2023 Awards - Partnership Submissions

Frailty-ACE (Assessment and Coordination of Emergency and urgent care) is an innovative approach to coordinating the health and care responses required to manage frail people at home, when a crisis would otherwise result in conveyance to the Emergency Department (ED) and/ or medical admission. The intervention is targeted to support our frailest patients who are at greatest risk of long admissions with 'no criteria to reside' in hospital.

The co-located F-ACE 'team of teams' comprises experienced urgent Primary Care and community clinicians, social worker and remote specialist frailty expertise, and works alongside our integrated mental health team. They remotely assess and manage frail people’s urgent physical health, mental health and care needs, including support for carers. F-ACE is closely integrated with Urgent Community Response, Frailty NHS@Home (virtual ward), social care, Frailty Same Day Emergency Care and 24-hour General Practice, enabling face to face assessment, and/ or ongoing monitoring and health, therapies or care interventions at home.

During the 6-week pilot, F-ACE managed 222 frail, complex and comorbid patients who were referred for medical admission, or by paramedics planning to convey, via a single point of access. ACE-F managed an unprecedented 65% without admission. Working as a joined-up, single team built trust, relationships and efficiencies across traditional service boundaries. These were key enablers for supported risk holding, shared decision making and person-centred coordination to tailor responses to patient's needs and wishes. ACE colleagues consistently reported how rewarding and enjoyable the work was, and valued the rich learning environment. Patient and carer feedback has been positive, with excellent paramedic and GP feedback.

The pilot period was associated with a step change in ED 4-hour performance for major cases of all ages, which appears to have been driven by people aged 80+. We estimate that coordination and collaboration between existing services during the ACE-F pilot saved up to 2016 bed days and £760,000, based on an average length of stay of 14 days each costing £5,300.

With a strong focus on improvement, we are looking to build our links with neighbourhoods and localities to support frail people to keep well. We want to translate the ACE principles to support urgent and emergency mental health (M-ACE) and paediatric (P-ACE) needs, and a true healthcare professional single point of access for the system.

Please see our supporting video https://youtu.be/CHmtgZGulZM

The organisation has worked in collaboration with Care Homes and Norfolk and Waveney ICB to deliver an out of hours pilot project to Care Homes at the weekends. We identified a high volume of calls to our 111 service from Norfolk Care Homes which were resulting in unnecessary conveyances to hospital. This put a huge amount of pressure on the system and effects the ability to deliver services safely and effectively. The basis for the pilot was implementing remote technology to provide observations and support a more comprehensive clinical triage.

The NHS Long-Term Plan includes promoting the use of technology to help reduce the pressures on GP Practices and improve care to support those who live and work in and around Care Homes. Urgent care services in Norfolk and Waveney, in common with many other places, are stretched.

The impact & benefits of digital remote monitoring & virtual ward rounds are expected to:

• Reduce demand for in-person visits by Primary Care professionals
• Reduce demand for inpatient beds and pressure on Emergency Departments
• Reduce incidence of hospital acquired infection and deconditioning
• Improve the experience of care, and population health & wellbeing outcomes

The three main reasons for Care Homes requesting a clinical assessment are confusion, urinary problems, and cough/chest infection. When these symptoms are assessed and treated in a timely and person-centred manner there is a reduced risk of complications developing or requirement for hospitalisation.

The pilot phase to date has demonstrated that following clinical triage 83% residents were treated with home management, 14% had a home visit, 1.5% required an ambulance and 1.5% referred to Community Nursing.

The positive outcomes are reducing the detrimental effects on residents who suffer from deconditioning because of transfer and or a hospital stay.

Care Home Staff and resident feedback has been uplifting. Staff reported they feel more confident when talking with health professionals and believe that their residents are getting quicker, more appropriate care. The resident’s experience has been positive as they feel like they are part of the care provision.

A strong partnership has been developed between Norfolk and Waveney ICB, Care Home Staff and our organisation as we continue to build and expand this pilot.

We have a strong reputation for doing the right thing and doing it well. Because of this reputation, our NHS partners feel confident approaching us to develop new services (for example a centralised contact centre that includes a Clinical Advice Service and Single Point of Access, GP out of hours services, Urgent Treatment Centres, and extended access primary care services). Together, we have proven that collaborative partnerships can deliver excellent Urgent Care.

