Safely Reducing Avoidable Conveyance Programme

Urgent Care Practitioners working in Sheffield

Brief Description of Initiative

Team of urgent care practitioners working in Sheffield are providing urgent care see & treat services – patient assessment, treat and discharge where possible or refer on to community services or arrange direct admission. Dealing with minor injuries/illnesses, administering medications under PGDs.

Date Initiative was introduced in Trust

Initially started as a PP scheme in 2003 and developed into an ECP scheme.

Date of upload or review

Uploaded to Repository 1st January 2020.

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

Minor injuries / illnesses / Elderly Falls / Long Term Conditions i.e. Asthma, COPD, Diabetes, Frail Elderly.

Geographical area or location covered by this response model
  • Urban / Rural?

Urban – Sheffield City and surrounding area… approx 1500 sq miles

  • Population served

551,800

Key Aims
  • To provide out of hospital care in the home or community setting
  • To avoid unnecessary hospital attendance and admission
  • To provide clinical support and leadership to other frontline paramedics
Benefits for Patients
  • Better, more expedient patient experience; right care, right time, right place.
  • Avoid unnecessary hospital attendance / admission
  • Improve clinical outcomes
  • Ability to be referred directly to other appropriate care or social services
Benefits for Trust or System
  • Appropriate care  for patients at point of contact

Reduced requirement for ambulance transportation

Established career path for paramedics

Less hospital admissions and attendance due to joined up working in the community – essential that supporting pathways are in place/available and signed up to by the local Trust.

The provision of a source of support for local ambulance crews.

Implementation

1.     How long has this initiative been operational?

Initially started as a PP scheme in 2003 and developed into an ECP scheme.

2.     Days / Hours of operation:

  • 24/7, from 0700 – 0200
  • 365 days a year

3.     What other providers/partners are involved

YAS ECPs link directly with a wide range of other health and social care providers within Sheffield and the wider region.  Care homes refer to the scheme directly.  GPs can refer for minor injuries in the community.  Specialist centres such as mental health services can refer for wound closure ie self harm.  YAS ECPs can refer into the community teams and into appropriate specialties within hospital.

4.     How is the initiative funded – level of engagement from CCGs

Commissioned by Sheffield CCG.

5.     Facilitators / blockers / dependencies for implementation

Ensure appropriate usage of ECPs.

Identifying clinical cases most appropriate to skill mix.

Risk of being under or over utilised due to communications misunderstanding of role or being used as an immediate response.

Development of a new structure and coordination from Emergency Operations Centre.

Appropriate level of skills, knowledge, academic background, placements and supervision to the required level to ensure standardisation across a Trust.

Dependent on appropriate dispatch process.

6.     How many ambulance staff are involved?

14 wte.

7.     What other staff roles?

Specialist paramedics have also started to become involved in the scheme within their own scope of practice and they receive development/clinical supervision by the ECP team.

8.     What other key resources are needed e.g. vehicles?

7 FRVs based on Sheffield model, and paramedic kit (extended as per RRV + ECP kit i.e. PGD POM’s cupboard, Dressings box / cupboard).

Evaluation & Monitoring
  • Monthly report on activity
  • Clinical management of patients as timely and delivered as close to home as possible
  • Increased levels of appropriate non-conveyance due to the enhanced clinical skills of ECPs allowing them to assess and treat, assess and refer and assess and convey to alternative care sites (when clinically appropriate)
  • Direct referral to ECPs through a triaged service of calls to 999 and 111, if appropriate, avoiding potential dispatch of ambulance or attendance at A&E

  • Provide an integrated service, which supports a coordinated approach from health and social care professionals
  • Provision of a safe, responsive and high quality service which is focused on improving the patient journey
  • Reduction in attendance at A&E for specific patients
  • Provide direct referrals to the most appropriate pathway for the patient
  • Provide direct access to hospital admissions, reducing the need for a visit to A&E prior to admission
  • Increased patient satisfaction
Sustainability
  • How are these measured/collated/monitored (frequency etc.)

Monthly reporting of activity to CCG

  • What are the current findings in terms of these measures

as above… plus;
Monthly targets achieved overall – time on scene < 1 hour
Avoided hospital attendance > 60%
Improved staff morale
Increased falls referrals

  • Does the Trust intend to continue with this initiative?

Yes, we are extending our provision in line with urgent and emergency care review, and now have 4 wte’s in Bradford, 2 wte’s in Rotherham, and11 wte’s in York.  We also have a different scheme in Northallerton whereby the team of 5 SPs and 1 ECP undertake GP home visits during the day and provide an outreach GP home visiting service to the GPOOH service.

Sharing & Learning

1.     What has the Trust learnt most from introducing this process?

Importance of including key metrics from an early stage and further training to develop staff into this role.

Dispatch is key to ensuring the most effective delivery of service.

Integration into wider system in order to find most appropriate outcome for patient.

Ensuring appropriate education and supervision for staff.

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

Have a larger part of the organisation commitment – fleet / equipment more involved at an early stage.

Identify champions within the service to deliver the model.

Ensure we have the training captured in the financial model.

ScHARR Evaluation

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

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