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Integrated urgent care improvements driven by new system-wide contract

Delivery of urgent and emergency care (UEC) services in Hampshire, Isle of Wight (HIOW) and Surrey Heath was fragmented with separately operating 111 contracts. To meet the national requirements to join up the system a new type of contract was introduced, with the support of the SCW contracting team. The aim was to provide a more integrated experience and a better service for patients. 

The new contract covers the end-to-end UEC process across the system. Its goal is to treat people closer to home, rather than in A & E, saving money by directing people to alternative pathways. 

The new system-wide contract is delivered by South Central Ambulance Service (SCAS). Benchmarking across the country has shown that SCAS have the lowest conveyancing to hospital rate and one of highest conveyance to alternative pathways.

Challenge

Urgent and emergency care across Hampshire, Isle of Wight and Surrey Heath (HIOW) had been operating in a fairly fragmented way for many years.

Three years ago NHSE introduced a national requirement for an Integrated urgent care system but HIOW wanted to explore all options available and to get their vision and strategy right before procuring their new service.. 

This new approach was intended to reduce the number of people attending acute hospital emergency departments with the goal to treat them closer to home. The intention was also to save money downstream in terms of bed days, A&E admissions etc, by directing people to alternative pathways.

HIOW formulated their vision and could see the system benefits of this more joined-up approach but they needed support to introduce this new type of contract. They could see that a  more integrated system would enable them to manage their urgent and emergency care (UEC) processes better and bring them into line with the national requirement. This was no small task, to bring together numerous different providers to co-produce a new system and way of working.

Luckily SCW’s contracting team were on hand.

Approach

SCW provided leadership and advice to the contracting process. HIOW valued our subject matter expertise and our experience of introducing this type of contract elsewhere.

This expertise reinforced the support we provided in programme management, financial modelling, business intelligence, reporting, evaluation, scenario planning and modelling of activity and finance. We carried out a full analysis of all the options, advised which would be the best for them, and wrote all the contracts.

Following a formal procurement notice to the market a contract was awarded to South Central Ambulance Trust.  As part of the new integrated care contract, the existing GP Out of Hours (OOH) contracts were to be subcontracted by South Central Ambulance Service (SCAS), under the new arrangements. We already managed the individual contracts with the OOH providers so were able to facilitate discussions, smooth the process and relationships, and reassure the GP OOH providers about the changes. 

Outcome

The contract was awarded in early 2020, and a mobilisation period took place with strong engagement from all Stakeholders. The launch of the end-to-end integrated contract took place on 1 June 2021 in Southampton, Hampshire, IOW, Portsmouth, and Surrey Heath.

The integrated urgent care contract delivered via the 111 call handling service acts as the front door for urgent care with the patient quickly directed to the right source of support or appropriate clinician. 

If retriaging by a clinician indicates an emergency department appointment is required the patient is given a booked appointment to attend. There is also a callback opportunity for non-urgent cases. The expectation is that 50% of the calls that would previously have required an ambulance would have additional intervention to triage to an alternative pathway.

Initial feedback is that the new contract is working well in the Hampshire system delivering the end-to-end patient pathway. It is directing people away from 999 and the emergency department, downgrading ambulance calls and directing patients to self-care or other services.  

A more holistic approach is provided to patients with both 111 and 999 clinicians having access to the national care summary records including care plans which helps understand complex needs and medications.

Benchmarking across the country has shown that SCAS has the lowest conveyancing to hospital rate and one of highest conveyance to alternative pathways. 

Due to a national change in reporting by pathway rather than individual call management, direct comparisons of the two service’s KPI’s is not possible. The new service will be continually reviewed to ensure it is delivering value for money.

For more information contact Kath Havisham, Associate Director Urgent and Emergency Care Contracts This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

 

 

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