From July 22 to March 23, we surveyed 40% of the patients who used our largest service and received 2,159 responses. The majority of responders rated their experience as ‘very good’ or ‘good’, and provided comments such as “Although there were delays in getting a GP to visit me at home I knew that I could ring up should my symptoms worsen”, and “The care I received was exemplary without the staff who treated me I wouldn’t be able to take this survey”.

Because of our effective partnership with our local ICS, we were able to manage and support 715,922 patient cases between 01/04/22 and 31/03/23. Examples of those services include:

• preventing 80% of patients who used the NHS111 Online tool from going unnecessarily to ED via our ED Validation service,
• treating 86,788 patients in our local walk-in services, and
• supporting patients on 9,160 occasions via the Urgent Community Response (UCR) partnership.

The UCR partnership is a great example of collaboration. As four providers working together, we can respond to health and social care needs from a single referral through our contact centre. Between November 2022 – July 2023, UCR received 7,001 referrals and our advanced clinicians closed 39% of them remotely, passing the remaining cases to our partners for a face-to-face visit. Our approach to collaboration has enabled UCR to consistently achieve the 2-hour response standard, ensure less than 3% of referrals are passed back due to capacity reasons, and prevented more Emergency Department attendances and ambulance dispatch/conveyance by managing the Cat 3 & 4 cases for the Ambulance Service. The timely intervention our partnership provides enables better outcomes for the patients, with 94% not receiving an emergency admission within 24 hours, and 87% within 30 days, of a face-to-face UCR visit.

To share learning on our UCR service we have presented at national NHS England Ambulance webinars, worked with local health reporters to gain news coverage, and held workshops with international medical students from Brazil and India.

The NHS Health Check is a 20-minute appointment for adults in England aged 40-74. If helps detect early signs of cardiovascular disease and other long-term conditions. As part of the health check provided, we offer point of care testing for cholesterol and HBA1C which provides instant results to our patients. The instant results enable the clinician to offer lifestyle advise and any follow-on care accordingly. A regular donation is given to the British Heart Foundation which allows us to share their booklets & leaflets with our patients.

This service is delivered using a single decker bus which has been fully refurbished into a mobile clinic with disabled access. Upon designing the service, the locations were carefully selected based on partnership work with population health focusing on the Core20PLUS5 patient cohort which in the Blackpool area highlighted the need for hypertension reviews. We provide this service across 7 days to ensure accessibility for all patients.

Blackpool is a very busy seaside town with a very transient population and severe deprivation, the areas we have chosen to focus, have been highlighted through data shared through our close work with the population health team. The local council have commissioned us to do this work following on great pre-existing work we have done throughout the pandemic and beyond.

As an extension of the NHS Health Checks, FCMS in collaboration with Blackpool Council also offer an additional service called Know Your Numbers. This is providing local workplaces the opportunity for their employees to attend our mobile unit for a BP, Pulse and Cholesterol check despite their age to help highlight the early detection of hypertension/hypotension.

We are delighted to report that since the start of this service, we have delivered 1562 Health Checks.

Patient feedback:

“If it wasn’t for the service you provided, I am not sure I would be here”.

“I feel so much better for knowing my results”

“I feel so reassured that the lifestyle changes I have made have helped my results”

“Very clear instructions and advise”

“Answered all my questions, would recommend to my friends and family”

“Very efficient and easily accessible service”

“Very informative and reassuring”

“Amazing service, everyone should do this for monitoring their health”

“I do not like doctors surgeries so this health check was a breath of fresh air”

“Pleased and grateful I was offered the service”

Our Mental Health Integrated Access Partnership is an innovative service, enhancing the standard of urgent and emergency mental health care in the South-West.

Benefiting Patient Care: At its core, this partnership centres around patient well-being. We have joined forces with Integrated Urgent Care Service, South-Western Ambulance Service, Avon & Wiltshire Mental Health Partnership, Avon & Somerset Police, Avon Fire & Rescue, and voluntary organisations to create a service tailored to the unique needs of individuals facing a mental health crisis. Our collective aim is to offer patients immediate access to mental health professionals, thereby eliminating the stress of re-telling their story multiple times.

Productive Relationships: Open lines of communication among all stakeholders have been crucial. Weekly huddles and a shared digital platform allow for ongoing dialogue, ensuring that each organisation contributes its expertise to create a harmonised approach to care.

Joint Work: Breaking away from the traditional model of healthcare, the service leverages the skills and expertise of multiple agencies to raise the bar for mental health care. This innovative approach has made us a leading example in collaborative patient care, as reflected in our remarkable outcomes.

