SUCCESS & GP OOH Governing Body 22nd February 2018 - Swindon CCG
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SUCCESS & GP OOH
Governing Body
22nd February 2018
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamSUCCESS Services
Swindon Urgent Care Centre & Expedited Surgery Scheme (SUCCESS) was originally put in place in
2014.
It was initially funded from the Prime Ministers Challenge Fund wave 2, and commissioned by the CCG
(on behalf of all practices) from SEQOL.
When set up it provided 3 main services;
- Urgent Care Clinic (UCC), at 1 then 2 locations
- Children's & Young Persons Clinic (CYPC), at 1 location
- Home Visiting Service (HVS), mobile service
Patients registered with all local GP Practices were able to access the service.
The services were for urgent/on-the-day demand.
Capacity was allocated on a first come first serviced basis.
Black Pear was used in the UCC to facilitate booking and transfer of a precis of clinical record.
Practices were required to triage appropriate patients into the UCC
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamSUCCESS Services
Medvivo took over the care-taking of the service from 1st April 2017.
The funding for the service is from a budget delegated to the CCG to provide
‘extended access primary care services’.
The national requirements mandate the budget to be used to provide primary care;
- At weekends
- Until 8pm on weekdays
- In central hubs
- To provide 45 mins extended access per 1,000 population
- Promotion of services to patients and equal access for the local population
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamSUCCESS Services Review
In September 2017, CCG began engagement with practices as part of service review, summary of feedback is
shown in table below;
CURRENT What is working well? What are the current issues? What would you change?
SERVICE
Urgent Care ∂ It’s there. ∂ Scope of the SUCCESS Dr’s work. e.g. investigations not always requested. ∂ Increase scope - take ‘urgent demand’ and ‘urgent need’.
Clinic ∂ Patients are getting used to it. ∂ Geography – only in two sites in the town and practices close use it the most ∂ Adult ‘self-referral’ (like the children’s clinic).
∂ Enables good access to ∂ Relieves some of the pressure as the demand is there, capacity has ∂ Uniformity of investigation requests across the Dr’s (e.g.
appointments. improved with Medvivo. some do request 2ww appointments, others send patient
∂ Patients like the easy parking. ∂ Not equivalent to ½ GP partner which practices were promised. back to the practice).
∂ Urgent/on-day capacity ∂ Follow up appointments for results would be good. ∂ Physio clinic at weekend.
∂ Practices can book ∂ Weekend slots not always used by practices. ∂ More routine services at weekends.
∂ Variable triage by practices into the service ∂ Full access to clinical system patient record.
∂ Increase diagnostic tests and ability to refer on.
Children’s & ∂ Patients happy with service. ∂ Appointment slots are only visible to practices for the next 30 min – ∂ Access to patient medical records.
Young ∂ No complaints for different location introduce alert when system is full. ∂ Integrated systems.
Person’s by parents, In some instances, it’s a ∂ System not integrated into all clinical systems. ∂ Enable NHS 111 and practice to be able to book
Clinic preferred location. ∂ Full patient records can’t be seen -should be the same functionality as the appointment for the patient.
∂ Preferred service by parents rather adult’s records. ∂ Weekend routine service.
than own GP practice. ∂ Can get overwhelmed due to volume of usage. ∂ An additional C&YPC for patients in West / South
∂ Parents travel to the hub ∂ The service is not advertised enough therefore patients are still unsure of Swindon.
∂ Parents now going direct what to expect from the service.
∂ Telephone clinical triage ∂ Advertisement is needed about weekend appointments.
Home ∂ Not working well for practices – ∂ 1 paramedic & car – was originally x2 and a GP who was more efficient ∂ BaNES expedited weekend home visiting
Visiting service has been diluted since it ∂ Very limited availability / capacity ∂ BaNES model – GPs & cars (their own)
Service was put in place, due to skill mix ∂ Not providing any extended access to Primary Care ∂ Purpose – good service (possibly)
and capacity. ∂ Not value for money ∂ Issue – low volume/new approach
∂ Capacity low at 3 visits per day ∂ Reprovide as transport service to UCC or CYPC?
∂ Only available during the day ∂ Practices could re-configure how they provide core
∂ 1 practice uses majority of capacity visiting services outside of SUCCESS
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamSUCCESS services
Changes made to services during 2017/18 and based on feedback from practices
- One of the UCC hubs moved from Hermitage to Swindon NHS Health Centre (SHC) in July 2017.
- The HVS was de-commissioned in November 2017 and capacity re-invested in additional clinical triage capacity in CYPC
and UCC.
- Additional CYPC was put in the SHC.
