Gloucester GP Out-of-Hours Service: 12 month review...Version 4.0 Page 3 of 33 Introduction The...

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Gloucester GP Out-of-Hours Service: 12 month review 17 May 2016

Title: Gloucestershire GP Out-of-Hours Service – 12 month review

Prepared by: Emma Williams, Head of Operations (Urgent Care Services)

Nick Evans, Gloucestershire OOH Service Manager

Presented by: Dr Andy Smith, Executive Medical Director

Main aim: To provide an overview of the first 6 months of the Gloucestershire GP OOH service delivered by South Western Ambulance Service NHS Foundation Trust


Contents Introduction .............................................................................................. 3

The patient journey ..................................................................................... 4

1. Patient origin/access points ................................................................... 4

2. Patient flow through the out-of-hours service .............................................. 8

Service provision ....................................................................................... 9

1. Primary Care Centres (PCCs) ................................................................ 9

2. Mobile/home visiting service .................................................................. 9

3. Clinical Hub .................................................................................... 10

Service performance ................................................................................. 11

1. Overall activity ................................................................................. 11

2. National Quality Requirements ............................................................. 12

3. Local Indicators ............................................................................... 16

4. Shift cover ...................................................................................... 19

5. Quality .......................................................................................... 27

Challenges to service delivery ..................................................................... 31

Recent successes .................................................................................... 31

Developments & Improvements .................................................................... 32


Introduction

The South Western Ambulance Service Foundation Trust (SWASFT) commenced the

delivery of the Gloucestershire GP out-of-hours (OOH) service on the 1 April 2015. The

service specification ensures three levels/types of response for the resident and visiting

population of Gloucestershire:

Primary Care Centre (PCC) – these are located within hospitals, adjacent to either an

Emergency Department (ED) (at Gloucester Royal Hospital and Cheltenham General

Hospital) or Minor Injury & Illness Units (MIIU) (in Cirencester, Dilke, Moreton and

Stroud). The PCCs are run by GPs and Advanced Nurse Practitioners (ANPs) and

primarily see patients who have booked appointments, and also those who may have

walked in or been referred from the ED or MIIU.

Clinical hub – calls from NHS 111 and other sources are received, triaged and

assessed by clinicians with patients either being given self-care advice, being directed

to suitable community services, or booked for a home visit or PCC appointment.

Mobile home visiting service – patients who are unable to make their way to a PCC

and who need to be seen by a clinician (primarily a GP) will receive a home visit.

This paper will provide an overview of the first year of service delivery.

Specifically it will:

Summarise the way patients flow through the service

Describe the service model

Review the performance

Focus of treatment centre cover

Patient feedback

Highlight current issues & challenges


The patient journey

1. Patient origin/access points

There are four main access points to the out-of-hours service for patients, through

111, as a referral from a minor injury and illness unit (MIIU) or through the emergency

department (ED) and as a ‘walk-in’.

111

A patient will call 111 and be taken through a triage using a system called NHS

Pathways – a nationally implemented IT system based on clinical algorithms. Patients

will be asked a range of questions relating to their presenting complaint, and

depending on the responses given to the questions asked, an outcome will be

reached. Sometimes the initial call taker will be able to direct the patient to the

appropriate service, but in many cases further clinical advice and support will be

provided to further assess the patient’s needs.

NHS Pathways will provide guidance as to what type of onward care the patient

needs, which could include self-care advice, advice to seek primary care services

within a specific timeframe, or dispatch of an emergency 999 ambulance. There is a

wide range of possible outcomes, called dispositions, and several of these will refer a

patient requiring primary care support to the local out-of-hours service during the

appropriate time periods.

All the local health services that could provide care to the patients are described within

templates which sit within a system called the Directory of Services (DOS). These

templates provide demographic data about the service (name, opening hours etc) as

well as specific information listing the type of clinical complaints that the service can

manage. It is through the use of this DOS that having reached a disposition, NHS

Pathways seeks the most appropriate service within the patient’s local area. The

Gloucestershire out-of-hours service has a comprehensive template and it is this


which facilitates the directing of appropriate NHS111 patients to the service during

evenings and weekends.

