Safely Reducing Avoidable Conveyance Programme

Community Enhanced Response (CER)

Brief Description of Initiative

A Specialist Practitioner working within an MDT to avoid hospital admission where possible.

Date Initiative was introduced in Trust

The PCER started in January 2019. The SCER started in June 2019.

Date of upload or review

Uploaded to Repository 1st January 2020.

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

The initiative looks at all patients who would normally fit within the criteria of the MDT.

Geographical area or location covered by this response model
  • The Southern CER car covers the Gosport and Havant area of Hampshire
  • Demographics: Gosport and Havant are 2 fairly larges towns with a combined population of 130,000 people.
  • The Portsmouth CER car covers the PO1-PO6 area of Portsmouth but will incorporate PO7 if the patient is registered with a GP in the PO1-PO6 area.
  • Demographics: Portsmouth is a densely populated city in the county of Hampshire. Approximate population of 200,000 people with the Portsmouth area.
    The Island of Portsea which covers PO1-PO6 has a high proportion of service users for the local Portsmouth Rehabilitation and Reablement team (PRRT).
Key Aims

The priorities of the service are:

  • To take referrals directly from Allied Health Professionals within the MDT where an ambulance would have been called for a Paramedic based assessment
  • To reduce the number of Ambulance call outs for the above
  • To integrate and understand the workings of the MDT so that when back on frontline operations, the Specialist Paramedic can refer into the MDT with increased knowledge and awareness
  • To intervene at an early stage before an ambulance is dispatched if the service user uses 999/111 as a contact point.
Benefits for Patients

The patient will get improved care in the community where previously they may have attended hospital. Patients will also feel more at ease having been treated in their own home.

Benefits for Trust or System
  • A reduction in call outs for assessment, taking a frontline resource away from patients that require it.
  • Cost savings based on admission avoidance.
  • Individual SPs will become more familiar with community processes and this will improve appropriate referrals.

How long has this initiative been operational?

  • The PCER started in January 2019. The SCER started in June 2019.

Days / Hours of operation:  

  • The CER cars operate 4 days a week:
    Monday, Tuesday, Thursday and Friday; 08.00 – 18.00.

Which other partners are involved in providing the response?

PCER: Solent Health NHS Trust PRRT are based on Portsea Island and cover the PO1-PO6 area. They have premises in the city that is used as a base for their staff. The PCER is located within this building.

SCER: Southern Health NHS Foundation Trust has premises across the area. The SCER is based either in the main hub in Gosport at Aerodrome house or the Havant Health Centre.

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

  • A fully kitted SRV is supplied for the initiative. This enables the SP to respond to an emergency should the situation present itself.

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

  • The CER initiatives are funded via monies from the Fareham and Gosport South East Hants Clinical Commissioning Group.

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

  • SPs will rotate through on a daily basis depending on rota. This ensures that all SPs in the South East remain familiar with the initiative.
  • Staff have had to be trained on system 1 and this is used in conjunction with SCAS EPR depending on job origin.

How many ambulance staff are involved?

  • 12 in total. One SP on a SRV, fully kitted from the South East SP cadre.

What other staff roles are involved?

  • PCER: Solent Health NHS trust have a Duty Matron that staff can gain assistance from.
  • SCER: Southern Health NHS Foundation Trust have a duty number that staff can gain assistance from.

What other key resources are needed e.g. vehicles

  • A fully kitted SRV is supplied for the initiative. This enables the SP to respond to an emergency should the situation present itself.
Evaluation & Monitoring

What are the success measures?

  • Figures are collated daily/monthly and sent to the CCG project lead.
  • Admission avoidance is collated with the primary question being asked, “Did this prevent admission?”. 

How are these measured/collated/monitored (frequency, who reported to etc)?

  • Monthly; the spreadsheet is sent to the project lead for collation.

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

  • This is dependent on future funding.

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

  • There is a risk that if a member of staff goes sick at short notice, we cannot cover this shortfall. If long term then we may have to look at using a frontline shift to cover, causing conflict with our core business.

Is there potential to expand this response model?

  • Yes, if demand is there then a second SP could be utilised or the project expanded to 7 days.
Sharing & Learning

What has the Trust learnt most from introducing this process?

  • There is a place for SPs within an MDT. Workload is varied in type and quantity. Staff benefit from greater knowledge of the Healthcare community. Further skills added to the SP skillset could see them reach out to a greater number of patients.

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

  • Unable to comment as this is still fairly new.
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.

Contact us about these Initiatives

Please note, this enquiry facility is for the use of NHS colleagues to find out about the set up of this initiative. Patient enquiries about a case or care experience need to go direct to the relevant ambulance NHS trust.

Search for Initiatives here

You can search initiatives via Category or Trust or Keyword, or via a combination of all three.

If you wish to submit an Initiative that is working well to safely avoid conveyance to ED - and ensures patients get the right care in the right place, first time - please complete the form here.