Safely Reducing Avoidable Conveyance Programme

Wigan Community Response Team

Brief Description of Initiative

Referral pathway to community multi disciplinary team allowing MDT wrap around care, coupled with social service input to provide responsive community care to patients with acute need.

Date Initiative was introduced in Trust

6 August 2018.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

Traditionally commissioned Acute visiting Scheme (AVS) had limited capacity as staffed by 1 GP, and a proportion of patients would then be referred onto Community Response Team (CRT) anyway by GP. Efficiencies identified within the system to remove the AVS GP and allow NWAS clinical staff to refer directly to CRT.

CRT is a community based MDT with nurses, therapists, advanced practitioners, GPs and social care all co-located to provide timely response to patients within set timeframe.

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

Frail elderly – average patient age for referral is 72.

Geographical area or location covered by this response model

Wigan CCG area.

Key Aims
  • Increase volume of patients being referred to community / primary care services
  • Reduce conveyance rates by NWAS to local ED from within CCG
  • Maintain clinical safety
Benefits for Patients
  • Treated in or near own home
  • Reduced risk of admission in the older adult
  • Personalised wrap around care
Benefits for Trust or System
  • Reduced demand on UEC system
  • Better use of already commissioned services bringing financial efficiencies
  • Ambulance time more readily available for higher acuity 999 calls
Implementation

1.      How long has this initiative been operational?

  • Since August 2018.

2.      Days / Hours of operation:

  • 7 days per week;  08:00 – 18:30.

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

  • No output investment made by CCG, already commissioned services.

4.      Which other partners are involved in providing the response?

  • Wrightington, Wigan and Leigh NHS Foundation Trust – community division.

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

  • N/A.

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

  • From within current commissioned service.

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

  • Agreed response within MOU following MTS triage and assessment.
Evaluation & Monitoring

1.      What are the key success measures?

  • Volume of patients being referred
  • Conveyance to ED rates
  • Clinical safety (re-contact)

2.      How are these being measured / collated / monitored?  (frequency / who reported to etc)

  • Collated monthly, volume of referrals, re-contacts, conveyance rates to ED.
  • Local Advanced Paramedic monitoring.

3.      Has a formal evaluation process been undertaken (independent / inhouse)?

  • MSc Advanced Practice dissertation project has been written regarding the planning and implementation of this project.

4.      What are the current findings in terms of the success measures?

  • Increase in referral to community service of 220%
  • Decrease in Ambulance conveyance over first 12 months of 8%
  • Clinical safety (recontact) audited and found to be 3.6%, regionally 3.5% across the wider trust, indicating safer care.
Sustainability

1.      Does the trust intend to continue with this response for the foreseeable future?

  • Yes

2.      What long-term resourcing requirements are there?

  • None.

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

  • Missed referral opportunities, refused referrals. Mitigated by provider relationships and monthly learning events between NWAS and WWL as provider to ensure that all failed referrals and adverse incidents are thoroughly and robustly investigated and learning is occurring.

4.      Is there potential to expand this response model?

  • Depending on availability of similar schemes commissioned across the region, from within CCG footprints.
Sharing & Learning

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

  • That multi-disciplinary community-based teams may allow for greater flexibility in terms of acuity of patients able to be referred and managed at home.

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

  • Learning events set up earlier in the process, and better communications and staff engagement.
ScHARR Evaluation

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

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