Quality Account - dhuhealthcare.com

Quality Account

2020/2021

Image taken by Dave Bird, Ladybower, Peak District

Contents

Introduction and CEO Message 2

Section 1 Message from Our Chairman 5 Section 1 Our Objectives 2020/21 6

Section 2 Our Services 7

Section 3 Our People 57

Section 4 Our Quality Assurance 69

Section 5 Our Patient Experience 98

Section 6 Our DHU Objectives 2021/22 114

Section 7 Statement of Director Responsibilities 115

Section 8 Statement from Commissioners 116

Section 9 Glossary 119

DHU Health Care CIC Quality Account 2020/21

Index Page

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Introduction & CEO Message


Introduction to the DHU Health Care CIC Quality Account 2020/21 from Stephen Bateman, CEO

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Welcome to our Quality Account for DHU Health Care Community Interest Company (DHU) which sets out what we have strived to achieve to provide safe, effective and quality healthcare to our patients and the communities that we served during the year 2020/21. DHU’s mission is to provide caring, high quality, safe and effective healthcare with a clear vision to engage with our employees and our patients in order to improve our services, and to be the healthcare provider of choice to commissioners. I have to start by saying how proud I am of all our DHU colleagues for the care, compassion and commitment they have shown throughout the most challenging year. We have endeavored to ensure that the quality of care for our patients living in the communities that we serve was our utmost priority. This pressure faced by our staff throughout 2020/21 was immense in so many ways, and I am so pleased that the DHU team could be part of the NHS family in the fight against the global COVID-19 pandemic. As we have experienced, the pandemic has been an unprecedented societal challenge that has had an

immeasurable impact on the health of the nation, and the NHS and Social Care sector as a whole. Throughout the last year I have continued to be inspired and am so grateful to work with such a passionate team of people here at DHU, and also appreciate all colleagues from across our NHS and Social Care partners. Our DHU staff have demonstrated fantastic resilience and professionalism, and also continued to CARE for our patients and fellow colleagues under the most tremendous pressure and personal risk. By far the most challenging times over the last year were the deaths of 3 members of the DHU team due to COVID-19. The loss of Rebecca Mack, Dr Thomas Oelmann and Suzanne Loverseed was tremendously difficult for all colleagues, and we came together to pay tribute to all three at the time and on the anniversaries of their deaths. Our thoughts remain with their family and friends, and we are committed to continue to support their families in the future. At the beginning of the year we successfully mobilised new COVID-19 services across

Derbyshire and Leicester, Leicestershire & Rutland (LLR) to meet the needs of our GP Partners, Primary Care Networks (PCNs) and Commissioners. These included Hots Hubs, Red Home Visiting services, testing centres and Care Home testing for residents. As part of our local Health & Care systems, now known as Integrated Care Systems (ICS’s), our role and responsibilities as an integrated Urgent Care provider and trusted system partner enabled us to step up and support the frontline delivery of additional essential services in response to the COVID-19 Pandemic. These formed part of the Local Resilience Response structures put in place that supported the national pandemic response co-ordinated through the Department of Health and Social Care. We have been fully engaged at a strategic, tactical and work stream level in support of this coordinated pandemic response and recovery to meet the needs of our patients across pathways within acute, emergency, community, urgent and primary care services. We are supported by strong corporate, clinical and financial governance with patient safety remaining the primary focus of our Board.

Stephen Bateman

Chief Executive Officer


Our Board assurance framework gives us the opportunity to review the excellent quality of care and contractual performance that we deliver. We have continued to remain focused on clinical governance and patient safety underpinned by a transparent culture aimed at reducing incidents of avoidable harm to patients. We also have a learning culture, where outcomes are acted upon to improve patient safety, and we continue to take learning from any serious incident that occurs. Some of the other most significant highlights for 2020/21 are as follows:

We continued to manage exceptional growth in NHS111 and Urgent Care patient demand across our services because of the COVID-19 pandemic. In response to the pandemic we implemented a “Triage First” model of care to ensure we maintained the safety of our patients and staff as a priority. Across our services, we now care for more than 3 million patients per annum over a population of 5.5 million.

The dynamic response we provided to the Care Home and House Bound patients as part of the COVID-19

testing and vaccination programmes in Derbyshire and LLR. We have also supported a number of national and PCN local testing and vaccination centres across our region through the last year.

We piloted and successfully mobilised with system partners the “Think 111 First” programme across the East Midlands and Milton Keynes. This NHS England national programme was introduced to direct people to use 111 first when they have an urgent but not life-threatening medical need, rather than going straight to A&E. If the patient needs urgent care, NHS 111 can now book them in to be seen quickly and safely in A&E/Emergency Departments, or into another more appropriate healthcare service such as a hospital specialty, urgent treatment centre or GP Practice.

Following our accreditations in 2019 we successfully passed our quality inspections (held virtually) in the three ISO standards held across our organisation, namely;

ISO 9001 Quality Management

ISO 27001 Information Security

ISO 22301 Business Continuity management systems

We improved the Physical and Mental Health and Wellbeing for our staff, including the areas of mental health, psychological support, flu vaccination and COVID-19 testing and vaccination programme.

We enhanced our comprehensive infection, prevention and control practices across our organisation in response to the COVID-19 pandemic and national guidance. This resulted in our sites being approved as COVID-19 secure from July 2020, and this has been monitored every two weeks in line with our Health & Safety requirements and Business Continuity Management response.

We won the Apprentice of the Year Award in the East Midlands Chambers Business Award with Cerys Addis in the DHU 111 HR team. We were also runner up in the Excellence in Customer Service award.

We enhanced our corporate social responsibility through the donations and support we have given some of our essential local charities who have been severely impacted by the pandemic.


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We continued to focus on improving staff engagement and recognition from listening to feedback through the daily/weekly CEO communications and weekly Health & Wellbeing newsletter as we responded to the pandemic.

We also maintained the monthly limelight awards to recognise colleagues that had gone over and above for our patients, and the monthly DHU United company-wide and divisional newsletters, quarterly staff representative forums and annual staff survey.

We have successfully taken on the running of the 3 GP Practices in Leicester city in March 2020 from our GP Federation partners. I am really pleased to report that following the implementation of a quality service improvement plan for our patients this resulted in an improved CQC inspection at our Bowling Green GP Practice in December 2020.

DHU Health Care believes our Quality Account clearly demonstrates our commitment to our mission and vision. We are committed to being a learning organisation and looking to the future to see how we can improve our patients

experience and outcomes, as well as ensure we engage our staff and stakeholders in reviewing our mission, vision, values and overall strategy. In 2021 we will be undertaking a comprehensive review of our strategy to ensure it is focused on meeting the needs of our patients and the communities that we serve. Our parent board and divisional board meetings continue to feature a patient story ensuring that patient experience, outcomes and learning is always at the heart of our decision making process. Despite the impact of the pandemic, I am very pleased to report that we continue to receive excellent Patient feedback through the NHS Friends & Family test and independent Patient Satisfaction Surveys. We have maintained strong processes to address complaints, respond to national guidance, and to make sure that learning from all our feedback is implemented through our Patient and Public Involvement sub-committee (PPI). I am extremely grateful to those who have contributed to the content of this year’s Quality Account (2020/21) and to those who have worked with us to ensure that they accurately reflect the work that we have undertaken throughout this unprecedented year. I look forward to working with my Executive team and

Parent Board in supporting our great DHU team to build on our successes and learning so that together we can develop exciting plans to strengthen our company and enhance our services in the future. We remain focused on responding to our local and regional commissioning intentions through our collaborations and strong relationship across our developing Integrated Care Systems, and to continue to support the population health needs of the people and the communities that we serve. Faced with adversity we have learned many things over the last year, and it is clear that we could not have got through this without the support from our work colleagues, family and friends. I want to finish by saying thank you and paying tribute to our families and friends, and our system partners for all the support they have provided to our DHU colleagues throughout 2020/21. Stephen Bateman Chief Executive Officer

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Message from our Chairman


Message from our Chairman David Whitney

It is a pleasure once more to be able to say a few words as an introduction to the Quality Accounts document for 2020/21. I will not replicate the very comprehensive report from our CEO Stephen Bateman but rather limit myself to a few general comments.

For me this remains the most important document that DHU produces each year. Clinical Quality has and always will be at our very highest priority. It sets out very clearly why it remains an absolute privilege to be associated with DHU and all the remarkable staff that we employ and the high quality and responsive services that they deliver across the East Midlands. If ever these achievements needed further endorsement then the past year has provided it many times over as our DHU staff have responded so magnificently and in so many ways to the unexpected and unpredictable demands of the COVID 19 pandemic that have clearly dominated the services that we have delivered. As Stephen has reflected this essential work has come with a heavy price with the very sad and tragic loss of three members of DHU staff; our thoughts have been very much with their families and friends throughout this time. Once again my Board colleagues and I are truly humbled by the skill, dedication and bravery of all our DHU staff and this report is a tribute to and reflection of those qualities.

David Whitney

Chairman

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Section 1 Our Objectives 2020/2021

DHU Health Care CIC Quality Account 2020/21 6

Throughout 2020/21 we have focused on the following five objectives to improve the quality of our services,

ensuring that they were safe, effective, caring, responsive and well led.

Objective 1 - Patient Safety

We will provide a high quality effective and safe

service to all our patients. Placing patients at the

heart of safe, compassionate and competent

care.

Objective 5 - Good Governance

We will be a well led, financially viable

organisation, balancing effective decision

making with innovation and transforming

services.

Objective 2 - Integration through partnerships

We will develop new models of integrated care

through embedding key partnership working

which commenced in 2014/15. This will Include

the redesign of Emergency and Urgent care

pathways.

Objective 3 - Supporting our workforce

We will aim to attract, recruit, retain and

develop all our staff to be part of delivering

good quality health care services.

Objective 4 - Focus on prevention and self-care

We will use our experience and expertise to

work with patients, families and our local

communities to develop resilience and capacity

in preventative services and self-care.

Section 2 Our Services


Pauline Hand

Managing Director DHU111

DHU’s 111 service has continued to be one of the best providers of the NHS 111 service in England, since September 2018. The service covers a population of approximately 5 million across the East Midlands which includes Derbyshire, Nottinghamshire, Northamptonshire, Leicestershire, Rutland, Lincolnshire and Milton Keynes. Due to its performance and high reputation within the East Midlands, DHU was asked to support London Ambulance Service (LAS) with their NHS 111 calls in North East and South East London in January 2021, initially for three months. This was due to significantly increased winter call volumes in London, and the negative impact of COVID absences on their staffing levels, and this support has now been extended for the entirety of 2021. DHU’s commissioners were exceedingly supportive of DHU assisting an ambulance provider as it was providing a much improved level of access for patients in these areas. This service was mobilised within 8 days of agreement to proceed, a fantastic achievement involving many staff members across DHU who went the extra mile to

support their London colleagues. Within a matter of days. LAS’s patients were able to access the service in a timely manner and receive their normal good service. LAS staff were exceedingly grateful as this took a lot of pressure off them and they were finally able to catch a breath in between calls! Our three contact centres in Derby, Chesterfield, and Leicester have been offered over 1.96 million calls between the 1st April 2020 and 31st March 2021, which which is a minor decrease of -1.5% on the previous year, however, the previous 2019/20 year activity was skewed by an approximate 200,000 call surge in March 2020 due to the first wave of Covid-19. A National NHS 111 advertising campaign commenced in October 2020 running through to end March 2021. This was aimed at encouraging the public to contact NHS 111, either via telephony or online, instead of just turning up unheralded at Accident & Emergency departments. The campaign included TV, video on-demand and social media and promoted the ability of NHS 111 services being able to book appointments. This advertising continued to create brand awareness across the NHS111 community, and it has now been

evidenced that 38.8% of the East Midlands population have an increased propensity to call DHU 111 compared to an average of 34.0% across England. In 2017/18, 2018/19, 2019/20 DHU 111 had one of the lowest Emergency Department (ED) referral rates of any NHS 111 provider in the country, and this has continued throughout 2020/21. DHU 111’s skilled clinical team validated 13,314 ED referrals for Northamptonshire and we avoided sending 6,547 patients to the ED department where ED validation was an option. Furthermore our NHS 111 clinicians validated 147,260 (96.9%) of Category 3 & 4 ambulance calls, generated by the NHS Pathways triage software. We avoided sending the category 3 and 4 ambulances in 93,186 cases (63.3%) Our consistent aim is to ensure that we only refer patients to our emergency service partners when absolutely necessary and appropriate. Patient satisfaction increased this year again by 2% to 87% of patients being satisfied or very satisfied with our service. DHU 111 continues to be at the forefront of

developments within the NHS 111 and

Integrated Urgent Care services nationally.

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DHU introduced the facility to book appointments in GP

Practices and A&E departments, through GP Connect. We

are currently working with Vodafone and NHSE England on

introducing a new technology for 111 called Natural

Language Processing, which is more commonly known as

speech recognition, which allows patients to use their voice

to determine reason for calling, rather than using the

traditional telephone key-pad number selection.

The Covid 19 pandemic presented DHU 111’s service with a

challenge of trying to forecast calls in an unknown

environment. There have been many occasions whereby

government announcements and short notice changes

have affected our provision, both positively and negatively.

During the winter period lockdown demand for the usual

patient winter ailments was reported by NHS England as

being down by 82% at times. This was particularly

noticeable in February 2021. Flu, colds, coughs, norovirus,

diarrhoea and vomiting cases were all reduced due to

better personal hygiene standards, wearing masks and not

mixing socially during lockdown. We continued to provide

flu injections for all colleagues and had a 90% take up this

year.

It was with great sadness that we received news at the

beginning of the COVID outbreak that we lost a valued

member of our remote clinical nursing team in April 2020.

At the start of the pandemic DHU introduced all practicable

methods to keep our staff safe within the call centres. A

particularly stringent internal ‘track and trace’ procedure

led by our clinical team was put together, handwashing at

every opportunity in place, sanitising stations with

increased Clinell wipes, one way systems, regular fogging

to kill all germs, homeworking set up for those most

vulnerable and Perspex pods around the desks at all call

centres. This regime has enabled us to manage any

outbreaks of covid extremely well and keep everyone as

safe as possible.

NHS England has supported the NHS 111 service and

decreed it a ‘first line NHS service’ which enabled us to

receive a supply of lateral flow tests. Having these tests

available enabled us to test all of our staff regularly and

new starters before commencement of their training. In

addition we have managed to get 100% of our staff offered

the COVID vaccination.

Work to support the health and wellbeing of our staff has

continued to be a key focus for us. Many areas of support

have been offered to ensure staffs resilience, mental health

and overall health and safety at work. This support for our

staff includes reflective supervision, psychotherapy

sessions, chaplaincy services, Westfield health provision

and mental health support. All front line staff are receiving

additional mental health training in order that they can

support our patients and themselves appropriately.

Our call centre staff have organised many fundraising

activities to help those that are less fortunate and will

continue to do so through the year.

There has also been many fun activities in the centres

whereby we have celebrated Easter, Ramadan, Eid,

Christmas and other events such as Children in Need, Red

Nose Day, etc. There have been many competitions such

as the children’s colouring competitions which aim to get

families involved. Our colleagues have some very

artistically talented children!

Our monthly limelight award for staff achievements and

our staff forums all demonstrate to our staff how much

they are appreciated for the difficult work they undertake

every day.

DHU 111 is planning to move their Derby Call Centre in

autumn 2021 and work has been ongoing to bring this to

reality.

We remain committed to being the best NHS 111 service in

the country through continuous improvement and

development of our staff and services, and we look forward

to the opportunities the next 12 months may bring.

Pauline Hand

Managing Director DHU111



DHU 111 (East Midlands) CIC Performance

NHS 111 is national healthcare service which helps patients get the treatment they require when they need it. NHS 111 is available to the public via both a network of telephony providers across the country and the web based product NHS 111 Online provided by NHS Digital. The NHS 111 service is available 24 hours a day, 7 days a week, and 365 days a year. NHS 111 services were first developed back in 2010 across several pilot areas in England, including Derbyshire in the East Midlands. Since that time, and based on the success of the pilot areas, NHS 111 services have been commissioned across all of England, with similar services now commissioned in Wales and Scotland, In England, there is currently a national population of 56,678,470 people that is served by these collective NHS 111 services. DHU 111 serves a population of 4,990,315 people in the East Midlands and Milton Keynes, which represents 8.8% of the total population of England, although activity in the East Midlands and Milton Keynes actually equates to 10% of overall NHS 111 call volumes. Public awareness of the NHS 111 service has continue to grow, and despite no Covid-19 activity surge to compare the first wave back in February and March 2020, the collective NHS 111 services across England once again received 19.3 million calls, which is -0.3% annual growth, however, the activity in 2019/20 normalised to off-set this Covid-19 activity, then organic growth is around 2.5% year on year. Similarly, in the East Midlands, there was -3% net growth

due to the same wave of Covid-19 calls in February and March 2020, however, normalised activity shows a 4.8% organic growth year on year. NHS 111 services have evolved to be commissioned locally by Clinical Commissioning Groups (CCG’s), however there is now growing momentum towards significant transformation of local commissioning arrangements into Integrated Care Systems (ICS) arrangements to improve local patient healthcare through partnership arrangements across multiple agencies, incorporating councils, hospitals, GP’s, social care, and environmental agencies. There are currently 16 local NHS 111 providers in England, spanning Ambulance Services, Community Interest Companies and Social Enterprises, and Commercial Enterprises. All of these 16 NHS 111 providers are required to achieve a number of key performance indicators (KPI’s), which provide assurance to both local commissioning groups and NHS England on the quality of services that are provided by each local NHS 111 service. Originally, NHS 111 KPI’s were nationally mandated and were applied across all NHS 111 contracts globally, however, as NHS 111 regional services have developed across England, they have adapted to diverse local urgent and emergency landscapes where service requirements are varied, and performance measurements have become localised as a result of these service variations, however, this localisation is in the process of change once again. A new range of KPI’s has being developed by both NHS England reflecting the change to Integrated Urgent Care (IUC) across England.

This new set of IUC KPI’s will replace the existing the existing performance indicators from April 2021, and this new data set is published on the NHS England website under the Integrated Urgent Care Aggregate Data Collection section. Up to March 2021, DHU 111 was still measured against a set of locally agreed KPI’s with all of the collective commissioning groups in the East Midlands. These KPI’s consist of: -

The average time taken to answer a call , which has a target 27 seconds

The number of calls abandoned after 30 seconds, which has a target 5%

The number of calls transferred to a clinician, both in 111 and across primary/urgent care providers, which has a target 50%

The number of calls where there is a self-care outcome, which has a target of 17%

These KPI’s measure patient access, service efficiency, service quality, timeliness and extent of appropriate clinical intervention, and the level of instruction for patient self-management to minimise the downstream impact on other services. To support the measurement of these KPI’s, DHU 111 provides a comprehensive suite of daily, weekly, and monthly reports based on currently agreed KPI’s to both local commissioning groups and NHS England, which provides on-going assurance on the quality of services that are being provided in the East Midlands and Milton Keynes.



A number of these reports are published nationally, so that

performance benchmarking against nationally achieved averages can

be undertaken by key stakeholders across NHS England and the local

commissioning groups. In addition to the suite of periodical reporting

that is provided, DHU111 and local clinical commissioning groups hold

monthly collaborative meetings which are focussed on quality of

patient care and service performance. All urgent and emergency care

stakeholders from across the region, including patient representative

groups, are invited to these meetings. The monthly meetings provide

appropriate forums for debate on quality assurance and performance,

and also support discussion on service developments which allow for

further improvements to patient care.

The opposite key events shown as a timeline have had a significant

impact on the call volumes that have been received by our East

Midlands service during 2020/21: -

April 2020 – DHU 111 dealt both a continued call surge from the first wave of Covid

-19, together with Easter and the start of the early May Bank Holiday weekend.

August 2020 – October 2020 – Covid-19 second wave from easement of lock down

conditions and schools returning in September resulted in increased patient contact

with potential Coronavirus symptoms

October 2020 – March 2021 – National and regional NHS 111 TV, Radio, and Social

Media advertising campaign to promote the NHS 111 First initiative, launched by

NHS England to promote the use of NHS 111 and minimise unheralded patient

attendances at local Accident & Emergency Departments

December 2019 – January 2020 – Increased seasonal call volumes across the

December and January periods due to increased brand awareness from the national

and regional NHS 111 advertising

January 2021 – March 2021 – As vaccines became more widely available from

January, then Primary Care colleagues were asked to support the ambitious

Government vaccination roll out programme, from which, reduced capacity in

Primary Care led to increased patient traffic into NHS 111, particularly Monday to

Friday from 0800 -1800 hours each day.



Whilst Covid-19 was less prominent in 2020/21, DHU 111 still received a total of 1,933,996 calls for 2020/21, which is a marginal activity decrease of 3.0% from 2019/20, but an increase of 14.5% compared to 2018/19. This figure indicates that an equivalent of 38.8% of the population served by DHU 111 has used its 111 services. This compares to 34.0% of the population across England, which continues to show that patients in the East Midlands and Milton Keynes regions are more likely to utilise NHS 111 services than other parts of the country. DHU 111 answered a total of 1,648,567 calls in 2020/21, an increase of 5.6% year on year, which is an average of 4,517 calls answered every day across the year. Across the year, DHU 111 answered these calls in an average time of 33 seconds, which is a year on year improvement of 63 seconds or a 65% improvement in the average speed to answer calls.. DHU 111 answered 91.8% of calls in 60 seconds against a national target of 95%, which is an improvement of 4.6% year on year, and 8.4% over the past 2 years. Abandoned calls after 30 seconds averaged 1.8% for the year against the national and local target of 5%, which is an improvement of 4.4% year on year. The following charts and tables show the performance and quality of outcome for DHU 111 across the year: -

Calls Received (Offered) The table shows that there has been sustained activity in 2020/21 following the initial Covid-

19 wave in March/April 2020, and the second wave of Covid-19 that traversed the late summer and autumn period in

2020 is clearly identifiable.



Average Speed of Answer

The data shows that the average speed of answer has improved significantly in 2020/21,

and only the months affected by Covid-19 activity in April and September 2020 had any

direct impact on the speed of patient access into the service.

Overall, the average speed of answer in 2020/21 was 33 seconds, compared to 96 seconds

in 2019/20.

Percentage of Calls Answered in 60 seconds

Calls answered performance was excellent across the 2020/21 period, with performance

averaging 91.8% across the years, and DHU 111 achieved the national 95% target in 7/12

months and 90% or more in 10/12 months.

This compares to an average of 80.0% nationally, where the target of 95% was not

achieved in any of the 12 months, and 90% or more was only achieved in 2/12 months.



Percentage of calls Abandoned after 30 seconds Calls abandoned performance was excellent across the 2020/21 period with only an average of 1.8% calls abandoned across the 12 month period, and the abandonment target was achieved in 11/12 months. In comparison, the national average abandonment for 2020/21 was 5.3%, and the target was only achieved in 8/12 months.

Calls Transferred to a Clinician DHU 111 continues to recognise the added value that additional clinical intervention can yield for the patient experience, which in turn minimises downstream impact on emergency services across the collective system In 2020/21, DHU 111 has continued to exceed targets for signposting patients to appropriate clinical resources in 111, primary care, and urgent care across the region. DHU 111 averaged 66.2% of calls to clinicians, compared to 63.5% in 2019/20, which is a further increase of 2.7% year on year. The national average for calls to clinicians in 2020/21 was 52.5%. The following chart shows the level of clinical support that patients receive in the East Midlands region:-



Self-Care Patient Outcomes DHU 111 recognises the importance of patients receiving appropriate levels of care, and where it is clinically safe to do so will recommend that patients are supported through self-care in their home environment, which is turn, protects other urgent and emergency care service through reduced downstream impact. DHU 111 has a local target of 17% for self-care, which it achieved in 10/12 months. In 2020/21, DHU 111 achieved an average of 18.7% for self-care, in comparison to the national average of 15.7%. The following graph shows the strong reputation for self-care that DHU has built across 2020/21:-

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Service Referrals DHU 111 is proud of its record supporting other urgent and emergency care services in the region, by ensuring that patients are directed to the most appropriate service, as the following table shows:-

As the table shows, there has been a continued year on year reduction of 999 and A&E referrals, and an increase in primary Care, Self-Care, and Clinical Calls, all of which benefit both the patient and the system as a whole, by minimising the downstream impact for partners across the regional urgent and emergency care network. Spotlighting A&E Referrals demonstrates this positive system impact to great effect. Following the first wave of Covid-19 from February to April in 2020, NHS England developed an initiative called “111 First”, which was based on a change in observed patient behaviours throughout this period where foot fall into A&E Departments fell dramatically. This initiative was designed to leverage this change in patient behaviour by reducing unheralded patients number in A&E Departments, and develop an inherent patient understanding that in order to determine whether an A&E attendance is required, then the patient should ring 111 in the first instance. Following triage and clinical validation, then if an A&E attendance is required, then an electronic A&E booking is made to allocate an arrival time for the patient. This allows A&E departments to understand the trajectory of patient foot fall in their department as well as reducing the risk of nosocomial infection. This initiative was then supplemented by national 111 First TV advertising, and each STP area developed its own implementation plan for A&E deflection, with assistance from NHS England central and regional teams, together with system providers.



The following graph by month for Accident and Emergency referrals shows how DHU has been able to maintain a low referral rate to A&E, with an average of 6.2% of all triaged calls resulting in an A&E outcome in 2020/21. This compares to an average of 10.5% across England, and indicates the success that DHU and its partners have achieved in reducing unnecessary A&E attendances.



Category 3 and 4 Clinical Ambulance Validation DHU 111 continues to work with system partners and commissioners to minimise the downstream impact of lower acuity 999 referrals from 111 on its local ambulance service partners. DHU 111 achieves this through clinically validating category 3 and 4 low acuity ambulance outcomes, so that the initial ambulance outcome can be revisited and managed in a different way, such as booking the patient into a face to face appointment in primary care for example. In the year 2020/21, DHU 111 validated 145,717 category 3 and 4 ambulance outcomes, which is an increase of 27,102 validations or 22.8% on the previous year, which is a significant achievement. The following graph shows the on-going success of this clinical ambulance validation programme: - Future Developments In 2021/22, DHU111 will continue to work with NHS England national and regional teams, commissioners, and other system partners across its contract areas in order to develop further strategies by working towards a fully integrated care system that will ensure that patients are referred to the most appropriate service for their specific health care needs. Additionally, DHU 111 will continue to innovate, and in 2021/22, this will include technical developments for increased digital appointment booking into Primary Care, Accident & Emergency Departments, Same Day Emergency Care, and Urgent Treatment Centres. We will be developing our knowledge and application of non NHS Pathways clinical triaging systems using Pathways Clinical Consultation Support (PaCCS) software to allow us to recruit a more diverse clinical workforce, and we will be developing enhanced pathways for our existing clinical skill sets, so that clinical cases can be managed across a wider DHU clinical workforce. We will also be working with NHS England and Vodafone and developing a speech recognition system on the NHS 111 telephony system to allow patients to be routed to the most appropriate skill set more efficiently, and capture of demographic details to reduce the patient journey times.

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Our NHS 111 Key Achievements

DHU 111 (East Midlands) CIC is a critical member of the Integrated Urgent Care network in the East Midlands, and Milton Keynes and covers a population size of 4.9 million. DHU 111 is a fast-paced service at the forefront of Urgent and Emergency Care developments. In order to keep pace with, enhance and support these developments, we have completed a number of key achievements during the previous year.

COVID-19

DHU 111 have been pivotal in the East Midlands and Milton Keynes healthcare response to the COVID-19 pandemic. The unprecedented call volumes received at the beginning of the pandemic required DHU 111 to quickly react and innovate in their approach to patient care whilst still maintaining the quality required by the service and patients. During the worst of the pandemic we maintained excellent communication and collaboration with other providers of health, as well as NHS England, to try and ensure patients received the care they needed in a timely manner. The challenges of supporting patients with COVID-19 symptoms have continued throughout the rest of the year. DHU 111 recruited temporary clinicians and trained them to specifically support those patients with concerns about COVID-19. This helped to ensure their waits for advice

were as minimal as possible during this worrying time, and also to keep waits minimal for other patients with non-pandemic related symptoms. Our software system that is used for assessments required multiple short notice changes over the period of the pandemic. We always met the deadline for installation of these to make certain that our assessments were current with the latest Government issued guidance. We took the time to brief our DHU 111 teams as thoroughly as possible with the changes to help them keep up with the evolving situation and to ensure we answered any clarifying questions they had. Later in the year, DHU 111 demonstrated its ability to respond immediately and effectively to vaccine queries from patients; both routine queries and those specific toconcerns regarding side effects discussed in the media and by Government. We have also had the challenge of a number of our staff being unwell or required to self-isolate. To mitigate the impact of self-isolated staff we worked with NHS Digital to support our advisors to work from home subject to IT and governance requirements being met. We have made additional contact with staff who have been unwell themselves with COVID-19 to make sure they were supported with their illness. As part of the NHS front line workforce supporting the pandemic response, DHU 111 have been able to offer a vaccine to all of its staff, helping to protect them and their families as well as helping to keep staff at work to support patients contacting the service. We also made sure we implemented robust infection prevention and control measures with the aim to keep our workforce healthy and ready to support patients needing help.



DHU 111 CQC Rated Outstanding

DHU 111 was inspected by the CQC in March 2019 and became the first NHS 111 service in the UK to be rated as ‘outstanding’. Work has continued over this year to embed the outstanding approaches we have been recognised for. These include our approach to innovation that supports patient care, that our care/service performance has been consistently better than other NHS 111 providers over a sustained period of time and that we have a strong emphasis on staff health and well-being. The CQC commented that our service, “innovated to improve patient outcomes and to benefit the wider healthcare community and stakeholders” DHU 111 is recognised as leader in the partnership working with other providers to enable direct appointment booking by 111 across our counties. Through our teams proactively working with other providers DHU 111 enabled the option to book patients directly into urgent and primary care appointments and contribute to a seamless patient journey. Appointment booking has been somewhat restricted during the COVID-19 pandemic with the

move away from face to face care. However, DHU 111 is working with wider healthcare providers to re-open appointments, where possible, for 111 services to book into as the health care system returns to increases in face to face care alongside virtual consultations. The work we undertake to ensure a positive patient experience is reflected in our patient satisfaction score which sits at 87% very satisfied or satisfied.

Continuous Quality Improvement

To monitor and ensure the quality of patient assessments, the DHU 111 team complete patient contact audits using the NHS Pathways audit tool. The number of audits completed per team member is based on their level of experience and competence. DHU 111 quality monitoring currently requires over 2000 audits per month and we consistently achieve over 100% audit compliance with this requirement. Our audit approach aims to ensure a continuous learning environment with learning needs promptly fed back and staff supported to address them.

