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Attach 3

SERVICE SPECIFICATION

St George’s Hospital Urgent Care Centre

31 May 2012

Version Number: 0.6

Final Version

Document: Version: Date:

St George’s Hospital Urgent Care Centre Service Specification 0.6 31 May 2012

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Version Control

Document Approval

St George’s Healthcare NHS Trust

Patrick Mitchell (COO) St George’s Healthcare NHS Trust

Signed:

Date

Dr Phil Moss A&E Consultant / Clinical Director St George’s Healthcare NHS Trust

Signed:

Date

SWL Sector

Dominic Wright ( Interim SWL Cluster MD) On behalf of SWL Sector Board

SWL Cluster Board Meeting Approval Date:

Signed:

NHS Wandsworth (NHSW)

Graham Mackenzie (NHSW Director of Commissioning) On behalf of NHS Wandsworth Clinical Commissioning Executive (NHSW CCE)

NHSW CCE Meeting Approval Date:

Signed:

VERSION AUTHOR DATE COMMENTS

0.1 Daniel Thompson 11 March 2011 Initial draft

0.2 Daniel Thompson 10 May 2011 Second draft incorporating substantial changes and feedback from multiple stakeholders

0.3 Daniel Thompson 28 September 2011

Third draft incorporating various general additions and changes in particular in respect of patient redirection pathways and the proposed payment model

0.4 Daniel Thompson 18 October 2011 Final draft incorporating minor changes only

0.5 Daniel Thompson 25 November 2011 Updated workforce plan by Anne Carter

0.6 Alison Lyons 31st May 2012

Updated document approval names and start date



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NHS Sutton and Merton (NHSS&M)

Adam Wickings (NHS S&M MD) On behalf of NHSS&M Clinical Commissioning (Delegation) Committee (NHSS&M CCdC)

NHSS&M CCdC Meeting Approval Date:

Signed:

NHS Lambeth (NHSL)

Andrew Eyres (NHSL MD) On behalf of NHS Lambeth Clinical Commissioning Collaborative Board (NHSL CCCB)

NHSL CCCB Meeting Approval Date:

Signed:



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Table of Contents

1 DOCUMENT TERMINOLOGY ..................................................................... 6

2 EXECUTIVE SUMMARY .............................................................................. 6

3 BACKGROUND ........................................................................................... 7

4 ABOUT THIS DOCUMENT .......................................................................... 7

5 SERVICE OBJECTIVES .............................................................................. 8

6 COMMISSIONER SERVICE REQUIREMENTS ........................................... 9

7 PROVIDER SERVICE MODEL .................................................................... 9 7.1 Overview............................................................................................................................. 9 7.2 Name ................................................................................................................................ 10 7.3 Access .............................................................................................................................. 10 7.4 Patient Flow ...................................................................................................................... 10 7.5 Triage ............................................................................................................................... 11 7.6 Redirections ..................................................................................................................... 12 7.7 Central Reception ............................................................................................................. 13 7.8 Unregistered Patients ....................................................................................................... 13 7.9 Flagged Patients .............................................................................................................. 13 7.10 Waiting Areas ................................................................................................................... 13 7.11 Assessment and Treatment ............................................................................................. 14 7.12 Children ............................................................................................................................ 14 7.13 Diagnostics ....................................................................................................................... 14 7.14 Discharge ......................................................................................................................... 14 7.15 Follow Ups ........................................................................................................................ 14 7.16 Supply of Medicines ......................................................................................................... 14 7.17 Patient Records ................................................................................................................ 16 7.18 Workforce ......................................................................................................................... 16 7.19 Estates and Facilities ....................................................................................................... 18 7.20 Information Technology .................................................................................................... 19

8 INTEGRATION WITH OTHER SERVICES ................................................ 19 8.1 SGH .................................................................................................................................. 19 8.2 GP Practices .................................................................................................................... 20 8.3 OOH Provider ................................................................................................................... 20 8.4 LAS ................................................................................................................................... 20 8.5 Mental Health ................................................................................................................... 20 8.6 Community Services ........................................................................................................ 21