Learning Opportunities: The partnership provides ample opportunities for cross-disciplinary training. Workshops and training sessions are common, helping us refine our methods and learn from each other’s strengths and weaknesses.

Quantifiable Benefits: The impact has been transformative. Mental health calls to 999 and 111 have a significantly reduced wait time, allowing patients to access mental health clinical triage more promptly. We have effectively minimised the strain on ambulance services and emergency departments by providing alternative, more specialised responses.

Integral Partnership with Police: Police link-officers work alongside us, resulting in one third of calls that would previously have led to police dispatch now receiving more apt mental health care. Their role is vital in making our service comprehensive and truly integrated.

Our Mental Health IAP is more than just a collaboration; it's a transformative force in the healthcare landscape of the South-West. By combining the strengths of diverse organisations and adopting a consistently patient-centred approach, we have set new benchmarks for effective, immediate, and compassionate care. We don’t just respond to calls; we change lives, substantiated by measurable improvements in service delivery and patient outcomes. This partnership serves as a compelling blueprint for what can be achieved when organisations unite around a shared mission: to provide exceptional mental health care for those in urgent need.

In December 2022, a community dermoscopy service was introduced in east Suffolk for patients with skin lesions, delivered by experienced primary care clinicians and managed by Suffolk GP Federation. The service aims to improve the quality of secondary care referrals, reduce unnecessary hospital activity and provide care closer to home for patients.

To date, 285 patients have attended of whom 68% have been discharged with reassurance. 31 patients have been referred on the two-week wait (2ww) pathway, supporting faster cancer diagnosis. There has been a 32% reduction in referrals to secondary care, associated cost savings and excellent patient feedback.

The service success was down to the successful collaboration of Suffolk GP Fed and the local ICB who innovatively funded the project through an existing service model allowing us to test and learn leading to improved outcomes and a better patient journey.

We proudly nominate the partnership led by Kernow Health CIC (KHCIC) with Cornwall Ambulance Service, Lifeline and the South Western Ambulance Service NHS Foundation Trust (SWASFT) in the implementation of the Integrated ITK and Rapid Response Falls Service for Best Partnership. A video on this can be found here: https://www.youtube.com/watch?v=kkeWrEms5KU

Outline

In Cornwall, historic challenges with ambulance response times have led to falls patients suffering ‘long-lies’, in many cases remaining on the floor 8 hours +. These vulnerable, often elderly patients often develop hypothermia, infection, pressure ulcers and in some cases develop embolic disease due to the length of time on the floor, resulting in significant morbidity and complex admissions.

Innovation

This collaboration broke down inter-organisational clinical, governance, HR and technologic barriers with IUC clinicians gaining access to the live 999 queue, identifying falls patients and dispatching them to a specialist RRFS. Furthermore, improved capture of patients was gained through an agile relationship developed with Lifeline, where pendant alarm activations for falls are directly ‘hot transferred’ to the RRFS, avoiding 999.

Ambition

Despite already achieving high numbers of referrals and an 85%+ ‘discharge on scene’ rate, the RRFS has increased its scope to include patients with increasing illness and injury, with practitioners now delivering catheterisation, urinalysis, antibiotic administration, infusions and, through successful charitable fundraising of an advanced point-of-care-blood-testing device, advanced on scene diagnostics.

Effectiveness

The partnership has been remarkably effective. The service averages 300-350 calls per month, is on scene with the patient in 51 minutes (directly equivalent to the SWASFT Cat 2 mean response time even though RRFS does not travel on blue lights) and discharges over 85% of patients. This is compared to the SWASFT discharge on scene rate of 30%. Importantly, over 50% of activity now arises from outside the SWASFT ITK (from Lifeline, care homes, GPs etc.) reducing pressures on 999.

Care and Quality

The RRFS has just been rated as ‘Outstanding’ by CQC in recognition of this service. Alongside this, care and quality are palpable through the exceptional patient satisfaction feedback, excellent feedback from frontline workers across the partnership and the service has been positively highlighted as a marker of best practice in the Houses of Parliament.

Impact

The impact is substantial. The service not only addresses immediate patient needs but also improves system flow and reduces 999 operational pressures. August’s data, comparable to other months, demonstrates that 165 additional complex admissions were avoided as a result of this service.