Our audit also allows us to acknowledge and positively reinforce the excellent levels of good practice identified. The outcomes of our audit demonstrate that we are providing a high standard of good quality care to our patients. To ensure all elements of patient related interactions are quality assured DHU 111 has undertaken a pilot in collaboration with NHS Digital to audit any advice given to staff by their colleagues with the aim being to ensure the advice is safe, accurate and current. NHS Digital is considering whether to make this approach part of the NHS 111 national audit framework. DHU 111 is proud of their approach to sourc-ing and testing innovations to improve the quality of patient care. Over the last year the 111 clinicians trialled the use of video consultation, using the GoodSAM product, and completed an evaluation to evidence where the benefits of being able to see the patient over a video aided a more effective consultation with more appropriate out-comes. Our data showed that 95% of the clinicians using video to support a patient assessment felt that it added value and 65% of patient care outcomes were altered in response to the clinician being able to see the patient.

This includes 42% of Patients being directed away from needing their care in an Emergency Department or Urgent Care setting. Patients have expressed positive comments about their experience of video usage with clinicians commenting: ‘mum was pleased to be offered this’, ‘patient seemed very pleased when it was offered.’ NHS England has now identified GoodSAM as the NHS supported product for use by NHS 111 services.

Workforce Development

DHU 111 is committed to supporting the development of a workforce with the appropriate skills and competence for the health care of the future. Over the last year we have developed and embedded a change to managerial roles to support our teams and now have a stronger operational and clinical model as well as an increased number of dedicated Team Managers and Clinical Performance Managers. Our training content has had a review to ensure the content helps prepare our staff for the complex roles they will undertake. This review led to some additional content being added which we think will enhance our already comprehensive training package further.



We are also providing additional support to our coaches helping them to develop skills that will enable them to consistently and effectively develop the practice of others. To aid talent management and clinical retention DHU 111 has developed a clinical career framework that demonstrates the opportunities for progression that are available to our clinical workforce. We are very proud of the DHU 111 team and the work they do and are continually striving to identify ways to support them in the roles they do for example, one area of concern raised by our staff has been the challenges of people calling with mental health needs. DHU 111 advisors were concerned about how they could best safely and effectively help this group of patients. To address these concerns we have delivered some bespoke in-house training and have now also commissioned some external mental health training provision to build on this further. Over the last year, DHU 111 has firmly embedded the role of Service Advisor into our teams. Service Advisors are available to help patients who do not need a full NHS Pathways assessment, for example patients who are not feeling unwell but require a repeat prescription, or may have a dental problem that can be referred directly to a dental service or dental nurse. This role supports our career pathways as Service Advisors who achieve the required competencies are supported to progress into the Health Advisor role if they wish. Health Advisors deal with more detailed patient assessments.

DHU 111 has further committed to increasing the retention and recruitment of clinicians and part of this has included developing the clinical remote working team. DHU 111 now has a well embedded team of clinicians working around the country, with access to equipment, resources and systems from a private and confidential area of their home. The remote worker clinicians have improved the availability of these staff to support patients requiring a detailed clinical assessment of their needs. This model has been particularly useful during the COVID-19 pandemic where staff wanted to keep working but could not have otherwise done so due to self-isolation guidance or the need to shield as per Government guidance. A progressive addition to our remote working team is the appointment of Advanced Clinical Practitioners. These clinicians have additional qualifications and experience in advanced patient care and it is hoped they will support the DHU 111 service to improve clinical outcomes and patient experience further. Over the last year, we have expanded our clinical workforce as we strive to ensure we have the right skill sets to support patient needs; we now have additional pharmacists, dental nurses, paediatric nurses and mental health nurses to complement the general skilled nurses and paramedics within the teams.



Emergency Outcomes

DHU 111 has been working to ensure that ambulances are only sent to those patients that really need them. To do this we validate Category 3 ambulance outcomes that have been reached by a Health Advisor during the initial part of the patient assessment. Validation involves having a clinician speak to the patient within 30 minutes of that initial call being placed into a queue (Category 3 outcomes are for those patients with less urgent symptoms but still potentially requiring an emergency response). The clinicians validating these calls provide a more detailed and enhanced assessment of the patient’s symptoms. The clinician can despatch the ambulance if needed or refer the patient onto a different outcome for their ongoing care that is more appropriate to their symptoms and clinical need. This validation of Category 3 ambu-lance patients has been in place for a while and works exceedingly well. Our DHU 111 Clinical Team has managed to avoid the despatch of over 91,000 Category 3 ambulances between April 2020 and March 2021. DHU 111 continues to support the development of the integrated urgent care model across the East Midlands and Milton Keynes. As part of these developments, DHU

111 has worked with other healthcare providers to ensure that only patients who need to attend an Emergency Department (ED) do so. We have created and embedded processes for Health Advisors that they can follow on reaching an ED outcome for the patients they are assessing. The Health Advisor can now refer the patient for a clinical assessment rather than sending them immediately to the ED. This outcome validation allows a clinician to determine if the patient does need to attend the Emergency Department or another alternative and more appropriate place of care. This ensures patients receive the right care in the right place and reduces the pressures on local Emergency Departments. Whilst this model has been in place for some time it has now evolved further with the introduction of ‘111 First’. 111 First aims to encourage people to call 111 before attending the Emergency Department so the need to attend is validated and other places of care are considered if the skills of the Emergency Department are not needed. If, after the initial assessment, it is clear the patient does need to attend the Emergency Department then DHU 111 can book an arrival time slot for the patient (in areas where commissioners have enabled this). The arrival time slot helps reduce waiting times for patients as the flow of patients into

the Emergency Department can be more controlled. Validation of outcomes reached by Health Advisors for some ambulance and ED care outcomes shows the value of adding clinical assessment into the patient’s journey. Clinicians can ensure the right outcome is reached on more complex calls; by ensuring the right outcome there is improvement for the patient’s experience as well as for other care providers involved in the patient’s care.

Leadership & Management Skills

The DHU 111 management team have a significant role to play in ensuring the NHS 111 service is delivered to a high standard and that patients remain safe and receive the care required. We have invested resource into developing our managerial support roles to reflect the growth we have had in the service. We are keen to ensure our managers feel well equipped for their roles and have worked with the Learning and Development Manager to create bespoke training for frontline managers. We have also undertaken learning needs analysis of our middle and senior managers to identify and address their training needs

where required.

Integrated Urgent Care (IUC)

DHU 111 has an integrated Urgent Care platform within the Adastra software system. From this platform we share visibility of patients requiring care from a 111 clinician or from an Urgent Care clinician for the Derbyshire and Leicestershire counties. Our IUC platform within Adastra improves the patient’s journey through the integrated care setting. It allows for multidisciplinary teams to work from specially designed ‘shared queues’. 111 teams can support Urgent Care teams when service demand is high through the shared queue, reducing the potential wait for call backs for the patient. This support is reciprocal with Urgent Care teams also being able to support 111 clinical care when needed. Across other East Midlands counties, DHU

111 have supported a range of approaches

to Integrated Urgent Care both within and

external to the NHS111 service. Our aim is

to ensure patients receive a seamless and

complete episode of care concluding with

either: advice on self-management, a

prescription, or an appointment for further

assessment or treatment wherever possible.



As part of the 111 First aims to reduce inappropriate attendance into the Emergency Department, DHU 111 has been part of the national approach to referral of patients into Same Day Emergency Care (known as SDEC). Work is underway to enable 111 clinicians to refer patients to Same Day Emergency Care where needed and this will give further improvements to the patient journey as well as relieve some Emergency Department pressures.

patients with special patient notes (SPNs)

DHU 111 is committed to improving the experience of care for patients who have a note attached to their care record because of specific care needs they may have. Special Patient Notes have in the past been written to be read by healthcare professionals and therefore the content is of a clinical nature and often complex. The first assessment for all patients contacting the DHU 111 service is carried out by non-clinical members of staff (Health Advisors) and so this required all patients with special notes to be transferred to a DHU 111 clinician so that the notes could be interpreted and appropriate care arranged. DHU 111 is continuing to work with commissioners to ensure SPNs that have clear, easy to read instructions. Work so far has improved the patient journey as the sharing of clear care information ensures we get patients to the right place of care to meet their needs via the Health Advisor’s assessment when appropriate.

Health and wellbeing of our DHU111 staff The nature of the NHS 111 service can be very challenging and demanding at times. To help colleagues cope with the demands and to recognise what value they add to the healthcare system and patient care, DHU 111 has committed to supporting their general wellbeing and mental health wellbeing. Health and wellbeing initiatives offered in the last year include:

Flu vaccinations

COVID-19 vaccinations

Lateral Flow Testing for COVID-19

Reflective supervision

Westfield Health- access to counselling

Safe Spaces for Listening sessions in response to COVID-19 demands

Mental Health First Aid Access

Domestic Violence Support Advisors within NHS 111 come from a wide range of backgrounds and experiences. For each person there will, on occasion, be challenging calls to face whilst assisting patients. A key focus of supporting colleagues has been increasing access to reflective supervision following a difficult call. Immediate supervision, where needed, occurs at the time of the call followed up by reflective supervision on a different day.

DHU 111 has increased the numbers of trained clinical supervisors who can support this reflection over the past year to ensure timely access to support. We are very grateful that we have had the opportunity to offer such a variety of wellbeing innovations to our hardworking NHS 111 staff and we continue to develop further opportunities to help maintain a happy and healthy workforce ready to support patients across the East Midlands.



Paul Tilson

Managing Director Urgent

& Emergency Care

Throughout 2020/21 the DHU Urgent Care (Derbyshire) division has faced some of its greatest challenges with respect to the evolving response to the Covid-19 pandemic. As the covid-19 pandemic escalated across the country at the start of the year the DHU Urgent Care (Derbyshire) team responded immediately. We continued to deliver all of our services and diversified the way we deliver health care by using a greater amount of telephone and video consultations to ensure our patients still received the best care possible. The Urgent Care (Derbyshire) team have also supported the wider Derbyshire health system by delivering clinical services around the management of Covid-19 through from the diagnosis of the condition (via large drive thru screening sites in both the North and South of the county), the management of potential Covid-19 patients at our specific designated clinical sites (Red Hubs) and the visitation of patients in their home when they have had symptoms of Covid-19 (the acute home visiting service). Along with this, DHU have vaccinated a large number of care home residents and their staff in Derbyshire, including the homeless patients and have also supported

the mass covid vaccination sites situated across the county. During the past twelve months the team has continued to work alongside our local health partners, the Clinical Commissioning Group (CCG), local hospitals and Local Authority to develop and transform Urgent Care services, whilst continuing to provide a high quality service to patients. We have introduced Urgent Treatment Centres (pilot) at both the large acute hospitals in Derbyshire. We have also further developed our Primary Care services in the Emergency Department Queens Hospital, Burton. This service has evolved from our previous GP co-located streaming services that has helped divert patients away from needing to go through to the main Emergency department. DHU has led on the introduction of the national NHS111 First initiative across Derbyshire and continue to support this venture in how patients access urgent and emergency care. Alongside this, our traditional Out of Hours service that is provided by the DHU team has continued to provide high quality care that is further complimented by a number of the services opposite that are provided by the DHU team across the county:

Countywide Community Nursing services (Out-of-Hours) across Derbyshire

Urgent Treatment Centres (pilot) situated alongside Emergency Departments (Chesterfield Royal Hospital and Royal Derby Hospital NHS Foundation Trusts)

Primary Care Streaming services at Queens Hospital Burton NHS Foundation Trust

Primary Care Out of Hours at The Rotherham Hospital NHS Foundation Trust

Urgent On-Day Primary Care services and Ext ended Access Hubs

Acute GP Home Visiting Services countywide and East Staffordshire

Phlebotomy services and Walk-In clinics

Community Hospital Medical Cover

Clinician Telephony consultation support

Weekend Palliative Care Home Visiting service

Home oximetry monitoring of patients with Covid-19



The Urgent Care (Derbyshire) GP Out-of-Hours and Community Nursing services are accessed via the NHS 111 service that DHU also delivers This allows integration and partnership working to ensure efficient, effective and safe patient focused care. Patients can also be referred via the NHS 111 service following an initial assessment by a Health Advisor or by a Healthcare Professional. The Ambulance Service, Community Nursing and Primary care teams across the county have direct access to refer patients into the services we provide. This integration has the ability therefore to streamline the patient’s journey. A team of highly skilled clinicians within the Urgent Care team ensures a timely assessment is undertaken either by telephone, face to face at one of our 12 Primary Care Centre locations across Derbyshire or via a home visit. The locations of such centres and services are based around the county to ensure ease of access to patients. The above 12 Primary Care Centre locations are in addition to the 3 hospitals where DHU work alongside Emergency Department colleagues to deliver urgent care services for patients. Our 24/7 home visiting services which includes Out of Hours, Community Nursing and Acute Visiting services is supported by a fleet of 25, 4x4 vehicles. The home visiting service enables DHU clinicians to visit patients, either within a 1, 2 or 6 hour timeframe depending on clinical priority. Home visits are necessary for a number of patients predominantly the elderly, terminally ill or housebound patients that require a clinical assessment and are unable to travel to one of our Primary Care Centres. The ability to review patients in their own homes by an experienced clinician ensures they receive the correct

treatment and care promptly and avoids unnecessary transfers to the Emergency Department or hospital where appropriate. During the last 12 months, over 300,000 consultations were undertaken by the Urgent Care (Derbyshire) division team, a significant increase compared to the previous year. These consultations comprised of Primary Care Centre face to face appointments, telephone consultations, video consultations and home visits. Patients also visited one of our 4 drive-thru covid-19 swabbing centres. Home visits were also made by our Community Nursing Team to housebound patients. Of the over 300,000 consultations that were undertaken, less than 10% of patients required onward referral to an Emergency Department (ED) or admission to hospital speciality. The Covid-19 pandemic has affected the ability for patients to access primary health care in the normal traditional model of seeing a clinician face to face and as a result there has been a shift to conducting appointments by telephone and video consultations. This has been well received by patients as the convenience and efficiencies of not having to physically leave their homes during the ‘lockdown’. This change to a more telephone/video based consultation has also been carried through in to our DHU urgent care settings meaning the risk to patients leaving their home during the pandemic have been minimised. The ability to electronically send prescriptions to local pharmacies has also further ‘digitalised’ the delivery of health care and DHU are now focused on using the latest innovations to steer our future clinical strategy.

Paul Tilson (Managing Director): “During the last 12 months the Urgent Care (Derbyshire) division has continued to deliver outstanding care to our patients and residents across Derbyshire despite the difficulties faced with Covid-19 and we are determined to continue put patient care at the centre of our future clinical strategy. Derbyshire’s Urgent Care and Community Nursing services have continued to expand, improving the patient journey whilst meeting the needs of patients locally at one of our 12 Primary Care Centres, on the telephone or from one of our home visiting teams. I am delighted to inform that Urgent Care (Derbyshire) has not only achieved all of the Local GP Out-of-Hours National Quality Requirements but we have exceeded the National Key Performance indicators despite the demands place on the service due to Covid-19. The Urgent Care (Derbyshire) team’s continued dedication and professionalism in ensuring that we provide a clinically led, high quality service and positive patient service is a testament to them. The Quality Account showcases the advances within the Urgent Care (Derbyshire) division, and exhibits the accomplishment of our innovations in delivering high quality patient focused Urgent and Primary Care Services across the county.”



Delivering our DHU Urgent

Care (Derbyshire) in

collaboration with system

partners

DHU Urgent Care(Derbyshire) Division is proud to be an evolving service, working very closely with local Clinical Commissioning Groups (CCGs) and other health care services to provide services to our patients around the clock. Traditionally, our services were provided in the ‘Out-of-Hours period’ when patients’ GP surgeries were closed between 6.30pm and 8.00am. Due to the Urgent Care needs of patients, by working collaboratively with our partners, a number of our services also operate during the day time between 8am and 6.30pm. Our team truly provides health care 24 hours a day, 365 days per year, and having delivered services across Derbyshire for many years; we have been successful in continuing to provide services in neighbouring counties on behalf of East Staffordshire CCG, South Yorkshire and Nottinghamshire CCG’s

A list of the organisations and services we are proud to collaborate with are shown on the chart:

Services provided by the DHU Urgent Care (Derbyshire) division

Chesterfield Royal Hospital NHS Foundation Trust, Urgent Treatment Centre (UTC)

GPs and Advanced Practitioners working in the UTC area of the Emergency Department.

Derby Teaching Hospitals NHS Foundation Trust, Urgent Treatment Centre (UTC)

GPs and Advanced Practitioners working in the UTC area of the Emergency Department.

Derbyshire PLACE Amber Valley, Chesterfield, Derby City South, High Peak & Dales, North East Derbyshire, South Dales. Senior Clinicians providing additional appointments for GP practices evenings and weekends as part of extended access

East Staffordshire CCG Acute Home Visiting Service (AVS)

GPs & Advanced Practitioners providing Acute Home Visiting service for all East Staffordshire GP practices

Erewash CCG Acute Home Visiting Service (AVS)

Advanced Practitioners providing an Acute Home Visiting service for 12 GP practices across Erewash

Erewash CCG Extended Access Hubs Advanced Practitioners providing additional appointments for 12 GP practices across Erewash, at a weekend.

Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital

GPs and ANPs providing hospital medical cover evenings, overnight and weekends

Derbyshire Community Health Service NHS Foundation (DCHS) (Derbyshire)

GPs and ANPs providing complete medical cover for all patients within the community hospitals Out-of-Hours GPs and ANPs providing advice and clinical review for patients admitted over the weekend

DCHS Vehicle Support (Derbyshire) DHU Vehicles provided for staff to take patients on home visits

DCHS Community Nursing (Derbyshire) DHU provide the evening and overnight Community Nursing Service across Derbyshire

Nottinghamshire Healthcare NHS Foundation Trust(Bassetlaw)

Overnight GP and ANP Clinician Advice/Home Visits and administrative services including clinical audit and clinical supervision

GP Practices: Derbyshire GP practice telephone support as required

Rotherham NHS Foundation Trust GP support for primary and community urgent care services

Southern Derbyshire CCG Daily Phlebotomy clinics for children and adults

DHU/ DCHS: 4X4 Inclement Weather Resilience

Provide ad hoc 4x4 Vehicle Support at times of severe inclement weather in the County of Derbyshire. Transporting staff and ambulatory patients as required.

QUEST (Quality, Uninterrupted, Educational Staff Training) & PLT (Protected Learning Time)

GPs and ANPs providing GP practice teaching cover across Derbyshire to facilitate their QUEST and PLT sessions.



Delivering our DHU Urgent Care (Derbyshire) Services in 2020/21 DHU Urgent Care (Derbyshire) saw a consistent increase in the number of patients requiring our services overall, in comparison to 2019/20, including many of the specific services that were mobilised to support the pandemic response. All Primary Care Centres operate seven days per week providing Urgent Care during the Out of Hours period. Ashgate Manor, Derby Urgent Care Centre and Ilkeston Community Hospital also cover the overnight period. During the covid-19 escalation DHU only closed one of its 12 Primary Care Centres (PCC) in April 2020. Clinicians from this PCC were redeployed to support the increase in consultations at our main PCCs. The clinic reopened during the weekend for 4 hours per day and was reopened early summer.

Ashgate Manor, Chesterfield

Buxton Hospital

Derby Urgent Care Centre

Ilkeston Community Hospital

North High Peak Urgent Care Centre

Swadlincote Urgent Care Centre

The following additional facilities are open at the weekend and on bank holidays:

St Oswald’s Hospital Urgent Care Centre, Ashbourne

Castle Street Medical Centre, Bolsover

Long Eaton Health Centre

Clay Cross Hospital

Ripley Hospital

Whitworth Hospital All UCD services are available to the residents of Derbyshire along with visitors to the county and can be accessed by contacting NHS 111 or walking into one of our

designated walk-in services at New Mills, Ashbourne or Swadlincote. Following a thorough and detailed assessment of a patient’s health care requirements, an NHS 111 health advisor can recommend to each patient the most appropriate course of action. For example:

Self-Care advice

Local Pharmacy

Local Dentist

Own GP during daytime opening hours

Arrange a senior clinician telephone consultation from DHU’s clinical team if Out-of-Hours and subsequently either a Primary Care Centre appointment or home visit, if required.

Advise attendance at a local Minor Injury Unit or Urgent Treatment Centre.

During 2020/21 the way patients access DHU services has evolved in line with national guidance and the covid-19 pandemic. Face to face consultations have always been and continue to be available for patients accessing DHU services. Over the last 12 months through digital technology, virtual consultation and video consultation we have been able to consult with patients differently. Overall there has been an increase in telephone consultations, video consultations and home visits. PCC attendances have decreased despite being available if required. The Rotherham NHS Foundation Trust

During the last 12 months DHU Health Care have been working with our Rotherham Hospital colleagues supporting deliver the Out of Hours service for the residents of Rotherham. The DHU team has been able to

deliver local Out of Hours urgent care in the Urgent and Emergency Care Centre within the Emergency Department via telephone consultation or if required during a home visit. Our working partnership with Rotherham Hospital continues to go from strength to strength. Nottinghamshire Healthcare NHS Foundation Trust DHU Health Care continues to provide overnight Clinician Advice, Support, Visits and Administrative Services on behalf of Nottinghamshire Healthcare Foundation Trust (NHFT). NHFT are a group of local General Practitioners and Clinical Practitioners who provide primary care outside of the normal GP working hours for service users registered within the Bassetlaw area. NHFT are based at the Primary Care Centre in Bassetlaw General Hospital. Their service is available to everyone registered with a Bassetlaw GP and is accessible via NHS 111. In addition to this service, we now undertake Clinical Audit, utilising the RCGP Clinical Audit Toolkit, as this provides DHU Health Care and Nottinghamshire Healthcare NHS Foundation Trust with robust system checks to help deliver and ensure good, safe practice. Information we gain from clinical audit is used to support doctors and nurse’s appraisal, certification and revalidation competencies. Furthermore, the clinical team have access to Clinical Supervision. This is a formal and disciplined working alliance that is generally, but not necessarily, between a more experienced and a less experienced member of the clinical team. The supervisee's clinical work is reviewed and reflected upon, with the aims of: improving and supporting the supervisee's work, ensuring patient welfare and supporting professional development.

25



Urgent Care (Derbyshire) Out-of-Hours Service Performance Report

Out-of-Hours (OoH) services continue to be assessed in line with the National Quality Requirements (NQRs) for Urgent Care Services which have to be achieved by all OoH providers. The DHU Urgent Care (Derbyshire) team pride ourselves in highlighting our exceptional patient care, not only through patient feedback but supported by our continual achievement of the NQRs. The NQRs by which we are assessed are National Quality Requirement 10 (NQR10) and National Quality Requirement 12 (NQR12) which both focus on the timeliness of delivering our Urgent Care Services. NQR10 specifically assesses face-to -face clinical assessment from arrival to treatment times for both urgent and routine walk -in patients. Despite the challenges that we have faced the Urgent Care (Derbyshire) division has again achieved above the target of 95% compliance for 2020/21 with our clinicians successfully being able to see and treat 96.3% of all urgent walk-in patients within one hour of arrival and 99.8% of routine walk-in patients within two hours of arrival. National Quality Requirement 12 relates to face-to-face Primary Care Centre / Home Visit clinician consultation. This standard relates to patients who are identified as requiring an appointment at one of our primary / urgent care centres or a home visit. Based on these standards, the Urgent Care (Derbyshire) service continually reviews clinical service provision, to ensure that staffing levels and opening times are available when patients who then require an appointment or home visit receive these within the specified timeframe. As a result of our commitment to patient care and the continual improvement of the services we provide, over the last year we have achieved even better performance results. As highlighted, our performance has continued to improve over the last twelve months despite the challenges due to the covid-19 pandemic. However, maintenance of these standards, improvement of these standards and ensuring a quality patient focused service, is our continued goal.

CQUIN - Flu Vaccinations

The CQUIN for 2020/21 was split into two parts and focused on Flu vaccination. Staff flu vaccinations are a crucial lever for reducing the spread of flu during winter months, where this can have a significant impact on the health of patients, staff, their families and overall safe running of NHS Services. CQUIN 1a : In order to achieve this target DHU were required to demonstrate that 80% of front line staff were vaccinated by Quarter 4 based on the number of staff employed as of the 1st September 2020. 154 staff was identified as being front line within the division and work was undertaken across the organisation to promote flu vaccination uptake. Vaccinators were trained to offer planned and adhoc vaccines within our Primary Care Centres and call centres. At the end of Quarter 4, 126 members of staff in applicable roles (81.8%) were vaccinated, meeting the CQUIN target. CQUIN 1b : In order to achieve this target DHU were required to demonstrate that we had supported the Derbyshire Flu Programme, offering support to the Primary Care Networks (PCN) to complete vaccination within Care Homes. Each PCN was allocated a number of sessions of support, calculated per patient population. The PCN identified the Care Homes to support within the programme and liaised with the DHU lead. The immunisation team consisted of two qualified nurses trained in the administration of vaccinations, one of whom was a Non-Medical Prescriber. 64 Care homes, 1763 Flu vaccinations were completed during the period of September – November 2020. A small number of PCN’s had already completed the care home vaccinations and we therefore supported them, as an alternative with housebound and clinic provision. This provided a further 288 vaccinations. The success of this programme provided valuable experience and insight to utilise when planning the subsequent COVID-19 Care Home vaccination programme.



ED Clinical Validation

The DHU Urgent Care (Derbyshire) team have continued to support the delivery of urgent care services across Derbyshire working alongside our NHS 111 colleagues. The Urgent Care (Derbyshire) team delivers the Emergency Department (ED) Clinical Validation service. When a patient contacts the NHS 111 service and speaks to a Health Advisor and the outcome of the assessment advises that a patient potentially needs to attend their local Emergency Department (ED) the patient is offered an in depth clinical consultation with an Urgent Care (Derbyshire) GP, Advanced Nurse or Paramedic Practitioner. More often than not patients appropriately prefer to speak to a clinician rather than go to the ED. The ED Clinical Validation Service consists of senior clinicians a GP, Advanced Nurse or Paramedic Practitioners. This service is available 24/7, 365 days per year and accessible following a NHS 111 telephone assessment. The call back from the senior clinician is within 20, 30 or 60 minutes depending on the NHS 111 assessment priority timeframe assigned. Over 93% of patients were contacted within the above timeframe with a senior clinical consultation being completed. During May 2020 we also worked with NHS Digital services to enable patients to request a senior

clinician callback if the same outcome was advised if patients are accessing the NHS 111 online service as opposed to accessing the NHS 111 Service via telephone. The ED Clinical Validation service has provided excellent outcomes for patients. Over 11,000 patients (>65%) that received a senior Clinician callback and consultation from a member of the Urgent Care (Derbyshire) team did not need to attend their local Emergency Department. Providing this high level clinical consultation has further supported patients being referred to the most appropriate service or receiving self-care health advice.

27



RCGP 2020-2021 Results

Urgent and Emergency Care is usually accessed at a time when patients can be at their most frightened and vulnerable. The Royal College of General Practitioners (RCGP), in partnership with The Royal College of Emergency Medicine (RCEM), has developed an Urgent and Emergency Care Clinical Audit Toolkit. This toolkit has also been extensively piloted by the RCGP and RCEM and is also endorsed by the Ambulance Service and the Royal College of Paediatrics and Child Health. Our patients have a basic right to a high quality of urgent care at whatever time they use the health service and we must have the knowledge and ability to provide robust system checks to help deliver and ensure good, safe practice is learnt from and maintained. Use of this toolkit will:

Improve the quality of individual consultations along with the patient who presents with urgent and emergency care needs;

Strengthen and develop the needs of the workforce, contributing to an improved patient experience for urgent and emergency care services;

Develop strategy and implement to encourage continuous quality improvement and improvement in productivity (QIP);

Allow information from the audit to be used to support doctors and nurse’s appraisal, certification and revalidation competencies. Audits are completed by clinicians that have been trained in the use of the RCGP toolkit.

Audits are completed by clinicians that have been trained in the use of the RCGP toolkit. RCGP recommendations set a target for 1% of all cases to be audited each quarter. It is a commissioning requirement as part of the OOH Quality Schedule to ensure that clinicians are audited as per recommendations. A random export of 1% of all clinical notes from the Adastra system is completed on a monthly basis. These calls are then imported into the Quality Assessment Management module (QAM) on a monthly basis. The QAM system creates a template for the Auditor to complete as a record of the audit. SystmOne audits are completed manually for each module used, 1% of a clinicians workload. Within Adastra, clinical notes are then randomly selected for audit from the imported notes. A report is produced through QAM and monitored by the Audit Team to ensure that an individual is not over/under audited. Within SystmOne the auditor randomly selects a case to audit from a date range. Clinical notes will be assessed by the Auditor using the voice recording and the appropriate Adastra/SystmOne summary. All Quality Assurance scoring will be in accordance with the latest RCGP Standards. The Auditors will complete the template as they listen/review to the call/case and then summarise their findings. The system will automatically calculate the outcome in respect of performance. The electronic version of the audit will be stored within the Adastra system. For SystmOne a

manual report will be collated, stored within the clinician’s personal folder. Only RCGP protocols and instructions will be scored in an audit. Any DHU Health Care CIC procedures will be identified in the audit comments for feedback purposes but not complied. New starter staff will be audited at least four times during their probationary period. Feedback to staff that are being mentored during their training period should be given by both their line manager and the training team. This is recorded for information only on the new staff members file. Appropriate training needs are identified during this feedback in order to facilitate areas for development. New DHU Health Care CIC staff who have had satisfactory audits. The training team/line manager will receive feedback consistent with the process for all other ACPs/NPs/SNPs/GPs. All Feedback following the audit of a call is delivered in a timely manner. Overall scoring for each case will elicit a Rag Rating, demonstrated below. This will be used as a visual guide to compliance

Rag Rating 90-100%

75-89%

0-74%



Urgent and Emergency

Care Derbyshire Results

Please see opposite RCGP Audit 2020-2021 results table (Average scoring over the year period) The audit results over the past year have ensured and reassured the Board and Stakeholders, that all clinicians within DHU Health Care are working to a very high standard. However, it is one thing to attain success and another to maintain it sustainably. The audit and quality improvement approach has the advantage of engaging those placed to make change and those expected to deliver and maintain change on a daily basis. This approach has a demonstrated track record of delivering and maintaining service improvement for DHU Health Care. Where there are expectations of delivering and maintaining better quality care and outcomes, the audit and quality improvement should be the normally used first-line approach. The findings RCGP Clinical Audit outcome reviews and all other forms of reviews and assessments will be one of the principal mechanisms for assessing the quality and effectiveness of healthcare services provided by DHU Health Care. Over the coming year we aim to continue with our nurturing ethos. This will be maintained and achieved by the continuation of communication and encouragement of audit:

With the regular publication of a DHU Health Care Audit Newsletter, highlighting developments and

findings from recent reports.

