The first areas to pilot new integrated care models for urgent and emergency have been announced.
The eight sites – referred to as “vanguards” by NHS England – will test new urgent and emergency care models, and will get access to £200m transformation fund.
“We’re backing our frontline nurses, doctors and other staff… to radically redesign our urgent and emergency services”
They are tasked with changing the way in which NHS organisations in England work together to provide care in the face of increasing pressure on accident and emergency departments, and patient confusion over their urgent care options.
Under the project, urgent care will be expanded to GPs, pharmacists, community teams, ambulance services, NHS 111, social care and through patients being given support to manage their own conditions. Another aim is to break down boundaries between physical and mental health.
They form part of NHS England’s new care models programme, as set out in its five-year plan the Five Year Forward View. The eight new vanguard sites are:
- South Nottingham System Resilience Group – a partnership including Nottingham University Hospitals Trust, South Nottingham and Erewash clinical commissioning groups, Nottingham City and County councils, and East Midlands Ambulance Service
- Cambridgeshire and Peterborough CCG
- North East Urgent Care Network
- Barking and Dagenham, Havering and Redbridge System Resilience Group.
- West Yorkshire Urgent Emergency Care Network
- Leicester, Leicestershire and Rutland System Resilience Group
- Solihull Together for Better Lives – comprises Heart of England Foundation Trust, Birmingham and Solihull Mental Health FT, Solihull Metropolitan Borough Council, Solihull CCG, primary care and lay members
- South Devon and Torbay System Resilience Group – led by South Devon and Torbay CCG, South Devon Healthcare FT, and Torbay and Southern Devon Health and Care Trust
The sites will get access to funding from NHS England’s £200m transformation fund in 2015-16.
Six vanguards will cover smaller local systems that may include hospitals and surrounding GP practices and social care.
However, two network vanguards – those in North East England and West Yorkshire – will be working with much larger populations to integrate care on a greater scale.
NHS England next intends to establish 23 urgent and emergency care networks across England, each covering populations between one million and five million, to set and monitor standards of care and “designate urgent care facilities”.
In announcing the vanguard sites, NHS England noted the “regional major trauma networks” set up three years ago, which according to the Trauma Audit and Research Network have resulted in a 50% increase in the chance of survival for trauma patients.
“It’s clear that we need to deliver a step change in the way that health services in this country are used and delivered”
NHS England’s director for acute episodes of care, Professor Keith Willett, said: “This proves a modern NHS needs a very different approach and shows, even in times of austerity, we can transform patient care.
“We cannot delay in now securing that same advantage for the thousands of other patients,” he said.
He said it was “equally important” that the new networks “support and improve” all local urgent and emergency care services – including A&E departments, urgent care centres, GPs, NHS 111 and community, social care and ambulance services – “so no one is working isolated from expert advice 24-hours a day”.
Professor Willett added: “The solution does not lie in simply providing more and more money to emergency departments. It’s clear that we need to deliver a step change in the way that health services in this country are used and delivered.”
NHS England chief executive Simon Stevens, said: “The NHS will begin joining up the often confusing array of A&E, GP out of hours, minor injuries clinics, ambulance services and 111 so that patients know where they can get urgent help easily and effortlessly, seven-days a week.
“We’re backing our frontline nurses, doctors and other staff, in partnership with local communities, to radically redesign our urgent and emergency services,” he said.
Details of the first eight urgent and emergency care vanguards
South Nottingham System Resilience Group
The South Nottingham System Resilience Group is made up of more than a dozen local partners.
These include Nottingham University Hospitals NHS Trust, the South Nottingham and Erewash clinical commissioning groups, Nottingham City and County Councils, East Midlands Ambulance Service, Nottingham CityCare Partnership, County Health Partnership, Nottinghamshire Healthcare NHS Foundation Trust, Derbyshire Health United Ltd (111 provider), Nottingham Emergency Services (GP out of hours), Health Watch Nottingham and Health Watch Nottinghamshire.
The vanguard will support ambitious improvements in urgent and emergency care for the citizens of South Nottinghamshire. Partners will look at what more they can do, using innovative workforce solutions to ensure that people receive care in a timely way and closer to home – in many cases avoiding the need for assessment or admission to hospital.
Work will focus on:
- Enhancing mental health services in the community to give patients the care they need, in the best place in a timely manner. This will include rolling out and extending the National Mental Health 111 pilot to provide faster and better care when it is needed.
- Improving access, clinical assessment and treatment to primary care clinicians at the ‘front door’ of the emergency department so that patients are assessed and then followed up closer to home.
- Enabling more direct clinician to clinician conversations so that more patients are directed to the right service, first time, every time.
The system will involve patients, carers and wider partners in its improvement to lead the way in providing ever more timely and safe emergency care.
Cambridgeshire and Peterborough Clinical Commissioning Group
Cambridgeshire and Peterborough Clinical Commissioning Group has three System Resilience Groups (SRGs) and is part of the East of England Urgent and Emergency Care Network.
The CCG’s vision is to create an overarching super SRG with strong clinical leaders, as part of the existing network.
As a UEC Vanguard the CCG aims to accelerate improvements and develop a best practice model for urgent care services which helps address variations in access to services and health inequalities in the region.
The “super SRG” will focus on:
- Promoting self-care and management.
- Helping people with urgent care needs get the right advice first time and to access the right service seven days a week.
- Providing highly responsive urgent care services outside of hospital.
- Developing a workforce to meet these needs including GP fellows, advanced nurse practitioner and advanced AHP roles, developed community pharmacist roles, physician’s assistants and staff equipped to meet mental and physical health needs.