Current service configuration (Jan 2018)
• Urgent Care Clinic (UCC)
• 2 locations: at Moredon & SHC
• Doctor & Nurse appointments
• Weekdays: 10am to 8pm (Moredon) & 10am to 6.30pm (SHC)
• Weekends: 10am to 4pm (Moredon only)
• Booked by registered practice
• Children's & Young Person's Clinic (CYPC)
• 2 location: at Moredon & SHC
• Nurse telephone triage (access point)
• Nurse appointments
• Weekdays: 8am to 8pm
• Weekends: 8am to 4pm
• Direct access by patients, via dedicated telephone number
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamSUCCESS services future configuration
High level future service aims;
i. To provide short-term primary care services for acute problems
ii. To provide a primary care hub with access to routine primary care services
iii. To provide services at SHC for patients who walk in
Service configuration;
- To enable access to all SUCCESS services from;
• NHS 111
• Direct by patients
• Practice signposting (booking into telephone triage slot)
- To include service-led clinical triage
- To continue with minimum of 2 hubs at Moredon & SHC
- To continue with current opening hours as a minimum (to 8pm weekdays & 4pm weekends)
- To utilise the Black Pear full clinical viewer
- To utilise ‘telephone/technology first’ with clinical triage, prior to face to face appointments where possible
- To increase scope of clinic appointments, e.g. to enable referrals, investigations and fit notes to be issued, with results followed-up within agreed protocols
with practices
- To include a patient walk-in service in SHC where patients can be seen within 4 hours or booked into an appointment
- To change the name to enable better promotion of services (Primary Care Access Hub?)
- To provide services for all registered patients of practices in Swindon and Shrivenham and those unregistered temporarily in the area
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamSUCCESS services future configuration
It is acknowledged that the proposed configuration moves away from providing urgent/on-the-day demand only.
This change is proposed to ensure that the extended access model is providing increased access for patients as
well as additional capacity for local practices. Also to maintain walk-in service in the centre of town.
The scope of services provided will include;
- Acute care
- Minor illness
- Blood tests/phlebotomy
- Ear syringing
- Wound care
- Dressings
- Smears
- ABPM
- Planned primary care appointments for unregistered patients
It is not prosed that the service provides all Enhanced Service currently commissioned from other practices, as
the service will not have registered patients, but it will provide those that are relevant to un-registered and
homeless patients.
It is proposed at Carfax Health Enterprise continue to provide the Swindon TB service and this is not duplicated.
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamProcurement
There is an need to procure the SUCCESS services as the contract with Medvivo is on a care-taking
basis until end March 2019 only.
There is also a need to procure the Swindon GP Out of Hours Service (OOH). This service was
transferred from GWH to Medvivo on a care-taking basis from 1st February 2018 for 12 months.
Opportunities to include the GP OOH service in the STP-wide Integrated Urgent Care (IUC) contract
have been explored but have not been possible.
The GP OOH service provides urgent clinical care services outside normal GP surgery hours. This
service is available by contacting NHS 111 who will triage the call and determine if it should be
assigned to the OOH service. The OOH team will action an appropriate response which may include
an appointment at one of the two Out of Hours clinics in Swindon, a home visit by a clinician or self-
care advice.
It is therefore proposed that a procurement process for both SUCCESS/Primary Care Access Hub
and GP OOH service is put in place as soon as possible.
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamProposed Service Configuration & Procurement Process
Primary Care Access Hub GP Out of Hours
Monday to Friday (until 8pm) Saturday and Sunday (until 4pm)
Clinical Triage
NHS 111 Clinical triage Face to face Appointments
appointments
WALK-IN Home Visiting (OOH)
ACCESS
PRACTICE
Clinical Treatment Weekends
PRE-BOOK Triage Diagnostics &
PATIENT Referral 8pm – 8am
Moredon
8am – 8pm overnight
Swindon HC Moredon Swindon HCConsiderations
- Further engagement with all practices will be undertaken at Commissioning Forum
on 21st February 2017.
- Wider stakeholder briefings will need to take place.
- Project plan to have comprehensive Communications Plan.
- Project team will be put in place to ensure delivery.
- Clinical Leadership Group to oversee development of service specification and
procurement process.
- Plans to take into account IUC mobilisation from May 2018 and link to wider urgent
care and Urgent Treatment Centre models.
Our Mission: To Optimise the Health and Wellbeing of the People of Swindon and ShrivenhamProcurement outline timescale
Finalise service description: Service specification, KPIs etc – by end of March 2018
Documentation sent to Governing Body for approval - April 2018
Preparation of tender documentation – May 2018
Advert and ITT published – June/July 2018
Clarification period – June/July 2018
Individual tender evaluation – August/Sept 2018
Bidder presentations – Sept 2018
Moderation meeting – Sept/Oct 2018
Documentation sent to Governing Body for approval – Oct 2018
Authorisation to proceed to formal award - Oct 2018
Voluntary standstill period for unsuccessful bidders – Nov 2018
Authorisation to proceed to Contract – Nov 2018
Contract award – Nov 2018
Mobilisation – Dec 2018/Jan 2019
Service Commencement – Feb 2019
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