9 QUALITY STANDARDS AND CLINICAL GOVERNANCE ....................... 21

10 SERVICE COMMENCEMENT ................................................................... 21

11 PERFORMANCE MANAGEMENT ............................................................ 21 11.1 Management Board .......................................................................................................... 21 11.2 Activity Reporting ............................................................................................................. 22 11.3 Performance Measurement .............................................................................................. 22

12 PAYMENT MODEL .................................................................................... 22 12.1 Trial Period ....................................................................................................................... 22 12.2 In Year Operational Payment Model ................................................................................ 22 12.3 Payment Ceiling and Floor ............................................................................................... 22

13 ACTIVITY ................................................................................................... 23 13.1 By HRG ............................................................................................................................ 23 13.2 By Geography .................................................................................................................. 23

14 PROCUREMENT AND CONTRACTING ................................................... 23 14.1 Main Contract ................................................................................................................... 23 14.2 Sub Contract .................................................................................................................... 23

15 PUBLIC CONSULTATION ......................................................................... 24



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16 COMMUNICATION AND STAKEHOLDER ENGAGEMENT ..................... 24 16.1 Provider Internal Stakeholders ......................................................................................... 24 16.2 External Stakeholders ...................................................................................................... 24

APPENDIX 1: SUMMARY PATIENT FLOWS ..................................................... 26

APPENDIX 2: REDIRECTION PATIENT PATHWAY OPTIONS ......................... 27

APPENDIX 3: NEW SGH ED LAYOUT ............................................................... 29

APPENDIX 4: PROGRAMME PLAN ................................................................... 30

APPENDIX 5: ACTIVITY REPORTING ............................................................... 31

APPENDIX 6: PERFORMANCE MEASUREMENT ............................................. 33

APPENDIX 7: LAS HANDOVER ......................................................................... 36



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1 Document Terminology

The following terminology will be used throughout this document:

Children’s Department consists of Children’s Majors, Children’s UCC and the Paediatric Assessment Unit (PAU).

Existing SGH A&E Department means the St George’s Hospital (SGH) Accident and Emergency (A&E) department as currently configured (i.e. consisting of majors, resuscitation, minors, paediatrics and CDU).

Initial Assessment means the performing of additional tests, investigations or treatment on appropriate patients after Triage to inform the prioritisation of these patients according to their clinical condition.

Main Treatment means the treatment a patient receives in Adult Majors, Resuscitation, Adult UCC or the Children’s Department after Triage and an Initial Assessment (if appropriate).

New SGH ED means the St George’s Hospital (SGH) Emergency Department (ED) after reconfiguration (i.e. consisting of Adult Majors, Resuscitation, Adult UCC, Children’s Department and CDU).

Triage is the process by which patients are assessed by a qualified clinician (prior to formal registration) when they arrive at the New SGH ED to facilitate the immediate prioritisation of these patients according to their clinical condition.

2 Executive Summary

St George’s Healthcare NHS Trust (SGH) (the “Provider”) and NHS Wandsworth (NHSW) (the “Commissioner”)

1 have agreed (see UCC Project Initiation Document) that

NHSW will commission SGH to provide an Urgent Care Centre (UCC) on the site of the Existing SGH A&E Department;

The commissioning by NHSW of the UCC is part of a wider reconfiguration of the Existing SGH A&E Department;

The Tooting Walk-in Centre (TWiC) will cease to operate in its current location in Clare House but will instead be integrated with SGH A&E minors into a new primary care lead Urgent Care Centre (UCC);

The new UCC will be physically and clinically fully integrated into the New SGH ED from 6 August 2012;

A key feature of the new service model at the New SGH ED will be triaging patients on arrival and then redirecting appropriate patients back to their own GP Practice or to their OOH Provider;

Independent primary care GPs will be employed to help safely triage appropriate patients away from the New SGH ED, along with a dedicated non-clinical Navigator who will assist patients in booking alternative appointments (GP Practice, OOH or other community service);

The Navigator will also help register unregistered patients and generally educate patients about appropriate services available in the community;

1 NHS Wandsworth is Lead Commissioner for SGH. 82% of SGH patients come from NHS Wandsworth (43%), NHS Sutton and

Merton (28%) and NHS Lambeth (11%).