Salford Primary Care Together was reviewing how we can best use data in an innovative way to help improve our efficiency. The dilemma was how we address rising demand, in a difficult operating environment, which all urgent health care providers continue to face.

We reviewed various business intelligence platforms and worked with a local primary urgent care provider (also a UHUK member – Mastercall) to review the advanced BI function that they were able to offer.

Working with colleagues from Mastercall and their BI teams has helped SPCT implement an advanced BI platform which has allowed us to evaluate data in much greater detail. The platform links with our clinical audit and rota software.

As such we have been able improve efficiencies and minimsie duplication. The BI platform also allows us to review clinician down time and productivity during sessions and has helped us identify which staff we need, where we need them and ensure that we minimise patient contacts during the patient journey, all whilst ensuring we maintain safety and quality.

As we entered a challenging winter during 2022/2023, we were aware that COVID had not gone away, and the projections for Acute Respiratory Infection, including outbreaks of Flu were deeply concerning. North Hampshire place had previously come together successfully to work at scale during the pandemic to deliver COVID Assessment and Treatment Centres, as well as a Vaccination Service, with great outcomes and patient feedback, so we were keen to innovate and look to deliver an Acute Respiratory Hub at scale to support our population.

The North Hampshire Integrated ARI Hub was a collaborative service covering 15 practices, 5 PCNs and 230,000 patients. This built on a strong culture of integration, developed during the pandemic, and included Primary and Secondary Care, Community Providers, Virtual Wards and 111CAS/999 services. The ARI Hub was Primary Care led, based in the Basingstoke Hospital Emergency Department, and was fully integrated into the North Hampshire system. With strong Governance and a single Clinical Model in place, we implemented a "no wrong door" for patients, who could access the Hub from several entry points using a single, joined up clinical pathway.

We used a single IT platform, EMIS Hub, and designed a model where patients could be directly referred to the Hub from Primary Care, from the front door of the Emergency Department, the 111CAS service, from the 999 Desks, the SCAS paramedics, and from our Community Nursing providers and Urgent Community Response team. This was very different from existing models, as previously there were multiple pathways for patients presenting with an Acute Respiratory Infection, depending on where and how they accessed the service. The single Clinical Pathway allowed us all to speak the same language, which was extremely helpful.

During the consultation, we wanted to innovate and ensure that the right patients received the right ongoing clinical care. We partnered with the Chief Scientist at our Trust to pilot and evaluate two Point of Care tests for our patients. This allowed us to identify the right patients to test, for whom the outcome would change their management. We reduced antibiotic prescribing and could initiate antiviral medication for the vulnerable patients with COVID or Influenza and access Virtual Wards for patients who would otherwise be managed in a hospital bed.

We also ensured that the service was well integrated for onward flow of patients. If a patient needed admission we had a clear pathway into SDEC and the Medical Teams, and were closely linked with Virtual Wards for those patients who could be managed at home. Finally for those patients we could treat and discharge, we had clear safety netting via NHS Pharmacies and 111. We were keen to learn, and to measure efficacy through patient, stakeholder and staff experience surveys, through data collection, clinical audit and through a full service evaluation.

The Hub was open for three months during Winter 22/23 and over that period saw 1836 patients in a small Hub next to Basingstoke Emergency Department. Most patients (91.3%) were assessed, treated, and discharged home, although there were 91 patients (5%) who would otherwise have been admitted to hospital and were able to be managed on Virtual Wards following a face-to-face assessment and access to Point of Care testing. In total 91 tests were carried out, with a case positivity rate of 26.4%.

Patients were able to be seen quickly and effectively and patient feedback was extremely positive. Outcomes were excellent, with early access to care reducing admission rates and the close links to the Virtual Wards allowed people to be cared for in their own homes, avoiding deconditioning that can follow an admission to hospital.

The North Hampshire Integrated ARI Hub was one of the first in the country to become operational in Winter 22/23 and the North Hampshire Standard Operating Procedure was shared widely on the National Learning Networks and used as a blueprint for others. Dr O'Keeffe, the NHUC Medical Director and Clinical Lead also presented the model both within Hampshire and IOW, and also regionally in the South East as well as at the National ARI Community of Practice meetings. She also carried out an Evaluation of the Service following the pilot and this evaluation was presented to the National ARI Evaluation Community of Practice to look at shared learning and the potential for future services.