Calls originating in NHS111 will be mapped across to the GP out-of-hours service in

such a way to enable NHS111 to either directly book patients directly into PCC

appointments, or to place them into a clinical queue for GP to phone the back

(telephone triage) , which in turn can facilitate home visits as required.

Referrals from other departments

The PCCs are generally co-located with other units, primarily emergency departments

(EDs) or minor injury and illness units (MIIUs), the service was commissioned to

accept referrals from health care professionals within these services. Should a patient

presenting with an urgent primary care condition arrive at the unit, following an

appropriate initial assessment, the patient can be referred across to the PCC to be

seen by one of the out-of-hours General Practitioners (GPs). In addition, the out-of-

hours GPs provide a response to community hospital wards where the patient has a

clinical need which cannot wait until the ward doctor visits next.

Walk-ins

Whilst the largest proportion of patients arrive at the out-of-hours service via NHS111,

there is an increasing number of patients who are self-presenting at the PCCs by

arriving at reception – these are considered ‘walk-ins’. They are briefly assessed and

booked appointments with either a GP or an advanced nurse practitioner (ANP). They

may have to wait.

The graphs below demonstrate the activity seen in the out-of-hours service in relation

to the origin of patients/calls.


This chart demonstrates that the most significant activity originates within the 111

service

This graph demonstrates the fluctuation of activity by origin across the financial year

89%

7% 4% 0%

Calls by origin - proportion for FY 2015-16

111 calls

Referrals from ED & MIIU

Walk-ins

Ward calls

0

2000

4000

6000

8000

10000

12000

Calls by origin - total number (FY 2015-16)

111 calls Referrals from ED & MIIU Walk-ins Ward calls


This graph demonstrates the change over time of the activity by origin across the

financial year.

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Calls by origin - proportion (FY 2015-16)

111 calls Referrals from ED & MIIU Walk-ins Ward calls


2. Patient flow through the out-of-hours service

Having been passed to the out-of-hours service, as described in the introduction, there

are three main services provided:

Clinical telephone assessment, advice and management

Face-to-face assessment and management at a primary care centre

Face-to-face assessment and management via the home visiting service

Across the whole patient journey within the out-of-hours service are a range of key

performance indicators (KPIs) – these will be discussed more later.


Service provision

1. Primary Care Centres (PCCs)

The service is commissioned to provide six PCCs across Gloucestershire. These are

either co-located with an emergency department or at a community hospital.

In each location the staff provision consists of clinicians GPs primarily with advanced

nurse practitioners (ANPs) in four of the six PCCs. The hours of operation are shown

below.

PCC Opening Hrs Weekday Opening Hrs Weekend

Cheltenham GP:1800-2300

ANP: 1830-2300 GP: 0800-2300

ANP: 0800-2300

Cirencester GP:1830-2300 GP: 0800-2300

Dilke GP:1830-2300 GP: 0800-2300

Gloucester GP:1800-2300 & 2300-0800

ANP: 1815-2315 GP: 0800-2300 & 2300-0800

ANP: 0800-2300

Moreton ANP: 1830-2200 GP: 1000-1400

ANP: 1400-2200

Stroud GP:1830-2300

ANP: 1830-2300 GP: 0800-2300

ANP: 1000-2200

2. Mobile/home visiting service

The service operates a visiting service based out of Staverton Ambulance Station and

covering the whole Gloucestershire CCG area.

These mobile resources are staffed with either a GP and urgent care assistant, or a

nurse/specialist paramedic. The hours of operation are shown below.


Day No of mobile resources (GPs plus ECPs)

Morning Afternoon Evening Overnight

Monday-Friday 0 0 4 3

Saturday & Sunday 5 6 5 3

3. Clinical Hub

The coordination centre of the out-of-hours service is the hub based in the

Gloucestershire Tri-Service Centre (GTEC). It is at this location that the supervisor

overseeing the service during operational hours is based, in conjunction with the

dispatchers managing the home visit activity, and telephone triage clinicians (GPs,

paramedics and nurses).


Service performance

1. Overall activity

Below is a graph of actual activity against the baseline within the contract.

As can be seen from above, whilst the initial two months’ activity was approximately at

the level predicted, this fell during the summer months and into the autumn. From

December onwards, the overall activity has returned to the baseline and in March

2016, activity was greater than predicted. This high activity in March may relate to the

Easter period.

