Improving Access October 2017 HAVE YOU REGISTERED YOUR CAR FOR - - PowerPoint PPT Presentation

Improving Access

October 2017

HAVE YOU REGISTERED YOUR CAR FOR PARKING????

New regulations are in place and although the parking is free, you do need to enter your registration number at the parking machine, if not you WILL incur a fine!

Live participation: How to use Slido

• Connect to Somerdale Pavilion wifi network
• n your laptop, tablet or smartphone:

Network: SOM_Guest Password: Aqu4t3rr4

• Open slido.com
• Enter the code: #GPClusterOctober

Live participation: How to use Slido

• Click the ‘Questions’ tab to ask a question
• View other participants’ questions on the

screen

• Click the ‘thumbs up’ to vote for other

questions you ‘like’. These will move to the top

• f the presentation screen.

Running order

2:00 Welcome 2:05 IT changes at RUH – Dr Mike Price 2:30 3 Straw Men 2:50 Questions 3:00 Breakout 3:45 Tea 4:15 Development of draft model 4:45 Next Steps

The Big 3 IT changes @ RUH

Roll-Out of the Electronic Patient Record – The Big 3

Mike Price, SRO for FirstNet, CCIO (EM doctor)

Context

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD



The Trust is already one of the most digitally advanced in the region.



However, it recognises there are significant quality and financial benefits in the extended use of digital technology.



The current capital plan allocates £6.5m to IM&T projects and infrastructure in 2017/18.



The Trust plans to invest £11.3m capital in IM&T over the next 5 years.

Big 3

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD



We’re proposing to add the following additional functionality into the Trust EPR, starting on Saturday 4th November



Electronic Prescribing & Medications administration (ePMA)



Emergency Department – full replacement of Patient First with Millennium version (FirstNet)



Requesting & endorsing radiology & pathology in Millennium (Order Comms)



Detailed planning over the sequencing of the Big 3 roll-out is underway, and will be informed by a lessons learned paper from our provider (Cerner)



The Clinical Informatics Board (and the 3 clinical Project Boards for each project) has considered the options for deployment, and our plan is to implement the roll-out over a 2 week go-live period

High-level Roll-Out Plan

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD

We’ll need to train c2,500 clinical colleagues

• i. Prep Phase
• ii. ePMA Go-live
• iii. ED &

Order Comms Go-live

• iv. Post Go-live

Sat 4th Nov

3-4 days later

Sat 18th Nov

Up to 650 inpatients’ meds will need to be transcribed

We’ll need c150 Super- Users to cover a 12 hour period

Significant change for ED – likely impact on 4 hours Likely that flow will be impacted – how we minimise and correct?

Why are we doing it?

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD

Legibility and consistency of information. Clinical Decision Support. Real-time Information and Reporting. Improved patient outcomes. Improved patient flow. Full audit and alerting capability. Reduction in Missed Doses. Reduction in Medical errors. Reduced printing of paper charts Shared diagnosis, assessment, risk alert information from ED for inpatients Reduction in the use of paper notes Streamlining of the process for booking and moving patients into the hospital Simplification of booking outpatient referral from ED Reduced interface issues between Patient First and Millennium Enables further tools to support bed management Already generic benefits in ICE Moving into Millennium will save time and errors by not having to switch between two systems Enables the use of mobiles devices that will reduce transposing results

• nto paper

Endorsing of results in clinician ‘message centre’ Ability to combine orders for tests with requests for medication – develop condition-specific order sets

Summary of changes for external partners

FirstNet

• New discharge summary format
• Electronic distribution of discharge summaries
• Compliance with new Emergency Care Data Set

(ECDS) reporting requirement

• 4 hour impact

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD

ePMA

• Tabular format to show prescribing record (meds on

admission, prescribed during stay and TTAs on discharge summary)

• Removal of FP10s for patients receiving prescriptions to

be dispensed by RUH outpatient dispensary

Order Comms

Within the RUH and our Community Services we will:

• a. Stop ordering Pathology and Radiology Tests on ICE and Start ordering on Millennium
• b. Start endorsing all results on Millennium improving Patient Care and Safety

GPs will continue to use ICE both to Order Pathology and Radiology Tests and view results (including results that were

• rdered by clinicians at the RUH)

GP Practices will no longer be able to print labels from ICE for tests that were ordered at the RUH - Given this Patients who needs bloods to be taken at the GP (but ordered at the RUH) will be given the appropriate Pathology Labels by the RUH to take to the GP Practice

Reporting (learning from other sites)

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD

Risks

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD



There are significant risks associated with any IM&T deployment.



The Trust can build on successful previous deployments.



Further work is in progress to quantify and mitigate all known risks to patient safety, experience, flow, reputation and finance.



Risks are being managed through a agreed programme structure HOWEVER



A large part of the success of this deployment will rest on the ability of the

• rganisation to engage with the planned

changes in work flows.

