Safely Reducing Avoidable Conveyance Programme

Chipping Norton IPCS (Integrated Primary Care Service)

Brief Description of Initiative

Chipping Norton First Aid Unit (FAU) was commissioned to assess patients, deliver treatment and implement appropriate referrals for patients presenting with minor injuries and illness within the local communities of north/west Oxfordshire. This service helps address some of the pressures faced by Emergency Departments and the Ambulance service.

The service enables a dedicated team of Specialist Paramedics/Nurses to offer a drop in service that allows the complete treatment of patients avoiding hospital admissions or Ambulance attendance. The FAU regularly treats patients presenting with minor illnesses (e.g. chest infections, cellulitis, headaches, dizziness) and minor injuries (e.g. wound care, insect bites and stings, minor burns and scalds, foreign body in the eye, head injuries where there has been no loss of consciousness, bruises, sprains).

The service does not have x-ray facilities. Specialist Paramedics/Nurses are able to offer a selection of antibiotics and analgesia under specific PGDs to enhancing the patient care offered.

The Specialist Paramedics/Nurses also have the ability to refer patients to specialist services/medical departments/surgical departments at local hospitals. If staff working at the unit are not “patient committed” at the time of a local 999 ambulance “red call” they may be asked to temporally close the FAU and attend the incident.

Date Initiative was introduced in Trust

The service was launched in April 2011. During the initial stage the service was run from a town centre building but in 2015 moved to the community hospital building. The Specialist Paramedics/Nurses and equipment are provided by SCAS. The staff remain employees of SCAS.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

The initiative for this service was to help alleviate some of the pressures that were faced by Emergency Departments, Minor Injury Units, Ambulance Services and GP surgeries within the local area. The service continues to work closely with GPs, 111/Out of hour’s services and the medical/emergency departments at the Horton and John Radcliffe Hospitals.

The service offers a “drop in service” for all patients. Patients do not have to live locally or be registered at a local GP surgery to attend. Local GP surgeries, pharmacies and 111 often advice patients of the FAU service.

Which specific patient group or presenting need is this response targeted at?

The FAU is a drop in service that aims to treat patients within the FAU. Patients have to be able to make their own way to and from the unit. All presenting patients will be seen.

Geographical area or location covered by this response model

There are no geographical exclusions to patients self-presenting to the FAU. The service generally provides a service to patients within Chipping Norton and the surrounding villages of north/west Oxfordshire.

Chipping Norton has a population of 6337.

Key Aims

The priorities of the service are:

  • Ensuring patient safety and quality of care
  • Enhancing the experience of care for patients and their carers
  • Providing a supportive service for patients
Benefits for Patients
  • Clinical assessment and treatment conveniently located within their community during evenings and weekends.
  • Clinicians able to treat and discharge the majority of patients at the FAU.
  • Ability to refer patients directly to alternative departments/services avoiding the pressures on Emergency Departments, GP services and the Ambulance Service. Emergency treatment can also be initiated and Emergency Ambulance transport can be arranged.
Benefits for Trust or System
  • Reduction on operational demand as patients are able to “drop in” and have a face to face consultation locally.
  • Complete care package for the treatment of most minor illness and minor injuries.
  • Increased revenue for SCAS as the service is charged.
Implementation

How long has this initiative been operational?

  • Since April 2011

Days / Hours of Operation

  • Mon- Friday 1700hrs-2100hrs
  • Bank Holidays and Weekends 1000hrs-2100hrs

Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

  • 2 WTE Specialist Paramedics work up to a maximum of 50% collaborate working incorporated within their rota.

Which other partners are involved in providing the response?

  • Plans are in place to move the FAU from its current location at Chipping Norton Community Hospital to Chipping Norton Health Centre. This is on the same site, opposite the hospital building. The service offered and hours worked are not planned to change in the immediate future. The move is planned for January 2020.
  • Currently Chipping Norton Community Hospital ‘League of Friends’ have offered occasional financial support for specific items or equipment.

What other key resources are needed for this response to work? (vehicles, specific equipment etc)

  • All IT equipment is currently provided by SCAS (radios, laptop & printer) – This may change with the proposed relocation.
  • A single car is required for the scheme. This is currently Ford Mondeo fully kitted with front line Specialist Paramedic Ambulance equipment. The kit includes of an SP PGD medication,12 lead ECG monitor & defibrillator, SP dressings, oxygen, Entonox, consumables and catheter bag. The proposed relocation in 2020 would involve a withdrawal of responding to emergency calls locally, therefore a fully kitted response car wound not be required.

How is the initiative funded? (level of engagement/support from CCGs etc)

  • This service is funded entirely by the Oxfordshire CCG and contracted out to SCAS to facilitate.

What were the main facilitators / blockers / interdependencies when introducing this response?

  • The main difficulties have been extracting our qualified staff from operations to be able to work at the FAU within the current rota and working patterns. The collaborative projects as a whole have however had a positive effect in that the trust have resulted in recruiting a far greater establishment of staff (trainee and qualified SPs).  Going forward this will aid the provision of the service in the future.
Evaluation & Monitoring

What are the key success measures?

  • Year on year increasing numbers of “see and treat” patients.
  • Positive feedback from all GP’s and surgeries who come into contact with to the scheme.
  • Positive feedback and support from the community – including patients, families and carers.

How are these being measured / collated / monitored?  (Frequency / who reported to etc)

  • SCAS undertakes an in-house monthly audit of patient consolations to identify trends in patient encounters and treatments.

Has a formal evaluation process been undertaken (independent / in-house)?

  • SCAS undertake an in-house monthly patient record audit identifying referral trends, patient conditions, treatments and pathways used.
Sustainability

Does the Trust intend to continue with this response for the foreseeable future?

  • SCAS are currently in the process of relocating the FAU to Chipping Norton Health Centre to bring the service in line NHS England’s guidance on FAU/Urgent Care Centres. This will not only enable the FAU to continue but will also enable a closer working relationship with GPs, Practice Nurses and the on-site Pharmacy.

 What long-term resourcing requirements are there?

  • Specialist Paramedics
  • Vehicles
  • Medical supplies and equipment
  • IT, radio and navigation equipment

What risks have been identified (for patients / trust / system) in providing this service and how have these been mitigated?

  • Any risks to patients have been captured via feedback and regular clinical audits undertaken by SCAS. Any learning events are addressed and shared with staff. Datix reports are investigated and responded to in line with SCAS policy.

Is there potential to expand this response model?

  • There is no reason why this scheme couldn’t be replicated within other areas dependant on the numbers of SP staff, vehicles, equipment required and services already offered locally.
Sharing & Learning

What has the Trust learnt most from introducing this process?

  • The value of bringing together team working within the wider health service and how collaboration of services can benefit both providers and patients.

What might be done differently with the benefit of hindsight if implementing again? (in another part of the Trust for example)

  • Careful consideration and planning of staff and rotas to enable smooth extraction from operations to collaborative working.
Additional Information

Wider, contextual information about SCAS’s Urgent Care Pathway Improvement Programme is available to download here.

ScHARR Evaluation

This Initiative has been the subject of an evaluation review by ScHarr – read the report here.

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