Trafford Clinical Commissioning Group

Trafford Clinical Commissioning Group

Trafford Urgent and Emergency Care by Appointment

Briefly describe the initiative/ project/service; please include your aims and objectives

There is a national directive to reduce the footfall in Urgent Care settings as part of the pandemic response. The national campaign aimed at ED’s is known as Urgent & Emergency Care By Appointment. Trafford CCG have taken the principles of the UEC by Appointment and tailored them to deliver a locality based offer for urgent care, this has been done as part of a wider Health and Social Care Recovery and Reform Portfolio at Trafford. Background and Programme Objectives: Like many localities in England, Trafford has an urgent care system that is under unprecedented levels of pressure in terms of demand and long term financial sustainability. As a system we recognise we need to be looking at new ways in which we can deliver these services for our patients and ensure we can manage the pressure in the system by transforming our urgent care services within secondary care, primary care and the community.

During the months of the first peak of the coronavirus pandemic the number of people attending Emergency Departments(EDs) reduced dramatically, particularly those seeking help for minor illnesses and injuries. However, since May the number of people visiting EDs has been rising. At the same time, due to social distancing and infection prevention and control precautions, the space in EDs has reduced. We must now guide the public in making the right healthcare choices to ensure their safety, as well as making sure they get the right treatment in the most appropriate place for their needs. NHS 111 will make it easier and safer for patients to get the right advice or treatment when they urgently need it and increasingly, they will be able to book direct appointments/time slots into a service that is right for them.

Around 70% of ED attendances are made up of walk-in patients, so as patient numbers have increased, the NHS aims to keep patients safe despite the reduced space in waiting rooms. We also know that a significant proportion of those attending EDs, particularly type 3 and 4 patients could be seen elsewhere, for example in primary care, an Urgent Treatment Centre or in the community. From December 2020, NHS111 will be able to book a timed slot for patients that need to be seen in an Emergency Department, to ensure patients are seen as safely and conveniently as possible. Our ambition is to provide a better experience of care, whether that is by phone or online from NHS 111, at home from a paramedic, in a GP practice or pharmacy or when necessary in an emergency department. The aim is to improve patient experience in healthcare settings during COVID-19 and provide a long-term model of access to urgent and emergency care services. A national campaign called ‘111 First’ will support the changes: ‘NHS 111 First’ refers to offering people a different way of accessing and receiving healthcare, including a new way to access Emergency Departments. In short: NHS 111 First aims to build on and embed the beneficial changes in the way patients have been accessing healthcare during the COVID-19 pandemic.

In line with the national 111 First campaign ‘Trafford UEC by Appointment Programme’ patients are encouraged to call 111where possible to access urgent care services and potential patient outcomes following clinical triage are:

– Booked slot with GP through GP Connect
– Advised to attend ED
– Hear & Treat advice provided
– Advised to visit community pharmacy
– Booked appointment at the Walk in Centre (WiC) or the Urgent Care Centre (UCC)
– Referred to out of hours service

If the patient arrives at Trafford General Hospital between the hours of 8am -8pm without a booked appointment they are triaged at the front door and booked in to the appropriate service. Trafford General Hospital currently has a Walk in Centre provided by Mastercall and Urgent Care Centre provided by MFT these are co-located and use the same front door to access. Mastercall are currently operating a triage process at the front door of the UCC / WIC. The short term proposal is that the UCC and WiC become bookable only services and the two services align to form a UTC for Trafford. If patients do not book an appointment to attend they will be triaged on arrival and streamed to the WiC or UCC dependent on their needs.

The appointment only service at TGH went live on 27th October 2020. Patients from the local area who call 111 for a minor illness or injury who previously would have had an outcome of attending the UCC or WIC are referred to the TPAS for secondary clinical assessment. If still appropriate for physical attendance at the UCC or WIC they are booked an appointment. Patients who self-present to TGH without calling ahead will also be booked into an appointment slot, these patients will remain in the waiting room while they wait for their appointment, rather than leaving the site to return later. The aim of the implementation of the system is to ensure TGH reduces overcrowding to support social distancing.

What are the key achievements?

As part of MFT’s response to Covid-19, it was decided that Trafford General would be designated as a Green site (COVID-19 free). To ensure the site is as safe as possible, patients must be triaged for Covid-19 before arrival therefore the WiC and UCC patients needed to be managed differently. This then meant that Trafford General needed to go live with the 111 First initiative ahead of the rest of GM. As a result of this, the TPAS (Trafford Local Assessment Service) was stood up and new patient pathways were introduced in a matter of weeks. The Trafford ‘local’ clinical assessment service known locally as the Trafford Patient Assessment Service (TPAS) is available from 8am -8pm and follows the same model as the GM local Clinical Assessment Service (GMLCAS) which seamlessly takes the calls outside of TPAS operational hours. NHS 111 refers patients to TPAS/GMLCAS who ordinarily would have been directed to the UCC or WIC at TGH for a clinical assessment by either a GP or Advanced Practitioner. The TPAS is then able to manage the patient virtually through “Hear and Treat” or Advice and refer them on to the most appropriate service for their needs if necessary.

Patients are now able to call 111 and they are directed to be clinically assessed at which point they are either booked in to and appropriate services including GP practice or they are advised on how to self-treat if clinically appropriate. When they are directed to one of the urgent care services at Trafford General then they are given a booked appointment slot, avoiding the risk of overcrowding on the site. This offers the patient a better urgent care experience with limited wait times. This service has been live since the 27thOctober in Trafford. Since go live Trafford has seen a significant drop in patient numbers being referred to the WiC and UCC, although anecdotally this seems to prove the success of the model at this stage further analysis of all the data is required to ensure we fully understand the impact. Early data analysis is showing that there a >50% reduction of patients attending the service, with a large proportion being clinically advised to self-treat.

Friends and Family feedback:
Key Messages
– 90% reported very good and 10% reported good overall experience at TGH
– Quick and efficient to be seen by a Doctor
– Friendly and helpful behaviour by all staff – Receptionists, Triage Nurses, Specialist Nurses, Doctors
– Colleagues have a wealth of knowledge/expertise and are informative throughout the process

What are the key learning points?

– Targeted communication approach has worked very well
– Understanding the historical behaviour of patients is really critical and that evidence base should be used to design the implementation plan
– Implementing this during the pandemic has been helpful from a patient behaviour aspect however this will need to be monitored through easing of restrictions
– System approach to the change and collaborative working has been critical to the success of this programme
– This programme has provided Trafford with an opportunity to deliver a fully integrated care system enabled by a single point of access ‘111’ or ‘999’ where organisations will collaborate to deliver a range of high quality clinical services from clinical assessment to intervention. This will be in a number of settings including: Urgent Care, OOH, Primary care, community etc.

Additional Comments

The rapid implementation and success of Trafford’s Urgent and Emergency Care by Appointment has only been possible due to the collaborative working approach between Trafford CCG, MFT and Mastercall. We believe this is a great example of what can be done when organisations work together and hope for more success like this moving into the new world of integrating care.

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