discussion RRT PEC will discuss and develop model Providers Initial work has been done with both RRT GP OOH providers to map out which roles in the model each provider can fill. Local GPs have indicated willingness to work for the PCT within the model. Commissioning arrangements with NHS Direct after 01/04/04 are being explored (meeting second week December 2003) .
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