The Rossendale Minor Injuries Unit (RMIU) is part of a large non profitable organisation, FCMS (Fylde Coast Medical Services NW Ltd). Although RMIU are not part of the East Lancashire Hospital Trust, or Primary Care Networks (PCN), we have been successfully networking with both, over several years, to develop and implement standard operational procedures, to benefit care offered to the local community.

Over several months, RMIU has taken a huge step in networking with East Lancashire's Senior Medicines Optimisation Care Home Pharmacy Technician, who has won awards for her work in identifying patients who are at risk from Anticholinergic Burden in the > 65s. With her support, RMIU embarked on a patient improvement strategy, to develop a Standard Operational Procedure (SOP), that would align care within the 'patient incentive scheme' within the Primary Care Networks, which too, would help to identify patients who may be at risk from falls due to Anticholinergic Burden (ACB).

As RMIU see a significant amount of patients over the age of 65, we use strict assessment tools and pathways in the effective management of 'Silver Trauma'. By also using the Rockwood Frailty scale, this further identifies those patients >65, who could potentially suffer the catastrophic consequences of a simple fall from standing height alone, and it is recognised, the higher the frailty, the higher the risk of serious injury.

As reducing falls is high on the agenda in the NHS, RMIU has combined all of the above, and developed a SOP, to identify patients >65, with a significant ACB score, incorporating the frailty status and the effects relatable to Silver Trauma. Should patients score significantly on such scores, RMIU can now relay this information back to GP's and/ or Clinical Pharmacists, aiming to trigger the consideration of a medicines review, thus helping to prevent falls and reduce hospital admissions.

To get 'buy in' from the PCN's and Clinical Pharmacists, networking has been a slow and tactful process, since it ran the risk of PCN groups feeling we could potentially increase their already busy workload.

With the perseverance of meetings, presentations, ICB approval, discussions with frailty teams and constant networking with the Senior Medicines Optimisation Care Home Pharmacy Technician, there has been a positive acceptance across East Lancashire with regards to RMIU's processes in helping to identify patients of 65 and over, who may be at risk from falling.

The Falls Lifting service (pilot) provided a lifting service post falls for all people over 18yrs who at the time of the call were deemed non-injured.

The GMUPCA (GTd, Bardoc and Mastercall) pilot was provided in 5 areas (Manchester, Stockport, Salford, Rochdale and Bury) of Greater Manchester, operated 8am-8pm 7 days a week.

Historically, if a person fell, they would normally contact the ambulance service. Many of which result in conveyance to hospital due to frailty and length of time the person is on the floor.

A long lie is when a person who has fallen spends a prolonged period of time on the floor because they are unable to get up. Implications of long lies include dehydration, pressure injuries.

Objectives of the reactive falls service:

• To improve response times to non-injured fallers
• Improve outcomes for people
• Reduce unnecessary ambulances for non-emergency falls
• Increase referrals to more appropriate services such as Crisis teams, Urgent care response teams

The non-clinical responders were trained on taking observations, NEWS 2 and how to escalate concerns (using SBAR framework) to NWAS/ clinicians.

The service worked in partnership with NWAS taking direct referrals, took direct referrals from care homes in Stockport, referred people to the local falls prevention teams, urgent care response teams, safeguarding teams, Out of hours and Pathfinder services and other community services. Whole system wide partnership working.

Results:

• More timely response reduced long lies. 100% on scene in < 1hr
• Proactive referrals to falls prevention teams
• Identified people who required an upgraded ambulance response. 11.5% of all referrals (225) as required ED review.
• Increased referrals and utilisation of community services
• Reduction in ED conveyances
• Identification of safeguarding/ social services concerns and referrals
• Empowerment and upskilling of staff 100% satisfaction.

For each attendance that didn’t require an ambulance attendance, there is a cost saving of the difference between a Hear & Treat call (when the ambulance service take the call, but hand it to a third party, as in this case), and a See & Treat attendance (when they send a crew to the scene, but don’t take the patient to hospital). National reference cost data for 2021/22 suggests the average cost of a See & Treat attendance was £268.39, the potential ambulance cost saving was £205.49 per case.

Future scope was planned to include:

• referrals from all care home,
• expand the service to all GM,
• electronic referrals from NWAS
• electronic referrals to Falls prevention teams

Our organisation has run a GP service alongside the local ED department for a number of years.

When the plan to build a UTC at the hospital was announced, we offered to to jointly manage and govern this space.

The project has been ongoing for the last 5 years with the planned opening date being May 2024.