Feeding back on the performance of individual clinicians within clinical audit, providing a one to one service as appropriate for reflection and action.

By raising the profile of clinical audit with clinicians and all staff working within the DHU Health Care, including our stakeholders and professional bodies to encourage audit amongst their disciplines and specialism.

Developing closer partnerships working with other organisational clinical audit teams to improve knowledge and understanding of national and local audit/review activities.

Working in partnership with other healthcare organisations e.g. Public Health England, NHSE/I to promote and encourage a culture of participation in audit and action on findings.

Question Average Scores %

1. Elicits REASON for call/visit 99.88%

2. Identifies EMERGENCY or SERIOUS situations 100.00%

3. Takes an appropriate HISTORY (or uses algorithm appropriately) 99.75%

4. Carries out appropriate ASSESSMENT 99.50%

5. Draws CONCLUSIONS that are supported by the history and physical findings

99.88%

6. Makes appropriate MANAGEMENT decisions following assessment 99.63%

7. Correctly fills in appropriate DOCUMENTATION 99.50%

8. Appropriate PRESCRIBING behavior 95.39%

9. Displays adequate SAFETY-NETTING 91.29%

10. Did the clinician address any potential SAFEGUARDING issues? 94.84%

11. Makes appropriate use of IT / Protocols / Algorithms 95.94%

12. Displays EMPOWERING behavior 100.00%

13. Develops RAPPORT 99.76%

14. Satisfies ACCESS criteria where appropriate [info available] 100.00%

Overall Average 97.82%



Community Nursing Service

Urgent Care (Derbyshire)

DHU continues to provide the evening and overnight community nursing services across Derbyshire. The service is provided on behalf of Derbyshire Community Health Service (DCHS) NHS Foundation Trust in Derbyshire County from 6pm-8am and Derby City 10pm-8am. The team consists of District Nurses, Community Staff Nurses and Health Care Assistants. The service delivers nursing care to housebound adults countywide, working in partnership with our colleagues in DCHS who provide the service 8am-6pm, in order to provide a 24/7 community nursing service to the population of Derbyshire. The north Community Nursing staff have also supported the successful delivery of the Palliative Care Service pilot during the day time at weekends and bank holidays. Community Nursing is an essential service in helping people to maintain their independence, facilitate the avoidance of unnecessary admission to hospital services by managing patients at home and supporting patients to manage their health conditions. The Community Nursing team are key to the successful delivery of care closer to home. Throughout the covid-19 pandemic the Community Nursing service have continued to visit patients at home, face to face whilst using the appropriate personal protective equipment (PPE).

The Community Nursing service operated by DHU is also integrated with the NHS 111 service and the Out-of-Hours GP service. This ensures that there is a team approach to care and the most appropriate member of the team visits the patient as required. Patients can be supported by all DHU services allowing communication and a joined up approach to patient care. The team provide both planned and urgent care to patients in their own homes. DHU have community nursing teams based at the Cavendish Hospital in Buxton, the Whitworth Hospital near Matlock, our Chesterfield base at Ashgate Manor and our head office at the Johnson Building in Derby. Each team consists of a District or Community Registered Nurse and a Health Care Assistant, or an Assistant Practitioner and Health Care Assistant, who travel around the county together in fully equipped response vehicles. Recently the local CCG have funded the purchase of additional syringe drivers for the team to enable them to continue to provide timely treatment to patients at home at the end of their life. In the last year DHU has implemented the role of the Assistant Practitioner within the Community Nursing team. The Assistant Practitioners have either completed, or are currently completing the Assistant Practitioner foundation degree. As part of their training the Assistant Practitioners study values and ethics, clinical practice skills, medication management and person centred care. The introduction of this role within the Community Nursing team has allowed us to develop our Health Care Assistants further and introduce further skill mix into the team.



The service operates on the SystmOne electronic record system which allows communication and electronic referrals between the day and evening service. This mirrors the system that is accessed by our Community Nursing colleagues during the day. Accessing the same system enhances patient care and provides seamless communication between the day, evening and night Community Nursing services. If the patient has consented and the GP service is a SystmOne user, it allows the team to view all relevant information relating to the patient and their care. The Community Nursing Service continues to deliver evidence based interventions which may include (but not be restricted to):

End of Life and Palliative Care

Syringe Driver Management

Catheter management

Bowel Management

Wound care/tissue viability

Complex wound management

Leg ulcer management

Diabetes care

Medication administration

Please see below graph as a comparison of activity:

Phlebotomy Service at the DHU Derby Urgent Treatment Service

Our team have continued to play an important part throughout the Pandemic in offering Derby City patients a blood taking service. At times the service has been the only access for patients to walk in to have their blood taken whilst others have preferred to make an appointment. During the lockdown periods across the UK attendance was understandably lower than the previous year. As the UK has moved through the lockdown phases the numbers of patients utilising this service has increased significantly. Overall the service has seen a 41% increase in patients attending the service. There has been a decrease in children attending for blood tests but a 53% increase in adults attending in 2020/21 compared to 2019/20. To meet this demand we have worked closely with the Derby & Derbyshire Clinical Commissioning Group (DDCCG) to enhance the staffing provision within the service provided across the system to meet the patient demand experienced in both the acute hospital trust and community phlebotomy clinics.

Urgent Treatment Centre Transformation

In October 2020 Chris Marrow-Frost (Clinical Head of UEC Improvement and Transformation for NHS England and NHS Improvement) completed a ‘Missed Opportunity Audit’ on the Emergency Departments (EDs) within the East Midlands. The data produced for Royal Derby Hospital (RDH) and Chesterfield Royal Hospital (CRH) highlighted that 70-75% of ambulatory patients attending the ED could be effectively managed within an Urgent Treatment Centre. Based on this there has been a regional move to provide co-located Urgent Treatment Centres (UTCs) at both RDH and CRH. DHU Health Care has worked alongside and supported the leadership teams at the respective hospitals providing project support and expertise in order to mobilise fully functioning UTCs. Provisional data suggests that the UTCs are managing around 80-110 patients per day equating to around 30% of total ED attendances. Both sites are seeing positive performance in relation to the four-hour targets with >98% achieved. CRH has consistently been ranked in the top 10 performing ED nationally in recent months and the UTC is believed to be a contributing factor to this. We continue to see patient numbers managed within the UTC increasing as the clinical offering of the services develops and evolves to meet the needs of the patient demographic. NHS England released revised UTC principles and standards in February 2021 that outline the Service requirements.

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DHU Health Care has formulated a detailed project plan based on the 79 standards identified, in order to ensure the UTCs developed meet the national standards and requirements. Work has been undertaken for both RDH and CRH to produce a gap analysis and identify further actions that need to be implemented in order to reach the gold standard of UTC provision. Both services are well on their way to achieving these standards and in some cases going above and beyond. Both CRH and RDH UTCs are able to offer the full range of diagnostics required of a UTC standards, with access to radiological services also. Clinical pathways have currently been agreed at both sites with Same Day Emergency Care (SDEC) and ambulatory care services to allow direct referral and ED avoidance. Work continues at both sites to introduce new clinical pathways that will improve the referral processes to specialties such as Gynaecology and Surgery in the hope that further patients can be managed without the need for ED intervention. Work with external providers and the wider healthcare network is underway to build an improved healthcare network and access to community services for patients within the UTC. Patient information leaflets have been created advising patients on accessing health services and an education package is currently under development for the ambulance service, to support ambulance staff in identifying patients suitable for UTCs, in order to reduce the pressures on the EDs. The level of progress achieved at both CRH and RDH in such a short space of time has been commendable, and this is represented in the feedback. The following patient feedback was received rating the UTC at RDH as ‘Very good’ with the following comments “All staff this evening brilliant…” Emergency Care Consultant, Dr Katherine Lendrum (CRH) says: “We’re setting out to improve our patients’ experience by trialing an Urgent Treatment Centre (UTC) style of care, but within our existing Emergency Department (ED).

It will help to make sure that everyone is seen in the right place, first-time, by the most appropriate clinician and importantly gives us greater capacity to care for those patients with the potentially life-threatening and serious conditions that require high-level emergency medicine skills and expertise.” Pictured below left to right: Reiss Bond, Head of UTC, DHU Health Care, Dr Sole Garcia, UTC Deputy Clinical Director, DHU Health Care. Mike Hedland, Service Manager, Emergency Care, Chesterfield Royal Hospital. Genieve Revell, Sister, Emergency Department, Chesterfield Royal Hospital. Paul Tilson, Managing Director, DHU Health Care and Claire Lambie, Head of Operations, Chesterfield Royal Hospital.

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DHU Urgent Care Derbyshire Support for COVID-19

Over the past 12 months DHU Healthcare has been commissioned by Derby and Derbyshire CCG (DDCCG) to provide a number of COVID-19 testing programmes across the county.

Symptomatic Testing

Following a short period of symptomatic testing of people in their own homes, during the initial stages of the COVID-19 pandemic, three ‘Drive Thru’ testing sites were mobilised at the following sites with the support of our partner organisations:

Newholme Hospital, Bakewell; Derbyshire Community Health Services (DCHS)

Tapton House, Chesterfield; Chesterfield Borough Council

All Saints Church, Derby; The Parishes of Kirk Langley, Mackworth and Muggington

In April 2020 two larger sites, to replace this provision, were sourced by the Local Resilience Forum (LRF) and DDCCG at The Proact Stadium in Chesterfield and Toyota Manufacturing Plant at Burnaston in Derby. Both sites went onto the National Portal in June 2020 providing a capacity of 500 tests per day, seven days per week managed by a team of Nurses, Healthcare Assistants, Marshalls and Security. In September 2020 the sites were upgraded to ensure they were winter ready with heating and lighting. Both sites have been extremely successful in their delivery of testing during the pandemic. In summary, between April 2020 and March 2021 the sites completed 80,000 tests. ‘We would like to take this opportunity to thank you for the close cooperation and work undertaken by the staff at the test sites’ - Derby and Derbyshire CCG



Outbreak Swabbing

DHU has provided a mobile team of Health Care Assistants trained in completing COVID-19 swabbing to support Care Homes and other residential settings since February 2020, commissioned by DDCCG. The team have responded to outbreaks within Care Homes, Prisons, Schools, Independent Hospitals and Asylum Seekers accommodation across Derbyshire. This programme has required the team to work closely with Public Health England to ensure prompt testing is undertaken reducing the spread of infection amongst vulnerable people within our population. Training and support to complete regular asymptomatic testing has been provided to a number of Care Homes across the County.

(The team and staff at The Park Nursing Home in Derby pictured above )

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Community Testing

DHU provide clinical oversight to the asymptomatic testing sites provided by Derby City and Derbyshire County Council across the county. These sites provide Lateral Flow Testing to the community to reduce asymptomatic spread.

Antibody Testing

DHU worked with a number of partners in the roll out of a programme of Antibody testing in the summer of 2020 to determine the level of COVID-19 immunity in the community. All DHU staff were offered an antibody blood test; 776 staff were tested, 13% had a positive antibody response in line with national data. Subsequent testing and result processing was completed for approximately 8000 staff across Derbyshire compromising of Primary Care, Podiatrists, Pharmacists, Dentists and Social Care.

Lateral Flow Testing

All DHU staff have been offered Lateral Flow Testing to reduce asymptomatic spread to the patients our teams come into contact with and also our colleagues within the organisation. This test is completed at home twice weekly and results are registered online as part of NHS Test and Trace. “I found the Lateral Flow tests quite reassuring, with all the media presence and scare regarding Covid it was nice to know that I was ‘safe’ (for want of a better word) knowing that I was getting regular testing and that I was not unintentionally passing the virus to others.” Kerry Pritchard (NHS 111 Call Advisor/CC Coach)

Donna Brewster Senior Nurse Practitioner, who delivered the

training to the teams.



National Swabbing Pilot

A national pilot was commenced on the 7th September 2020, coordinated by the Department of Health & Social Care, offering symptomatic patients a COVID swab test as part of the countywide Red Hubs and Acute Visiting Service provided by DHU. This pilot was designed to improve access to COVID testing and streamline the process for patients. In particular this has been helpful to those patients who are housebound and find it difficult to access testing which then impacts on the length of isolation for families and carers. The clinician assists the patient to complete both the test and online registration. The experience for patients and clinicians has been excellent and this has been fed back nationally.

COVID-19 Vaccination

DHU teams commenced COVID-19 vaccination at the beginning of December 2020 supporting the Derbyshire system. Initial support included Vaccination Hubs at Chesterfield Royal NHS Foundation Trust, The Winding Wheel in Chesterfield, Newholme Hospital and Derby Arena. On the 29th December 2020 we commenced a programme of vaccination covering Care Homes and subsequently the housebound, across several Primary Care Networks, in Derbyshire. In total, for dose 1, we vaccinated the following;

4500 Care Home residents and staff

2500 Housebound residents

250 Homeless and hard to reach people at Derby City Mission and across Derbyshire

This has been an incredible achievement in just over 9 weeks and we will continue to complete dose 2 alongside vaccination support to the system to complete further cohorts. In January 2021, DHU supported the booking of COVID-19 vaccinations on behalf of Erewash Primary Care Network (PCN).

A wide cohort of patients were contacted to book just over 800 appointments for 1st & 2nd Dose vaccines over a 2 week period. This support enabled the PCN to co-ordinate a central approach to the booking process and was a successful service and appreciated by patients. The service particularly focused on supporting the over 70 years of age population of Erewash and facilitated the timely and successful delivery of the vaccination programme. ‘’I wanted to write to express my (and on behalf of all of the care home residents, staff and many of the GP surgery staff) appreciation for the DHU team who have supported vaccination. And with my other hat on (as JUCD Place Board Chair) this is such a wonderful example of collegiate and inter-organisational working at its best.’’ Dr Penny Blackwell, GP, Hannage Brook Medical Centre. Place Board Chair and Governing Body GP, NHS Derby and Derbyshire CCG GP Lead for Shared Care Pathology.

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Covid Oximetry @ Home Service, Urgent Care (Derbyshire)

Working with NHS England and our local Derby and Derbyshire Clinical Commissioning Group (DDCCG) DHU commenced The Covid Oximetry at Home service in December 2020 supporting the care of patients across Derbyshire who have received a positive COVID-19 test result, are at risk and are symptomatic. A DHU Care Co-ordinator and Advanced Practitioners have supported patients at home and the delivery of the service across Derbyshire. Regularly monitoring of oxygen levels via virtual consultations and if required a face to face consultation have enabled the team to closely monitor patients and aid their recovery from covid-19. The Covid Oximetry at Home service has seen just over 260 patients enrolled through the service and supported with hospital admission avoidance. Throughout December 2020 to March 2021, the service was rolled out to include patient referrals from the following services;

GP Out Of Hours

Primary Care/GP Surgeries

Hospital Acute Trusts/Emergency Department’s/Medical Admission Unit’s ‘MAU’

All Covid Red Services including Acute Home Visiting and Primary Care Centre Hubs

Care Home Outbreak Swabbing Service on behalf of Public Health England (PHE)

As treatment of COVID improves, earlier detection of (silent) hypoxia (low oxygen levels) at home could help further reduce mortality and morbidity. There is good evidence that the lower the oxygen saturations at presentation, the higher the expected mortality. Patients at risk of poor outcomes are best identified by poor oxygen levels (Richardson et al, 2020). Unpublished evidence from over 1,000 COVID patients’ initial oxygen saturation recordings in the community (that were later admitted to hospital) shows that if they are below 93%, the mortality rate is nearly 30% (see Fig. 1). If we can identify COVID patients with low oxygen levels early, there are proven treatments that improve the survival rates (Dexamethasone- 20% improved survival in those requiring oxygen and 35% in those being ventilated), improve recovery and reduce hospital length of stay.

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Figure 1 – The importance of Oxygen Measurement (WMAHSN, 2020).



Patient are enrolled and embark on a program of oxygen level self-monitoring using pulse oximeters that can detect low oxygen levels and enable proactive interventions to take place if required. The DHU Care Co-ordinators and Advanced Practitioners have enabled the delivery of this highly successful service. There are two elements of patient monitoring in the home environment: COVID Oximetry at Home and COVID Virtual Ward. The service has been praised by many of the patients with positive feedback as seen below.

‘’This is an amazing service and has helped so many patients; thank you to all

involved.’’

‘’Thank you all for your help during this horrible time, I appreciated everyone and

everything, very reassuring.’’

‘’You cannot improve on perfection.’’

‘’Excellent service, good to have and felt safe.’’

DHU Red Acute Home Visiting Services (RHVS) Urgent Care (Derbyshire)

At the beginning of the pandemic in 2020 the DHU Urgent Care (Derbyshire) Division worked with the Derby and Derbyshire Clinical Commissioning Group (DDCCG) to deliver a home visiting service to support patients in their own home and primary care services across the county. The home visiting was designed to see patients who were suffering from the classic Covid-19 symptoms; a fever, a new continuous cough and/or loss of taste and smell. This service was to be delivered during daytime hours and therefore in essence an increase in primary care provision to support patients who were clearly not well and because of the pandemic were unable to leave their homes. By the virtue of the patients that the service was visiting it was deemed appropriate to identify these patient visits as requiring ‘red’ visits. Patients not displaying any signs or symptoms of covid-19, if requiring a home visit were deemed as requiring a ‘green’ visit and would still be visited by their own GP practice team. The RHVS commenced on 06 April 2020 and is still in operation to date. It continues to provide a home visiting service for those patients that are in need of a GP or Advanced Practitioner clinical consultation but because of some of their symptoms or if too unwell they are unable to travel to their GP Practice. The service initially operated 08:00 – 18:00 Monday to Friday which also included Bank Holidays. In 2020 primary care GPs were operational for most of the bank holidays until August to support the care required for the vast numbers of patients being infected by Covid-19. Due to the continued escalation of the pandemic in July 2020 the service was further expanded

with the home visiting service operating until 19:00 each weekday evening, thereby provided extra support to patients in their own homes and preventing any extra pressure other service across the county. The service commenced with two vehicles; one in the north and one in the south of Derbyshire however that soon escalated to 4, then 5 and increasing to 6 plus vehicles undertaking the home visits. At the peak of the pandemic 11 vehicles were visiting patients across the county. Each of the DHU vehicles is driven by a dedicated driver working with the clinician assigned to the car/service. Each vehicle carries a full kit of resuscitation equipment including oxygen and an appropriate selection of medications. DHU RHVS clinical teams comprises of GPs and Advanced Nurse or Paramedic Practitioners. The commissioned service is supported by a robust service specification and a standard operating procedure (SOP) which was widely circulated at the very start of the service. The SOP was shared with all of the GP practices, DHU operational staff including our administrative call receivers, operational clinical staff and our highly experienced visiting co-ordinators to ensure that the service is as efficient as possible. The flexibility of provision was wholly supported by the CCG who continue to receive daily updates on the numbers of patients requiring the service. Throughout the whole of the service provision DHU have flexed the contract to suit the needs of the patient population in a time of crisis. The highest number of patients seen on one day was 98 on Monday 25 January 2021 with many other days demanding almost as many visits. In total the service has visited 8, 472 patients over an operating period of 275 days (06.04.20 – 30.04.21).

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Many patients have been very complex due to Covid-19 symptoms. Complexity can often increase consultation times for clinicians and at times our clinicians have had to send patients to hospital because of the severity of their condition. Throughout the pandemic our clinical staff and dedicated drivers have not been without PPE. At the beginning of the pandemic DHU received additional support from schools, colleges and businesses to provide additional PPE to ensure that there was supply for all of our staff. DHU is now and has been, since the end of May 2020, receiving National NHS PPE push supply and we continue to monitor the usage in order to assure ourselves that our staff and subsequently our patients are safe. As a consequence of the Derbyshire provision of a red home visiting service our county border neighbor in Burton, East Staffordshire CCG contacted DHU to ask if a red home visiting service could be offered to their patients; this was in addition to the currently existing green home visiting service that has been in operation since November 2017. Since January 2021 DHU has also been successfully operating a red home visiting service to patients of East Staffordshire and South East Staffordshire supported by utilising an additional car and visiting clinician every day. This service will cease on 11 June 2021 however the CCG are discussing how they can potentially incorporate red home visits in with their existing green home visiting service - watch this space!

DHU Red Hubs Service During the pandemic in 2020 and following the successful implementation of the Red Home Visiting service DHU Urgent Care (Derbyshire) Division worked with the Derby and Derbyshire Clinical Commissioning Group (DDCCG) to provide a red hub service to support patients across Derbyshire and primary care.

The red hub service was designed to see patients face to face who were suffering from the classic Covid-19 symptoms; a fever, a new continuous cough and/or loss of taste and smell. This service was to be delivered during daytime hours and therefore in essence an increase in primary care provision to support patients who were clearly not well but were able to leave their homes. The Red Hubs commenced on 13 November 2020 based at Ashgate Manor in Chesterfield and Derby Urgent Treatment Centre (DUTC) in Derby with an additional Red Hub being commenced at Littlewick Medical Centre in Ilkeston on the 14th December 2020 and all three Red Hubs are still in operation to date. They continue to provide a clinical face to face appointment service for those patients that are in need of a clinical primary care consultation but because of their potential COVID symptoms they are unable to be seen at their GP Practice. The service operates 10:00 – 18:00 (Ashgate Manor & DUTC) and 11:00 – 16:00 (Littlewick Medical Centre) Monday to Friday excluding Bank Holidays. The Red Hubs are delivered by GPs working closely with the RHVS team. Similar to the Red Home Visiting service the flexibility of provision is wholly supported by the CCG who continue to receive daily data on the numbers of patients being seen by this service. Throughout the whole of the service provision DHU have flexed the service capacity to suit the needs of the patient population in a time of crisis, i.e. COVID-19. The highest number of patients seen on one day was 70 on Monday 18 January 2021 with many other days demanding almost as many face to face appointments. In total the service has seen 3734 patients over an operating period of 96 days (13.11.20 – 31.03.21) totalling an average of almost 39 patients seen and treated every day. Many patients have presented with complex conditions due to not accessing routine primary care, a consequence of the pandemic.

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Paul Tilson


& Emergency Care



In 2020/21 the LLR division, like other DHU divisions and all providers of NHS services nationally, has seen huge change and risen to the significant challenges brought by the Covid-19 pandemic, both internal and as key partners in the LLR health and social care system. Whilst we have mobilised many new services in response to the pandemic, often at short notice in order to meet a newly emerging need, the LLR division has also worked very hard to ensure that our existing services are safe, effective and delivering quality care throughout this difficult period. For example during 2020/21 we replaced all defibrillators across all LLR services in order to upgrade and standardise our equipment, removing variability across the use of equipment and making it easier for staff to respond effectively in an emergency. Our focus and determination to deliver excellence was recognised by the Care Quality Commission in February following inspection of Bowling Green Street GP Surgery, which was in special measures prior to DHU taking sole responsibility in March 2020. The CQC said “I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.”

We also received recognition from The Department of Health and Secretary of State in relation to an innovative Covid-19 vaccination clinic delivered to our Somali patients. Paul Tilson (Managing Director of Urgent Care) said: “The feedback we received both from the CQC following inspection of Bowling Green Street Surgery and The Secretary of State in relation to our innovative pop-up vaccination clinic are very welcome recognition of what we in LLR already know, which is that our staff continue to deliver patient-centered, high quality service to over a 1 million LLR patients. I am extremely proud of all our staff, who have continued to work exceptionally hard throughout the Covid-19 pandemic and have risen to the many challenges presented. Our partnerships with GP Federations, Primary Care Networks, NHS Clinical Commissioning Group and LLR system colleagues have been the bedrock to our success and we look forward to a continuing fruitful working relationship in the coming months.”



LLR Services

At the heart of LLR Integrated Urgent Care (IUC) sits our Clinical Navigation Hub (CNH), where we strive to reduce avoidable emergency admissions and ensure that patients are directed to the best service for their needs. The Hub provides 24/7 GP led telephone triage with access to patient records to support clinical consultation. DHU Clinicians triage patients with Emergency Department (ED) dispositions referred from the NHS 111 service, support the triage of low acuity ambulance NHS 111 dispositions and all referrals from Health Care Professionals. In June 2020 we recommenced a pilot in partnership with EMAS and CCG colleagues, transferring a pre-determined cohort of patients initially assessed as requiring a Category 3 and 4 ambulance response to our CNH. In 2020/21 we delivered all face to face LLR IUC and GP extended access services. Our West Leicestershire integrated primary and community urgent care service runs in partnership with 4Fed (the combined West Leicestershire GP Federations), offering GP extended access for patients 7 days a week within the area, as does our flagship Loughborough Urgent Treatment Centre, a 24/7 walk in and a pre-booked

appointment service that typically sees over 65,000 patients every year. In East Leicestershire and Rutland (ELR) we provide IUC and extended GP access in six different locations covering a wide geographic and largely rural area, delivered in partnership with ELR GP Federation. In partnership with Leicester City Health (LCH) GP Federation, until January 2021 DHU LLR provided primary care streaming services for one of the busiest Emergency Departments (ED) in the UK. The Leicester Royal Infirmary ED sees on average over 750 patients every day, although patient numbers were lower during 2020/21 due to the Covid-19 pandemic. All walk in patients were seen and assessed by DHU within ED and where appropriate directed towards primary care where they are seen by a GP or senior Nurse. Our contract with University Hospitals of Leicester (UHL) ended in January 2021 due to the impact of NHS 111 First and a wider system review of LLR urgent care provision, but we continue to work with UHL as system colleagues and as part of the developing Integrated Care System (ICS).

We are extremely proud of our 24/7 LLR Urgent Care Home Visiting (HVS) service, serving a population of 1.1 million patients. The HVS supports patients who have urgent health needs and who are at increased risk of admission into hospital, reducing pressure on the urgent care system and general practice. A key aim of the service is to reduce the number of avoidable emergency admissions and attendances to ED and to maximise the use of other care pathways. In 2020 we expanded the inclusion criteria for this service to include routine visiting, to support Primary Care. Night Nursing is included within this service which is provided 7 days a week from 9pm to 8am. DHU LLR services also include two GP surgeries: Bowling Green Street, The Heron (including branch St Matthew’s Medical Centre), which together have a combined practice population of 16,000 patients. Prior to March 2020 these were delivered in partnership first with Leicester City Health (LCH) GP Federation and later with The Willows Group, who provided clinical leadership, human resourcing, governance and finance support. DHU LLR supported LCH with mock Care Quality Commission (CQC) inspections, audit and recommendations.



From March 2020 The Willows Group withdrew and DHU took sole responsibility for the practices. DHU have subsequently implemented significant clinical and operational improvements, including appointment of an experienced practice manager and recruitment of salaried GPs. We are delighted that the most recent CQC inspection on 11th December 2020 brought the practice out of Special Measures and rated Good in three areas: Caring; Responsive and Well-Led. Since December further improvement has been made and we look forward confidently to our next inspection being rated Good in all areas. In May 2020 we began delivering a brand new flagship mental health service for children and young people across LLR, the Children and Young People’s Emotional and Mental Health Triage and Navigation Service. Our small team of mental health professionals and administrators offer a central point of contact for professionals working with children and young people, parents and carers to enable navigation and referral to the most appropriate service(s). Most referrals are made by GPs but we also accept referrals from school nurses, social workers and the community paediatrics team. In 2020-21 we received 4,500 referrals, of which 21% were referred onward to Leicestershire Partnership Trust’s Children and Adolescents Mental Health Service (CAMHS), with 37% being referred to the Early Intervention Service. We work closely with LPT and all partners to deliver an excellent service to children and young people. We are able

to refer direct to CAMHS and the Early Intervention Service and can signpost to a wide range of services provided by Local Authorities and third sector providers according to need.

LLR Response to the Covid-19 Pandemic

Like all areas within DHU, the LLR division stepped forward early to offer support for the Covid-19 pandemic response. Our first ask was to extend the existing Influenza and Invasive Group A Streptococcus outbreak swabbing service for care homes to include Covid-19 swabbing, which we gladly offered outside of the agreed contract and provided testing for care homes across LLR. We rapidly mobilised three ‘Hot Clinics’ at Loughborough Urgent Treatment Centre, Oadby Urgent Care Centre and New Parks Health Centre, which provided care for patients with symptoms of Covid-19 who were referred by their GP or via the Clinical Navigation Hub. A new service model was developed to reduce transmission of the virus. A telephone or video conference assessment took place and patients were only invited to attend the care setting where this was absolutely necessary. Where a face to face consultation was required, patients were assessed whilst remaining in their vehicles if possible. It was found that only one in three patients required face to face consultation and this successful model of telephone/video assessment with the option to invite patients to attend the site has since been rolled out to other DHU services. Almost 6000 patients were treated at the Hot Clinics. When the first wave of the pandemic abated and the

DHU Hot Clinic service was no longer required, North West Leicestershire Primary Care Network (PCN) and four East Leicestershire and Rutland PCNs commissioned DHU LLR to provide a telephone assessment and optional home visiting service to their patients experiencing Covid-19 symptoms from October 2020. DHU LLR provided a number of Covid-19 antigen testing services, mobilised quickly and at short notice to respond to changing needs through the pandemic. Our first services were small in scale, reflecting the relatively small numbers of cases in the community. We mobilised our home visiting service to offer antigen testing in patients’ homes (including care homes), followed quickly by an innovative drive-through swabbing service based at a closed McDonald’s restaurant at Enderby and another based in an ambulance vehicle at Loughborough Urgent Treatment Centre. We also mobilised a service to test 2750 factory staff at their place of work, which identified non-symptomatic cases and reduced transmission. These services stood down as prevalence of the virus became more widespread and community based antigen testing became more available. However in September LLR system health partners identified a growing operational resilience workforce risk associated with prolonged isolation of frontline staff when either they or a household member were symptomatic, caused by the inability to quickly and effectively access Antigen testing and thereby facilitate a rapid return to work of those returning negative tests. We rapidly mobilised a self-access seven days a week antigen testing service delivered from Loughborough Urgent Treatment Centre, New Parks Health Centre and later Oadby



Urgent Care Centre. We achieved 99% of results provided to 800 patients within 48 hours. We also provided resilience support for primary care through delivery of Covid-19 antibody testing between October and December. The national antibody testing programme was commissioned to provide tests for health and social care staff as well as pharmacists, dentists and optometrists, primarily delivered via general practice. However in LLR there was insufficient GP capacity to deliver the whole service. DHU LLR provided antibody testing to social care staff, dentists, pharmacists and optometrists, with the results being shared with patients within 48 hours of them becoming available to DHU. We held clinics at several locations and at different times to accommodate diverse working patters, including clinics held at weekends. Overall we tested 417 patients and provided 100% of results within the agreed timeframe. As effective vaccines against Covid-19 became available, we stepped up to offer vaccination support to the LLR system and also provided additional support to Primary Care Networks (PCNs) in Lincolnshire. We vaccinated over 1000 staff and residents of more than 20 care homes on behalf of Rutland, SOLAS, Market Harborough and Bosworth and Leicester Central PCNs in January, following up with a second vaccination dose in March and thereby enabling the PCNs to meet their vaccination of care homes targets. We additionally visited and vaccinated over 400 housebound patients on behalf of Four Counties and

Leicester Central PCNs. The LLR division was delighted to have been able to support PCNs and the national vaccination programme and it was encouraging to note that almost every staff member and patient consented to receive the vaccine. Of course our own GP practices have been working hard to deliver vaccinations to their registered population, and we were extremely proud to have been recognised by The Department of Health and Secretary of State for providing a pop-up Covid-19 vaccination clinic in March, meeting the needs of our Somali patients and tackling vaccine hesitancy.

