Safely Reducing Avoidable Conveyance Programme

Oxfed Primary Care Visiting Service

Brief Description of Initiative

Oxfed have been commissioned to deliver a home visiting service across Oxford City, to help address some of the pressures that practices are facing. The service will enable a dedicated team to respond to same-day home visit requests, to allow earlier assessment of patients, mobilise out of hospital care and prevent admissions where possible.

Date Initiative was introduced in Trust

The service was launched on 3 April 2018. During the initial stage the service was provided by one GP and two Specialist Paramedics. The GPs worked for Oxfed on a self-employed basis and the Specialist Paramedics were provided by SCAS and remained their employees. A Clinical Lead was recruited to supervise the service. Following the initial trial period, the service is now delivered entirely by Specialist Paramedics and nurses which has increased to four practitioners daily. During the piloting phase, feedback from patients, practitioners and practices helped to inform and develop the service. Currently SCAS is providing two Specialist Practitioners per day between Mon-Fri (weekends and BH excluded).

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 the GP surgeries within the Oxford ring road were facing. The service was set up and continues to work within postcode zones. Each practitioner is allocated a postcode area for example either OX1&2, OX3 or OX4. The patients which live within these postcodes are allocated a visit based on their specific needs once the GP has ensured that they meet the written criteria as set out in a booking template during telephone consultation.

Visits are only offered to housebound patients or for reasons of complex co-morbidity. The visits are booked within an excepted and agreed 8hr window and are patients are not given an expected time of arrival, thus leaving this the responsibility of the visiting clinician to triage the patients due to clinical need and also on location to make the best decisions within a timely manner.

The service is provided from 9.30am-4.30pm Mon-Fri.

Each practitioner is expected to see 6 patients per day, within a 50min slot which includes travel, assessment and ongoing referral where required.

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

This is a GP initiated home visiting service, aims to treat patients within their home environment whether this be a private address or care home.

It is aimed at the elderly housebound patients or have co-morbidities leaving them unable to attend the surgery for assessment and/or treatment.

Geographical area or location covered by this response model

Oxford City, within the ring road to include OX1, 2, 3 & 4 postcodes.

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 practices.
Benefits for Patients
  • A same day, clinical assessment within their own home
  • Clinicians able to directly liase with their own GP to ensure continuation of care.
  • On the spot referral processes in place for acute admission and direct access to emergency care and ambulance transport if required.
Benefits for Trust or System
  • Reduction on operational demand as patients able to have a face to face consultation in their own home decreasing the temptation to call 999 if not appropriate
  • Improved working relationships between emergency and urgent care providers to ensure joined up working and shared ideas and responsibilities
  • Increased revenue for SCAS as service is charged at a daily/hourly rate to Oxfed at an hourly rate of £54.64 for qualified staff and £47.60 for an SP trainee.
Implementation

How long has this initiative been operational?

  • Since April 2018.

Days / Hours of operation:  

  • Mon- Friday 9.30am – 4.30pm (excluding BH’s).

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

  • Specialist Paramedics and trainee SP’s up to a maximum of 50% collaborated working to be incorporated within the new rota.

Which other partners are involved in providing the response?

  • Oxfed have recently recruited some of their own practitioners to work alongside our own staff but remain the employ of Oxfed themselves.

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

  • All IT equipment is provided by Oxfed to include mobile phone, laptop and chargers. Training on the IT system (Emis) is provided by Oxfed and has generic access into the system and VPN but personalised EMIS access.
  • Vehicles used within the scheme currently are unmarked Ford Mondeo’s which carry basic kit, selected for the purpose of home visiting and not as a fully functioning RRV used for operations. The kit is comprised of observation pouch, basic green bag response bag, drug pouches, AED defibrillator, SP dressings, oxygen, Entonox, consumables and catheter bag.
  • Mobile phone and radio for each car currently being reviewed

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 Oxfed to facilitate.

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

  • SCAS were chosen to be part of the HEE project researching the work and evaluation of the new “rotating paramedic” model. This initiated the pilot scheme and collaborative working project alongside Oxfed with the vision to bring a home visiting service to Oxford.
  • The main difficulties have been extracting our staff from operations to be able to work on these projects within the current rota and working patterns.
  • The collaborative projects have however had a positive effect in that the trust have agreed to recruiting a far greater establishment of staff both trainee and qualified SP’S going forward which will aid the provision of such collaborations in the future.
Evaluation & Monitoring

What are the key success measures?

  • Quality service monitoring, calls made directly to the patients who have consented during their consultation and response collated by Oxfed
  • Complimentary responses from all contractors with approximately 99% satisfaction response received
  • Positive feedback from all GP’s and surgeries affiliated to the scheme.

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

  • Oxfed regularly make direct calls to patients and relatives that have accessed the service and carry out regular audit on the responses given. They receive regular feedback from all the GP surgeries and GP’s directly who report on the service. The clinical director also carries out regular audits on clinical note writing and feeds back directly any compliments, near misses, serious incidents or learning points at the monthly clinical meeting for all staff.

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

  • Evidence was collated at the end of the HEE project which clearly showed the number of patients that had been successfully treated at home and saved from unnecessary hospital admission. This combined with regular positive feedback given to Oxfed and gratitude received daily by the GP’s accessing the service is hard to measure but none the less provides evaluation of the services provided.
Sustainability

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

  • Yes, it is understood SCAS is currently in negotiations with Oxfed to arrange/extend the contract going forward.

 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 audit of paper work undertaken by Oxfed’s Clinical Lead.
  • Any learning events have been addressed both to the parties involved and then shared anonymously to all staff to learn from.
  • SCAS staff have summited Datix reports which have been shared with Oxfed and resolved appropriately.

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. GP surgeries are actively seeking Paramedic practitioners as they realise what benefits to both practice and patients they can provide. Even surgeries that fall within OX postcodes have advertised for their own paramedics to compliment the Oxfed service as they realise that demand outweighs resource.
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 ands 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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