To support this project we dedicated a team of staff to address the needs and planning of this massive project.

Specifically, since the end of COVID this work has increased.

We have undertaken a massive amount of data analysis so that the workforce plan could be written. We are on all working groups jointly with the hospital including IT, communications, equipment and pathways.

We are taking the lead on writing patient pathways so on the opening of the UTC with the aim that patients will be seen in the right place first time. This involves close working with our ED colleagues and other specialities across the hospital.

We recognise the largest issue working in partnership with another organisation revolves around relationships and culture. In response to this we have started to set up a series of workshops leading up to the opening of this service that will bring the two teams together to create optimum working environments and relationships.

Working closely in this setting also has fostered a learning environment for all. ED have a greater understanding of the capabilities of primary care and our primary care clinicians are able to learn more in relation to acute medicine with the support of our ED colleagues when working in this setting.

We continue to support the hospital in additional ways such as increased staffing at times of industrial action and over bank holidays and have demonstrated that we are always willing to react to additional requests of support. Over the winter period we have proposed an additional service to support the paediatric ED recognising that this area comes under exceptional pressure at this time.

Our proactive approach to supporting ED is continually evident and working so closely with emergency care over these years has improved patient care and safety in this setting and created a really positive working environment that will hopefully results in a happy dynamic workforce in the new UTC.

Bringing primary care and emergency care together in this way has clearly improved patient outcomes, communication across these areas and led to positive relationship building.

We have moved from a "them and us"culture to a joined up co-responsive approach to addressing the demands in emergency care.

The Greater Manchester Urgent Primary Care Alliance is an alliance of 4 organisations with a combined experience of over 100 years who, by working collaboratively are pioneering change in Urgent Primary Care across Greater Manchester.

Since its formation in December 2018, it has earned recognition through various award nominations.

Services include:

• GM Clinical Assessment Service (GM 999 & 111 CAS – 100% clinical staffing)
• GM Dental (Urgent Dental helpline & dental nurses)
• GM UEC Adastra Programme (direct booking & EPR platform)

As the first integrated provider alliance of its kind in GM, it’s services have had a profound impact on patient care.

Below are some of the highlights:

• 0.5million GMCAS cases handled with a c0.02% complaint rate
• c40,000 virtual ward bed days delivered
• Every day we reduce on average 140 patients from needing an ambulance response and, in doing so, release c63,875 ambulance response hours per year.
• We have an integrated 24/7/365 digital hub and single digital architecture which can take and send cases seamlessly from NWAS and to Primary Care Practices and Emergency Departments, Urgent Treatment Centres and more. Ensuring that patients notes are sent ahead avoiding duplication of effort and frustrated patient journeys.
• With hundreds of thousands of direct bookings across Greater Manchester and the merging of a single patient record system across our GMUPCA partners we are transforming data architecture and data flows through central integration.
• We combine over 100 years in clinical delivery experience when we meet each fortnight to discuss best practice we are harnessing our yesterdays for your better tomorrows.
• We deal with millions of calls and cases each year; our shared data modelling helps bring insights and recommendation for UEC reform.
• C200,000 cases p.a; 82% of 999 ‘hear and treat’ in GM is delivered by the GM CAS.
• Adastra is critical in achieving ED Safeguarding; first in UK process safeguarding DNAs to ED (saving domestic violence preventative attendance and much more). It has been rolled out to every hospital emergency department in Greater Manchester

The focus of the partnership is and always has been to improve patient outcomes, enhancing the lives of residents of GM which it has done exponentially, year on year.

Please see supporting evidence for further information.

An overview of the Adastra programme can be found here: https://www.youtube.com/watch?v=BN4Ne13D6zI

Due to an unforeseen delay in mobilising a new contract the idea of a formalised approach for NHS111 contingencies was broached by with NHSE’s Integrated Urgent Care team. Nothing on such a scale had ever been commissioned so this service was designed as a trailblazer.

Through a collaborative process, an incremental short term national contingency model was agreed with NHSE.

It enabled patients to access services at times of high demand, support other NHS 111 providers as directed by the NHSE team and allowed us to utilise our on-going recruitment pipeline productively.

We put forward an ambitious mobilisation of this National Contingency solution of one month – with the aim of starting a service on November 1st 2022 through to February 28th 2023 on a 7am-11pm basis.