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There will be some building reconfiguration work to accommodate the UCC in the New SGH ED, including an upgraded A&E patient arrival area, which will help facilitate patient redirection to more appropriate services outside the New SGH ED;

The UCC will not be actively marketed to patients and it is anticipated that the redirection of patients will result in reduced attendances at the New SGH ED and that the independent primary care GPs in the UCC will also help cut admissions, both eventually reducing long term costs to Commissioners.

3 Background

SGH acquired Community Services Wandsworth (CSW) in 2010. CSW operate the Tooting Walk-in Centre (TWiC) which is geographically located only 100 metres from the Existing SGH A&E Department (including A&E minors). It is an inefficient use of resources to have two services which can treat similar patients operating independently but so geographically close together.

Attendances at the Existing SGH A&E Department continue to rise (combined A&E and TWiC attendances are up to approximately 500 patients per day).

It is estimated that approximately 25% of patients currently presenting at the Existing SGH A&E Department could be treated in community primary care facilities

2. It is further estimated that 80-

90% of patients presenting at TWiC could be treated in community primary care facilities3. This

means that when the TWiC is integrated into the SGH UCC in April 2012, there could be around 70,000 patients (c40% of total patient presentations) per year presenting to the New SGH ED with primary care treatable conditions.

The Existing SGH A&E Department reception and waiting areas are badly in need of an overhaul, especially with the increasing patient volumes.

4 About This Document

This is a joint Provider and Commissioner document that combines the Commissioner’s service requirements for the UCC with details of the Provider’s proposed service model for the UCC. This document should be read in conjunction with the following other UCC project documentation:

Document Title Status Owner

UCC Project Initiation Document (PID)

Final version approved at UCC Project Steering Group meeting on 11/08/2010

Andrew McMylor

UCC Business Case (Provider and Commissioner)

Version 0.1 drafted Project Manager (Daniel Thompson)

UCC Governance Arrangements

Final Project Manager (Daniel Thompson)

2 This is based on a paper audit of 1,000 patients attending at SGH A&E between 1 April 2011 and 18 April 2011 where 29% of

patients were deemed to be suitable for treatment in community primary care. See also Blackpool PCT UCC Business Case (March 2008) which included an audit of 2,416 patients attending A&E of which 25% of were deemed suitable for streaming to primary care. 3 May/June 2011 audit of 431 patients presenting to TWiC illustrated that 90% of patients could have been treated in community

primary care.



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(Delivery Stage)

UCC Project Plan To be produced once project initiation stage completed.

Project Manager (Daniel Thompson)

UCC Operational Policy

Final Craig Wood

Clinical Guidelines for Assessment of Patients in St George’s Hospital A&E Department

Version 0.7 drafted Phil Moss / Heather Jarman

Navigator Guidelines Version 0.1 drafted Project Manager (Daniel Thompson)

Estates Design Specification

4

Final version completed Sharon Welby

IT Requirements Version 0.1 drafted Polly Farmar

GPs in UCC Business Case

Final Project Manager (Daniel Thompson)

The final version of this document will be inserted into Schedule 2 of the main acute contract between the Commissioner and SGH for 2012/13 (the Acute Contract).