Delivering and Improving Quality in LLR Services

Clinical Navigation Hub The Clinical Navigation Hub forms an integral part of the LLR urgent care model. This important service sits alongside a number of other DHU services that together deliver Integrated Urgent Care across LLR including:

LLR CCGs Integrated Community Urgent Care Services (West, East and City)

LLR Home Visiting Service The Clinical Navigation Hub (CNH) provides 24/7 clinical triage, assessment, onward referral and remote prescribing for patients who have been electronically referred (electronically) by NHS 111. Targeted patient cohorts include NHS 111 ED illness pathways disposition codes and out of hours ‘speak to’ dispositions.

Clinicians working in the CNH can directly book or refer patients into a plethora of urgent and primary care services and can prescribe remotely where necessary, supported by access to the patient’s full SystmOne GP record. CNH also provides a clinical advice and support service for all LLR healthcare professionals working in the community including care homes staff. The overarching objective of the Health Care Professional (HCP) Line service is to reduce avoidance emergency admission and ED attendance At weekends we provide a ward clerking service for LLR community hospital admissions.



2020/21 Quality & Innovation Achievements 2020/21 again saw a significant increase in CNH activity, driven by the impact of the Covid-19 pandemic and our collaborative work with NHS 111, CCG and LLR system colleagues to deliver the NHS 111 First programme. Overall we supported almost 140,000 patients during this challenging year. In June we recommenced a pilot in collaboration with EMAS, transferring a pre-determined cohort of patients initially assessed as requiring a Category 3 and 4 ambulance response to a dedicated CNH clinician. We expanded the code set and opened up access to patients under the age of 18, enabling us to support more patients to receive care in the right place at the right time. The evaluation of the pilot in August demonstrated the benefits of this innovative service and the findings were presented to Sustainability and Transformation (STP) and NHSE leads across the East Midlands. The service will be brought into business as usual during 2021/22 with the introduction of a fully automated solution for passing calls from EMAS to CNH. Outcomes are excellent, with around 70% of cases being closed without need for an ambulance and a see, treat and discharge rate of 10%.

In 2020/21 we worked with our NHS 111, CCG and NHS Digital colleagues to deliver the LLR element of the national NHS 111 First programme, which aims to encourage patients to call 111 before attending emergency departments and to increase the range of direct-booked and urgent care services in the community. We reviewed the CNH Directory of Service profile to enable more NHS 111 patients who reach an ED disposition to receive clinical assessment in LLR. We know that when this happens, up to 85% of patients avoid an ED attendance. In November we also began to clinically assess approximately 350 patients per months who had used NHS 111 Online and who would otherwise have been directed to ED. We enabled the Emergency Department Digital Integration system (EDDI) for our clinicians in March, allowing clinicians to book arrival slots at Leicester Royal Infirmary and thus reducing overcrowding in the ED waiting room. We continue to work with our system partners to increase the number of patients who are referred direct to a specialty from CNH, for example urology, or Same Day Emergency Care services, and we look further to further validation of NHS 111 online dispositions in 2021/22, including ambulance dispositions. Clinical and non-clinical performance has been a particular area of focus in CNH in 2020/21. To enable us to understand areas of challenge we redesigned our audit tools to identify performance gaps and established regular communication of feedback. For non-clinicians this takes place monthly and for clinicians, fortnightly. Role cards were updated by the Clinical Director, providing greater clarity on expectations. We have developed and implemented a triage competency growth plan, providing additional education, skills and support to triage clinicians in the areas of history taking; skin conditions; ear, nose and throat; head and facial pain;

dizziness; respiratory conditions; abdominal conditions and neck, back and muscular-skeletal conditions. The first cohort of triage conditions began their additional training in March and we look forward to a further two cohorts completing the sessions by the end of 2021. LLR Urgent Care Home Visiting service Inextricably linked with our Clinical Navigation Hub, the Home Visiting Service (HVS) provides a rapid response to illness and injury 24 hours per day. The service is provided by skilled and experienced health professionals, such as General Practitioners, Emergency Care Practitioners, Advanced Nurse Practitioners, Clinical Practitioners and, during the overnight period, Community Nurses. We deliver a rapid response, targeting patients who are at risk of admission or attendance at hospital, reducing unnecessary ED attendance and acute admission. The service also carries out visits to patients in community hospitals as part of the weekend admissions clerking service. 2020/21 Quality & Innovation Achievements

Staffing the HVS was challenging during peak periods of the pandemic, when Covid-19 related absence was high and demand on our services greater than ever. Nevertheless the HVS rose to the challenge, providing a home visiting Covid-19 antigen swabbing service at the very beginning of the pandemic, before community testing was in place. We quickly issued remote working equipment to enable self-isolating staff to continue to offer HVS triage from home. We replaced and upgraded our vehicle fleet in March 2020 making them more efficient and environmentally friendly as well as offering a more comfortable experience for staff.

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Outcome % Ambulance requested 33.7% Community service referral 1.3% Direct admission to acute 0.3% Urgent care referral 5.6% Own GP 4.1% Other 22.0% Home visit referral 6.7% ED referral 16.1% See treat & discharge 10.2%

Image above: 2020/21 Outcomes Following Validation of

EMAS Cat 3 and 4 AMPDS Codes



The fleet was also centralised at our Fosse House base to enabling staff cohorting, to reduce and

avoid cross-contamination and better protect vulnerable patients.

We also worked with commissioners to support primary care by expanding the inclusion criteria of

the HVS to include routine visiting. In 2020/21 we carried out almost 16,000 home visits during core

GP hours and supported 87% of patients to remain at home.

We provided a responsive service, visiting 93% of patients triaged as urgent in under two hours and

less urgent in under six hours.

We also visited over 22,000 patients during the out of hours period in 2020/21, but supported 88%

to remain in their own home despite generally more acute presentations during the out of hours

period and in general during the Covid-19 pandemic.

Figure 1: In-hours Home Visiting Service Performance -Target To Be Seen Within 2

Hours and 6 Hours Figure 2: HVS Outcomes In Hours and Out of Hours



West Leicestershire Integrated

Urgent Care Services

The aim of West Leicestershire integrated urgent care services is to provide a model of local integrated urgent care and extended GP access that enables the rapid assessment, diagnosis and treatment of patients with urgent care needs in a number of locations across West Leicestershire, seven days a week. The services provided are responsive to local demand in primary and community care settings and prevent and reduce the number of patients avoidably attending an ED, with emphasis on providing best value for money. Tier 1 services are available at Hinckley, Coalville and Loughborough whilst Tier 3 is provided at Loughborough Urgent Care Centre. Loughborough Urgent Treatment Centre (LUTC), based within Loughborough Community Hospital, is a busy, 24/7 Tier 3 Urgent Treatment Centre offering assessment, diagnosis and treatment of a wide variety of urgent presentations. Rapid access to x-ray and specialist medical expertise enables the management of simple fractures and sprains, reducing pressure on ED and providing care closer to home for patients. LUTC offers a service for both walk in patients and those who have received a directly booked appointment made by NHS 111 or the LLR Clinical Navigation Hub. In addition, due to our provision of a suite of point of care testing machines and trained staff, West Leicestershire GPs are able to book patients into appointments for a range of ambulatory care

pathways including:

Palpitations needing same day assessment

Acute exacerbations of asthma/CCF/ COPD/ heart failure

Community acquired pneumonia

Gastroenteritis requiring IV rehydration

Acute management of macroscopic haematuria

Diabetic Complications requiring urgent assessment

Cellulitis

DVT assessment

Hyperkalaemia

2020/21 Quality & Innovation Achievements

In 2020/21 we saw over 38,000 patients, most of whom walked in (90%). 99.7% of walk in patients were seen, treated and discharged within 4 hours and 99.9% of patients with a booked appointment were discharged within 2 hours of their appointment time. Just 5% of patients who walked in during 20120/21 required onward referral to acute care, despite relatively high acuity presenting conditions. This was particularly the case due to the Covid-19 pandemic as patients who had avoided seeking health care due to anxiety or perceived inability to be seen at their own GP practice attended LUTC when their condition became unmanageable at home. In response to the change in demand and as a reflection of the fact that LUTC was the only walk-in option for patients requiring urgent care across LLR, with the exception of the Emergency Department, we quickly drafted and implemented Covid Standard Operating Procedures (SOP) to

keep patients and staff safe. This was shared and adapted by Public Health England and used as a benchmark for the development of other similar SOPs nationally.

In February 2021 we carried out a detailed gap analysis against the revised Urgent Treatment Centre Principle and Standards (NHS England, February 2021), which showed that LUTC met 69% of standards (and all of the key elements) and partially met a further 15%. We quickly put into place a detailed project plan to enable the service to meet or exceed all of the standards by December 2021 and we are making great progress. For example, in order to support the Clinical Assessment Service and to help keep patients Covid safe, we introduced telephone assessment appointments in February and shortly afterwards began to offer video assessment, with the option to invite the patient to LUTC for a face to face appointment if this is needed.

Image above: Loughborough Urgent Care Centre Performance Against 4 Hour Walk In Standard



These appointments enable two out of three patients to avoid attending the LUTC in person, yet still receive great care. We have also introduced an appointment system so that patients who walk in at exceptionally busy times can be invited back at a later planned time, without having to wait on site. We have standardised and enhanced our response to patients who need emergency contraception, to include education and sexual health signposting. We know that our clinicians provide lifesaving intervention for our patients when we need it, but this was demonstrated in December when a patient experienced a heart attack in the LUTC car park. Thanks to the clinical skills and equipment available at LUTC this patient was resuscitated and following ambulance conveyance to hospital, went on to make a full recovery. During 2020-21 we committed to provide Advanced Life Support training for all our salaried clinicians and will complete this by December 2021. We redesigned our clinical system during 2020-21 and the new SystmOne unit went live in March 2021. For LUTC this improved staff experience and the ability to effectively record patient care. For

example, x-ray referrals were previously printed, scanned and emailed to the x-ray team but since March they are simply emailed to the x-ray team at the touch of a button, saving clinical and administrative time.

Leicester City Integrated Urgent Care Services

Merlyn Vaz, Westcotes, Saffron, Brandon Healthcare Hubs form an integral part of the LLR Integrated Urgent Care model. All four Tier 2 hubs offer urgent on the day appointments with GPs, Advanced Practitioners and Clinical Practitioners. They provide GP extended hours and core hours GP appointments for approximately 330,000 patients registered with the 53 GP practices within NHS Leicester City Clinical Commissioning Group. Additionally, the Merlyn Vaz hub is also available for pre-booked and walk-in services to patients from across all 3 CCG areas of LLR. Their objective is to provide an extended local urgent care offering, ensuring continuity and least disruption to families as a result of minor illness and to prevent and reduce the number of patients avoidably attending ED. The hubs accept referrals from General Practice, NHS 111, the Clinical Navigation Hub and the Streaming and Assessment function of the LRI Emergency Department.

2020/21 Quality & Innovation

Achievements

During 2021 we replaced and redesigned the SystmOne unit, which is the clinical system used to record patient care at Merlyn Vaz and the Leicester City Hubs. At the request of commissioners we redesigned the system using a GP Hub unit type, which went live as two separate units – one for Merlyn Vaz and the other for Leicester City Hubs – in March. This was a major undertaking not only for the redesign project team, but also for operations staff and in particular the reception team who needed significant training and support to use the new system. The replacement of the unit not only improved clinical staff experience but also enabled us to mandate and define the method of recording safety netting advice, create a unit that looked and felt identical across all services to make it easier for staff to work across services and improve reporting. Clinicians are now able to prescribe electronically, reducing cost to the NHS and making life easier for patients who now may not even need to attend a face to face appointment in order to receive the care and medication they need.



Separating the services into two units also makes it impossible for patients registered with GP practices outside of Leicester City to be accidentally booked by NHS 111 into a Leicester City Hub. Whilst this did not happen often previously, it caused inconvenience to patients and we are pleased that this is no longer a risk. In March 2021 we purchased a suite of point of care blood testing machines with CCG investment, to enable testing and management of patients with suspected conditions such as Deep Vein Thrombosis and Hyperkalaemia etc. These have been installed and the first pathway put into place and we look forward to the opportunities this equipment brings to improve patient care in 2021/22.

East Leicestershire and Rutland Integrated Urgent Care Services

As with West Leicestershire and Leicester City, the services DHU provide within East

Leicestershire and Rutland are an essential component of the LLR Integrated Urgent Care

model. Urgent care services are provided at Oadby, Market Harborough, Melton Mowbray,

Oakham, Lutterworth and Enderby. In addition to providing pre-booked and walk in urgent

care services for all LLR patients, these sites also deliver GP extended access for 327,000

patients registered with the 31 GP practices within East Leicestershire and Rutland CCG.


We are delighted that 99.7% of patients who attended urgent care services in East

Leicestershire and Rutland during 2020/21 were seen, treated and discharged within 1 hour

of their arrival, whether they walked in or attended an appointment. Whilst numbers of

walk in patients were low due to the Covid-19 pandemic, nevertheless this represents great

patient experience. We quickly responded to the pandemic by introducing segregated ‘hot’

and ‘cold’ areas and entrances of Oadby Urgent Care Centre to keep our patients and staff

safe.

East Leicestershire and Rutland urgent care services were the first to experience the SystmOne redesign described in detail above for Leicester City and Merlyn Vaz services, going live in December 2020. Since then our GPs in particular have enjoyed the benefit of being able to offer electronic prescribing to patients, as many of them are already familiar both with the GP hub unit type and also with electronic prescribing in primary care. At commissioner request, in February 2021 we carried out a gap analysis of Oadby Urgent Care Centre against the In February 2021 we carried out a detailed gap analysis against the revised Urgent Treatment Centre Principle and Standards (NHS England, February 2021), with the results as follows:

Whilst Oadby was not commissioned as an Urgent Treatment Centre, and there are no current plans to adapt the service, it is nevertheless encouraging that Oadby is able to demonstrate many of the elements of an Urgent Treatment Centre, which enable the service to deliver great patient care to the local population.

GP Practices Our two general practices, Bowling Green Street and The Heron (including branch practice St Matthew’s Medical Centre) together have a combined practice population of 16,000 patients. As described above, until March 2020 these were delivered in partnership first with Leicester City Health (LCH) GP Federation and later with The Willows Group, who provided clinical leadership, human resourcing, governance and finance support. Since March 2020 DHU have held sole responsibility for the practices and we have implemented significant clinical and operational improvements. Bowling Green Street was most recently inspected by the Care Quality Commission on 11th December 2020. The practice

Total Require-ments

Percentage

Not Currently Possible 2 3%

Not Met 19 24%

Partially Met 16 21%

Met 41 53%

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had previously received a comprehensive inspection in July 2019 when it received an overall rating of inadequate and the practice was placed in special measures. The most recent report brought the practice out of Special Measures and rated Good in three areas, recognising that significant improvements had been made to the quality of care offered by the practice in the six months since DHU had sole responsibility for the practice.


The pace of change and improvement at our GP practices has been almost dizzying during 2020/21. Early in 2020/21 we used the Gold Standard Framework to review our current offer of appointments and built a better offer for patients, taking into account the needs of all patient groups including those of working age. We then revised our staffing model to ensure that we are able to deliver the model, which exceeds the requirements of the framework. In March 2020 there were no salaried GPs working in the practices and no practice manager. We held an effective recruitment drive and by the end of 2020/21 we had appointed 5 substantive GPs, an experienced practice manager, practice nurses and advanced nurse practitioners across both practices. Previous CQC inspections at Bowling Green prompted us to create detailed improvement plans focussing on areas of weakness, which applied across both practices. For example we undertook and allocated additional clinical pharmacist hours to structured medication reviews, focussing initially on reviews of controlled drugs and those patients on over 15 medicines as a priority. We ran a survey to see if patients agreed that improvements had been made over the previous nine months had been effective and were delighted to learn that patient satisfaction with reception had increased to 73% approval. Recognising that identification and support for carers had been a previous weakness, we worked in collaboration with the CCG on carers’ passports and with the Patient Participation Group to raise awareness, as well as appointing a carers champion. This helped us to increase our registered carers list from under 1% to over 1.4% of the registered population, enabling us to better support carers of all ages. Coding of patient correspondence was identified by the CQC as a weakness, which we have since addressed by adopting Ardens Templates to standardise the way in which care is recorded and highlight any incorrect diagnostic clinical coding.

Image above: Patient Satisfaction With Reception, GP Survey Questionnaire Recognising the benefits to our patients, we implemented social prescribing in May 2020 and now offer an excellent service to patients, supported by training given to reception staff in care navigation. The impact of these is reviewed at Primary Care Network meetings. We invested in Kardia Mobile devices for our practices, enabling patients to be screened for atrial fibrillation without the need to travel to an outpatient appointment at an alternative location. The way in which incidents and complaints were recorded at our practices was improved and aligned with DHU clinical governance processes in February, when we implemented Datix. Datix enables the effective reporting, recording and management of incidents and complaints.

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Lastly, we are very proud to have been able to serve the Somali population of St Matthew’s by providing a pop-up Covid-19 vaccination clinic in March, tackling vaccine hesitancy and keeping patients safe. We vaccinated 537 patients in just one day, using a mosque as the venue and segregating male and female areas in order to meet cultural and religious needs. Positive feedback was received from the CCG, The Department of Health and Social Care and the Secretary of State and the model has since been used with success elsewhere in the United Kingdom. Clinical and Non-Clinical Staffing Quality Improvements 2020/21 During 2020/21 we invested in our clinical management structure, introducing two new management roles to LLR. Three new Deputy Clinical Service Managers now support the three existing Clinical Service Leads, who have responsibility under the Head of Clinical Services for all LLR services. They are further supported by Clinical Team Leaders. This new structure enables us to provide a Duty Clinical Manager working seven days a week across all contracts. Previously this role was in place for the Home Visiting Service only, and for the first time this role is delivered by clinicians who are not GPs. An in-hours Clinical Lead role has been implemented, which has been key to delivering clinical leadership and support to our Clinical Navigation Hub and all services. Finally we have also introduced an in-hours shift operational supervisor role, recognising that our in-hours services have become more complex during the last year.

Student paramedics and nurses were introduced to the LLR division for the first time in 2020/21 and this has led to the appointment of a substantive practice nurse when the staff member qualifies in September. Finally we also recruited our first clinical pharmacist in the LLR division, providing an additional skill to enhance and complement the existing clinical skill set. We have further invested in our staff across all services, supporting them to reach a higher advanced practice level through further training and education. In particular we have continued to attract non-medical staff (for example paramedics and nurses) to undertake and complete prescribing training, reducing reliance on scarce GP resource, improving quality, safety and reducing the number of patient hand-offs. We also identified and trained staff to offer clinical mentorship helping our staff to reach their potential and deliver the best patient care. Discrete training courses offered during 2020/21 included management and project management and Mental Health First Aid, and clinical training included paediatrics and verification of death. Substantive staffing increased overall in 2020/21 and we reduced reliance on agency staff across our services, enabling us to provide a more effective, predictable and higher quality service. Our retention of clinical staff also remained high, particularly amongst clinical practitioners and advanced practitioners. Implementation of a new rolling rota system has assisted with retention as staff are better able to plan their working/non-working time, providing stability.



Paul Tilson


& Emergency Care

Urgent Care (Northamptonshire) delivers high quality, patient-centred GP Out-of-Hours services to the population of Northamptonshire, providing access to unplanned urgent care; working in partnership with the wider urgent care system across primary, community, secondary health and social care. Servicing an estimated population of 747,622, the service provides enhanced triage services, face-to-face clinic appointments and home visits to those requiring urgent care, with a total of 98,604 overall patient contacts confirmed within the first 12 months. Through integration and partnership working we are able to ensure efficient, effective and safe patient focused care. This integration has enabled DHU Health Care to streamline the patient journey and encompass a multidisciplinary approach to ensure a prompt referral to the most appropriate health care professional. The Out of Hours service operates from 4 Patient Contact Centres (PCC) situated throughout the county (Appendix 1). We also operate a fleet of 5 vehicles to support the Out-of-Hours home visiting service. The fleet of vehicles enables the clinicians to visit the elderly, terminally ill or housebound patients that require a clinical assessment and are unable to travel to one of our Centres. Patients who are unable to attend a Centre may receive a routine home visit (within six hours) or an urgent home visit (within two hours). Where clinically indicated, a clinician will undertake an emergency home visit (within one hour). Patients requiring an emergency home visit are predominantly terminally ill patients who require an almost immediate assessment and review to provide prompt symptom relief in their preferred place of care.



Performance Out-of-Hours (OOH) services continue to be assessed in line with the National Quality Requirements (NQRs) for Urgent Care Services which have to be achieved by all OOH providers. DHU Urgent Care (Northamptonshire) are able to highlighting our exceptional achievements in relation to patient care, not only through patient feedback but supported by our continual achievement of the NQRs. The NQRs by which we are assessed are National Quality Requirement 10 (NQR10) and National Quality Requirement 12 (NQR12) which both focus on the timeliness of delivering our Urgent Care Services.

NQR10 specifically assesses face-to-face clinical assessment from arrival to treatment times for patients who walk-in to one of our 4 Primary Care Centres (PCC). For the 2020-21 period, there were no walk-in appointments within the service. NQR12 assesses face-to-face clinical assessment from arrival to treatment times for patients who are either booked into one of our Patient Contact Centres or are deemed appropriate for a home visit. Once again UCN performed above the required target of 95% by seeing 99.8% of all patients booked into either an urgent or routine appointment at one of our Centres within the required timeframes.

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Service Response The Covid-19 pandemic which hit in March, has led to significant changes in how the Urgent Care Northamptonshire service is delivered and used. This has seen the implementation of new policies and national guidelines across the service which have resulted in clear shifts which have affected the whole care pathway of patients accessing the service. This includes remote triage of all referrals in to the service and a reduction in face to face consultations in hospital settings, as well as new collaborations across the health and care system in Northamptonshire. A number of ‘enablers’ have made these changes possible despite the huge strain on the system. These included our ability to proactively review service activity on a daily basis, highlighting areas of pressure within the system and provide support to our 111 colleagues, as well as more time for clinicians to make innovative decisions, in line with the best interests of the patient. Our model for sustainable change brings together different factors to maintain new ways of working. Changes we have implemented include: Promotion/Prevention/Self-Management

Increase home visiting for vulnerable groups

Use of online health promotion resources which are provided to patients at consultation

Promotion of local remote self-monitoring and management tools i.e. oximetry at home project

Delivery of medication to vulnerable patients with no familial support

Primary and Community

Total triage’ of all contacts in the queue

Digital consultations using AccRx and GoodSam systems

Electronic prescribing

Promotion of Emergency Department streaming

Increased skill mix within teams i.e. GP’s, Advanced Nurse Practitioners and Paramedic Practitioners

Community admission avoidance

Workforce The staff working in the Urgent Care Northamptonshire service are its greatest asset and are key to delivering high-quality care. This has been exemplified more than ever throughout the Covid-19 pandemic with staff demonstrating remarkable resilience and commitment. The pandemic has underlined how staff across the urgent care sphere within Northamptonshire, often work under enormous strain as a result of workforce shortages. Our approach to recruitment and staff retention coupled with good retention figures has ensured that the service has managed to avoid workforce shortages faced by our local colleagues. We recognise that unfilled vacancies increase the pressure on staff, leading to high levels of stress, absenteeism and turnover. We actively monitor vacant hours on a weekly basis and ensure that vacancies are advertised in a timely manner. Absenteeism levels have been low throughout the pandemic which is testimony to the sense of ownership, that our staff feel, towards the service that they provide to the population of Northamptonshire.



Clinical Audit Urgent and Emergency Care is usually accessed at a time when patients can be at their most frightened and vulnerable. The Royal College of General Practitioners (RCGP), in partnership with The Royal College of Emergency Medicine (RCEM), has developed an Urgent and Emergency Care Clinical Audit Toolkit. This toolkit has also been extensively piloted by the RCGP and RCEM and is also endorsed by the Ambulance Service and the Royal College of Paediatrics and Child Health. Our patients have a basic right to a high quality of urgent care at whatever time they use the health service and we must have the knowledge and ability to provide robust system checks to help deliver and ensure good, safe practice is learnt from and maintained. Use of this toolkit will:

Improve the quality of individual consultations along with the patient who presents with urgent and emergency care needs;

Strengthen and develop the needs of the workforce, contributing to an improved patient experience for urgent and emergency care services;

Develop strategy and implement to encourage continuous quality improvement and improvement in productivity (QIP);

Allow information from the audit to be used to support doctors and nurse’s appraisal, certification and revalidation competencies. Audits are completed by clinicians that have been trained in the use of the RCGP toolkit.

Audits are completed by clinicians that have been trained in the use of the RCGP toolkit. RCGP recommendations set a target for 1% of all cases to be audited each quarter. It is a commissioning requirement as part of the OOH Quality Schedule to ensure that clinicians are audited as per recommendations. A random export of 1% of all clinical notes from the Adastra system is completed on a monthly basis. These calls are then imported into the Quality Assessment Management module (QAM) on a monthly basis. The QAM system creates a template for the Auditor to complete as a record of the audit. SystmOne audits are completed manually for each module used 1% of a clinician’s workload. Within Adastra, clinical notes are then randomly selected for audit from the imported notes. A report is produced through QAM and monitored by the Audit Team to ensure that an individual is not over/under audited. Within SystmOne the auditor randomly selects a case to audit from a date range. Clinical notes will be assessed by the Auditor using the voice recording and the appropriate SystmOne summary. All Quality Assurance scoring will be in accordance with the latest RCGP Standards. The Auditors will complete the template as they listen/review to the call/case and then summarise their findings.

The system will automatically calculate the outcome in respect of performance. The electronic version of the audit will be stored within the Adastra system. For SystmOne a manual report will be collated, stored within the clinician’s personal folder. Only RCGP protocols and instructions will be scored in an audit. Any DHU Health Care CIC procedures will be identified in the audit comments for feedback purposes but not complied. New starter staff will be audited at least four times during their probationary period. Feedback to staff that are being mentored during their training period should be given by both their line manager and the training team. This is recorded for information only on the new staff members file. Appropriate training needs are identified during this feedback in order to facilitate areas for development. New DHU Health Care CIC staff who have had satisfactory audits. The training team/line manager will receive feedback consistent with the process for all other ACPs/NPs/SNPs/GPs. All Feedback following the audit of a call is delivered in a timely manner. Overall scoring for each case will elicit a Rag Rating, demonstrated below. This will be used as a visual guide to compliance.



Urgent and Emergency Care Northamptonshire RCGP 2020-2021 results

(Average scoring over the year period) The following elements are considered for each clinician during the audit: 1. Elicits REASON for call/visit 2. Identifies EMERGENCY or SERIOUS situations 3. Takes an appropriate HISTORY (or uses algorithm

appropriately) 4. Carries out appropriate ASSESSMENT 5. Draws CONCLUSIONS that are supported by the

history and physical findings 6. Makes appropriate MANAGEMENT decisions

following assessment 7. Correctly fills in appropriate DOCUMENTATION 8. Appropriate PRESCRIBING behaviour 9. Displays adequate SAFETY-NETTING 10. Did the clinician address any potential

SAFEGUARDING issues? 11. Makes appropriate use of IT / Protocols / Algorithms 12. Displays EMPOWERING behavior 13. Develops RAPPORT 14. Satisfies ACCESS criteria where appropriate The audit outcomes consistently demonstrate good quality documentation by clinicians within the service, with the majority scoring 90% and over. Whilst the review of call recordings as part of the audit, demonstrate that clinicians provide patients with safety netting advice during the consultation, it is often found that the documentation within the clinical notes, does not

reflect this in sufficient detail. The main areas identified where safety netting documentation is not sufficiently robust, relates to patients who are referred to A&E or healthcare professional (HCP) to HCP calls. On occasion it is noted that clinicians document “safety netted” within the medical records, however the RCGP audit guide advises the following:

Clearly document advice given about when to return/call back

Records advice given (worsening instructions)

Clinicians are provided with formal audit outcome letters following each audit. The clinical documentation audit

across Urgent Care Northamptonshire, continuously demonstrates an on-going overall high standard of documentation by clinicians.

Staff Engagement It has been a year like no other. Covid-19 has changed much of the way that we provide services and support our teams and this has impacted on our approach to staff engagement. Whilst overall, staff engagement across the Urgent Care Northamptonshire services has been very positive, there are some key lessons from our local experiences which we will use to ensure that staff feel engaged with, listened to and that they feel that they have

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Month Average Scores GP’s % Average Scores ANP’s %

April 2020 96% 94%

May 2020 97% 94%

June 2020 96% 94%

July 2020 97% 95%

August 2020 98% 96%

September 2020 99% 96%

October 2020 97% 96%

November 2020 98% 95%

December 2020 98% 95%

January 2021 98% 95%



the ability to contribute to the way that the service is provided to the population of Northamptonshire. Through discussion at monthly team meetings for each discipline within the service i.e. nurses, receptionists and drivers etc. our learning has included:

a decisive response to local staff engagement and feedback

an initial priority to develop a single source of information i.e. monthly Urgent Care Northamptonshire newsletter

innovative feedback mechanisms for chats with operational management teams, management presence 7 days per week during out of hours periods at bases, a “you said we did” ethos to action all outcomes from team meetings and open dialogue with each particular staff group

the roll-out of the 2020 DHU staff survey, to ensure that staff are able to give feedback and to give focus to key issues

We are using the lessons learned during the initial outbreak as a basis for building on for future challenges, whether new outbreaks or as part of our business as usual. We have been taking on board this learning and share these experiences across the wider DHU business and will also be communicating this via future newsletters and collaboratively as part of the wider DHU weekly updates. The key has been for us to adapt our methods while continuing a commitment to responding to staff concerns.

