Our urgent and emergency care programme approach to supporting services for people with long-term conditions to stay well at home

Introduction

People with long term conditions can sometimes become unwell and need urgent or emergency care and treatment to get well again. For what are called urgent care sensitive conditions an effective and efficient urgent and emergency care service should prevent the need for admission and treat people with the right care, in the right place, first time.

By monitoring these conditions, we can see how effectively services are managing demands and focus on how well avoidable admissions for acute episodes are achieved.

Urgent care sensitive conditions, extends the concept of ambulatory care sensitive conditions and focuses on avoidable admissions for acute episodes of “urgent care sensitive conditions”. In this way urgent and emergency care services can monitor how effectively the services are managing demand for care for urgent conditions without admitting the patient to a hospital bed.

Urgent Care Sensitive conditions extends the chronic ambulatory conditions and includes:

COPD; acute mental health crisis; non-specific chest pain; falls (patients aged 74 years or over); non-specific abdominal pain; deep vein thrombosis; cellulitis; pyrexial child (patients aged 6 years or under); blocked tubes, catheters and feeding tubes; hypoglycaemia; urinary tract infection; angina; epileptic fit and minor head injuries.

There are large inequalities in the rate of emergency admissions for urgent care sensitive conditions when comparting the most deprived to the least deprived areas nationally, with people from the most deprived being twice as likely to be admitted to hospital. Locally, inequalities persist and these should be minimised for the benefit of patients, with the rate of emergency admissions for urgent care sensitive conditions in more as well as less deprived areas reducing overtime.

How are we doing (our urgent and emergency care focus)

A well performing, an urgent and emergency care system should prevent the need for an admission for both ambulatory care sensitive conditions and for urgent care sensitive conditions.

 

Bradford Districts CCG - greatest need for improvement 

  • for emergency admissions for urgent care sensitive conditions a result of 2,940 emergency admissions per 100,000 of our population shows we have the greatest need for improvement,
  • for urgent care sensitive conditions there is a marked difference in emergency admissions among the least and most deprived populations in the Bradford districts area,
  • the most deprived people in Bradford urgent care sensitive conditions emergency admissions rate is 2,828 per 100,000 (in England the rate is 2,168), this result for Bradford Districts CCG appears in the highest 25% of CCGs and shows we have the greatest need for improvement.

What we have achieved in 2016/17

  • collaborated in West Yorkshire Acceleration Zone (WYAZ) driving local changes to improve quality and performance in accident and emergency departments by the end of 2016/17,
  • led partners in the delivery of nurse streaming implementing it by 1 November 2016, achieving good progress within our urgent care service vision
  • plans to implement 8-11pm primary care streaming by the end of June 2017,
  • working across the economy we have supported schemes of increased ambulatory care unit and enhanced multiagency discharge team provision.
  • the A&E delivery board was established in October 2016 and provides guidance and oversight of the agenda with an executive level focus. This assisted with winter and easter planning and in delivery of the WYAZ initiatives.
  • the Urgent Care Programme Board has been extended and re-timetabled to include partners in Bradford and Airedale for a wider joint focus and to mirror representation on the A&E delivery board 
  • a multi-agency discharge team is in place at Bradford Teaching Hospitals NHS Foundation Trust, conducting routine length of stay multidisciplinary meetings and undertaking regular winter calls to monitor system pressures. This has reduced our delays in transfers of care (DTOC).
  • focused work to strengthen ‘step-up’ access to intermediate care services for older people in order to reduce avoidable acute admissions. In addition, there is also a children’s and young people programme which will reduce the need for admission and provide a community acute nursing service to meet local family needs,
  • working with partners improved access to GP Practices over bank holidays have proved successful and urgent access to primary care services will be repeated over future bank holidays at Christmas, New Year and Easter,
  • our urgent and emergency care strategy 2014/19 outlines plans to create a simple to navigate sustainable and people-focussed urgent and emergency care system. This year the CCG have refreshed the strategy to bring it in-line with rapidly emerging national priorities.
  • we are refreshing the Airedale Wharfedale and Craven 2014 – 2019, urgent and emergency care strategy in light of the joint management arrangement across the three Bradford district and Craven CCGs, national guidance and A&E improvement plans.

Our plans for supporting those with long-term conditions over the next two years with their urgent and emergency care needs

Across West Yorkshire the urgent and emergency care vanguard and accelerator site has resulted in the formation of a region wide approach, with the vanguard programme expecting to see changes over the next two years. To support this West Yorkshire wide programme in our CCG over the next two years we will aim to (please not that this is nott an exhaustive list):

  • drive the adoption of NHS 111 direct booking into GP surgeries,
  • work with Bradford Teaching Hospitals NHS Foundation Trust to implement 7 day service clinical standards in their Accident and Emergency department
  • ensure providers maintain the accuracy of the directory of services so patients can be seen by the right person at the right place, first time.

Our urgent & emergency care commissioning plans for the next five years

  • establish 'proof of concept' for acute community children's nursing service,
  • improve experiences and health outcomes for patients,
  • improve access to primary care,
  • improve quality of services and complete the refurbishment of the A&E department at Bradford Royal Infirmary,
  • expand GP stream,
  • improve management of urgent and emergency care demand,
  • review ambulatory care pathways,
  • go live for urgent care practicioners.

The programme is concerned with transforming services in community and there are other transformation programmes that link to the metrics related to long term conditions such as the Urgent & Emergency Care Board, Bradford Beating Diabetes, Bradford Healthy Hearts and Bradford Breathing Better. You can find links to what we are doing with these programmes here.