5 Service Objectives

There has been a historical trend of continued A&E annual attendance growth moreover increases in the rate of annual attendance growth at the Existing SGH A&E Department. By commissioning the UCC, the Commissioner requires the New SGH ED (including the integrated UCC) to operate with a fundamental change in philosophy, culture and mindset about how patients are dealt with when they attend A&E departments to avoid this trend continuing. With this in mind, the Commissioner’s expected measurable quantitative outcomes from commissioning the UCC service and which will constitute “success” are to:

Reduce the number of patients attending the New SGH ED. This will be achieved by redirecting non-urgent patients presenting at the New SGH ED back to primary care and other community services (see Section 7.6 and UCC Business Case);

Reduce the number of SGH admissions from the New SGH ED. This will be achieved by the different approach to the clinical treatment of patients seen in the UCC by experienced GPs (see Section 7.11 and UCC Business Case); and thereby

Reduce the total cost to the Commissioner of commissioning the New SGH ED (see UCC Business Case).

Other expected qualitative benefits from commissioning the UCC are to:

Improve the patient flow through the New SGH ED which will in turn:

o Ensure the patient is efficiently prioritised and directed to the right area of the New SGH ED to see the right clinician and receive the right treatment;

o Improve the patient experience and quality of service provided to patients (see Appendix 6); and

4 The service specification will be maintained in accordance with the principles outlined in the NHS Estate code (NHS Estates -

Essential Guidance on Estates and facilities Management May 2007).



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o Reduce the proportion of LAS “arrival to patient handover times” over 15 minutes.

Ensure a patient’s ongoing healthcare needs are met in the most appropriate setting within the community or primary care (see Appendix 6);

Improve the integration of primary, community, Out-of-Hours (OOH), secondary and mental health services in the local area and help provide seamless care pathways between different service providers;

Develop the distinctive culture and approach of a primary care service within the New SGH ED;

Use the same IT system throughout the New SGH ED and allows staff from the New SGH ED to read patient GP records (where permitted) (see Section 7.17);

Maximise the use of existing human resources in terms of skills, knowledge and competencies;

Facilitate the registration of unregistered patients with a GP Practice;

Provide health promotion, self management, education and sign posting of patients to other primary healthcare services in the community;

Operate as a fully integrated element of urgent care provision on the SGH site with a seamless patient transition from UCC to other parts of the New SGH ED (and vice-versa) where required; and

Provide a seamless pathway to any further assessment required within the New SGH ED, including referral (if necessary) to a hospital specialist.

The UCC will not:

Be a further access point for routine primary NHS care in the local health economy (these patients will be appropriately and actively navigated back into core primary healthcare services in the community); or

Duplicate existing service provision by primary care services.

6 Commissioner Service Requirements

The Commissioner requires the Provider to implement and operate a primary care led UCC which shall:

Have a service model as described in Section 7;

Integrate with other healthcare services as described in Section 8;

Meet the quality and clinical governance standards as described in Section 9;

Meet the service commencement date as described in Section 10;

Meet the activity and performance measures as described in Section 11; and

Utilise the payment model as described in Section 12.

7 Provider Service Model

7.1 Overview

The UCC will provide 24 hours / 365 days a year:

A safe and consistent primary and secondary care joint led Triage service to all patients presenting at the New SGH ED;



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A “navigation service” that safely redirects appropriate patients away from the New SGH ED to other community based services more appropriate to meet their needs, as well as assisting unregistered patients to register with a GP Practice;

A Central Reception that will be the single point of patient registration for the whole of the New SGH ED; and

A primary care led main assessment / treatment urgent care service.

7.2 Name

The New SGH ED (including the UCC) will be called “St George’s Hospital Emergency Department” and will not, for example, be called “St George’s Emergency and Urgent Care Centre”. The rationale for this is consistent with the idea that the UCC service will not be actively marketed to patients (see Section 16.2.3).

7.3 Access

7.3.1 General Principles

A Triage clinician will determine if a patient who presents for Triage at the New SGH ED is seen in the UCC (see Section 7.5).

Educating patients about the appropriate use of healthcare services will be an important part of the UCC Provider service model and will be a pervasive theme as patients move through the New SGH ED. This will include, for example, helping unregistered patients register with a GP Practice or providing leaflets to patients on local pharmacy or dentistry services.