0

2,000

4,000

6,000

8,000

10,000

12,000

Actual v baseline for 2015-16

Patient Contacts in 2015/16 Contract Activity Baseline


2. National Quality Requirements

All out-of-hours services are contractually measured against a suite of national

performance indicators, in this case they are called national quality requirements

(NQRs). See appendix A for full performance data.

NQR 1 to 7 plus 11 & 13:

These relate to general reporting to the CCG and sharing of data between

providers, the use of language line to facilitate communication; some having been

superseded by local indicators. The service is consistently compliant with these

KPIs.

NQR 8 & 9:

These are no longer OOH KPIs as they relate to initial calls being received, now

assigned to 111.

NQR 10 a, b & c:

These relate to walk-in patients only and are measures of the timescale for face-to-

face assessment to have commenced.

NQR 10a = % of emergency cases passed to appropriate acute response within 3

mins. The service is consistently compliant (target ≥ 95%).

NQR 10b = Time to start of face-to-face assessment of urgent adults (20mins) &

children (15mins). The service is under compliant 72.19% for adults, 38.98% for

children for 2015-16 FY (target ≥ 95%).

NQR 10c = Time to start of face-to-face assessments for all other patients (60mins).

The service has demonstrated improvement from 89.19% Q1 to 96.55% Q4; FY

average performance is 94.49% (target ≥ 95%). These improvements are shown in

the graph below.


NQR 12 a, b & c:

These relate to patients attending PCC appointments and those receiving home

visits. The compliance levels target for the 2015-16 FY is ≥ 95%.

NQR12a = Emergency consultations started within 1hr of completion of definitive

clinical assessment.

NQR12b = Urgent consultations started within 2hrs of completion of definitive


NQR12b = Less urgent consultations started within 6hrs of completion of definitive


NQR PCC/base appointment Home Visit

NQR12a – emergency (1hr)

75.86% 68.09%

NQR 12b – urgent (2hrs) 93.26% 86.36%

NQR12c – less urgent (6hrs)

98.40% 91.24%

80.0%

85.0%

90.0%

95.0%

100.0%

105.0%

0

100

200

300

400

500

600

NQR 10c

Total number of less urgent patient cases presenting at PCCs Performance


Consultations at Base Sites (Treatment Centres)


Consultations by home visit


3. Local Indicators

Gloucestershire CCG have implemented a suite of local performance indicators to be

delivered alongside the NQRs

LI1:

All calls must be answered within 60 seconds. The service is under compliant

79.66% for 2015-16 FY (target ≥ 95%).

LI2 a, b & c:

Timely call-backs to patients (target ≥ 95%, data for FY):

– Emergency (within 1 hr) performance 92.16%

– Urgent (within 2hrs) performance 82.19%

– Less urgent (within 6hrs) performance 86.16%

LI3 & 4:

Indicators looking at engagement with the system to manage patient demand, and

patients being treated by appropriate member of staff. The service is compliant.

LI5:

Timely call-backs to Paramedics to avoid unnecessary conveyance to Emergency

Depts. (target ≥ 95% within 20mins). The service is under compliant 62.76% for

2015-16 FY (target ≥ 95%).

LI6:

Qualified response to Healthcare Professional request for advice (target ≥ 95%,

data for FY):

– Emergency (within 60min) performance 84.21%

– Urgent (within 1hr) performance 85.58%

– Less urgent (within 2hrs) performance 88.05%


LI7:

Check of consistency of service delivery. The service is compliant for the FY,

narrative reporting.

LI8:

Appropriate attendances at Emergency Depts (target ≤ 4%). The service is

compliant 3.69% for the 2015-16 FY.

LI9:

Timeliness of prioritised palliative call-backs, within 20mins (target ≥ 95%, data for

FY): 61.05%, but significant improvement from 20.0% (Apr ‘15) to 91.67% (Mar

‘16).

LI10:

Appropriate prescribing practice relating to high-risk anti-microbial medications;

target is a continuing reduction. Remaining at approx 10%, 10.70% in Jan-Mar

2016.