Thanks – Any Questions?

ROLL-OUT OF THE ELECTRONIC PATIENT RECORD

Improving Access Timeline

June 2017: CCG / NHSE, Cluster meeting / Your Health Your Voice engagement sessions Summer 2017: Review of feedback within CCG / NHSE

• BEMS update to August Cluster meeting summarising feedback

so far Autumn 2017:

• Further engagement sessions at Cluster / Primary Care Forum
• NHSE GPFV Time for Care session 14 Nov
• Options discussed and agreed

Autumn / Winter 2017: Refined plans submitted to NHSE

• NHSE procurement webinar 21 Nov

Schemes mobilised during 2018/19 to be at full capacity by 31 March 2019

• GP Federation - 1 practice based hub
• Multidisciplinary Staff Model – GP appt available at all times - 24% of capacity

Example 1 – Oxfed - Oxfordshire CCG

21

Core Requirement Delivery Model Met

minimum additional 30 minutes consultation capacity per 1000 population, rising to 45 minutes per 1000 population 210,000 population – 106 Hours 30 mins per 1000 population

✓

weekday provision of access to pre-bookable and same day appointments to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day 5pm - 8pm weekdays (1 ½ hours in core, 1 ½ hours in “evening”)

✓

weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays to meet local population needs 10am - 3pm Sat & Sun

✓

provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week Open 25 hours per week 31% capacity in Core Hours 31% in Evenings 38% at Weekends

✓

Hours Open / Workforce Hours Mon Tue Wed Thu Fri Core Total Mon - Fri Mon Tue Wed Thu Fri Evening Total Mon - Fri Sat Sun Weekend Total Sat -Sun Total Hours Hours Hub Open 1.5 1.5 1.5 1.5 1.5 7.5 1.5 1.5 1.5 1.5 1.5 7.5 5 5 10 25 GP 1.5 1.5 1.5 1.5 1.5 7.5 1.5 1.5 1.5 1.5 1.5 7.5 1 1 10 25 ANP 1.5 1.5 1.5 1.5 1.5 7.5 1.5 1.5 1.5 1.5 1.5 7.5 1 1 10 25 Nurse 3 3 6 3 3 6 12 Pharmacist 1.5 1.5 1.5 1.5 6 1.5 1.5 1.5 1.5 6 1 1 10 22 Phlebotomist 1.5 1.5 1.5 1.5 6 1.5 1.5 1.5 1.5 6 1 1 10 22 Total Hours 9 6 6 6 6 33 9 6 6 6 6 33 20 20 40 106

• OOH Provider - 2 community hospital hubs
• GP, Nurse & HCA Model –GP appt available at all times – 43% of capacity

Example 2 – Windsor Ascot & Maidenhead CCG

22

Core Requirement Delivery Model Met

minimum additional 30 minutes consultation capacity per 1000 population, rising to 45 minutes per 1000 population 154,000 population – 121 Hours 47 mins per 1000 population

✓✓

weekday provision of access to pre-bookable and same day appointments to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day 6.30pm – 9.30pm weekdays - 2 hubs

✓

weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays to meet local population needs Sat : 10am - 6pm – Hub 1, 10am - 2pm – Hub 2 Sun: 10am - 2pm - 1 hub only

✓

provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week Open 46 hours per week (19 & 27 hours per hub) 0% core 67% in Evenings 33% at Weekends

✓

Hours Open / Workforce Hours

Mon Tue Wed Thu Fri

Core Total Mon - Fri Mon Tue Wed Thu Fri Evening Total Mon - Fri Sat Sun Weekend Total Sat -Sun Total Hours Hub 1 Hours Open 3 3 3 3 3 15 4 4 19 GP 3 3 3 3 3 15 4 4 19 Nurse 3 3 3 9 4 4 13 HCA 3 3 6 4 4 10 Hub 1 Total Hours 6 6 6 6 6 30 12 12 42 Hub 2 Hours Open 3 3 3 3 3 15 8 4 12 27 GP 3 6 6 3 3 21 8 4 12 33 Nurse 3 3 3 3 3 15 8 8 23 HCA 3 3 3 3 3 15 8 8 23 Hub 2 Total Hours 9 12 12 9 9 51 24 4 28 79 Total Hours 15 18 18 15 15 81 36 4 40 121

Year 1 - 2018/19

• Integrated Urgent Care Provider - Clinical Hub - 2 hours per day (Mon – Fri) 3 hours

per day (Sat/Sun) 16 Hours per week (from Q4) £100k tbc (part year effect)

• Core Hours Access and Early Intervention - EHV footprint 100 hrs per week £440k
• Remaining practices move to TPP - £100k