7.3.2 Opening Hours

The UCC will be physically co-located with, and be an integrated part of, the New SGH ED. It will therefore be open 24 hours / 365 days per year.

7.3.3 Telephone Access

The UCC will not provide clinical advice over the telephone to patients. Patients calling the UCC will be advised to either contact NHS Direct, 111 (from April 2013), 999, their GP Practice, OOH or to attend the UCC in person.

7.3.4 Appointments

The UCC will not provide pre-booked first appointments to patients. The use of the UCC by patients as an alternative to primary care should be actively discouraged by the Provider as part of the education of patients.

Patients will be able to book appointments for the follow up of certain conditions (see Section 7.15).

7.3.5 Registered Patients

The UCC will not be a “traditional GP Practice” in the sense that it will not have a list of registered patients.

7.4 Patient Flow

The high level summary patient flow throughout the New SGH ED (including the UCC) is set out in Appendix 1. For the detailed patient flow see the Clinical Guidelines for Assessment of Patients in St George’s Hospital A&E Department document.



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The patient flow described in Appendix 1 (in particular Triage (see Section 7.5) and Redirections (see Section 7.6)) will be the subject of ongoing scrutiny and continual refinement to ensure the best possible service model is achieved for patients, the Provider and the Commissioner.

7.5 Triage

All patients arriving at the New SGH ED (either by ambulance or self-presenting walk-in patients) will present for Triage

5. The rationale behind having Triage prior to the formal registration of a

patient is to get a clinical “eye-ball” of the presenting patient as soon as possible. This allows for immediate prioritisation of patients based on clinical need

6.

The Triage will be clinically safe for patients and consistent both in terms of the clinical staff doing it and the time of day when it is done.

7.5.1 Staffing

The staff doing the Triage will be a combination of GPs and experienced nurses (see Section 7.18.1) who will have sufficient clinical skills and experience, including the confidence to safely redirect patients (see Section 7.6).

To avoid queues of patients waiting for their Triage the volume of staff doing the Triage will be sufficient, appropriately scheduled and rapidly scaleable up and down to meet patient throughput (see table below).

7.5.2 See and Treat

There will never be “see and treat’’ (i.e. seeing patients when they arrive, assessing their needs, and providing treatment) during the Triage although “see and advise” (e.g. “you need to see a dentist”) is within the scope of the Triage. The rationale for this is the sheer volume of patient attendances at the New SGH ED and the queues that would form if the Triage clinicians were also “see and treating”.

7.5.3 Length of Time

The average target time for Triage will be 2 minutes 30 seconds. This is to manage the high volume of patient presentations (see Section 13) and avoid queues of patients waiting for their Triage.

The 2 minutes 30 seconds is an average target time which will allow for some Triages to be shorter (less than 1 minute) and some to be longer (e.g. to make a clinically safe redirection decision). The average target time for Triage will be monitored and adhered to.

5 Ambulance “blue light” and other seriously ill patients requiring immediate emergency treatment will be met at the ambulance

entrance to the New SGH ED and escorted straight through to Resuscitation, Adult or Child Majors. 6 If the process was for patients to FIRST formally register on arrival with a non-clinician BEFORE being seen by a clinician, there

is the potential for a seriously ill patient to be queuing behind a minor illness patient for some time as they wait to be registered. With the volume of attendances at SGH ED this process is clinically unacceptable.



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7.5.4 Physical Layout

There will be one dedicated station for Triage for patients arriving by ambulance and two dedicated stations for walk-in patients. In addition there will be two spaces adjoining the two dedicated stations for walk-in Triage that can be used flexibly (either for Triage or adult Initial Assessment) as well as two more rooms for adult Initial Assessment in close proximity.

See Estates Design Specification document for more details.

7.5.5 Outcomes

By using the Manchester Triage assessment process as described in the Clinical Guidelines for Assessment of Patients in St George’s Hospital A&E Department document, the Triage will result in a patient being directed (via a Initial Assessment if appropriate) to one of the following:

Resuscitation; or

Adult Majors; or

Children’s Department;

Adults UCC; or

The Navigator (see Section 7.18.5) for redirecting to other healthcare or social services in the community (see Section 7.6).