- Reassessing service standards based on outcomes and redefine payment methods to incentivise system redesign.
North East Urgent Care Network
Participation by the North East Urgent Care Network (NEUCN) in the Vanguard Programme will benefit the whole of the North East region.
This covers areas around Northumberland, Tees, Esk and Wear Valley, Newcastle, Northumbria, Gateshead, Tyneside, Sunderland, County Durham, Darlington and Hartlepool – a region with a population of 2.71 million. It is made up of three major conurbations, and spreads across both urban and rural areas.
The NEUCN – which consists of all the key physical, mental health and care stakeholders and providers – already has a strong history of working collaboratively to deliver successful innovative projects to support the recommendations made in the Urgent and Emergency Care Review as well as, importantly, improving patient outcomes and experience.
This programme will enable the Network to transform the regional UEC system and its services to further improve consistency and clinical standards, reduce fragmentation and deliver high quality and responsive health and social care to patients.
It will also enable them to move at pace in terms of creating and implementing one urgent and emergency care model as well as giving strategic oversight to urgent and emergency care services across the regional footprint, providing consistent and seamless care, wherever patients present, whatever the day or hour with no difference in the clinical outcomes delivered.
Barking and Dagenham, Havering and Redbridge System Resilience Group
Barking and Dagenham, Havering and Redbridge System Resilience Group aims to create a simplified, streamlined urgent care system delivering intelligent, responsive urgent care for 750,000 residents in the most challenged health economy in the country.
The SRG believes there is a need to do things differently and that patients are confused by the many and various urgent and emergency care services available to them – A&E, walk-in centre, urgent care centre, GPs, pharmacists, out of hours services.
Becoming a UEC Vanguard will support the SRG in its ambition to streamline these points of access to just three - supported by a smart digital platform that will recognise patients and personalise the help they get as soon as they get in contact. This involves:
- ‘Click’ – online support and information – will help people to self-care and book urgent appointments when needed.
- ‘Call’ – telephone for those who need more advice, reassurance or to book-in.
- ‘Come in’ – where patients really need emergency care – the front door of the hospital will become our new ambulatory care centres.
This ambitious plan is being developed with patients and staff, and will be implemented by building on existing successful partnership working between NHS and social care organisations across the three boroughs.
West Yorkshire Urgent Emergency Care Network
Established in 2014, the West Yorkshire Urgent and Emergency Care Network Vanguard covers Leeds, Bradford, Calderdale, Kirklees, Wakefield and Harrogate. It serves a population of around three million people.
The Vanguard will work with partners, including five local System Resilience Groups, to build on progress already made in transforming primary, community and acute care services.
Yorkshire Ambulance Service will develop a stronger focus on becoming a mobile treatment service delivering care at patients’ homes with conveyance to hospital for those who really need to go.
Three mental health service providers will work with West Yorkshire Police to deliver major service change which will see rapid crisis response through emergency response control centres and ‘street triage’.
Other planned projects include creating an Integrated West Yorkshire Care Record and a system-wide information dashboard which reports in ‘real-time’.
Leicester, Leicestershire & Rutland System Resilience Group
The Leicester, Leicestershire & Rutland System Resilience Group Vanguard covers the City of Leicester, Counties of Leicestershire and Rutland and surrounding towns, serving a population of 1.1 million people.
The Vanguard will create a new alliance-based urgent and emergency care system where all providers work as one network. This will bring together ambulance, NHS111, OOH and Single Point of Access services to ensure that patients get the right care, first time.
The network will include a same-day response team with GPs, acute home-visiting and crisis response services, community nursing, older peoples’ assessment unit and urgent care centres.
University of Leicester Hospitals NHS Trust runs the largest single site A&E department outside London. In 2016, the hospital’s urgent and emergency care front door will be re-launched to include an assessment team with the ability to refer patients to ambulatory clinics, assessment beds, on-the-spot urgent care centres or primary or community care.
Solihull Together for Better Lives
Solihull Together for Better Lives Partnership comprises the Heart of England NHS Foundation Trust, Birmingham and Solihull Mental Health NHS Foundation Trust, Solihull Metropolitan Borough Council, NHS Solihull Clinical Commissioning Group, Primary Care, and lay members representative of the Solihull population.
The partnership will create an integrated health and care system that extends healthy active life and optimises preventative out of hospital care with rapid access to specialist care. This will be both in and out of hospital when needed, including access to other wellbeing services both at the hospital and in the community.
This will involve building an Urgent Care Centre within the hospital site capable of delivering a minor illness and minor injury service in line with the description of Urgent Care Centres given within the Keogh report, which includes GP out of hours, urgent primary care and minor injury services.
Redesigning care models for older people - from prevention and early intervention through to end of life care - will alter the balance of care provided in both hospital and the community, reducing pressure on secondary care services.
South Devon and Torbay System Resilience Group
South Devon and Torbay’s vanguard is led by South Devon and Torbay Clinical Commissioning Group, South Devon Healthcare Foundation Trust and Torbay and Southern Devon Health and Care Trust, on behalf of the local System Resilience Group, which also includes Torbay Council, South Western Ambulance Services Foundation Trust, Devon Doctors Ltd and community pharmacy.
The group will serve a mixed urban and rural population.
The vanguard will develop new Urgent Care Centre facilities at pace in at least two areas, prioritising those of higher deprivation to reduce inequalities.
To make the best use of the resources spent locally on urgent and emergency care and avoid duplication, primary care facilities will be co-located with A&E and Urgent Care Centres in at least two locations, and primary care records will be shared with the out-of-hours provider.