Mandatory Training

The Covid-19 pandemic has put unprecedented pressures on the primary and urgent care system across Northamptonshire. In line with government guidelines, group training sessions have not been permitted. As such, DHU have utilised new ways of working, to ensure that the mandatory training agenda has continued throughout this period. Microsoft Teams has been utilised, to be able to present live training sessions remotely. In response to the pandemic, we have worked in partnership with the DHU training team to ensure that the minimum requirements for statutory and mandatory training have been met during the Covid-19 outbreak. We implemented a robust weekly monitoring process which provides staff with 8 week advance notification of the expiration of training certificates, followed by subsequent weekly reminders. Staff have responded well to this initiative and the service has been able to secure exceptionally good compliance across all staff groups, for mandatory training requirements. Please see below Mandatory training figures 2019-2020.

May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

Safeguarding 46% 82% 88% 86% 92% 94% 98% 100% 99% 98% 98%

Basic Life Support 84% 61% 83% 92% 93% 97% 98% 98% 93% 99% 97%

Infection, Prevention, Control 75% 74% 82% 89% 94% 97% 98% 100% 85% 100% 97%

Health & Safety 72% 73% 70% 82% 91% 96% 99% 99% 100% 99% 98%

Data Security 70% 74% 73% 77% 87% 95% 100% 100% 100% 99% 98%

Prevent 22% 75% 78% 73% 70% 62% 96% 99% 100% 99% 98%

Mental Capacity Act 35% 48% 62% 100% 100% 100% 100% 100% 100% 100% 100%

Section 3 Our People


Our People

Covid Pressures

It has been a very challenging year from April 2020 through to March 2021 with the organisation having to deal with the pandemic and the ensuing impact of the challenge of a significant increase in workloads across the business. In addition staff have had to get used to working in socially distanced environments, with plastic screens being installed around desks, face masks being worn when not seated, hand washing stations, hand sanitiser and clinell wipes in plentiful supply. Non-essential travel between sites is discouraged and for many staff home working became the norm, or a hybrid version of home/base working. The pandemic did bring into focus the possibilities around different ways of working and the pros and cons of remote working were carefully considered. All staff within the business are classed as key workers. For those roles where it’s not been possible to work partially or fully from home, the dedication and commitment of staff has been ongoing throughout and much appreciated. There have been increased periods of absence due to requirements to isolate and for those who were unfortunate to become ill with Covid. A number of staff have been shielding on several occasions as per Government directives. It’s been important to maintain contact with staff across the business and support those who may have felt isolated by their circumstances. Weekly calls were made to shielding staff to encourage group chats and participation in fun quiz

sessions to lighten the mood and enhance the feeling of continuing to be part of a team and 1:1s were carried out remotely where possible. For those staff on site, it has been important to ensure they felt secure and all played their part in ensuring that covid secure standards were maintained. In order to facilitate homeworking, arrangements were made to assess staff needs and competencies and equipment was rapidly provided and supplied to team members to ensure service delivery was not affected. Sadly, DHU lost two staff members to Covid. This has been an emotional period and contact has been made with colleagues’ families to try and support them through this difficult time. Over the past year, the organisation has continued to grow and staff numbers increased by 14.6% from last year with a headcount of 1808 as at 31st March 2021. Looking specifically at the focus on Covid over the past year, since the end of November 2020, 10 bank Pandemic Support Nurses were employed and between them they have worked a total of 1258.5 hours between December and the end of April. Swabbing sites in Derby and Chesterfield have been active since the beginning of the pandemic. At the Toyota site in Derby 2,412 shifts were allocated with a total of 15,563 hours, and at Proact in Chesterfield 2,086 shifts were allocated with a total of 14,160 hours, including Nursing staff and Marshalls. The 111 Division has continued to grow and ongoing intensive recruitment has been necessary to meet existing and new demands of 111 First and contracts.

Additional Team Managers have been appointed to reduce team sizes and ensure continued and improved support for team members. There have been ongoing opportunities for career progression for existing staff within the Division, either through temporary secondments or permanent roles. For LLR, the heavy reliance on agency support for clinical staff has been reduced as gaps in substantive clinical roles have been successfully closed. Alongside this, agencies are not used for operational roles, apart from specific tender or CCG requirements and agency logistical support has been removed. At the beginning of the pandemic and ongoing, applicants have expressed their interest in working for DHU in order to ‘give something back’ and to support the NHS.

Vaccinations - flu & covid

The yearly flu vaccination programme took place and 1162

of our workforce received the vaccine.

Covid vaccinations have been made available to staff and

88% of the workforce have received the first vaccination

with a drive to increase second vaccinations ongoing.

ISO Audit

The HR teams were part of the ISO audit for 27001 in

November 2020 and contributed to the successful retention

of accreditation.



Staff Satisfaction

Survey

DHU carried out its annual workforce survey of

all DHU colleagues in November 2020 to gauge

their views about a wide range of issues and

aspects relating to their experiences of being

an employee within DHU.

The results were collected in 2021 and

presented to the workforce as infographics to

simplify the results which this year were in line

with the NHS workforce survey.

Further analysis of the results were compiled to

enable the Managing Directors of each division

to identify areas of improvement. The analysis

looked at the emerging themes in key areas

including:

If colleagues consider care of patients to be

a top priority for DHU.

Whether DHU actions on concerns raised by

patients.

Whether DHU colleagues would

recommend the company as a place to work.

Whether a friend or relative needed

treatment colleagues would be happy with

the level of care provided by DHU.

Employee Health and Safety.

Discrimination.

Bullying.

Training and Development.

Internal processes.









Steps taken to address areas highlighted from the survey results are as follows

DHU111: Rota The DHU 111 Resource Planning Team is undergoing a transformation. We have appointed a workforce management expert, Head of Workforce Planning, who commenced in March, a new Senior Capacity Analyst (for forecasting of calls and review of rotas) and a Senior Scheduling Analyst (ensuring staff are in the right place at the right time) who both start in June. The technology, Injixo, that we currently use in the team is not effectively working for the size of the organisation that we have become and we desperately need a replacement. We are hopeful that the new team and a new system can really get to grips with what is required to best serve our patients and workforce. We recognise the rota is a challenge and DHU are investing in the team to ensure this works as well as it possibly can for everyone. Retention: DHU have invested heavily in the Team Manager structure over the last 12 months with a view to this directly increasing our retention of staff. Our approach is to ensure that all staff receive a monthly 1:1 meeting and annual appraisal, as a minimum. Exit interviews are scrutinised and feedback acted upon. Our intention is to ensure that all staff members feel well supported and cared for whilst in

the employment of DHU. The survey noted that not all staff upheld our CARE values, which is unacceptable, and we are working to develop this ethos across all our staff groups. Furthermore the investment into Fosse’s recent refurbishment and the upcoming move to the Orbis Centre in Derby supports our intention to provide the best possible working environment for staff. Ashgate site will be reviewed in line with the lease end in 2023. DHU Urgent Care: IT issues During the pandemic the DHU IT team have managed to ensure our core services continue to function. Alongside this the team has organisation wide;

Mobilised 550 laptops for homeworking, Red home visiting and Vaccination Roving teams.

Issued 36 mobile phones to support clinical services

Provided 30 Toughbooks to commence COVID services

Implemented MS Teams across the organisation More Training Traditional face to face classroom based teaching has been replaced by remote/Teams sessions, where appropriate This method of teaching has evaluated well and allows a greater number of people to attend the sessions often when staff are not local to our main sites. In summary during COVID DHU has provided the following for clinical

and non-clinical staff:

Mandatory modules and Corporate Induction provided via e-Learning for Health or Teams sessions

Mental Health First Aid

Domestic Violence

Managers training sessions to include appraisals, recruitment and conflict resolution

Paediatric assessment and management

Gynaecology workshop

Palliative Care

Alongside the above our Clinical teams have continued to receive funding and access to university accredited modules remotely:

5 staff are undertaking the MSc Advanced Practice

3 staff are topping up to an MSc

A number of stand-alone modules accessed e.g. paediatrics, clinical decision making.



Apprenticeship Development Programme The apprenticeship programme has continued to be very successful with several apprentices moving forward into substantive roles. One Apprentice has been moved to a substantive role as a Junior PA. In addition, the 111 HR Apprentice was nominated and was selected as a finalist for the East Midlands Chamber Apprentice of the Year Award for 2020 and won the category. This was a fantastic achievement and a very proud moment for the HR and management team of DHU 111. The incumbent has now been moved to a substantive role within the 111 HR team as HR Administrator. A Finance Apprentice who is coming towards the end of the Level 3 Assistant Accountant placement will continue with the Level 4 qualification. In addition, the apprenticeship levy has been utilised to continue to support learning and development across the business:

Two receptionists in LLR at Business Admin Level 3

A receptionist at Johnson Building is undertaking Customer Service Level 3

Assistant Practitioner Level 5 for clinical roles

HR Level 5 for HR Advisor/HRBP

HR Support level 3 – HR Admin

Training & Development Ongoing development, progression and investment in staff continues to be a high priority as can be seen from the suite of training opportunities below. In-house mandatory training is at 90% compliance, covering various modules including Health & Safety, Infection Prevention & Control, Safeguarding and Prevent. Within the 111 Division, several Team Managers have commenced a CMI Level 5 Diploma in Management and Leadership, with one Senior Manager commencing a CMI Level 7 Diploma in Strategic Management and Leadership. Two members of the 111 HR team have begun a CIPD

Level 5 qualification and a Full Academy HR Programme

covering Digital HR and HR Analytics.

In-house delivery of training sessions presented and

facilitated by HR has included the following:

Absence Management

Investigatory, Disciplinary & Grievance Training

Induction Training for New Managers

Corporate inductions have been moved online over the

past year and have worked well.

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Cerys Addis pictured above on winning the East Midlands Chamber (Derbyshire, Nottingham, Leicestershire) Derbyshire Business Awards, Apprentice of the year category 2020.



The HR Head of Training has conducted in-house

training over the past year as below:

Appraisal training

First Aid for Mental Health

Coaching Training

Apprentice Coaching Sessions

Recruitment & Selection

Domestic Violence

Disciplinary Skills

A 4 week programmed of Management

Training

The in-house training has been conducted online

and has been successfully delivered.

It is recognised that development of our

workforce is good for morale and retention.

East Midlands Chamber

DHU 111 were finalists in two categories for

2020, Apprentice of the Year as referenced

above and Excellence in Customer Service.

The ceremony took place online and the

Apprenticeship winner was announced at the

ceremony with the trophy being presented at a

later point by a representative of the Chamber.

.

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Equality, Diversity and Inclusion

At DHU Equality and Diversity is integral to all aspects of our business at every level, informing workforce management, service planning and community/patient engagement. Our policy sets out DHU’s commitment to provide an inclusive environment that within DHU equality of opportunity is promoted, unlawful direct or indirect discrimination does not occur, unacceptable behaviour is eliminated and diversity is celebrated. To respect the rights and dignity of all employees and patients, including visitors, suppliers and other stakeholders is core of our CARE values. DHU will not tolerate any behaviour contrary to this policy (or the linked Bullying and Harassment Policy) in the workplace. DHU provide the highest quality healthcare to patients and we encourage all staff to respect the different backgrounds, cultures, beliefs/opinions and ideas of all of our patients, always treating them fairly, equitably and compassionately. To be truly diverse, DHU understands that as a Company we must also recognise this within our own organisation. Our staff are our greatest asset and each one of us has a part to play in the success of the company. By enabling inclusive decision making through our staff representative forums we can ensure everyone has a voice. The details of our policy are communicated to all employees and new starters at induction. All job applicants receive details of the policy upon request. DHU provides training and information for employees to ensure that they understand DHU’s Equality and Diversity policy and their responsibilities

under the policy. In particular, training will be incorporated into:

Recruitment/ selection programmes

Induction programmes

Staff management programmes DHU monitors recruitment, training and promotion with a view to ensuring that the Equality and Diversity policy is effective. Workforce composition, promotion and applications for training courses are regularly monitored to ensure equality of opportunity at all levels of the organisation. Applicants are shortlisted ‘blind’ to remove unjustified barriers to meet the special needs of disadvantaged or under-represented groups.



Health and Wellbeing

The Health and Wellbeing of our employees is key to the successful delivery of care to our patients. With the Company mission, vision and values in mind, our Health and wellbeing programme strives to provide guidance for employees and managers to look after their own and others wellbeing in the workplace. With a dedicated resource, employees have opportunities to access appropriate services in relation to health and wellbeing across all of its geographical locations. It’s important that all of our employees feel a sense of belonging, that their contribution to the Company’s success is valued and that we can support each other to be safe, effective, that we CARE and thatwe are responsive, all whilst meeting one of the company’s key objectives; to attract, recruit, retain and develop its workforce, to deliver quality health care services and be the employer of choice. In what has been an unprecedented year on the health sector, the services for health and wellbeing in the workplace have never been as important and throughout the year we have further enhanced the health and wellbeing offering in a variety of ways;

Introduction of ‘Against Domestic Abuse’ training, highlighting the different ways in which a person might be harmed by a perpetrator. The course supports our Domestic Abuse Policy and offers signposting to local services to those in need.

A Health, Wellbeing, Diversity & Inclusion newsletter continues to provide insight to health conditions, speaking directly to the employee who may be suffering and signposting them to services

that can help.

All employees have access to an Employee Assistance Programme and Health Cash Plan, through Westfield Health that enables staff to access counselling services and general advice and information at any time of the day; in addition staff can receive cash benefits when accessing health services.

First Aid for Mental Health training continues to see an encouraging uptake amongst our colleagues, not only to aid them in their own thoughts and feelings, but to actively support each other and feel comfortable in starting a conversation.

A dedicated intranet page offers information and educational resource to employees and Line Managers on self-care and how to access services.

The Psychotherapy Room, an innovative service bringing University students and Professionals together offers employees a safe environment to support them through any work or personal issues or to seek a greater self-understanding and awareness of themselves.

Quiet Rooms have been introduced to help create a space of introspection, whether that be for daily prayers, self-reflection or simply to escape from the pressures of open plan working from time to time.

In addition to this we have actively engaged with our employees by way of staff survey to further identify key areas of health and wellbeing matters. This will support our health and wellbeing programme, further enhancing the access that employees will have both onsite and in their own time.

Community projects

DHU Health Care takes being a Community Interest Company seriously and throughout the year we have organised or assisted with many events that deliver social value. Every event we contribute towards is an exciting new opportunity to reach out to the wider population and bring our colleagues together under the umbrella of ‘One DHU.’ Below are just some of the many charitable events we have contributed to over the last year:

DHU111 Charity drive Support against Domestic Abuse

The DHU111 staff at Ashgate Manor donated items for a local charity. Karen Byfleet (Senior Health Advisor) and Carl Siddall (Ops Manager) both delivered two shopping bags full of groceries and toiletries to a local refuge that supports women who have suffered domestic abuse. The CEO of ‘The Elm Foundation’, Jennifer Calverley, said: I am very touched by the generosity of people and that the women would be really grateful. Please pass on the foundations thanks to the staff at DHU 111.

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DHU Holds Virtual Loyal Service Awards 2020

This year DHU were not able to hold our annual engagements events, however, our virtual Loyal Service Awards on Wednesday 2nd December gave us the opportunity to recognise and celebrate the remarkable achievements our DHU colleagues perform every day. With 90 colleagues being recognised for their loyal service, the event was a chance for DHU Health Care CEO Stephen Bateman, along with the Board of Directors and Senior Managers, to congratulate each member of staff for their time at DHU. David Whitney, Chairman of DHU Health Care, said: “It is one of the most pleasurable activities that the Board gets to perform. The reality is we are only as good as the quality of our staff and we have the most magnificent staff working for DHU. Witness the response you have given to the immediate crisis that we all face.”

There were many heartfelt stories from colleagues who have grown in their careers alongside the company as it has changed and grown over the years. Colleagues who were eligible for their award received a gift in the form of a voucher from the company along with a loyalty pin and certificate to commemorate the occasion and to show our appreciation.

Alzheimer Society - Elf Day Dec 2020

DHU participated in the raising of vital funds for the Alzheimer Society in December 2020. We recognised that Coronavirus has changed everything for people affected by dementia. As a result of lockdown, people have found themselves isolated from their families and more vulnerable than ever.

Thousands of people living with dementia or caring for someone with dementia will have been left struggling to get the help they need to live.

On Saturday 05th December 2020 members of staff went on an incredible 22 mile round bike ride for the charity. Starting at our Ashgate Manor office in Chesterfield they cycled all the way to Rother Valley Country Park and back. An overall amount raised was over £1000.

DHU111 Charity drive - Food bank delivery

As part of a charity drive, our NHS 111 team started collecting for the Hope Centre in Derby. The Hope Centre holds a food bank twice a week and also collects toiletries, nappies, baby food and more for a women’s refuge. This team were very successful and in just 5 weeks all the staff at the Johnson Building had generously donated foods and toiletries in abundance. Kate Weatherbed, NHS 111 Operational Shift Lead, said: “The items were successfully delivered on Tuesday 16th March, to which the Hope Centre welcomed us with warmth. It was fantastic to give a little something back, we are hoping to continue charity drives like this throughout the year, so definitely look out for more updates.”

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https://teamnet.clarity.co.uk/Library/ViewItem/a316a269-d0b4-46dc-8dfe-ac8a0100a06f



The Limelight Award The Limelight Award An intense

illumination of employee effort, as

someone placed in the ‘Limelight,’

centred on their exceptional

contribution to DHU in providing not

only quality patient care but care and

compassion for each other.

The monthly Limelight award encourages employees to nominate colleagues within all divisions of DHU Health Care. The winner is presented with a small financial reward in vouchers and the honorary Limelight pin badge which our employees wear on their lanyard to show they have been recognised for their contribution to DHU. The winner also receives a thank you message from Stephen Bateman CEO, and a personalised letter written by our CEO which is then placed in their personal file. Please see overleaf some of the winners for 2020/21 along with colleague nominations received during 2020/21.

June 18 - Gary Lee (Patient Navigator)

Tracie Wood, Miracle People System

Coordinator (Corporate)

April 2020

“This award is in appreciation of the ongoing support you show towards fellow staff members, always offering constant support looking after their mental health & wellbeing. This reward is also in recognition of your hard work and commitment to your role & in such unprecedented times, it is a privilege knowing we have such dedicated staff members willing to go above and beyond and doing so in such a professional manner.” Stephen Bateman, CEO

Sarah Toyne, Nurse Practitioner (UCD) May 2020 ‘’This reward is in appreciation of your ongoing commitment and determination you display within your role. You have been recognised for your proficiency in delivering tasks and doing so in such a professional manor. This nomination is particularly in recognition of how you went the extra mile for a patient in need, under certain circumstances displaying our care values in every aspect. ‘’ Stephen Bateman, CEO



Brenda Loughran, Nurse Practitioner (UCN) August 2020 ‘’You have been recognised for your commitment to your role and the caring and compassionate nature you display towards your patients, always going above and beyond of what is expected of you. Despite facing your own personal challenges over the last year, this nomination is particularly in appreciation of always upholding professionalism and remaining positive. It is a privilege knowing we have such dedicated staff members willing to go above and beyond. ‘’Stephen Bateman, CEO

Laura Cox, Health Advisor (DHU111) June 2020 ‘’This reward is in recognition of the outstanding bravery and support you gave to a gentleman following an incident where he jumped out in front of your car in an attempt to end his own life. This nomination is particularly in appreciation of how you handled the situation with such care using your health advisor experience to support this gentleman keeping him talking until help arrived. This is such bravery and a great example of upholding our DHU values. It is a privilege knowing we have such dedicated staff members willing to go above and beyond.’’ Stephen Bateman, CEO

Section 4 Our Quality Assurance


’We welcomed an announced comprehensive CQC inspection on 11th December 2020 of The GP Practice Bowling Green Street. Due to the impact of the COVID-19 pandemic, the majority of evidence reviewed and staff interviews were undertaken remotely in advance of the site visit on 11th December. I am pleased to say that The Practice improved its overall outcome rating from ‘Inadequate’ to ‘Requires improvement’ and achieved a ‘Good’ rating for providing caring, responsive and well-led services. The team has displayed commitment to our quality improvement agenda and are dedicated to improve the patient experience into the year 2021/22”

Our Quality Assurance

CQC Inspections 2020/21 The Care Quality Commissions (CQC) inspection programme formally assesses and rates whether DHU Health Care’s overall service provision is safe, effective, caring, responsive to people’s needs and well led. In March 2020 the CQC paused their routine inspections and focused on activity where there was a risk to patient safety or where an inspection supported the health and care systems response to the pandemic. An announced comprehensive CQC inspection took place on 11th December 2020 of The Practice Bowling Green Street. Due to the impact of the COVID-19 pandemic, the majority of evidence reviewed and staff interviews were undertaken remotely in advance of the site visit on 11th December. The practice had previously received a comprehensive inspection in July 2019 when it received an overall rating of inadequate. The safe, effective and well-led domains were rated as inadequate, the caring and responsive domain were rated as requires improvement. Following the CQC inspection in December 2020, the practice is now rated as ‘Requires improvement’ overall. The practice is also rated as good for providing caring, responsive and well-led services and requires improvement for safe and effective services.

CQC commented:

“The practice had made significant improvements since the previous inspection however there were still systems which needed to be embedded to ensure care delivered to patients was always safe”

“Staff treated patients with kindness and respect and involved them in decisions about their care. Patients were positive regarding the quality of care they received from practice staff which was shown in the latest survey results”

“The practice organised services to meet patients’ needs. Patients could access care and treatment in a timely way”

The LLR Team at The Practice have welcomed the feedback and have used this to continue forming and implementing their detailed improvement plans moving forwards.

Jenny Tilson Director of Nursing & Quality



Our current Care Quality Commission ratings are as below;

HU Urgent Care (Derbyshire) - Mallard House - Out of Hours desk based. Inspection date - 11th April 2017

DHU Urgent Care (Derbyshire) - Ashgate Manor - Out of Hours desk based. Inspection date - 11th April 2017

DHU 111 (East Midlands) - Ashgate Manor - NHS 111 Service. Inspection date - 11th - 15th March 2019




DHU 111 (East Midlands) - Johnson Building - NHS 111 Service. Inspection date - 11th - 15th March 201

DHU 111 (East Midlands) - Fosse House - NHS 111 Service. Inspection date - 11th - 15th March 2019

DHU Urgent Care (Derbyshire) - Evening and Overnight District Nursing Service. Inspection date - 9th & 10th May 2016




DHU Urgent Care (Leicester City, Leicestershire & Rutland) - Loughborough Urgent Care Centre. Inspection date - 31st January 2019

DHU Urgent Care (Leicester City, Leicestershire & Rutland) - Leicester City Hubs. Inspection date - 4th March 2020




DHU Urgent Care (Leicester City, Leicestershire & Rutland) - East Leicestershire Centres. Inspection date - 15th - 17th January 2020

DHU Urgent Care (Leicester City, Leicestershire & Rutland) - The Practice Bowling Green Street. Inspection date - 11th December 2020



Clinical Audit & Improvement Clinical audit is an integral component of the quality improvement process and is embedded within the DHU Healthcare Vision and Values. The requirement to participate and learn from audits is also a strong central component of the ethos within DHU Health Care. To encourage greater focus on DHU Health Care priorities, the Audit Team provided:

Leadership and endorsement for DHU Health Care’s participation in a rolling annual programme of clinical audit and review at the Clinical Effectiveness Sub-Committee

Encouraged widespread learning.

Action plans were developed promoting the quality and safety of patient care through Quality improvement in areas prioritised by the audit standards.

Quality improvement needs to be at the heart of clinical practice and is something that all health practitioners must engage in. Clinical audit drives continuous improvement through assessment of patient care and the delivery of a better experience for patients and their carers. During the year DHU Health Care had made a commitment and set a vision with both medium and long term plan of direction for clinical audit and quality improvement. The aim was to use clinical audit as a process to embed clinical quality at all levels within DHU Health Care, to deliver demonstrable improvements in patient care, create a culture that is committed to learning and continual development, and a mechanism for providing evidence of assurance about the quality of services. Our strategic objectives are:

Improve the quality of clinical audit and quality improvement activities.

Enable measurable improvements in clinical quality through clinical audit.

Integrate clinical audit and quality improvement within the day to day activities of each Division.

Enable all staff to participate in quality improvement activities by ensuring the necessary competency and support is made available by the Divisions.

Establish and implement Quality Improvements Projects (QIPs) across DHU Health Care.

Develop multi-disciplinary and multi-agency audits.

Focus on learning.

Improve engagement of Auditors and attendance at Clinical Audit and Effectiveness Committee Meetings.

Initiate Clinical Audit Awards. Key Achievements 2020/2021 As an organisation, we actively engage in research. We undertake research studies, discuss opportunities with researchers, and encourage our staff to access research training opportunities. We work hard to increase the level of participation in clinical research, recognising the part that this plays in the wider health improvement of the nation. During 2020/2021, we have been involved in two research studies. The research projects are as follows

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Research Title Service Involved Research Author

An audit of compliance with NICE Guideline [NG158] in the assessment and management of home visiting patients with suspected lower limb deep vein thrombosis.

Acute Home Visiting Ser-vice for Leicestershire

Clinical Practitioner

Can we improve patient expectation within the Out of Hours Service?

Out of Hours Urgent Care Centres

Clinical Auditor/Senior Nurse Practitioner



Furthermore, DHU Health Care CIC introduced Antimicrobial Stewards. Antimicrobial stewardship is one of NHS England’s key strategies to overcome antibiotic resistance. It involves the careful and responsible management of antimicrobial use. Antimicrobial stewardship:

Is an inter-professional effort, across the continuum of care.

Involves timely and optimal selection, dose and duration of an antimicrobial.

For the best clinical outcome for the treatment or prevention of infection.

With minimal toxicity to the patient.

And minimal impact on resistance and other ecological adverse events such as C. difficile.

“The right antibiotic for the right patient, at the right time, with the right dose, and the right route, causing the least harm to the patient and future patients” https://www.cdc.gov/antibiotic-use/healthcare/index.html During late 2020 and early 2021, DHU Health Care has been in consultation with NHS England/Improvement (NHSE/I) and the Royal College of General Practitioners (RCGP) in becoming a Pilot Site for two specific accreditations. These are namely, Veterans accreditation and Daffodil Standards accreditation. The RCGP Veterans Accreditation Programme enables GP practice’s to deliver the best possible care and treatment for patients who have served in the armed forces.

Accreditation is voluntary, but is included in the key commitments of the NHS Long Term Plan, which states: ‘To ensure all GPs in England are equipped to best serve our veterans and their families, over the next five years we will roll out a veteran’s accreditation scheme in conjunction with the Royal College of GPs.’ As DHU Health Care is not considered a GP practice, NHSE are utilising DHU Health Care (all sites) as a Pilot Site to promote this further into the Urgent Care RCGP Veterans Accreditation. Accreditation lasts for three years, and DHU Health Care must commit to the following:

Ask patients using DHU Health Care if they have ever served in the British Armed Forces.

Code it on the GP computer system. By using the coding - Served in armed forces/Treatment of military veterans

Have a clinical lead for veterans within DHU Health Care. This should be a registered health care professional, but not necessarily a GP – it could be a nurse or paramedic.

This clinical lead is required to undertake dedicated training, attend training events (RCGP or other provider), stay up to date with the latest research and innovations and ensure that DHU Health Care is meeting the health commitments of the Armed Forces Covenant. They should also be available to provide advice to colleagues, as well as possibly seeing veterans themselves.

Eligible providers should have a CQC 'good' rating or higher.

Where appropriate, you may need to refer patients to dedicated NHS services such as the Veterans' Mental Health Transition, Intervention and Liaison service (TILS), the Veterans' Mental Health Complex

Treatment Service (CTS) and the Veterans Trauma Network.

The RCGP Daffodil Standards Programme enables health care providers to gain a structure to enable continuous learning and quality improvement as an integral part of caring for people affected by Advanced Serious Illness and End of Life Care. The Daffodil Standards are a blend of quality statements, evidence-based tools, reflective learning exercises and quality improvement steps. The RCGP designed the Standards in partnership with Marie Curie National End of Life Care Clinical Champion. The Daffodil Standards will empower DHU Health Care to assess and improve the end of life care we provide in manageable, practical ways which suit our Vision and Values. DHU Health Care know our patients best, and the Daffodil Standards will help to quickly create a clear, structured approach that’s relevant to our service, our staff and our patients. The Standards cover eight core areas, with tools, resources and simple steps to help DHU Health Care assess and build on the good care we already give to our patients and their loved ones. The eight areas are:

Professional and competent staff

Early identification

Carer Support

Seamless, planned, coordinated care

Assessment of unique needs of the patient

Quality care during the last days of life

Care after death

General Practice as hubs within compassionate communities

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https://www.cdc.gov/antibiotic-use/healthcare/index.html



As the pandemic eases DHU Health Care will continue to work with NHSE on embedding the two pilots from April 2021 to March 2022, in turn, gaining some excellent outcomes for all of our patients in the forthcoming year.

Proposal for 2021/2022 At DHU Health Care CIC, we are looking forward to the coming year with the introduction an Audit Strategy. Last year, this was delayed due to the Covid-19 Pandemic. With the ever increasing demands of regulatory bodies and external agencies requires clinical audit to be embedded within the culture of DHU Health Care and evidence be available to provide assurance on patient safety and risk. DHU Health Care must demonstrate robust Clinical Audit processes and compliance with National Quality Standards such as those required from:

The Care Quality Commission (CQC)

The National Institute for Health and Care Excellence (NICE) Guidance

The National Clinical Audit and Patient Outcome Programme (NCAPOP)

Audits identified for inclusion in the NHSE Quality Accounts document

National guidance and recommendations from National Confidential Enquiries

National / Royal College Audits

National Service Framework (NSF) Clinical Audit is traditionally used as a tool to provide assurance against DHU Health Care’s quality improvement indicators.

The new Audit Strategy aims to create opportunity for more locally driven audit and Quality Improvement Projects, and to affect more realistic and manageable annual audit plans. Throughout DHU Health Care, our staffs demonstrate a commitment and enthusiasm towards change and improvements, promoting Clinical Audit in order to drive change. In addition to the Clinical Audit Strategy, DHU Health Care will be researching and reviewing other IT/Online platforms for the automation of RCGP Clinical Audits. This will undoubtedly improve feedback and learning across DHU Health Care, in turn, continue to improve patient care. During March 2020, the UK was sent into Lock Down due to the Coronavirus Pandemic. This initiated a change in everyday life for health care staff and the patient journey. Furthermore, clinical audit was reduced to allow staff to focus on frontline duties to improve patient care. To ensure quality throughout DHU Health Care, clinical audit continued in the background by minimal staffing to not compromise the front line. Furthermore, we completed Patient Satisfaction Surveys, to gain live feedback for two main services during this period. Monitoring and improving patient satisfaction has always been a very important factor for driving health care business forward. The main reason for this is that providing patients with the best possible care is very important in the modern healthcare industry. Conducting this patient satisfaction survey will allow DHU Health Care and Derby & Derbyshire CCG learn if they are meeting the expectations of their patients or if they are lacking in any area. It is essential that as a healthcare

provider, we seek the views of our patients so we can set standards and take action when those standards are not met. The first reason as to why we should be conducting patient satisfaction surveys is to learn what is important to our patients. You may not believe this, but the way our patients are treated from the moment they enter your facility is very important:

Are your front desk personnel friendly and helpful?