Total cost: £640k tbc Year 2 - 2019/20

• Core Hours Access and Early Intervention - EHV footprint 100 hrs per week £440k
• Core Hours Winter Escalation - EHV footprint (Oct -March) £320k
• Integrated Urgent Care Provider - Clinical Hub - 2 hours per day (Mon – Fri) 3 hours

per day (Sat/Sun) 16 Hours per week £500k tbc Total costs: £1.26m tbc

Example 3 – Local service development

23

Core Requirement Delivery Model Met

minimum additional 30 minutes consultation capacity per 1000 population, rising to 45 minutes per 1000 population 202,000 pop – approx. 101 Hours required, 116 min hours provided, escalating Oct - Mar

✓

weekday provision of access to pre-bookable and same day appointments to general practice services in evenings (after 6:30pm) – to provide an additional 1.5 hours a day 2hours, 6.30pm – 8.30pm weekdays - Clinical Hub

✓

weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays to meet local population needs 3 hours per day Sat / Sun tbc – Clinical Hub To be flexed, testing and refining demand / need for weekend appts

✓

provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week All schemes provide access to GP practice multidisciplinary team/ early intervention SPara. 84% core 10% in Evenings 6% at Weekends

✓

Improving Access to General Practice

Andrew Smith October 2017

Model

• Single head contract
• Sub-contract bases +/- staff
• 4 bases/hubs-
• could rotate (or not?)
• GP only v GP+EPCT
• Locations- UCC, Bath practice, Keynsham

HP, Paulton Hospital

• GP + EPCT member alongside
• Reception staff in place
• M-F 6.30pm-8pm
• Sat 9am-6pm
• Sun 9am-3pm
• Routine advance bookable (+ same day appts?)
• Bookable from anywhere + via 111- no choice
• IT system in place

Extended Primary Care Team services

• Rotates
• Different hours than GP cover
• Phlebotomy
• Health checks
• Smears
• Dressings
• Chronic disease Mx
• Vax- routine
• Physio- first contact
• Pharmacist-med reviews/Mx/CDM
• Family Planning- support working population
• MH worker
• etc

Enablers and Issues

Enablers

• Large scale working supports Practices
• Simplify
• Helping practice workload- including

adminstrative

• Single IT system
• Contract management- whole & NIA + EPCT
• Performance management
• Reporting
• Links with OOH/111 and UCC
• Staff employment
• High level direct links with other providers eg

OOH, RUH, Virgin, Voluntary Sector

• Staff resilience through scale
• Operational Management cover OOH
• Fairness of resource allocation

Enablers and Issues

Issues

• Availability for all patients?
• Manage fair usage
• Link with OOH- same day appointments?
• Admin tasks eg typing, referrals, follow up
• How are drug costs allocated to budgets?
• IOS income sharing
• Management overhead costs
• Indemnity
• Legal framework eg CQC reg, DDA, H+S
• KPI reporting and Contract Management
• Same day appts?
• Walk-ins?

Thank you Questions

• Resource – how much is available?
• Timetable?
• Clarity around Procurement and decision

making by CCG?

• Early Home Visiting Service included?
• Any for us?

Improving Access – Challenges / Opportunities

Challenges as planning guidance not formally updated.. Our interpretation:

• Small number of schemes, working at scale across

localities rather than 26 offerings

• Use of other practitioners / services within primary care

proposals

• Additional access funding is not just delivering additional,

face to face appointments with a GP Oct Cluster meeting aims and opportunities:

• Refine key components of a BaNES / locality / group approach
• Develop and discuss options for testing with NHSE

Improving Access – Key requirements

Consultation time:

• Minimum additional 30 minutes per 1,000

pop/week

• Minimum 1.5hrs per weekday after 6.30pm
• Saturday and Sunday hrs ‘to meet local

population needs’ Year 1 requirement to provide 100 hrs/week across BaNES BY March 31, 2019 Funding:

• Year 1 50% funding (£600k) from April 1, 2018
• Year 2 (£1.2m) - £6 per head from April 1, 2019

Improving Access - Considerations

In the first instance, NHSE will be looking for how evening / weekend access is improved Evidence for CCG proposal is likely be based on:

• Cluster / Primary Care Forum sessions during 2017
• BEMS+ Survey
• Your Health Your Voice feedback
• GPPS Survey Results
• Learning from local intelligence / schemes / pilots / GPFV

Resilience funding

• Local population needs e.g. patient survey via PPGs

Improving Access Timeline

June 2017: CCG / NHSE, Cluster meeting / Your Health Your Voice engagement sessions Summer 2017: Review of feedback within CCG / NHSE

• BEMS update to August Cluster meeting summarising feedback

so far Autumn 2017:

• Further engagement sessions at Cluster / Primary Care Forum
• NHSE GPFV Time for Care session 14 Nov
• Options discussed and agreed

Autumn / Winter 2017: Refined plans submitted to NHSE

• NHSE procurement webinar 21 Nov

Schemes mobilised during 2018/19 to be at full capacity by 31 March 2019

Breakout Session

• What do you like about what you heard?
• What don’t you like?
• What is missing?
• What does your preferred model look like?