This new service required a very experienced and knowledgeable mobilisation team which consisted of 111 Directors, Operational & Clinical Leads, CQI, PA’s and Workforce Planning together with IT, HR, Analytics, Estates, PMO, Communications and Finance. Without everyone’s contribution this National support service would not have been a success.

We collaborated exceedingly well and successfully as a team, with the NHSE Senior IUC Leadership Team, and three Ambulance Services.

We answered 156,000 patient calls through the contingency model over the four-month winter period.

91% of calls were answered within the 60 seconds performance target, with abandoned calls being only 1% (National target is less than 3%), a fantastic achievement.

The scale and success of this collaborative arrangement – through a nationally contracted model – has proved that we can provide a best practice service to enable support of the NHS system at times of high demand.

The partnership approach ensured that performance was very much geared to the provision of a quality service where patient experience was what mattered most. In addition the success of this innovation has enhanced our reputation.

This was a proactive idea that came about as a result of an unexpected delay in another contract go live. Overall regional pressures in healthcare were addressed by working together, colleagues in other services were relieved of some of the pressures they were facing (which supported their wellbeing) and above all, our collective 111 patients received a high-quality service aligned to national standards.

In response to the growing demand and pressure on Urgent and Emergency Care services, we have successfully collaborated with our ICB to introduce an ED streaming model in July 2022, aligned with the Fuller Stocktake vision. This model has proven to be highly effective, having served over 9,234 patients to date. It is a testament to the exceptional leadership and teamwork between our organisation and the local Trust.

The Service operates from two clinical rooms located within the Emergency Department of a Local Trust. It is staffed by an administrator and two clinicians (GP/Advanced Clinical Practitioner model). The Service is open seven days a week from 10:00 AM to 10:00 PM and primarily uses Adastra as its clinical platform. To make the transition into our Service smoother, we have integrated the primary clinical system of the Trust as part of our service adaptation.

The clinical model was agreed in collaboration ICB, including the Chief Medical Officer and the Hospital Trust. Due to the nature of primary care, the scope of inclusion is broad and requires the clinician to be adaptive and skilled in rapid triage and diagnosis. In addition, with the reintroduction of 4-hour ED targets, a key aim of the service is to ensure the patient’s journeys are tailored to the correct expert alongside supporting pressures on ED.

It is pleasing to note that throughout the year, the percentage of patients who were seen, treated, and discharged home has consistently increased. Additionally, the percentage of patients who returned to the ED has significantly decreased, with re-attendance dropping to 3.8% in Q4 of 22/23. This demonstrates improved streaming and joint working. The service is also capable of directly referring appropriate patients to SDEC specialties as needed to support ED pressure.

At our organisation, we hold ourselves to the highest standards of governance. This is why we utilise our clinical audit system, Clinical Guardian, to review clinical notes regularly. Additionally, we collect valuable patient feedback through PSQ cards, which are provided to patients during their streaming service. Our top priority is to deliver exceptional patient care, as evidenced by the positive feedback we consistently receive from patients and our partners in the wider system.

We continue to support the ICB vision of ensuring patients have access to the right care, in the right place, in a timely way.

In 2022 LCW joined forces with leading charity ‘The Ectopic Pregnancy Trust’ to develop and deliver a new Quality Improvement Initiative:

Healthcare Professionals Awareness Campaign on Ectopic Pregnancy

Our vision is to raise vital awareness and provide tools to start important conversations. We recognise that ectopic pregnancy impacts many including the woman or pregnant person, their partner (if they have one), family members, friends, and colleagues. People affected are from all backgrounds and range of personal circumstances and we recognise that unscheduled care can often be the first contact for patients presenting with symptoms of this acute condition.

Along with a small number of acute trusts nationwide, we have been involved in the design and implementation of Biocards as well as educational material (including videos) produced by the charity. This aligns with the new updated Nice Guidelines on Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management published in August 2023.

The Ectopic Pregnancy Biocard is an easy-to-use reference tool. It highlights signs of ectopic pregnancy and next steps for symptomatic women/people.

Our clinicians have been encouraged to keep the Biocard close by as a helpful reminder to bear in mind and consider the condition. It can be slotted into a lanyard holder. Made of durable plastic, it is hard-wearing and can be wiped clean.

Complimentary videos and further resources have been made available to our clinicians on our staff intranet and via The Ectopic Pregnancy Trust Pilot Website.

Think Ectopic - resources for pilot sites - The Ectopic Pregnancy Trust