LI11:

Appropriate management of frequent callers which is based on the use of special

patient notes. Increasing numbers of frequent callers are being managed

appropriately – monthly narrative report is produced

LI12:

Training of all current staff in the recognition & adherence to safeguarding issues for

adults & children,(target = 100%, data for FY): achievement at 83% with 6

remaining staff to be trained in May 2016.

LI13:

Service availability details provided. This is provided in monthly reports. Compliant.


LI14:

Co-ordinated patient care, linked to NQR3. A report is produced monthly.

Compliant.

LI15 a & b:

Complaints handling: a) complaints acknowledged within 3 working days.

Compliant at 100% (target = 100%); b) final responses completed within 25 working

days. Non-compliant at 60% (target = 100%).

LI16:

Service improvement through patient feedback/audit /survey, linked to NQR5.

Compliant (narrative report).

LI17a & b:

Patients & carers are able to provide feedback – reviewed through 6 monthly

surveys report and a percentage of patients given exit survey at time of

consultation. Compliant (narrative report).

LI18:

Integration with health economy through relationships with CCG, & other providers.

Complaint (narrative report).

LI19:

Working in partnership with CCG & other providers to ensure patients are aware of

the service & access routes. Complaint (narrative report).

LI20:

Ensuring patients are clear about the advice given in the event of deterioration.

Complaint (narrative report).


4. Shift cover

Primary Care Centres

Cheltenham Overall shift cover for FY 2015-16: ANP = 75% GP = 89%

Mar-16 Feb-16 Jan-16 Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15

GP or ANP %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered

Cheltenham ANP

87% 92% 91% 87% 93% 84% 77% 47% 62% 72% 67% 47%

Cheltenham GP

93% 92% 100% 93% 100% 95% 87% 87% 79% 75% 85% 90%

Closures

In total the PCC was closed for 28 hours during the FY 2015-16

Mar-16 Feb-16 Jan-16 Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15 Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

3 0 0 5 0 0 0 10 0 0 10 0


Cirencester

Overall shift cover for FY 2015-16: GP = 80%


GP or ANP %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered

Cirencester GP

81% 77% 83% 80% 79% 81% 89% 76% 78% 80% 81% 81%

Closures



Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

50 50 45 50 50 45 25 50 50 45 15 30


Dilke

Overall shift cover for FY 2015-16: GP = 80%


GP or ANP %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered

Dilke GP 92% 84% 86% 84% 89% 77% 71% 66% 78% 73% 83% 78%

Closures



Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

20 35 35 40 25 55 65 90 50 60 35 50


Gloucester

Overall shift cover for FY 2015-16: GP = ANP = 72% GP = 87%


GP or ANP %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered

Gloucester ANP

72% 86% 88% 96% 94% 87% 69% 51% 48% 61% 63% 57%

Gloucester GP 88% 89% 85% 78% 93% 92% 93% 89% 80% 78% 86% 90%

Closures

In total the PCC was closed for 33 hours during the FY 2015-16 for all shifts excluding the 2300-0800 overnight treatment

centre shift (OTC). For the OTC shifts, 837 hours were not covered however during these shifts one of the mobile resources

would attend the treatment centre to see patients.

Mar-16 Feb-16 Jan-16 Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15 Hours of

No Cover Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

PCC 0 0 0 0 0 0 3 0 10 0 10 10

OTC 54 90 135 153 54 45 45 63 99 72 9 18


North Cotswold



GP or ANP %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered

North Cotts ANP

5% 6% 5% 11% 10% 9% 10% 2% 12% 6% 18% 31%

North Cotts GP

90% 75% 63% 90% 100% 88% 100% 81% 77% 87% 91% 70%

Closures



Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

190 180 210 190 185 190 175 215 185 170 180 160


Stroud



GP or ANP %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered %

Covered

Stroud ANP 45% 79% 66% 74% 83% 74% 52% 20% 50% 60% 70% 87%

Stroud GP 88% 93% 87% 85% 93% 83% 76% 66% 76% 86% 83% 90%

Closures



Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

Hours of No Cover

25 5 10 5 10 20 20 80 20 0 0 0


Impact of PCC closures

Where patients are unable to be provided with an appointment at a PCC, they are directed to one of the others – this is usually

the next nearest, unless the patient choses otherwise. The data below shows the number of patients whose local PCC was

closed and therefore had to who attended other PCCs between 01 January and 31 March 2016.