Do your patients have to wait for long periods of time without any explanation?

Is there a play area for children and toys to play with whilst they are waiting?

All of these can be factors that may have your patients looking elsewhere, even if you provide excellent care. Chesterfield Royal Hospital, Emergency Department (ED) Streaming Service was reshaped, looking towards the Urgent Care Village model. The Emergency nurse Practitioners (ENP’s) looked at ways we could all work collaboratively to improve patient experience when arriving to the department. Prior to the changes made in ED at the beginning of the Covid-19 crisis, DHU Health Care staff had already developed a good relationship with the ENPs, furthermore, collaborative working and discussions to assist each other in delivering better care for our patients. During the Covid-19 crisis, ED was divided into “Green ED” and “Red ED”. Therefore, a pilot commenced, where the ENP and DHU Health Care staff worked together in streaming to provide improved care pathways, reduce waiting and treatment times.

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The Patient Satisfaction Survey was then instigated to gain the patients reaction to this change and how they found their individual journeys. Various questions were asked, gaining feedback from first walking in to leaving the department. Below are the results.

67 total questionnaire's returned

100% positive feedback

1 person stated not enough privacy booking

The second Patient Satisfaction Survey was taken at one of our Essential Workers Drive Thru Testing Facility. If we know what factors can turn a stressful visit to our service into an enjoyable one. We can then work towards making the patient journey as frictionless as possible. The questions we asked…

1. Were the staff welcoming?

2. Did the staff inside the tent explain the procedure?

3. Did you feel that you were treated with dignity and

respect?

4. What could improve your experience? Any comments?

We were overwhelmed by the results, in that 100% of all respondents felt that they were welcomed, had all the process explained, were treated with respect and dignity. This is a fantastic achievement. What was thought of the service: From free text comments, small improvements could be made. These were realignment of the cone system, so only one lane to direct in from the front entrance. In addition, we introduced better signs from the front entrance. A third Patient Satisfaction Survey was completed for the DHU Vaccination Programme of Care/Nursing Home facilities throughout Derbyshire. In December 2020, DHU Health Care CIC began the role out of Covid-19 Vaccinations to Care homes. This process was to ensure that as many local Care Homes in Derbyshire were given the Vaccination against Covid-19. During this process staffs within the care homes were asked to complete a short questionnaire based on their experience. Main points which arise from the questionnaire are:

Only 10% of staff asked, had taken up the opportunity to have an Influenza Vaccine at the start of the winter 2020 period.

No consistency in Lateral Flow Testing amongst the Care Homes

16-29 year old experienced more Covid-19 related symptoms during the peak of the Pandemic.

Staff have asked consistently if there will be an opportunity to have an Antibody Test?

The final Patient Satisfaction Survey was completed for the Covid Oximetry @ Home Programme. This is a National Patient Safety Improvement Programme, NHE England. There is good evidence that the lower the oxygen saturations at presentation, the higher the expected mortality. Unpublished evidence from over 1,000 COVID patients’ initial oxygen saturation recordings in the community (that were later admitted to hospital) show that if they are below 93%, the mortality rate is nearly 30%. If we can identify COVID patients with low oxygen levels early, there are proven treatments that improve the survival rates.

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The role out of Covid Oximetry @ Home is to enable monitoring of ‘at risk’ patients who have or potentially have Covid-19 within their own home, using point of care Pulse Oximetry and a diary, regular phone calls to these patients and clear guidance on oximetry ranges After a patient had been discharged from the programme, a brief phone questionnaire was completed to gain feedback on the patient experience and if we can learn from this. The purpose for completing Phone Call Feedback was to establish if any of the patients journey could be improved as DHU Health Care want to offer the best quality of care to patients within Derbyshire and this feedback was gained to ascertain if there is anything that DHU could do to improve on the standard of service we provide.

20 discharged patients were called, 10 Male patients and 10 Female patient, ages ranging from 65 to 95 years old. All had received their Influenza Vaccine via their GP Surgery in October 2020 All found that the instructions given were easy to follow All found reassurance with the Covid Oximetry @ Home Pilot 1 person found the device difficult to use, the comment was: “I got frustrated as found it fiddly and kept falling off – my niece helped in the end, was easier if someone did it for me”

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Safeguarding Children and

Adults

Safeguarding is like an umbrella to protect people from adverse elements. DHU Health Care continues to be committed to safeguarding and promoting the welfare of children and adults at risk. DHU’s core values revolve around putting patients’ interests at the heart of everything we do, respecting individual rights to respect and dignity, demonstrating excellence in everything we do and placing patients and colleagues at the heart of the organisation. These four core values underpin the safeguarding criteria within the internal structures of DHU. To support the delivery of the safeguarding agenda within DHU there is a clear governance and accounta bility framework in place. The framework provides assurance to our commissioners that whilst the ultimate responsibility and accountability for child and adult safeguarding lies firmly with the Board of Directors, every member of staff is accountable and is responsible for safeguarding and protecting children and adults at risk. DHU have robust referral pathways and strong communication and information sharing links with other organisations. In addition to this, the safeguarding team is also responsible for providing all staff with regular extensive training updates relevant to their roles.



Key achievements for 2020/21 It is recognised that the impact of Covid -19 has affected many people’s daily lives, in different ways. Financially, socially, family relationships and support networks, and children’s education to name a few. These changes increased the risk for some of the most vulnerable who were unable to protect themselves from abuse and neglect. During this past year the Safeguarding Team at DHU were involved in both National and Local campaigns and initiatives to safeguard Children and Adults at risk. Regular updates and information was distributed to clinical staff to assist them in recognising the risks associated with the pandemic and its subsequent lockdowns.

Safeguarding Leads were involved in the Regional meetings of Adult and Child Safeguarding leads to share and discuss issues relating to safeguarding and Covid 19.

Domestic abuse regional and national contacts were disseminated to all DHU staff via internal newsletters and updates

A Domestic Abuse campaign was

launched on DHU Social media (Facebook, Twitter etc.)

The screen savers across DHU were changed to show information on Domestic Abuse to increase Domestic Abuse awareness amongst staff.

Further development of Domestic Abuse procedures, information and training was evolved in conjunction with DHU Wellbeing Lead and Human Resources.

Awareness newsletters detailing safeguarding risks for children and adults during the pandemic were regularly sent out to staff.

Monthly Data analysis regarding safeguarding tending and referring data was reviewed to ensure that the needs of the service were adjusted and responded to. This highlighted that May, June, July and August 2020 saw the highest number of monthly Children and Adult referrals made to Social Care and Child Health by DHU for the last 4 years. There were 762 referrals made in May 2020 which is a significantly higher than any previous months.

In response to national concerns that parents were not seeking healthcare for ill children during the

pandemic - The comparison of calls for under 18’s into DHU via NHS111 for March 19 compared to March 20 showed an increase in calls for DHU.

However in April there was a decrease in calls relating to children of all age groups which was particularly significant in the under 5’s. To ensure that parents and carers were aware when to seek help and advice for unwell children, a poster designed by the NSPCC as part of a National Campaign to address this issue was distributed through DHU media sites (Facebook & Twitter).

Training provision for all DHU staff changed during 2020-21. Due to the COVID restrictions and infection control measures introduced, face to face training was no longer possible. This had been the preferred method of training

delivery within DHU. As a result the DHU Safeguarding training was restructured to utilise a variety of different training methods. Well recognised, certified eLearning packages were made available to all staff. However, the Safeguarding team have always recognised the value of group, face-to face training delivered by an experienced safeguarding practitioner. With this in mind the training team developed a training package, to incorporate the ‘Think family’ approach. This could be delivered in regular structured sessions via video link. This encouraged group participation and provided opportunities for scenario discussions and questions to be asked.

Local Safeguarding Boards and

commissioners seek assurance from

DHU that we meet the safeguarding

responsibilities and improve

outcomes for our patients. During

the past year the way these

assurances are provided have been

under review. DHU Safeguarding

Leads have been in collaboration

with Clinical Commissioning Groups

to develop new processes.



The Safeguarding Lead Nurses have been directly involved in all CQC inspections across DHU. Providing evidence that Safeguarding is the ‘golden thread’ that runs through all services and care provided by DHU.

The Safeguarding team have worked with senior managers within DHU on a variety of new service developments. They provided advice and guidance to ensure that safeguarding remained an important element of the

new service provision.

Current and future work The DHU Safeguarding team will continue to provide support to all DHU staff regarding safeguarding concerns and will develop new and innovative means of ensuring quality assurance within the safeguarding agenda. The DHU Safeguarding training will be further developed utilising various mediums and platforms to enhance the learning experience. The Safeguarding Leads are continuing to work with DHU Human Resources department, on initiatives to safeguard and support the staff themselves as well as our patients. DHU will continue to ensure that learning is shared and disseminated from both adult and children’s Safeguarding Adult Reviews and Serious Case Reviews across Derbyshire, Leicestershire and Northamptonshire irrespective of the area of origin.

The Safeguarding team will continue to work closely with governance personnel in order to safely manage Safeguarding Incidents and Serious Incidents requiring Investigation in line with company policy. The DHU Safeguarding Childrens and Safeguarding Adult procedures will be redeveloped into one overarching safeguarding procedure, in line with the ‘Think Family’ approach. This will be coupled with area specific guidance documents keeping abreast of important safeguarding initiatives both local and national and easily available to all staff across DHU . Going forward DHU will continue to be vigilant about the expanding range of initiatives and disciplines that come under the ‘safeguarding’ umbrella. DHU will continue to focus upon safeguarding practice, and as a partner agency within the Safeguarding network we will continue to work collaboratively, supporting the development and implementation of agreed safeguarding strategies and policies.



Clinical Training and

Education

Our vision at DHU is to ensure patients are at the heart of what we do, to provide excellent clinical outcomes and a safe first class experience. For this to be fulfilled the Organisation recognises the value of high quality education and training and is committed to developing its workforce so that they can provide excellent patient care and meet the challenges of new service developments. The following section of the report relates to the ongoing initiatives taken by the Clinical Training and Education team during 2020/2021 to influence this vision.

Key Achievements 2020/2021 Coronavirus Pandemic

2020-2021 has been an unprecedented year throughout the NHS due to the on-going coronavirus pandemic. From March 2020 to June 2020 all staff within the training team converted their training hours to support service demands on clinical services, leaving a short hiatus in the usual function of the Clinical Training and Education teams work. The pandemic also drove a rapid change in how patient care was delivered, requiring the ability to

work remotely rather than face to face and to provide patient facing assessments for our most vulnerable patients in their own home and care facilities. The commissioning of “red” pandemic cars to provide home visiting services for confirmed / suspected covid positive patients, required upskilling of a number of nurse practitioners in home visiting skills. Commissioning of pandemic cars across our services to meet the need for coronavirus assessment required flexibility and resilience from all staff and this was demonstrated throughout. In addition there has been an increase in the use of remote assessment / clinician advice / video consultations to provide assessment and management of the majority of presentations. The advanced clinical trainers worked additional hours to ensure staff were provided with supervision in practice and they were safe to cover pandemic care shift and perform remote consultations. These hours which were in addition to the normal demand. To avoid transmission of covid infections, all face to face training (including mandatory training) was suspended. This was initially for 3 months but as the

pandemic continues the training team have had to work in new ways to ensure clinical support and education has been provided. All members of the training team attended external sessions on how to deliver training/teaching remotely via online platforms- including Zoom and Microsoft teams. Over the last 12 months, as an organisation, we have become increasingly proficient in using these IT solutions. We have been able to continue with regular meetings and have provided a large number of training sessions using these services. To ensure clinicians have received support to gain competence in core skills, the training team have continued to work alongside practitioners in clinical settings by following covid guidelines but it has become apparent that remote training is also a valuable resource for our organisation. It has removed barriers relating to travelling time, parking, availability of staff and has also reduced expenses and has been environmentally friendly. Feedback from Clinical Trainers:

“The course concentrated on Zoom and not

Microsoft teams, so this was a bit of a

downside, but most of the information

shared was adaptable/transferable. The

facilitator was very knowledgeable and

engaging and had useful tips for dealing

with people who appeared to be not

engaging”

“I thought the training was good. I haven’t managed to use all of the strategies that were taught but I’ve been zooming ever since” “Good session pitched about right for those with some experience and those like me a technophobe . Good group of participants all willing g to share and help each other.’’

GP Supervision Session via Zoom



Advanced Clinical Practitioners (ACPs)

Advanced clinical practitioners (ACPs) remain an essential part of the work force and despite the covid pandemic; Health Education England (HEE) and the Higher Educational Institutions (HEIs) have continued to focus on the development of trainee ACPs. HEE provided a further 20 fully funded MSc programmes and 10 “top up” places of up to 100 credits to allow students on modular MSc pathways to complete their studies. 9 student from 2018-2019 and 6 students from 2019-2020 are still on-going with their MSc studies and portfolio. The training team have facilitated completion of the academic and portfolio elements of ACP progression within DHU. Personal development plans have continued to be undertaken as have face to face supervision sessions. The Derbyshire ACP group remain active in driving ACP standards forwards and the National HEE team has now recruited into regional advanced practice lead positions to drive forward standards for advanced practice.

Assistant Practitioner Apprenticeship DHU continue to support staff on the Assistant Practitioner Apprenticeship. At present we have 6 staff members who have commenced on the Assistant PractitionerApprenticeship Programme, and have continued with their Foundation Degree, we have three students in year two of the course and two will qualify in

June 2021 and the other in September 2021, the remaining three are in the first year of the course. They are mentored and supported by the Lead Clinical Mandatory Trainer and are adapting well to their developing roles in clinical practice and it is perceived that this role will bring a new skill mix to our services.

Clinical Mandatory Trainers DHU has substantive Clinical Mandatory Trainers. The team comprises of a Lead trainer supported by trainers for Derbyshire Leicestershire and Northamptonshire. One specific remit of the Lead trainer and the HCA trainer is to work with Clinical Operational Management team to support, develop and deliver clinical training sessions to the equivalent of our bands 1 – 4 within the organisation. The team produce and deliver training materials for mandatory training, in-house courses, assessments and re-validation of skills employing flexibility and variation of techniques to suit different learning styles.

Mandatory Training The Mandatory and Statutory Training (MAST) policy was reviewed in December 2020 at the Patient Safety Committee meeting due to some suggested modifications that were advised due to the ever evolving requirements within the pandemic health care setting. Face to face Mandatory training continues to be halted at present; the recommendation was reviewed following a governance review.

The move to online training platforms will continue to be used and reviewed on a monthly basis. Safeguarding Level 3 Think Family training sessions continued and will continue to be delivered via MS Teams for registered DHU staff. Our non-registered patient facing staff complete Level 1 & 2 via a training platform and office based staff are asked to complete a Level 1 training module on line devised by the Safeguarding Team. Mandatory training compliance is monitored via managers and the Training Team and reported through the DHU governance channels. All divisional managers have worked hard to improve our mandatory training compliance figures during 2020-2021 and we have seen improvements in many areas across the organisation.

Sepsis Training

In July 2020 staff were advised to complete 5 modules in Sepsis in Primary Care via e-Learning for Health modules as this was recognised as a learning need for clinical advisors and some of our registered staff.



Resus Modules & Resus Council

Lifesaver App

Due to the recent Covid-19 pandemic, a decision was made

to move our face to face Resus training to be completed via

the e-Learning for health training platform and for

registered staff to use the Lifesaver App on the Resus

Council website http://life-saver.org.uk/. This was used for

scenarios and to consolidate learning; a certificate could be

obtained on completion which could be used towards CPD/

Revalidation.

Registered Staff learning modules:

Non-Registered Patient-Facing learning module

Despite the Covid-19 pandemic we managed to maintain

compliance as shown below:

BLS Pop-Up workshops were previously held in 2019 -2020

and were very successful, staff feedback was very positive

and these were thought to be a great way of refreshing

previous training. Pop-Up Roadshow Workshops for all

staff were held throughout the year when circumstances

allowed and it was safe to do so .

Moving & Handling Level 1 & e-Assessment Level 2

January 2021

Due to an identified need, staff were asked to complete

moving & handling level 1 & e-Assessment level 2 via

training platforms dependant on whether their role was

clinical or non-clinical. This was well received.

http://life-saver.org.uk/



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Supporting Learning The organisation recognises the value of high quality clinical education and training and is committed to developing its workforce so that they can provide excellent patient care and meet the challenges of new service development. Throughout the pandemic even when face to face training wasn’t appropriate alternative learning support platforms were provided. Following staff appraisals, learning gaps were identified and subsequently we looked at how we could facilitate this and offer staff development accordingly. It is extremely important that staff receive access to training sessions and hopefully this will support the retention of a motivated, knowledgeable and skilled workforce.

NHS 111 Clinical Advisors Paediatric Training Sessions March 2021 Dr Edward Snelson, Consultant in Paediatric Medicine adapted the 2 day training sessions previously delivered to our Advanced clinical practitioners to deliver training for the NHS 111 Clinical Advisors .Sessions covered Recognising the Unwell Child and Respiratory Presen-tations in Children. Topics included an overview of the common respiratory presentations in children and an update on the latest guidelines on a variety of conditions that result in cough, wheeze, stridor and respiratory distress. The feedback received from staff across the DHU workforce was excellent. “Excellent training session, Edward always makes the sessions really interactive and informative” “I would also like to say that I found the paediatric 1st Training course was fantastic, and Dr Snelson was excellent as I have never done a training via Zoom and was a bit apprehensive thinking if the delivery would lose some of its meaning but it was brilliant, In its content, delivery of the session and I think I can safely say that everyone of us got something out of the sessions” “I would just like to say I thought the session was fantastic! The information given was relevant and some of it was a real eye opener. Dr Edward was interesting to listen to and gave us ‘no nonsense’ information that will be useful to all clinicians in telephone triage. I am sending out the link to his myth busting website to all clinicians but I really think this training session should be encouraged as much as possible”

Urgent care Training Sessions 2020- 2021

Learning gaps were identified at staff appraisals and staff requests for further training in the Out of Hours settings. This resulted in the following evening on line training sessions being planned and delivered by our own clinically trained staff and external providers. This training was available to all clinical urgent care staff

Burns Assessment

End of Life /Palliative

2 week wait indicators/Red Flags/Long Term Conditions

Ophthalmic Presentations

Gynaecological Assess-ment & Examinations

Basic Observations Theory in a clinical setting

Minor Illness & Conditions

Telephone Triage

ReSPECT

Verification of Death



Covid-19 Vaccination and PCR Training

During this time there was a need to concentrate on training staff for the impending Covid 19 vaccine administration role and DHU developed and trained many of our staff to have this skill. Training was also provided for our staff to perform the Polymerase Chain Reaction (PCR) test. We worked hard to ensure that competency documents were put in place for both these important roles .

Infection Prevention and Control

Training modules were completed via online learning platforms due to the cease of face to face mandatory training. However an example of important training provided face to face during this period consisted of Hand Hygiene technique, Donning

and Doffing of personal protective equipment and FFP3 Mask fit testing provided by an external trainer .

Proposals for 2020/2021 DHU will continue to encourage Healthcare Assistants to join the Assistant Practitioner Apprenticeship Programme in the next academic year (Sept 2021). DHU will continue to undertake training needs analysis from the appraisal process, additionally learning from incidents/feedback and continue to facilitate and promote high quality training opportunities to develop and maintain staff competencies. The compliance of mandatory training will continue to be reviewed during the Covid pandemic to ensure staff competencies are maintained to the highest level possible and utilising a safe and effective delivery style.

IMAGE



Medicine Management

DHU Health Care CIC follows the principles and guidelines of the Department of Health Document: ‘Securing Proper Access to Medicines’ in the Out-of-hours service. This means that in addition to being able to prescribe medicines when required for patients, our staff also carry stocks of approved out-of-hours medicines to issue to patients urgently. Robust protocols have been put in place to ensure that we meet the standards required for Care and Quality Commission (CQC) ready for inspection.

Key Achievements 2020/21

Following on from suggestions made following our most recent CQC inspection. The process by which DHU receipts controlled drugs entering the business, the manner in which they are stored, the movement within the company and their final supply to patients has been amended. This process was standardised and implemented across all three areas, Derbyshire, Leicestershire and Northamptonshire.

This new process has had a significant impact at reducing the number of incidents reported around the usage of controlled drugs internally. It has also expedited the swiftness which any incidents can be investigated and bought to conclusion. It gives assurance and an improved robustness to the entire process. Following the conclusion of the IUC pharmacist pilot in March of 2020 DHU Health Care now has a dedicated team of sixteen pharmacists permanently employed at DHU Health Care. Fourteen of these pharmacists are qualified prescribers, one is pending the result after completion of the course and one remaining pharmacist is undertaking the independent prescribing course. With the pharmacy team we have one Primary Care pharmacist employed within a PCN in Derbyshire. This helps link in with the primary care networks in the area. We successfully recruited two practice based pharmacists that work across the three surgeries within Leicester City Centre. They have oversight of the medicines management and will ensure

that we continue to seek and gain improvements in the CQC rating for the surgeries. Two of the pharmacists have completed the Advanced Clinical practice MSc and are embedded within the urgent care division within Derbyshire. They have assisted with the delivery of swabbing, vaccination services during the pandemic, as well as the transformational work at both of the hospital sites in Derbyshire. Leicester has a pharmacist undertaking the Msc in Advanced Clinical Practice, they have been involved delivering frontline services at Loughborough Urgent Care and via the Clinical Navigation hub.

Proposals for 2021/2022 Further investment has been made available for the development of the pharmacy team, expansion within the 111 service requires an additional 6 WTE and recruitment is well under way at the moment. Two training positions have been created within the Urgent Care division for Pharmacist Advance Clinical Practitioners. This will help create a definitive pathway for career development for pharmacists within DHU Health Care.



Health & Safety

The focus on safety offered to all of our staff, patients and visitors continues to be of a very high priority. This is to ensure that our excellent record in managing health and safety across the organisation is maintained. Covid-19 has created a number of challenges for the Health & Safety Team throughout 2020 and into the first quarter of 2021. Site visits have been reduced which in turn has meant that audits have been minimal, this will be rectified during the coming months. However Covid risk assessments were completed for all sites prior to the first national lockdown. The DHU Team and the wider health service continue to play a vital role in the identification and management of potential risks and hazards within the workplace and this collaborative work ethic means that DHU staff and third parties go the extra mile to ensure that anything that poses a risk to safety is raised at the appropriate levels in order that any remedial actions can be addressed.

The above statistics are taken from all contractual areas of the DHU business as reported through the organisation Datix incident reporting system. It should be acknowledged that for the year 2020-2021 the County and the Country have been experiencing the consequences of the pandemic, Covid-19. AS the pandemic period extended in 2020 patients continued to avoid contacting emergency / urgent care services in order to “support the NHS” despite many of them probably being quite ill.

As a consequence services experienced some lower activity levels during quarters 1 to 3. DHU continued to support a number of corporate functions working remotely, this may, again have had an impact on the number of incidents reported via Datix. These combined could very well be reflected in the lower number of incidents reported via the Datix system that DHU utilises. As a Division we will not be able to substantiate this theory until after March 2022 to allow for comparisons.

Whilst incident rates remained low during 2020/21 due to Covid-19 being classed as a reportable disease there were 6 cases that needed to be reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). Reporting was necessary as the cases of transmission potentially occurred within the workplace.

Accidents Needlestick False Fire Alarms Violence & Aggres-

sion (Face to Face)

Verbal Aggression

(Telephone)

18 3 3 5 2

Health & Safety stats 2020 - 2021 - DHU Wide



Key Focuses for 2020/21; During 2020/21 the key focus for the Estates and Health & Safety Team was to ensure the safety of our employees and partners throughout the pandemic. A number of initiatives were implemented to reduce the spread of infection not only within the workplace but by association within the community as well. These initiatives included;

Creation of a global Covid risk assessment and ongoing review and monitoring across all locations

Regular Senior Management review meetings

Regular outbreak review meetings including team members from IPC, Estates, Health & Safety, NHS 111, Clinical and Corporate

Increased hand washing/sanitisation facilities within all locations

Introduction of Perspex POD’s around desks

Mandatory mask wearing whilst away from desk

Increased cleaning schedules

Increased PPE supply

Regular site audits specific to Covid 19 risk

Safety Assessment and Decision (SAAD) assessments for all employees implemented to understand the risk of Covid-19 to individuals. Following these specific measures were employed to protect vulnerable staff.

Key Focus for 2021/22; In October of 2020 a new Head of Estates, Facilities and

Health & Safety was appointed with support of the appointment of a new Deputy Head of Estates, Facilities and Health & Safety planned for May 2021. The role of the Deputy Head of Estates, Facilities and Health & Safety will have a keen focus during 2021 on the health & safety function within the business. This will include;

Review of team structure and resource availability

Re-implementation of annual audit schedule for all sites following reduction in Covid audits

Review of current health and safety procedures to ensure fit for purpose and the identification of potential gaps in compliance

Ensuring compliance with the relevant health and safety legislation

Throughout 2020/21 we learnt that the use of face coverings, perspex pod’s and the reminders to practice regarding good hand hygiene not only helped to reduce the number of Covid-19 cases within the workplace but other illnesses. These practices have continued through to 2021 and will be reviewed at the appropriate times, with any reduction in requirements or activities only taking place once guidance and advice has been sought by both internal and external subject matter experts, such as the IPC team and PHE. During the early days of the pandemic home working was supported via the issue of new and existing equipment for those that were able to work from home. DHU is currently supporting agile working for employees where appropriate to the role going forward.



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Information Governance

DHU Health Care constantly strives to meet and exceed the standards of compliance in information governance and the introduction of the Data Security & Protection Toolkit means that all Healthcare organisations are required to meet the National Data Guardian 10 key standards. The ten key standards enable DHU to deal with the high volumes of confidential information handled both as a Data Controller and Data Processor. By completing the Data Security & Protection Toolkit DHU are reaffirming to its stakeholders that we have met the national Data Security Standards. Although the past year has been a difficult one, DHU prides itself on its ability to adapt to ever changing situations and as a key component of the Integrated Urgent Care System we have been able to play a key role in the battle against

COVID-19 by setting up systems and services that were aimed at providing support to the wider communities including but not limited to;

COVID Response Centres

COVID test Centres

Hot Hubs

Vaccination Centres

RED Home Visiting Services

111 Additional Services These services often had to be implemented at speed and through the use of existing systems and processes DHU were able to facilitate these without compromise to the security and integrity of personal or special category data of our patients or stakeholders, this puts DHU at the forefront of joint working across the east Midlands. As a

result of the Pandemic situation healthcare providers were provided an extension by NHS Digital for the compliance with the Data Security & Protection Toolkit to the 30th September 2020, this extension provided time for DHU Health Care to focus on dealing with the provisions associated with the pandemic situation providing key services to our patient population and protecting our staff that are at the forefront of providing these services. DHU completed the requirement of the DSPT within the required extension timeframe and provided assurance that we consistently meet our obligations in relation to information governance and data protection requirements. DHU are currently compiling the compliance documentation for the up and coming submission which is again due by the 30th September 2021.

Incident statistics for 2020/21;

The charts opposite represents the

volume of incidents reported across the

organisation, the key factor in these are

the overall severity of incidents being

reported and managed by the

organisation remain at an overall low

state



Continuation with ISO

Standards

In 2019 DHU Health Care were successful in achieving ISO accreditation to the internationally recognised standards for ISO 9001 (Quality Management Systems), ISO 27001 (Information Security Management Systems) and ISO 22301 (Business Continuity Management). Although DHU Health Care along with all Healthcare organisations have been battling the pandemic situation over the past year DHU have maintained a strong organisational emphasis on providing assurance to our stakeholders that information security, data protection and confidentiality of all information within and across DHU is maintained. During the pandemic DHU have continued with external verification audits conducted by BSI and we are pleased to announce that have maintained certification with the international ISO27001 standard, this continued assessment process emphasizes the

assurances provided by DHU Health Care around its approach to handling information.

Key Focuses for 2021/22

A key focus of 2021/22 is the continued promotion and maintenance of the ISO Business Management Systems across the organisation and the continued accreditation to the three key ISO standards;

ISO 9001 - Quality Management Standards

ISO 27001 - Information Security Standards

ISO 22301 - Business Continuity Standards

Infection Prevention & Control

DHU Health Care is committed to the prevention and control of infections using effective Infection Prevention and Control (IPC) leadership, mandatory procedures and annual training. IPC is ‘everyone’s responsibility’ and this continues to be our mantra. DHU Health Care promotes IPC as a core foundation of safe delivery of care for patients, service users, visitors and staff health. IPC is encouraged and embedded in everyday practice across the organisation. This is in line with The Health & Social Care Act 20081, which requires healthcare organisations to have clear arrangements for the effective prevention, detection and control of healthcare associated infection. DHU has a dedicated clinical IPC team, consisting of a lead practitioner, IPC practitioner and an IPC Health Care Assistant who work across the organisation. The DHU IPC team aims to ensure that;

All areas are aware of the IPC team and contact details to gain advice/support when required

There is oversight of the DHU Infection Prevention and control mandatory training package

Robust and timely outbreak management advice and support

A schedule of auditing for sites and services across all three counties

The DHU Infection Prevention and Control policy is up to date

There is guidance for COVID-19 that is reviewed and updated when required

IPC related Datix and trends are monitored and trends reported via Governance channels

The Sepsis and Flu Planning Groups meet monthly/ bi-monthly respectively

Site audits The health and social care act (2008) code for practice for the prevention and control of Healthcare Associated Infections (HCAI) requires that healthcare facilities have in place a schedule of audits to ensure site and staff compliance to policy is maintained and being implemented appropriately. Six monthly full site audits are conducted (with follow up and action plans as required) and unannounced spot checks completed to ensure that DHU is conforming to national standards During 2020-2021, audits such as IPC full site, hand hygiene and Personal Protective Equipment (PPE) and COVID-19 site compliance were undertaken. The full IPC site audit is comprehensive and scores the following areas:

Hand Hygiene

Environment

Kitchen

Disposal of Waste

Spillages and contamination by bodily fluids

Personal Protective Equipment

Prevention of Sharps Injuries

Management of vaccines (where appropriate for site).