Total number of patients attending each PCC location

Cheltenham Cirencester Dilke Gloucester North Cotswold Stroud

2356 598 709 3392 123 1059

Number of patients and locations to which they attended when not attending their local PCC

Cirencester Dilke North Cotts Stroud Gloucester Cheltenham Totals

Cirencester

0 0 24 15 5 44

Dilke 0

0 0 25 0 25

North Cotswold

2 0 0 0 4 6

Stroud 8 0 0 68 4 80


Distance and travel times between PCC locations

Cirencester Dilke North Cotts Stroud Gloucester Cheltenham

Cirencester

54mins/37miles 40mins/25miles 21mins/12miles 46mins/22miles 39mins/18miles

Dilke 54mins/37miles

70mins/46miles 58mins/25miles 32mins/16miles 43mins/23miles

North Cotswold 40mins/25miles 70mins/46miles

59mins/32miles 53mins/29miles 38mins/21miles

Stroud 21mins/12miles 58mins/25miles 59mins/32miles

31mins/11miles 33mins/14miles

Mobile/visiting service

The table below shows the shift coverage rate for planned mobile shifts across the financial year. As a total, 94% of mobile shifts were covered.

Mar-16 Feb-16 Jan-16 Dec-15 Nov-15 Oct-15 Sep-15 Aug-15 Jul-15 Jun-15 May-15 Apr-15 Total

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

% Covered

94% 95% 103% 109% 91% 93% 91% 80% 98% 90% 88% 93% 94%


5. Quality

Below is a copy of the patient safety reporting dashboard for the Gloucestershire GP

OOH service.

Source of Feedback A

pri

l

2015

May

2015

Ju

ne

2015

Ju

ly

2015

Au

g

2015

Sep

t

2015

Oct

2015

No

v

2015

Dec

2015

Jan

2016

Feb

2016

Mar

2016

To

tal

YT

D

Serious Incidents

1 0 0 0 0 1 0 0 0 0 0 0 2

Moderate Incidents

0 0 0 0 0 0 0 0 0 0 0 0 0

Adverse Incidents

15 7 14 10 9 11 7 23 14 8 10 10 138

HCP Feedback

2 13 1 0 10 0 14 1 0 0 2 0 43

Compliments

0 0 1 2 0 1 0 1 1 0 0 0 6

Complaints

8 6 6 3 6 4 3 1 4 13 5 10 69

Claims

0 0 0 0 0 0 0 0 0 0 0 0 0

Violence Related Injuries (to staff)

0 0 0 0 0 0 0 0 0 0 0 0 0

Never Events

0 0 0 0 0 0 0 0 0 0 0 0 0

Adverse Incidents

The Trust has reviewed all adverse incidents received during the year and has

identified that the highest reporting categories were as follows:

Reporting Category Number of AIs

Treatment and intervention 44.1%

Medication 21.5%

Consent, Confidentiality or Communication 16.7%

Infrastructure or resources (staffing, facilities, environment) 11.8%

Conveyance 5.9%


Feedback from other Healthcare Professional Organisations


Treatment and intervention 46.6%

Medication 24.7%

Consent, Confidentiality or Communication 17.8%

Infrastructure or resources (staffing, facilities, environment) 6.8%

Conveyance 4.1%

Complaints

Key themes coming out of these incidents and complaints include:

Delays in response (time to home visit or ring-back) to both patients and other

healthcare professionals.

GP assessments and attitude – including examples where patients were told they

would receive a prescription and this was not followed through.

When reviewing and addressing complaints, the Trust uses the 6Cs model as

recommended by Compassion in practice – this identifies each complaint under the area

of impact: Care, Compassion, Competence, Communication, Courage and Commitment.

Please note that these figures will not reflect the number of complaints received. Multiple

reporting categories are used per complaint


Care 26.4%

Compassion 9.6%

Competence 11.2%

Communication 23.6%

Courage 0.0%

Commitment 29.2%


Patient Feedback

Patient feedback is obtained both proactively and reactively. It is received through a

number of routes including the Patient Opinion website and NHS Choices website. In

addition to the above, the Trust occasionally receives feedback on the patient

experience from the local Healthwatch, no feedback was received during the year.