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An overall site score is collated and the results for 2020/2021 are demonstrated in the Tables below. Feedback is given at the time of the audit to link staff or site managers when present. The audit is RAG rated and sent to the senior management team responsible for the site with a SMART action plan if required.

IPC standards are being maintained at a high level across most sites, however; due to the Coronavirus pandemic gaining access to sites has proven challenging due to a restriction of visiting staff. As healthcare restoration continues working towards normality the DHU sites with outstanding audits will have assurance visits completed at the earliest opportunity.

Tables 1 - 3 demonstrate the results from the full IPC site audits undertaken across DHU during the reporting period The above tables show the audit compliance of the areas, broken down into geographical location and their results. During the current pandemic site audits have continued where sites have been open. Many of the smaller urgent care sites closed and gaining access was not priority. Any concern found during an audit is discussed at the time of audit and the completed audit and actions are sent via email to site leads, clinical managers and the property management team responsible for any environmental damages or required

works. For any repeat audit failures an escalation process is followed in an attempt to rectify the problem. At present each site has a bi-yearly audit completed; this is to be reviewed for consideration of increasing audit frequency in some of the busier sites. This would allow for any problems/concerns to be addressed and resolved at an earlier date. The results do demonstrate that the overall compliance of the clinical areas has been very positive, which also signifies the commitment of the staff, and the Organisation, to this hugely important element of compliance.

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Table 1: IPC full site audit results for Northants 2020-2021

Table 2: IPC full site audit results for Derbyshire 2020-2021

Table 3: IPC full site audit results for LLR



IPC Compliance 2020/2021

Compliance with infection prevention practice is a known global concern and given the longevity of the Coronavirus pandemic there will be expected fluctuations within IPC practice. At DHU there have been no major concerns regarding compliance to infection prevention practice.

In response to COVID-19, staff have been seen to have a committed approach to improved hand-washing techniques, donning and doffing techniques and increased touch-point cleaning practices.

The COVID-19 pandemic has put our health systems under unprecedented strain; however DHU has coped with the difficulties and challenges of the pandemic fantastically. This has been achieved by significant dedication by all departments working and pulling together and going the extra mile and beyond.

Board Assessment Framework for DHU

The Board Assessment Framework (BAF) has been invaluable throughout COVID-19 pandemic, in providing a clear structure and framework for staff to work within for IPC related matters. The BAF also allows us to provide assurance to the Parent Board, as well as outside agencies that we are adhering to all local and national policies and procedures at such a crucial time. The versions of the document are reviewed frequently and hence the detail updated to ensure that the most up to safe and relevant information is being captured and reported keeping our patients and staff safe during these unprecedented times. The sharing of the document and the dissemination occurred through our governance meetings in DHU indicating a seamless approach. The sharing and mandate of the document ensured that the procedures and policies within were continually updated.

Coronavirus 2020/2021

With the impact of the COVID-19 pandemic, it was essential to further strengthen the IPC assurance pathway, developing additional specific audit tools such as COVID-19 site compliance tool, Personal Protective Equipment (PPE) and increased Hand Hygiene audits which were in place from March 2020 onwards. Working closely with the Health and Safety team, measures to ensure that all DHU staff, patients and visitors were able to utilise COVID-19 secure environments were put into place. Dynamic risk assessments have been completed to continually monitor the safety of the COVID-19 secure measures. These risk assessments are then reviewed as per Government and Public Health England (PHE) guidance in a timely manner. Plastic Perspex pods were installed to add further protection for those staff that worked in the NHS 111 call centres or in reception areas. These pods provide reassurance for staff and aid in the reduction of viral spread. Personal Protective Equipment (PPE) has

been paramount in maintaining the safety of staff from the acquisition of Coronavirus. Clinicians have been supported by the IPC team in the education and use of Donning and Doffing of PPE. An audit tool was created using criteria complied by PHE. This has been used throughout the pandemic to provide assurance that PPE compliance remains our priority.

Managing Outbreaks Given the number of staff working within DHU there have been minimal staff outbreaks attributed to COVID-19. Where outbreaks have occurred there has been excellent communication with the staff involved, the health and safety team, facilities and PHE. Lessons learnt have been shared to minimise the re-occurrence of further outbreaks. Timely communication via email and the use of the Datix system has proven invaluable. There has not been any requirement to hold an outbreak meeting held since the beginning of March 2021.

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Fosse House

NHS111

Ashgate Manor

& Johnson 111

services

Urgent Care

Derbyshire

Urgent Care

LLR



COVID-19 swabbing service DHU was instrumental in setting up the first COVID-19 swabbing site in Leicester at a local MacDonald’s site. It was open between 18 April to 30 April 2020 and in that time 287 people were swabbed. Following its success the swabbing site was moved to a bigger location to cope with the increasing demand and was set up and co-ordinated by the government. Following this, swabbing has continued across care home facilities.

Month Number of swabs Number of sites

January 483 14

February 1126* 15

March 118 3

April 11 1

*646 swabs in February were for one site

Flu Vaccination Prpgramme

DHU healthcare are proactive in encouraging all staff members within the organisation to be vaccinated against seasonal influenza. There is an established Flu Planning team, chaired by the Deputy Director of Nursing and Quality and supported by IPC Lead. DHU Senior management team (SMT) actively encourage all staff to have the vaccination to help prevent transmission of influenza to the public and staff. The vaccination programme supports sickness reduction during the winter period whilst also focussing on staff’s health and wellbeing. In addition to promoting and delivering the influenza programme, the DHU Flu campaign will also reinforce vital communications for the other measures that can be taken to prevent the spread of influenza and other respiratory

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infections such as COVID-19. There was consistent message via IPC newsletters, corporate weekly emails and the DHU intranet promoting the use for good hand and respiratory hygiene, social distancing and work space cleanliness as these are essential elements in reducing the impact of transmittable infections. The table below compares the number of staff Flu vaccinated at the first of each month during the season for 2019-20 and 2020-21. It is evident that the percentage of staff vaccinations given in 2020-21 is considerably higher than in the previous year.

Flu comparison DHU overall 2019/20 and 2020/2021



Flu Vaccination Figures 2020/2021 The results of the 2020/2021 flu campaign are difficult to compare with previous years due to the Coronavirus pandemic. There was a mass vaccination programme for the COVID-19 vaccine being run at a similar time. There is guidance that the COVID-19 vaccine and the influenza vaccine should have a 7 day gap between administrations. This caused some staff to delay getting their flu vaccine as the COVID-19 Vaccine was prioritised. The Flu planning team continue to aspire in delivering innovative methods for communication and promotion for staff having their flu vaccination and ensuring that the importance of receiving the vaccine is highlighted at every opportunity. Given the success of previous years DHU continues to promoted the availability of the Flu vaccines by the use of regular communications to staff via newsletters and emails, myth busting fact sheets and creating Flu boards at Ashgate manor, Johnson building and Fosse House to keep staff aware of when vaccinations were available. Peer Vaccinators are utilised to the fullest. Each year peer vaccinators complete training via e-LfH which ensures that everyone has the latest information and guidance. As a result, all staff, regardless of shift time have the opportunity to receive a vaccine. In addition to the regular communications and information from peer vaccinators, the management teams could monitor staff uptake of the vaccine and were able to

communicate with those staff members that had not received an influenza vaccine. This approach allowed staff with vaccine hesitancy or potential questions to have their concerns allayed. This proved a successful methodology which will be built upon in the forthcoming 2021/22 campaign. DHU has selected two local domestic violence charities to

support during this year's flu campaign, Women’s aid &

ManKind. For every vaccination given a donation will go

towards the below two charities. The final donation

amount is yet to be confirmed.

Flu Vaccination Figures for 2020/2021



Sepsis The Sepsis Campaign came about in 2004 to begin to raise awareness of the early recognition, diagnosis and management of patients which would eventually become pivotal in the successful treatment of patients that otherwise may have been missed and subsequently come to harm. The Bundle, campaign and documentation has saved countless lives in clinical practice as well as improve patient outcomes. Over the past few years, DHU have been

fully engaged with the national campaigns and in conjunction with world sepsis day on September 13th 2019, the Infection prevention and control team promoted the ‘DHU sepsis 3 pathway’ which is a scaled down version of the national sepsis 6 bundle. This bundle supports early interventions such as: notifying the ambulance service, providing supplementary oxygen and intravenous fluids within 1 hour of the patient having a

suspected diagnosis of sepsis. The Sepsis 6 bundle is being used in in some of the Urgent Treatment Centres where they have the ability to provide the required interventions and timescales that must be adhered to in order to improve mortality from sepsis. Pictures Below: The Sepsis 3 Bundle and Adult Sepsis Screening and immediate Action Tool. Use of the sepsis bundle, which is embedded within Adastra (Derbyshire), is audited monthly and reported quarterly to CQRG Derbyshire by the DHU IPC team.

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Information regarding Sepsis Audit overall LLR services

Audit is based in the following criteria:

The graph opposite demonstrates where there is ‘Yes’ response to the questions posed. There is clear progression and improvements over the last 3 quarters. This potentially could be down to the education and increased awareness brought about by the teams. The graph also shows a lack in the administration of oxygen and IV fluids. These are key component of the Sepsis bundle and improving clinical outcomes. There is work being undertaken to increase the delivery of these drugs as and when required. There are currently minimal sites that can offer the full sepsis 6 provision which includes the administration of IV fluids, this has been raised and acknowledged within the Sepsis reviews .Within LLR, the sepsis bundle document sits in the patient notes where it can be audited via an internal audit report. The Sepsis Group is planning on relaunching Sepsis 3 and Sepsis 6 later this year there has been a negative effect on Sepsis due to the intensity of the COVID-19 pandemic and the similarity of core symptoms. Education, audit and provision of training for staff are being reviewed as part of the Sepsis group’s ongoing work in an effort to standardise practice across DHU and improve patient outcomes. Mandatory Sepsis training will continue to be monitored for compliance and reported via DHU governance committees.

Q1 - Has the patient been referred to Hospital?

Q2 - Has anyone called 999?

Q3 - Has Oxygen been administered?

Q4 - Have IV Fluids been administered?

Q5 - Has the bundle been completed within 1 hour?

Graph 1: Comparison of Sepsis 3 Bundle audit data LLR

Forthcoming initiatives 2020-2021

The COVID-19 pandemic impacted on the level of IPC activity within DHU exponentially from March 2020 onwards, not least due to the constantly changing guidance and short implementation time frames. There is a positive move towards the standardisation of audit documentation and practice and dynamic reviews for the restoration of services in adherence of COVID-19 guidelines for healthcare providers as set out by the government and PHE.

Collaboration with the patient safety team to design a Hand Hygiene poster with a QR code containing a short questionnaire for patients and visitors to use following consultation to provide assurance that the 5 Moments of Hand Hygiene is being adhered too.

Preparation for the Flu Season 2020-21 Health Care Worker programme will begin in spring 2020.

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Section 5 Our Patient Experience


Clinical Governance Department DHU have an open and transparent approach to reporting and managing incidents. The incident reporting policy provides a framework and guidance for staff to report incidents and near misses. A patient safety culture exists within DHU, staff feel confident to report anything which causes them concern and this was confirmed in our recent CQC inspections. All the members of the Clinical Governance teams are committed to ensuring that we learn from patient and staff experience to ensure that patients receive high quality care. All members of the team ensure that issues raised are investigated thoroughly to prevent the same issues arising again. The Clinical Governance teams are also proactive in monitoring themes and ensure that issues raised are triangulated across complaints, incidents, patient and health care professional feedback. The teams work in close partnership with Clinical Directors, Senior and front line staff, including external stakeholders such as EMAS to ensure that patient safety is a top priority. This provides confidence to DHU staff and external contacts that Complaints, Incidents and Feedback raised will be investigated thoroughly and appropriate action taken. Serious Incidents DHU follows the NHS England Serious Incident framework. During 2020/21 a total of 10 Serious Incidents (SI’s) were reported across all our Divisions. This is an increase of 4 Serious Incident reported the previous year (2019/20)

when we reported 6 Serious Incidents. The percentage of serious incidents (SI) reported in relation to patient contacts, across all divisions was 0.0004%. 5 SI’s were reported for the DHU 111, 1 for Urgent Care (Derbyshire), 3 for Urgent Care (LLR) and 1 for Urgent Care (Northamptonshire). Serious incidents are reported on STEIS the National Serious Incident reporting system to ensure learning is shared on a National & local level. Learning from Serious incidents reported in DHU has included: DHU 111 - the education of all DHU clinicans of ‘nonspecific’ cardiac symptoms and the consideration of possible cardiac causes with atypical patient symptoms Urgent Care (Derbyshire) - staff have been reminded of the signs and symptoms of nonspecific chest pain and Abdominal Aortic Aneurysms (AAA), as well as the management of both these medical conditions Urgent Care (LLR) – a comfort calling flowchart was developed which includes the roles and responsibilities of clinical and non-clinical staff; actions requiring escalation and decision making for downgrading home visits.

Urgent Care (Northamptonshire ) and DHU 111 - Distribution of the NICE Clinical Guidance for Head Injuries to all clinical staff with the reminder that patients who have sustained a head injury and are taking anticoagulation medication require referral to the emergency department for a CT scan. Patient Safety Incident Response Framework (PSIRF) The Patient Safety Incident Response Framework (PSIRF)

was developed as a result of a review by NHS England and NHS Improvement into the patient safety incident investigations carried out across NHS Trusts. The review showed that the quality of investigations carried out was poor; a number of investigations were being carried out on the same / similar issues with little change and the same learning outcomes. It was felt that there was not enough focus on causal and system issues to reduce patient safety risks and incidents. There needed to be more focus on system analysis of themes. Derbyshire CCG agreed to be one of the pilots / early adopter sites of the PSIRF. DHU are part of this pilot alongside other partner organisations such as: Chesterfield Royal Hospital (CRH); University Hospitals Derby and Burton; Derbyshire Community Health Services (DCHS); Derbyshire Healthcare Mental Health services. Each organisation had to review their complaints, incidents, clinical negligence claims etc. over the past 3 years, to identify themes and then develop their own patient safety incident response plan (PSIRP). This patient safety incident response plan (PSIRP) sets out how DHU 111 (East Midlands) CIC - Derbyshire Contract Area and Urgent Care Derbyshire will seek to learn from patient safety incidents reported by staff and patients, their families and carers as part of our work to continually improve the quality and safety of the care we provide. The focus is on specific themes and carrying out in depth investigations into these. The specific themes identified for DHU 111 (East Midlands) CIC and Urgent Care (Derbyshire) are as follows:

Atypical chest pain

Cauda equinae

Cases closed in error

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The new approach means that 3 in-depth patient safety investigations are to be done in each of the identified themes. Each patient safety investigation will require Director sign off. Following the completion of the 3 patient safety investigations a thematic analysis will be done, to identify any common causal factors or learning. DHU Health care have been commended by NHSE for their great work around this initiative as we are one of the first providers from an urgent care and NHS111 perspective to successfully apply these principles to our governance work .

Duty of Candour DHU follows the NHS Duty of Candour guidance, we believe in being open and honest with patients and their families when things go wrong. We contact patients and their families, to offer an apology where the patient outcomes are unexpected and sometimes tragic. We ensure that a thorough investigation is completed with full details of the investigation being shared with the patient and their families.

Incidents During 2020/21 the incidents reported as a percentage of patient contacts were 0.093%, with a total of 2,079 incidents reported across all our Divisions. DHU NHS 111 The top three areas of concern regarding incidents reported for the NHS 111 service are:

Delayed treatment

Information technology (IT) issues

Other agency review Incidents regarding an alleged delay in treatment, on the whole are regarding the NHS 111 referral Pathway selection or calls being placed into an incorrect queue. Learning from these incidents has

been identified and includes the need for staff to ensure that the service selected on the Directory of services (DoS) matches the staff member’s critical thinking and clinical judgement of the patient’s needs/ symptoms at that time. Potential delays in treatment on occasion have been raised to NHS 111 from other agencies for example a potential delay in patients with symptoms of testicular torsion and cauda equina being booked into treatment centres. On these occasions learning has been identified for the other agency regarding the approved clinical presentations for their service on the DoS. Learning was also identified for the NHS 111 service.Following a review of a recurrent theme of potential delays in patient care incidents across NHS 111, Health Advisors have been reminded of the importance of following the advice line crib sheets when calling through to the our NHS 111 clinical advice lines. The theme identified was that not all the necessary or pertinent information was being handed over for the query to be answered safely. This learning will ensure that appropriate outcomes can be achieved by providing the full clinical presentation of the patient’s condition. Those incidents involving information technology (IT) ...

Incidents Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21

CONTRACT

DHU (East Midlands) NHS 111

Service 50 56 70 95 62 80 78 91 70 82 57 81

Urgent Care Derbyshire 20 24 31 36 47 37 39 37 28 37 33 41

Urgent Care LLR 30 30 34 64 36 65 68 70 54 78 68 54

Urgent Care Northants 4 10 9 22 16 8 13 8 10 22 8 16

TOTAL 105 123 147 220 164 197 199 214 166 224 167 197

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have been both due to internal DHU cause and external causes; however no patient harm occurred as a result. On some occasions as part of DHU business continuity planning these incidents may have evoked the need for National contingency where calls are diverted from our NHS 111 service to other NHS 111 providers. This gave DHU the opportunity for to test and monitor its major contingency plans and also the National contingency plan. A number of incidents reported by the NHS111 service are under the heading of ‘other agency review’ these are incidents identified within our NHS 111 service which involve other agencies, external to DHU. For example included under this category would be the unsafe discharge of a patient from the acute hospital trust, a patient being discharged with a cannula still in place etc. In these incidents where potential learning has been identified for other organisations feedback is passed onto the outside agencies for external review. Incidents have also been reported relating to concerns regarding the availability of interpreters at the time of need and the attitude of the interpreter towards the patient. These incidents are discussed with the external agency involved for their internal investigation and learning.

Urgent Care Divisions A theme was identified across the three urgent care divisions in Derbyshire, Leicestershire and Northamptonshire regarding the safe keeping of controlled drugs. The incidents related to cross checking of prescriptions against the controlled drugs balance books and staff not adhering to the safe signing in and out procedure. The incidents resulted in response to changes in systems and processes across the divisions which had been implemented in order to ‘tighten up’ the management of controlled drugs. The incidents have occurred during the transition stage whilst staff learnt the new processes and embedded these into practice. These incidents were under the heading of alleged ‘missing medications’ however, the majority of the medications were found following investigation. The incidents were mostly due to errors in counting and calculating the number of tablets in stock and staff not adhering to the safe signing in and out of controlled drugs

procedures. Training videos have been developed by the DHU Lead Clinical Pharmacist on the controlled drugs procedures which have been shared with all clinicians. Communication has been sent to all staff reminding them of safe practices. Further controlled drugs balance books audits have not highlighted an ongoing problem and incidents reported related to the management of controlled drugs has significantly reduced. The actions below are some examples of changes made as a result of investigating

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A patient was prescribed the incorrect dose of prophylactic

medication

The DVT prescribing protocols were updated Specific administration

instructions to be written in the prescription and not

' take as directed'. Staff to be aware of their own safety and checking

Concerns over which PPE

was appropriate during the pandemic

COVID secure assess-ments of the work environ-ment took place, addition-al training on donning and doffing of PPE and guid-ance on the frequency to change PPE Face cover-ings in non-clinical envi-ronments and Perspex

screens at desks



Incidents Review NHS 111 An increase in incident reporting was noted in July and November 2020. In July 2020 a number of incidents were received regarding other agencies. Internally the main theme was the infection prevention and control issues associated with a lack of compliance on COVID 19 recommendations for social distancing within the work place, for example meeting rooms being used for too many people and masks not been used in smaller rooms. The IPC and Health and Safety team continually reiterated the measures to be adhered to with the medium of numerous methods of communication. Errors regarding staff misunderstanding were managed by good team leadership on the ground floor. During this time our incidences of Covid19 within our staff groups remained low compared to other similar organisations. In November 2020 – there was an increase in information governance incidents with staff overtyping on patient records errors and there was an increase in the number of staff not logging off the phones. Reminders were sent to the staff on both these issues. Urgent Care (Derbyshire) An increase in incident reporting was noted in August and October 2020. In August 2020 the main themes were other agency reviews including incidents regarding the use of Procell batteries which were incompatible with syringe drivers used in community (non DHU issue) and also adherence to IPC rules i.e. staff not washing hands when entering the Johnson Building. As highlighted above, an increase in medicines management issues were reported

i.e. missing medication/ medication not recorded correctly October 2020 there continued to be medication/CD errors – however these were promptly investigated and the outcome being that the ‘missing medication’ was found. Again the other theme were incidents related to ‘other agency review’, one of which was regarding Procell battery use, however this theme appears to now be well managed in the community. Urgent Care (LLR) An increase in incident reporting was noted in October 2020, November 2020, January 2021 and February 2021. In October 2020 a theme was identified under the category of Delayed treatment. These are broken down by the specific contracts and a further review showed that all the delays

were for differing reasons and there was no further consistent area of concern identified.In November 2020 the highest category of incidents logged were under script/ medication issues. These incidents were reported arising from the prescribing audits completed within the division. The sub-theme is that some clinicians are prescribing over the counter medications and this has been escalated within the governance process. Assurance is gained from the audit process and the governance process to triangulate incidents of this type. In January 2021 the highest category of the incidents logged this month relate to service to service concerns. 10 concerns were raised by other agencies about DHU care or processes and the other 8 were raised by DHU staff to partner agencies. . Positively, DHU LLR are now fully integrated within the LLR Transferring Care Safely process. It is therefore likely that

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there will be an increase in service concerns being raised due to the improved process between ourselves and primary care. The 10 service concerns raised against DHU services did not have a significant theme. In February 2021 incidents reported showed an increase in IPC incidents being reported which mostly related to reports of staff not using PPE appropriately . Feedback has been provided to staff members to remind them of the correct IPC procedures. Urgent Care – Northamptonshire Incident reporting has seen a steady increase over the last year in Northamptonshire due to promoting patient safety and encouraging incident recording, this was particularly evident in July 2020 when the Governance Lead visited all the OOH sites, to introduce herself and talk about the work of the clinical governance team. There was an increase in reporting in January 2021. On review there was an even distribution, of incidents reported throughout the month, with no themes or trends identified. The incidents were reported evenly between clinical and operational issues. There was also no specific reference to COVID -19 being an influencing factor.

Complaints In 2020-21, a total of 521 formal complaints were received across all DHU divisions. This amounts to 0.023% against patient contacts. 266 were reported for NHS 111 which is a percentage of 0.016% in relation to the call volume in the NHS 111 service. 118 were reported for Urgent Care (Derbyshire) which is a percentage of 0.051% in relation to patient contacts, 120 were reported for Urgent Care (LLR) which is a percentage of 0.048% in relation to patient contacts. 17 complaints were reported for Northants Urgent Care which is a percentage of 0.020% in relation to patient contacts.

COVID -19 and NHS Pause on Complaints COVID-19 has been challenging since March 2020, however DHU ensured that patients and the public were still able to raise concerns or make a complaint. As a result the Covid-19 pandemic there was unprecedented pressure on the National Health Service. NHS England and NHS Improvement released a system wide “pause” of the NHS complaints process, to allow staff to concentrate their efforts on the front-line duties and responsiveness to COVID-19. This “pause” period started on 27th March 2020 and continued until 29 June 2020.

During this for 3 month pause period, DHU continued to log complaints on Datix (electronic incident reporting software), acknowledge complaints, triage them for any immediate issues of patient safety, practitioner performance or safeguarding and take immediate action where necessary. DHU therefore adopted a proforma to triage complaints. We developed templates specific for COVID-19 for complaint acknowledgments, holding letters and any simple complaints received regarding waiting times. We also prioritised complaints approaching the 6 month timescale.

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NHS 111 The top three areas of concern regarding complaints received for the NHS 111 service are:

Staff Attitude

Communication

Waiting times – call back All complaints regarding staff attitude are reviewed thoroughly and staff receive feedback on a one to one basis with their line manager by reflecting and listening to the call as appropriate. Trends are monitored and if a member of staff is involved in 3 or more complaints regarding their attitude or even 2 complaints in quick succession, their line manager will be alerted by the clinical governance team. A management plan will be drawn up with the member of staff, including additional monitoring and call audits. If necessary support from our Human Resources advisors will be obtained and the relevant policies will be followed. Waiting times - call back complaints account for a high proportion of NHS 111 complaints received however, no trends have been identified within these complaints nor regarding the dates of contact. Urgent Care Divisions The top three areas of concern regarding complaints received for the DHU Urgent Care Divisions (UCD) are:

Staff Attitude / Communication

Diagnosis / Treatment

Waiting times Attitude complaints for the Urgent Care Divisions involve staff from all disciplines including GP, nurse practitioners, receptionists, phlebotomists, Health care assistants. Attitude complaints are all reviewed for themes and statements requested to ensure a thorough review of the situations from both the staff member’s perspective and the complainant. It is often difficult to review complaints regarding attitudes for ‘face to face’ consultations therefore in the majority these complaints are upheld/ partially upheld as clinician’s review of situation and how the complainant perceived/ felt may be different. However, there can always be learning for the member of staff in being mindful of how their actions and behaviours may be perceived by the patient and how this may make others feel. DHU have recently implemented customer service training for receptionists at the LLR GP practices in response to some patient feedback regarding communication and attitude , we are confident that our patients will receive a more improved experience in the future . Complaints relating to waiting times can be directly attributed to the unprecedented demand on the service as a result of the COVID 19 pandemic. The complaints over the year regarding diagnostic/ treatment complaints did not identify any specific themes. Feedback was given to clinicians involved, as appropriate, as often the complaints were not upheld.

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NHS 111 There was an increase in complaints received in September and March 2021. There doesn’t appear to be a specific underlying factor, however the main theme relates to staff attitude as previously stated. Urgent Care (Derbyshire) There was an increase in complaints received in May 2020, December 2020 and March 2021. Again there doesn’t appear to be a specific underlying factor, however the main theme relates to staff attitude. Urgent Care (LLR) There was an increase in complaints received in October 2020, November 2020 and January 2021 In October 2020 no specific themes was identi-fied. In November 2020 the highest category of complaints received were relating to staff attitude but there were no clear themes or systemic is-sues identified. In January 2021 there were no specific trends to note, complaints were proportionally spread across most LLR contracts. Urgent Care {Northamptonshire} The complaints figures reported for this small out of hour’s contract are low. Although there was a slight increase in complaints reported in July 2020 and January 2021, it still only amounts to 3 complaints in each of those. There were no particular trends identified.



Compliments During 2020/21 the formal compliments reported as a percentage of patient contacts were 0.015%, with a total of 358 formal compliments reported across all our Divisions. During the year, 1017 internal staff compliments were further reported. Compliments are received face to face, on the phone either at the end of the consultation or patients and carers may ring up specifically to pass on a compliment. Written compliments are received via email or by letters / thank you cards in the post. Patients / carers may also fill in feedback cards or pass on positive feedback with patient satisfaction surveys. These are all recorded as compliments.

It is very rewarding for staff to receive a compliment from a patient / carer. Staff receive a personal thank you from the Chief Executive for the compliment received and providing a high standard of patient care. There is a drop in the compliments received for the NHS 111 and Urgent Care Derbyshire services in March; this was potentially due to pressures in the service and the time taken to record staff compliments.

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Please see extracts below of some patient compliments received: NHS 111 service Derbyshire NHS 111 Service: ‘’After a very challenging weekend with a really poorly baby who ended up admitted to the children’s unit, I want to say thank you to the health advisors, the nurses and the doctors that all helped with my son. I received nothing but excellence and it’s much appreciated.’’ ‘’Patient had rung the service earlier today due to worsening mental health and wanted to thank the service as she now feels much better. Apologised and she felt agitated earlier to due her worsening health issues.’’ ‘’Patient calling to say thank you to the NHS 111 team and doctor that helped him quickly last night and enabled him to get some sleep.’’ Lincolnshire NHS 111 Service: ‘’Caller would like to thank the Health Advisor that spoke to her - felt she was lovely and would like to have given her a hug.’’ ‘’The GP website directed us to eConsult. We answered all the questions relating to my condition and at the end were advised to call 111.The 111 call receiver was considerate and supportive and ultimately helpful. The NHS 111 service is fantastic and doing a wonderful job and to all the people involved, your care and commitment is outstanding. I hope

our government can give you a fitting reward. A badge or medal to wear with pride - an increase in wages would be good.’’ LLR NHS 111 Service: ‘’Caller phoned 111 early hours of the morning, and had an ambulance out and said all of us at 111 are brilliant and wanted to pass thanks to us and the ambulance crew. Saying he was put at ease and felt calmed by them.’’ ‘’I’d like to express my gratitude for the service today. I had gone to Boots the pharmacy earlier to see if I could obtain something for my sister’s swollen infected finger/hand and arm but she advised me to contact 111 (a service I’d never ever used before). After having gone through the automated press button system I got through to someone who then spoke with my sister for an assessment. She passed it on and within 5 minutes my sister had a phone call during which an appointment was made with the out of hours GP at Rosenberg Street GP practice in Loughborough. We arrived and received an excellent service. The receptionist was friendly and asked us to wait and the Doctor would come. The Doctor saw my sister promptly and dealt with her very well, prescribing the necessary antibiotic medication. My thanks to both these members of staff. My sister had a stroke about 16 months ago and this has left her with significant loss of confidence. She said to me she thought she would have to wait until Monday and battle to even get through to her GP practice via telephone and would have to wait further for a ‘most likely’ video appointment. Instead she now has the right medication and has saved pressure on the GP & surgery. 111 certainly has been brilliant for us today.’’

Nottingham NHS 111 Service: ‘’I had to ring 111 for my youngest daughter about a problem with her eye and spoke to an Advisor. The Advisor was very friendly and professional throughout the call and explained everything in a way that could be understood. A credit to the role and DHU. Caller was extremely satisfied with how staff member dealt with her and thought she was so patient. Felt like she was really listening to her and didn't rush. She is an asset to the 111 team. Caller was wary of ringing back but the Health Advisor also understood and the patient was made to feel that everything was ok. Health Advisor is an asset to the team.’’ Northants NHS 111 Service: ‘’Patient would like to compliment 111 for how they helped him get to see his GP. Struggling with the loss of his mother and his overall health is not great. It may be a spot but it is important to him. He felt like the advisor the understood him and realised it is important to him. He would like to say thank you for 111 for helping him.’’ ‘’Told advisor that I'd had a negative COVID test day prior to call but after answering questions informed I was COVID-19 risk. However, practitioner/clinician extremely understanding and efficient and dealt with issue fully. ‘’ ‘’Wanting to thank us at 111 and then everybody that they spoke to from there. Said that the care all the way through was excellent.’’