The Trust has rolled out the Friends and Family Test (FFT) and obtain responses via

the standard patient survey as well as through the an online form, telephone call and

via text message. The Trust currently collates the scores for the UCS provisions as

one group; this includes all Community Health services e.g. the Urgent Care Centre

(UCC) in Tiverton.

Would recommend Would not recommend

FY 2015-16 89% 7%

Each month 1% of patients who contact the service are asked to complete a survey to

enable collation of patient experience data and information. For the year 1 April 2015 to

31 March 2016, the total number of surveys returned was 289.

Quality of care

Did you have confidence and trust in the healthcare professional?

Yes -209 To some extent – 44

No – 13 Not sure/Can’t remember - 1

(for patients confirming that they were in pain) Did you think that the staff at the GP Out of Hours service did everything they could to help control your pain?

Yes – 148 No - 32

Were you involved as you wanted to be in decisions about your care and treatment?

Yes – 205 To some extent - 43


Were you given advice on what to do if your condition got worse?

Yes, fully understood advice given – 106

Yes, advice given but did not understand – 5

Don’t know/can’t remember – 7 No advice given - 17


Access

During the call with 111, do you feel that the advisor/s listened to what you had to say?

Yes – 196 To some extent – 49


Environment Where you given enough privacy when discussing your condition or treatment?

Phone only – 73

Yes – 165

To some extent – 21

No - 7

The main themes of the positive comments related to:

Supportive and caring attitude of all clinical staff patients had contact with.

How patients were ‘impressed’ by the quality and speed of the service received.

Gratitude for support and help in times of crisis or need

The main themes of negative comments received during the year related to:

Delays; in being seen by a clinician or being called back by the service.

Triage questions are too many and too intrusive.

Patients citing not feeling listened to which impacted on diagnosis.

Learning from patient complaints and patient feedback

Additional GPs triage in the hub to reduce long waits

The GP Clinical Lead presented a paper regarding DVTs and risk factors during an

OOH GP Development Day. This was following a specific complaint. He also delivered

a telephone triage training session to support GPs who require support in this area.

Clinicians were asked to consider staying at the address longer until the patient’s pain

resolved and to ensure that the family, and patient, are happy with the follow up plan.

Issues relating to individual clinican’s attitude are picked up with the staff involved


Challenges to service delivery

Clinical staffing: GP & ANP availability

111: Priority of calls post-111 triage

GCS: GP cover and MIIU interface in community hospitals, district nursing service

capacity

GRH: Management of referrals and expectations, in particular with the GP pilot in ED

Commissioning of competing services: Prime Minister’s Challenge fund extending

Primary Care availability

‘Walk-ins’: Significant increase in general ‘walk-in’ patients volume. Contract volumes

remain stable but this impact is intensified at Gloucester PCC.

A comprehensive action plan has been developed and shared with commissioners which

provides remedial actions to address performance in critical areas. Examples of actions

include:

Incentivising key shifts – this is reviewed dynamically

Working with staffing agencies to source additional staff – ANPs in particular

Providing additional IT access at Staverton Ambulance Station to enable mobile GPs to

undertake additional triage when located there between calls

Recruiting to additional call taking and supervisory posts within the Clinical Hub

Re-introduction of remote triage working to support the service at times of

peak/increased demand

Recent successes

New lead nurse appointed to support nursing practice and re-validation

GPs working regularly are now on personalised regular rotas

GP development sessions are run on a monthly basis led by OOH GP lead

Increase in triage capacity within the OOH hub to support activity at weekends and

rescued delays for ring backs


Developments & Improvements

Managing Demand: work with stakeholders to ensure a shared understanding what

the service provides ie urgent primary healthcare to those who cannot wait until in

hours. Ensure patients are accurately prioritised at all times ie from NHS111, from walk

ins & from ED referrals. Improve integration with other services ie Choice Plus

appointments

Service delivery model review : review of the current model to consider opportunities

for an amended/updated model – with increased triage capacity, and with shift and

skill-mix changes better reflecting staff availability

Focus on key performance indicators : Continued focus on improvement against the

KPIs

Review the interface with existing providers & the public: ED, MIIU, Community

hospitals, community services, 111 to ensure that referrals are appropriate and that

patients experience seamless pathways of care


Appendix A: KPI Performance Data

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