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Milton Keynes NHS 111 Service: I always find the service helpful and reassuring. Asked to pass on thanks to 111 for excellent reassurance when he was very ill and scared. Said he was extremely grateful. I liked the friendly attitude and easy to understand approach.

Service was excellent and aftercare also excellent. .Urgent Care Divisions Urgent Care (Derbyshire): Patient wanted to thank us for everything, and thinks we are marvellous, telling us to keep safe. COVID 19 - Pandemic triage call. Patient highly impressed with the service and feels it is brilliant. Wants to thank all staff. Patient seen by myself at Ashbourne Primary Care Centre (PCC) stated that she was impressed with the efficiency from start to finish, only taking around an hour from the first phone call to being assessed. Patient would like to thank the NP for calling to keep him updated. He is autistic and has a fear of medical professionals and NP was very reassuring. He had previously spoken to 3 GP’s; they said his symptoms would not reach the level for referral for a DVT. The NP really listened to what he was saying and was sympathetic. She

said just to be safe she would refer him to the DVT clinic. He ended up being diagnosed with a DVT and had quite a serious condition and if she had not listened the situation could have been a lot worse. Often medical professionals do not listen because he struggles to communicate. NP was really professional and kind, he is really grateful. I would be grateful if the following compliment could be passed on to nurse K. The family of a patient that K visited during a DHU shift wanted me to pass on their thanks to her. Their family member was very unwell and reaching the end of life. K called the family to explain this. They felt very reassured following their conversation with her and they were very grateful to be able to be with their family member when they died. This visit was during the COVID-19 pandemic and the family were extremely grateful for her time and care. Just wanted to say thank you so much for the care and support of my dad. You foresaw that we needed help so swiftly and acted so efficiently. Your kindness was so appreciated. I don't know what I would have done without you. Thanks again. Urgent Care LLR: Our very grateful thanks to you for your kindness, care and concern for my husband. We went to L.R.I, A&E department and he was discharged without further treatment I would like to thank the doctor, who saw me, got me a bed at the LGH for suspected appendicitis. I was operated on the next day and I am forever thankful.

I attended urgent care and the care I received was exemplary. The GP who I saw in room 3, was such a nice gentleman explaining everything to me, he made feel at ease. X-ray staff very friendly the HCA who assisted and explained things to me was very sweet. Thank you all very much 'Doctor came across very friendly and explained everything well to me; the doctor liaised with my GP regarding my symptoms, very reassured.' Urgent Care (Northamptonshire): I would like to say a massive thank you to C who was on phone to me after I rang 111 regarding a rash two of my children have had. C was amazing, she talked me through stuff and together we managed to get a result of what was up with my children. A massive thank you to C she is so polite, kind and caring. Just wonderful how she managed her call, to myself regarding 2 of my children. Call received this morning to thank "J" and the service as a whole for helping this lady & her husband. Her husband has now been admitted to hospital. Excellent service. Well done. Keep it up. I was seen very quickly!

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In 2020/21 we continued to build on 2019/20, engaging with our patients through attendance at meetings and events and with continued focus on our patient and public network via our membership of larger stakeholder groups and attendance at their meetings. This ensures that we continue to receive regular feedback on a larger scale. However, a lot of this was done virtually during 2020/21 due to the COVID-19 pandemic. In addition we continue to collect other feedback throughout the year from our Client Focussed Evaluation Programme (CFEP) surveys as well as in-house bespoke surveys, Friends & Family Test (FFT), complaints,

Healthwatch across all six counties that we cover in the East Midlands, social media and other online feedback, i.e. Care Opinion and The NHS Website to identify any areas of concern where patients say they wish to see improvements. Our public website (www.dhuhealthcare.nhs.uk) provides patients and visitors with information about our services. We regularly issue press releases about good news and interesting developments within our services. Following the review in 2018 of the organisation’s Patient and Public Involvement (PPI) Strategy which remained valid during 2020/21 continuing to ensure strong patient centred and focussed engagement. In 2020/21 the Lay Representatives successfully recruited in 2018 as part of our DHU PPI Sub Committee continued to bring an added dimension to the membership (albeit virtually) as they come from both clinical and non-clinical backgrounds and their wealth of experience from their respective areas of expertise continues to have a really positive impact especially from a patient perspective in relation to ‘check and challenge’ and continuing to hold us as a healthcare organisation to account. They continue to be the Chairs of the PPG’s within their own GP practice’s as well as being involved with their individual Locality Groups.

Patient Feedback

Feedback from patients, family members and carers is

actively sought and encouraged by DHU and we respond to

both positive and negative feedback.

We will continue to collect feedback in a variety of ways,

including:

Care Opinion

Community conversations held by the DHU

Patient Experience Team (when able to meet

face to face again following the COVID-19

pandemic).

Friends and Family Test (FFT)

Patient Experience feedback forms including

CFEP surveys and Patient Satisfaction cards

Patient Stories

Social Media, e.g. Facebook & Twitter etc

The DHU Website

The NHS Website

Care Opinion:

Care Opinion is a non-profit organisation, based in Sheffield

and Stirling, and is funded mainly through subscriptions

from health and care organisations. They have been

sharing people’s experiences of health and care services

online since 2005 and have built a reputation for their

innovative and value-led approach to online feedback. At

Care Opinion they make it safe and simple for people to

share their stories online and see other people’s stories

too.



Judith Brown Patient Engagement Relationship Manager



Care Opinion use the web to carry the voices of users and carers into the heart of the health services. The aim is to make it quick, easy and safe for patients and carers to give feedback about their health care, and for health service providers and commissioners to respond and use the feedback for service improvements. During 2020/21 we received a total of 2 comments from patients via Care Opinion. Both of these were positive. The NHS Website: The NHS Website is funded by the Department of Health and Social Care (DHSC). The content, data and services on the website are commissioned by NHS England and delivered by NHS Digital. During 2020/21 we received a total of 13 comments from patients via The NHS Website; 10 of which were positive. All feedback received via Care Opinion and The NHS Website is generally anonymous. Following feedback, a process is followed where a response is uploaded onto the relevant website and this will direct a patient to raise their comment either informally as feedback or formally as a complaint by contacting DHU’s Clinical Governance Department. All feedback both positive and negative received is then recorded on DHU’s Datix system and the relevant Heads of Services are notified to make them aware of what has been received. Positive feedback is recorded as an Informal Compliment and negative feedback is recorded as feedback.

April

20

May

20

June

20

July

20

Aug

20

Sept

20

Oct

20

Nov

20

Dec

20

Jan

21

Feb

21

March

21

Compliments 0 0 0 0 0 0 0 1 0 1 0 0

Complaints 0 0 0 0 0 0 0 0 0 0 0 0

The following tables show examples of feedback received during 2020/21.

One compliment - NHS 111 For 4 days or so I had felt like I had a weight on my left side of the chest. As an asthmatic, I tend to worry. Finally decided to ring 111 as, according to Google I was heading for a heart attack. I was told to go to hospital. I attended A&E. I was seen almost immediately. The tests I received were quickly and expertly done. A particular mention to Vince. Luckily I didn't have anything bad. I was given antibiotics. They all deserve a medal.

April

20

May

20

June

20

July

20

Aug

20

Sept

20

Oct 20 Nov

20

Dec

20

Jan 21 Feb

21

March

21

Compliments 0 0 0 1 1 3 1 3 1 0 0 0

Complaints 0 0 0 0 1 0 0 1 0 0 1 0

One complaint – NHS 111

I know the Ladies name today on 111 who rang me ref toothache. I left it the whole weekend to try and get a dentist my-self, but the only way to get an appointment is dial 111. I have recently moved area and the prospect of getting registered for a dentist during Covid is non-existent. The rude Lady today told me there was a pandemic on. As an officer of the law keeping this Lady safe her attitude on the phone was not good. I and the rest of the world know there is a pandemic on. We are doing our best. Met with this awful level of service today, I have lost all faith in a service that has helped the Country through the pandemic. May I suggest customer service training for some of your 111 staff. Not all of them. The second Lady who rang was nice. If I spoke to the public on the front line lime I was met today, I would be out of a job.

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Client Focused Evaluation Programme (CFEP) CFEP Surveys support DHU to obtain statistically valid evi-dence on the quality of our patient care and service to ena-ble effective quality improvement. DHU worked with CFEP to develop a fit-for-purpose survey and that provides results which enable us to deliver im-proved outcomes. Please note that our CFEP patient feedback collection was halted from March 2020 – July 2020 inclusive due to the COVID-19 outbreak for the following services:

NHS 111

Derbyshire

Leicester, Leicestershire and Rutland

Lincolnshire

Milton Keynes

Northamptonshire

Nottinghamshire

Urgent Care

Derbyshire including Community Nursing


However, this was reinstated from 1st August 2020 and it should be noted that the number of Home Visits undertaken and Treatment Centre attendances were greatly reduced during the pandemic. DHU Friends and Family Test (FFT) The FFT remains an important opportunity for our patients and their relatives/carers to provide feedback on the care and treatment they receive from our staff and services. It is a simple way to identify both good and bad performance and gives us the opportunity to make improvements. It was introduced in 2013 and it asks patients whether they would recommend the particular service they have used, i.e. been on a hospital ward, attended an Emergency Depart-ment or used Maternity services etc. to their friends and family if they needed similar care or treatment. It ensures every patient accessing these services is able to give feed-back on the quality of the care they receive, giving these provider organisations a better understanding of the needs of their patients and enabling improvements. In September 2019, revised Friends and Family guidance was published for implementation from 1 April 2020, this replaced all FFT implementation guidance previously published. The new question from 1 April 2020 now asks the following, “Thinking about your recent visit to this site: Overall, how was your experience of our service? Patients will use a descriptive six-point response scale to answer the question with the following new response cate-gories:

Very good Good Neither good nor poor Poor Very poor Don’t know This is then followed with two additional narrative boxes asking, “Please tell us the reason for this answer”: and “Please tell us about anything that we could have done better:” In addition, we will also be asking for some addition-al information, i.e. gender, age, ethnicity, religion or belief and sexual orientation etc. to help us better understand our patient demographic and enable us to ensure when we de-sign and develop services that we do this by incorporating our patient’s needs and experiences but always ensuring we provide quality and safe services. Both the positive and neg-ative answers are analysed using a given formula which re-sults in a score (Net Promoter). Patient Engagement Work

East Midlands Academic Health Science Network

(EMAHSN)

During 2020/21 we continued subscribing to the EMAHSN

Public Face newsletter. The Public Face newsletter is distrib-

uted on a weekly basis by the EMAHSN and on receipt is

reviewed and anything relevant is highlighted and cascaded

within DHU to the appropriate staff and teams.

There were no face to face or virtual events during 2020/21

due to the COVID-19 pandemic.



West Leicestershire Integrated Urgent Care Patient Participation Group (WLUC PPG) – Bi-Monthly Meetings The PPG has not met during 2020/21 due to the COVID-19 pandemic. However, the group remains made up of seven people who are also members of West Leicestershire patient participation groups (PPGs) within their local GP practices. However, in 2021/22 as we come out of the pandemic we will be looking to reinstate our meetings albeit they may be virtual and will begin actively recruiting more members as well as the possibility of virtual members. It will also give us the opportunity to look back at the last year and as a result of the pandemic reflect on what was done differently, what was done better, what wasn’t and what changes if any we would like to implement as part of the new normal. DHU 4FED Patient & Public Involvement (PPI) Sub-Committee – Monthly Meetings This PPI Sub Committee has not met during 2020/21 due to the COVID-19 pandemic. However, the group remains as per the previous membership including the Chair and Vice Chair from our West Leicestershire Integrated Urgent Care PPG. However, in 2021/22 as we come out of the pandemic we will be looking to reinstate our meetings albeit they may be virtual. Patient Experience and Engagement Practitioners Forum (PEEP) – Quarterly Meetings During 2020/2021 and as a result of the pandemic this group met virtually via Microsoft Teams and we continue

to evolve and work together in relation to sharing best practice as well as shared learning in relation to patient experience, feedback and outcomes. Urgent and Emergency Care Patient Experience Project (Derbyshire) During 2020/21 the Patient Experience and Engagement Practitioners (PEEP) Forum were asked to undertake a piece of work in relation to Urgent and Emergency Care and patient experience within Derbyshire. This is around patient’s experience of using urgent and emergency care services (with the exception of specific mental health services such as CRHT, 24 hour helpline) during the COVID-19 pandemic (since 1st March 2020 onwards). This includes the use of:

999 emergency ambulance services (including “hear and treat” and “see and treat”)

Accident and Emergency Departments (UHDBFT and CRHFT)

Urgent Treatment Centres (Buxton, Ripley, Ilkeston, Whitworth & Derby City)

NHS 111 (DHU)

Primary Care Out of Hours services (DHU)

Same day emergency care services when developed – time frame not yet confirmed

The above will include people from other locations using Derby and Derbyshire services. It will also include those attending the above services for physical, mental or social care needs.

This project will only explore experience of adult users of these services i.e. age 18 years and over. Key areas to explore with users of services:

Does the experience feel different to pre-Covid?

Have the services changed?

Do patients feel comfortable attending services? Are they nervous?

How has the overall experience been?

How do patients feel about virtual / telephone consultations compared to face to face? Would they like to see this continue as one of a range of options?

Prior to Covid – 19 would they have gone to a difference service for treatment / support and why has this changed?

Is there anything that they would like to see work in a different way?

Were all their concerns addressed i.e. physical and social or mental health needs.

Key areas to explore with providers of services:

Has the volume of patient experience feedback changed as a result of Covid-19?

Has Covid-19 had any impact on the ability to collect, collate and analyse patient experience feedback information? If yes – what?

What are the current key themes? Have these changed during the course of the pandemic? From what to what?

Have feedback themes changed as a result of Covid-19?

110



Has patient experience feedback highlighted service changes made due to COVID–19 that you would like to keep and why?

Has Covid-19 highlighted any gaps in or between services that need to be addressed?

Key organisations involved in the project are:

UHDBFT

CRHFT

DHU – NHS111 and Urgent Care (Out of Hours ++)

EMAS

PEEP Forum Currently on hold as staff still deployed from main roles into the Vaccination Centres etc as part of the Derbyshire and wider East Midlands COVID-19 response. Joined Up Care Derbyshire (JUCD) – System Insight Group – Bi-Monthly Meetings Joined Up Care Derbyshire (JUCD) is the name for Derby and Derbyshire’s Integrated Care System (ICS). One of the main aims of JUCD is to plan, design and implement care closer to or in people’s homes to reduce the need for hospital stays or enable discharge from hospital when medically assessed as ready to return home. During 2020/21 a number of key developments began taking place and are being implemented around wider and more joined up patient engagement within Derbyshire using a variety of tools, e.g. a new ‘Online Engagement Platform’ as well as an ‘Integration Index’ which are all things that have been discussed at and borne out of the good work being done by the System

Insight Group that I am a member of. The System Insight group is made up of a variety of members from all over the wider healthcare system and who bring a wealth of experience and passion to the group. As a group there is definitely even more of an appetite as a result of COVID-19 to embrace and implement the use of digital technology more but also to work more collaboratively as providers which can only benefit everyone and importantly our pa-tients. Accessible Information Standards (AIS) During 2020/21 we have continued to ensure that if appropriate we are adhering to the Accessible Information Standards. With the commencement of new contracts and additional services across all our divisions the gap analysis previously undertaken continues to be an on-going and evolving process. For patients who have learning disabilities, language or literacy issues, dementia or visual impairment there is an easy read version of the feedback form available, which uses pictures of faces, ranging from very happy to very sad, to ascertain their response to their experience of care. In addition we continue to work on redeveloping our website to improve access for patients and their families/carers with individual/specific needs and we continue to use the Browse Aloud software on our website. In 2021/22 we will also work with our Digital Accessibility partners who provided our Browse Aloud software to look at ways of ensuring our Social Media platforms are also accessible from a content perspective for patients who have an impairment etc. We will continue the roll out of staff training in relation to AIS ensuring as an organisation we are

fulfilling our legal obligations but more importantly we continue to make good on our vision and values, e.g. DHU –We care for you – ensuring our patients and their families/carers continue to be at the heart of what we do. We continue to ensure that portable hearing loops are available across all our sites and response vehicles across all divisions and services to be used both in our Urgent Care Centres and on Home Visits including Community Nursing. We continue to facilitate/undertake both individual and group visits to our bases and incorporate demonstrations of the systems we use, e.g. NHS 111 Pathways etc as well as tours of our facilities. However, this was difficult during 2020/21 due to the COVID-19 pandemic. During 2020/21 we have continued to look at ways to further engage with patient groups and the wider health economy, e.g. Healthwatch across the whole of the East Midlands including Derbyshire, Leicester City, Leicestershire, Lincolnshire, Northamptonshire, Nottingham City, Nottinghamshire, and Milton Keynes etc to heighten the patient experience/journey. As a result of the COVID-19 pandemic we are also looking at other ways to engage in addition to face to face. I look forward during 2021/2022 to continue moving the patient experience and patient & public involvement strategy and agenda forward across DHU and all its divisions and services and making more positive changes. During 2020/21 we continued with our health promotion education days although due to the COVID-19 pandemic this was done virtually by our Health and Wellbeing Coordinator as part of the Health and Wellbeing section of our COVID weekly bulletins that were communicated out to staff as part of our pandemic response.



The PPI Sub Committee has met a total of 4 times during 2020/21. A reduction from 2019/2020 and this was due to both an organisational decision to change from meeting on a monthly basis to bi-monthly with effect from October 2019 as well as the effect of the COVID-19 pandemic. The Committee continued to discharge its responsibilities for developing and determining the organisation’s PPI intentions, plans and strategies, and monitoring delivery, performance and effectiveness. During the 2020/21 period at least one of the Executive Team attended each meeting. In addition, the meetings were well attended by a number of other DHU Heads of Service from all Divisions and Patient Representatives. We have continued to take action or discuss a range of issues including:

Enhancing Patient Experience & Engagement, i.e. the use of digital technology

Planning for 2021/22

Looking at all feedback received and action required as part of the “You Said we did”

Looking Forward DHU is committed to further improving patient and carer engagement, experience and involvement and to achieve this I will as our Patient Experience Lead in conjunction with our Director of Nursing & Quality lead this key priority for DHU, thus ensuring patient and carer engagement, experience and involvement has the focus and dedicated resources to take forward this fundamental strategy and deliver our priorities. The Patient and Public Involvement

(PPI) Sub Committees continue to contribute to the achievement of the organisation’s overall strategic objectives. In 2021/22 we will:

Implement the new Friends and Family Test (FFT).

Install “You said we did” boards at our main locations and display any changes that we make and highlight some of the actions that we have taken in response to the feedback that we have received to improve the services we offer.

Continue to offer patients, carers and family members the opportunity to give their feedback on the care that they receive and act upon this feedback.

Increase our Community engagement to enable DHU to be more visible in the local community, to listen to a diverse range of views on our services and promote and publicise the work of DHU Health Care.

Continue to use patient feedback to drive improvements to services and care.

Continue to communicate effectively with patients while they are in our care.

Recognise our patients’ individuality and involving them in decisions about their care.

Look at increasing the use of digital technology in relation to capturing patient feedback.

Many of the above have been carried over from 2020/21 as delayed or put on hold due to the COVID-19 pandemic.

112



113

Section 6 Our DHU Objectives 2021/22


114

We will continue in 2021/22 to improve the quality of our services, to ensure they are safe, effective, caring,

responsive and well led.

Section 7 Statement of Director Responsibilities


The Directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of

Health has issued guidance on the form and content of annual Quality Accounts (which incorporates the legal requirements in the

Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the National Health Service

(Quality Accounts) Amendment Regulations 2011).

In preparing the Quality Account, Directors are required to take steps to satisfy themselves that:

The Quality Account presents a balanced picture of the organisations performance over 2020/21

The performance information reported in the Quality Account is reliable and accurate.

There are proper internal controls over the collection and reporting of the measures of performance included in the Quality

Account, and these controls are subject to review to confirm that they are working effectively in practice.

The data underpinning the measures of performance reported in the Quality Account is robust and reliable.

Conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review.

The Quality Account has been prepared in accordance with Department of Health guidance.

The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the

Quality Account.

By order of the Board

2021 ….......................................................................... Chairman of the Board

2021 ….......................................................................... Chief Executive Officer

Section 8 Statement from Commissioners


Commissioner Statement

Quality Account 2020 / 2021

DHU Health Care CIC

Derby and Derbyshire Commissioner

Statement

Derby and Derbyshire Clinical Commissioning

Group (DDCCG) is responsible for providing the

Commissioner statement on the Quality

Account provided by DHU Health Care CIC.

General Comments NHS Derby and Derbyshire Clinical Commissioning Group (DDCCG) commissions the Out of Hours GP Services (OOHS) across Derbyshire which is provided by DHU Health Care CIC (DHU). DDCCG is also the Coordinating Commissioner on behalf of Leicester, Leicestershire and Rutland CCGs, NHS Lincolnshire CCG, NHS Northamptonshire CCG and NHS Nottingham and Nottinghamshire CCG for the NHS111 service provided by DHU 111 East Midlands (DHU 111). DDCCG has been given the opportunity to provide a statement regarding the DHU Quality Account which is restricted to the OOH and the 111 services. Careful

consideration has been given to the content and accuracy of the 2020/2021 Quality Account to ensure it is in-line with national guidance. The information provided appears to be accurate and representative of the information available to DDCCG through contract monitoring and quality assurance processes during the year. Where reference to NHS111 services is made, this is a coordinated response from the commissioners as set out above. Measuring and Improving Performance The Quality Account describes the quality of services provided by DHU against national, regional, and local standards as detailed in Schedule Four of the NHS Standard Contract; this includes the local quality schedule. The Quality Account has numerous examples of the excellent work undertaken by the organisation over the past year some of which are organisation wide and others that relate explicitly to the provision of Out of Hours and NHS111 services. Out of Hours Service DHU have been a key partner in delivering the Joined-Up Care Derbyshire system

response to the COVID-19 pandemic. This has resulted in the delivery of a number of new innovative services and include;

Red Home Visiting Service

COVID Vaccine Testing Centres

Care Home Testing

Red Hubs

Community Vaccination

Home Oximetry Service

The quality and performance monitoring of these services has been included in the interim DHU / DDCCG quality meetings. It has been demonstrated that these services have delivered responsive, high quality care to the population of Derbyshire CQUIN achievement has been excellent this year and a valuable contribution to the system prevention agenda. DHU are not required to undertake a national CQUIN for the Out Of Hours Service however participate in a locally agreed schedule. This year the local CQUIN was limited to the Influenza (flu) Vaccination Programme and had two sections; 1. Flu immunisation for staff, achieving

over 80% of the target for staff

employed in the Out of Hours Service

2. Membership of the Derbyshire Flu cell, supporting the delivery of the flu vaccination in the community

The Out of Hours Service is still awaiting a Care Quality Commission (CQC) inspection; this has been halted due to the COVID 19 Pandemic. NHS111 Service The organisations commitment to quality improvement and patient safety is recognised by the commissioners with the achievement of internationally recognised accreditations for Quality Management and Information Security and Business Continuity. The organisations CQC rating of Outstanding is particularly noteworthy. Commissioners recognise the collaborative working that has enabled direct appointment booking by DHU 111 across the counties. DHU 111 staff are now able to book patients directly into urgent and primary care appointments, improving the system approach and thus improving the patient experience. This is reflected in the patient satisfaction survey results that show 87% of patients were very satisfied or satisfied with their 111 experience.

116



Commissioner Statement

Patient Safety The routine programme of quarterly quality meetings was stood down for part of 2020/2021 due to business continuity status. To mitigate risks and to maintain open and transparent communications a monthly interim quality discussion has continued for services delivered by DHU. This has given commissioners the assurance in the level of quality that DHU provide, through the regular reporting of quality aspects such as how incidents and complaints are managed and the learning that is achieved through these cases. Commissioner’s note that they have consistently shown their focus on providing a safe and high-quality service. Clinical Effectiveness Out of Hours Service Clinical Audit remains central to the care provided by DHU; the Royal College of General Practitioners (RCGP) audit tool is

utilised to review and assess the care provided by clinicians in the out of hours period. The results consistently demonstrate scores of over 96% compliance with the criteria; a feedback loop is evidenced to show that clinicians receive feedback on their performance NHS111 Service In this year DHU 111 have achieved 100% of staff audit compliance. Commissioners recognise that this demonstrates the key focus of ensuring learning needs are promptly identified and addressed with staff and ultimately improving the care the patient receives. Commissioners would like to thank DHU 111 who have worked hard with partners in the East Midlands Health System during the COVID-19 pandemic to ensure patients’ needs are met in this challenging time. The commitment and support DHU 111 have enacted during this time

for patients has been vital. Priorities DHU has identified five key priories for 2020/21: 1. Patient Safety 2. Integration through

Partnership 3. Supporting our workforce 4. Focus on Prevention and

Self Care 5. Good Governance

These are based around the following CQC domains; Safety, Effectiveness, Caring, Responsive, Well Led and the principles found in the NHS Plan. Commissioners are pleased to see the organisation continuing a holistic approach in developing the 2020/21 quality objectives to ensure that patients and staff are at the centre of improvements. Additional Comments The Quality Account is an annual report to the public that aims to

demonstrate that DHU Health Care CIC is assessing quality of care across the healthcare services it provides. This quality account provides patients and their families with an accurate, honest and reflective account of the progress of this organisation throughout the year and includes its future plans to further enhance service provision. Commissioners are encouraged by how DHU and DHU111 support their staff. Dealing with patients who are unwell and stressed can be incredibly challenging and they have demonstrated a strong emphasis on staff health and wellbeing across all services. Support offered includes physical health checks, additional support following a difficult call and free access to counselling and psychotherapy. The percentage of staff responses to the staff survey is disappointing and the commissioner would encourage DHU to consider how this may be improved next year.

The quality objectives for the forthcoming year are well structured to support ongoing quality improvements of the service. Particularly with the developing Integrated Care Systems in mind, commissioners look forward to another year working closely with DHU and DHU111 to ensure the continuous improvement of staff and services and the highest standard quality of care across the Derbyshire and wider East Midlands population. NHS Derby and Derbyshire CCG



Quality Account 2020 / 2021 DHU Health Care CIC


CCGs Commissioner Comment on DHU LLR section of the DHU HC Quality

Account, 2020-21

Leicester, Leicestershire and Rutland (LLR) CCGs commission the services provided by DHU Urgent Care (Leicester, Leicestershire and Rutland) as outlined in the Quality Account for 2020-21. LLR CCGs welcome the opportunity to comment on the annual Quality Account for DHU Health Care CIC regarding the quality of services provided in LLR during 2020-21. The CCGs are happy to commend this Quality Account and find that it represents continued quality together with improvements in the services provided to patients of Leicester, Leicestershire and Rutland by the LLR Division and their ongoing commitment to their quality priorities, challenges and collaboration posed in this difficult year because of the Covid-19 pandemic. We find that the Quality Account outlines intended future improvements in patient experience and the care

delivered which we believe will further push the organisation in their continuing drive towards quality and outcome improvements for patients and staff. DHULLR were a fundamental and successful part of the local Covid-19 response and continue to provide and sustain quality core services, improving their general practice provision during the past year. The Quality Account reflects the progress made and ambition for future development as part of the LLR system. We also take this opportunity to again thank DHU Urgent Care (LLR) for their role and commitment in supporting the LLR Covid-19 response during this year. Together with the quality achievements for this year DHU have demonstrated they are a key provider of urgent care services across LLR and their commitment to supporting partnership working through the various LLR collaborative groups. We look forward to our continued working relationship over the next year as the LLR system moves towards integrated and collaborative partnerships in health and social care.

Section 9 Our Glossary


A&E— Accident and Emergency

AIS —Accessible Information Standards

ANP—Advanced Nurse Practitioner

ASD— Autism Spectrum Disorder

CEF—Colleague and Engagement Forum

CEO—Chief Executive Officer

CCG—Clinical Commissioning Group

CFEP—Client Focused Evaluation Programme

CIC—Community Interest Company

COPD—Chronic Obstructive Pulmonary Disease

COSHH—Control of Substances Hazardous to

Health

CPIS—Child Protection Information Sharing

CRH—Chesterfield Royal Hospital

CSE—Child Sexual Exploitation

CQC—Care Quality Commission

CQUIN—Commissioning for Quality and

Innovation Schedule

DCHS—Derbyshire Community Health Services

NHS Foundation Trust

DN—District Nurses

DOS—Directory of Services

DVT—Deep Vein Thrombosis

ECCG—Erewash Clinical Commissioning Group

ECP—Emergency Care Practitioner

ED—Emergency Department

EMAHSN—East Midlands Academic Health

Service Network

EMIDS—East Midlands

ENT—Ear, Nose and Throat

GCC—Global Corporate Challenge

GP—General Practitioner

HA—Health Advisors

HCA—Health Care Assistant

HCCG—Hardwick Clinical Commissioning Group

HSCIC—Health & Social Care Information Centre

HVS—Home Visiting Service

IP&C—Infection, Prevention and Control

ISO—International Standard Organisation

IV—Intra Venous

IVR—Interactive Voice Response

KPI—Key Performance Indicators

LLR—Leicester, Leicestershire and Rutland

LUCC—Loughborough Urgent Care Centre

LRI—Leicester Royal Infirmary

MCN—Minor Conditions Nurse

MIG—Medical Interoperability Gateway

MRCA— Methicillin Resistant Staphylococcus

Aureus

CA— Clinical Advisors

NDCCG—North Derbyshire Clinical

Commissioning Group

NHS—National Health Service

NP—Nurse Practitioner

NQR—National Quality Requirements

OOH—Out-of-Hours

PCC—Primary Care Centre

PDS—Personal Demographic Search

PEG—Patient Experience Group

PEEN—Patient Experience and Engagement

Network

PEPSI—Patient Experience Partnership Sharing

Information

PIP’s—Pharmacists Independent Prescribers

PGD—Patient Group Direction

PPG—Patient Participation Group

PPI—Patient and Public Involvement

RCGP—Royal College of General Practitioners

RDH—Royal Derby Hospital

RIDDOR—Reporting of Injuries, Diseases and

Dangerous Occurrences Regulations

RTA—Road Traffic Accident

SDCCG—South Derbyshire Clinical Commissioning

Group

SOP—Standard Operating Procedure

STP—Sustainability and Transformation

Partnership

TIA—Transit Ischemic Attack

TPP—The Phoenix Partnership

WLCCG —West Leicestershire Clinical

Commissioning Group

WRAP—Workshop to Raise Awareness of Prevent

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