Alternatively the patient may be advised no further assistance with treatment can be provided at the New SGH ED (described in Appendix 1 as “Immediate Redirection”).

7.5.6 4 Hour Clock

A patient will go through an abridged registration process at Triage. On completion of this “quick registration” the “4 hour clock” will begin for the purposes of recording total patient time spent in the New SGH A&E Department (see Appendix 6).

7.6 Redirections

As set out in Appendix 1, there are four “redirection” patient pathway options when a patient is deemed appropriate for redirection outside the New SGH ED:

GP Practice redirection (in hours);

Out of Hours (OOH);

Community Services redirection (hours dependent on individual providers); and

Immediate Redirection.

The redirection model described here will be used at UCC service commencement. However it is anticipated that the redirection model will be the subject of ongoing scrutiny and continual refinement to ensure the best possible service model is achieved for patients, the Provider and the Commissioner.

7.6.1 GP Practice Redirection (in hours)

Appendix 2 describes the detailed patient pathway for redirection to GP Practices from Monday to Friday 09.00 to 18.30.

7.6.2 GP Practice Redirection (out of hours)

Appendix 2 describes the detailed patient pathway for redirection to the SWL OOH Provider outside the hours of Monday to Friday 09.00 to 18.30.



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7.6.3 Community Services (hours dependent on individual community providers)

Appendix 2 describes the detailed patient pathway for redirection to Community Services. Community Services include dentists, optician, pharmacy, social services, expert patient programmes, drug and alcohol services etc.

7.6.4 Immediate Redirection

The patient is advised at Triage that no further assistance can be provided at the New SGH ED.

7.7 Central Reception

There will only be one Central Reception in the New SGH ED. There will not be a separate reception area in any other area of the New SGH ED such as in the Children’s Department, Adult Majors or the Adult UCC. The Central Reception will be the only place where those patients not successfully redirected are formally fully registered onto the SGH IT system i.e. there will not be separate reception areas, for example, in Adult UCC, the Children’s Department of the New SGH ED etc.

The Central Reception will have five reception desks (see Estates Design Specification document).

7.8 Unregistered Patients

All patients will be asked at their Triage if they are registered with a GP Practice. Any unregistered patients will be encouraged to register with the assistance of the Navigator. The Navigator will contact a GP Practice on behalf of the unregistered patient and arrange a convenient appointment for completion of their preliminary health checks necessary for GP Practice registration.

If the patient does not wish to choose a GP Practice while at the UCC, or if the GP Practice of their choice is not accessible, the Navigator will supply the patient with hard-copy information about relevant GP Practices and of the treatment they have received.

Unregistered patients from outside the NHS Wandsworth, NHS Sutton and Merton and NHS Lambeth areas will be asked to contact the registration department of their local PCT. The Navigator will help these patients to establish which their local PCT is and then provide them with contact details for that PCT.

7.9 Flagged Patients

The Commissioners and other organisations will provide the Provider with a list of “flagged patients” (for example, patients within the NHSW “virtual ward”, LAS “frequent flyers”, registered mental health patients) along with guidance as to what action should be taken for each flagged patient that presents at the New SGH ED. At patient registration the IT system will have the ability to flag up these patients and the appropriate action to be taken.

7.10 Waiting Areas

The UCC will have an adults’ waiting room that is separated from the Adult Majors waiting room by a low wall. This will provide a degree of segregation between the two waiting areas while still allowing the Triage clinicians and the Central Reception staff to be able to observe both the UCC and Adult Majors waiting areas.

There will be a separate waiting area for children within the Children’s Department (see Appendix 3). This waiting area will comply with accepted standards, national and local policies



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and statutory responsibilities7. This waiting area will be for children waiting for assessment /

treatment in either Children’s UCC or Children’s Majors.

7.11 Assessment and Treatment

The main assessment / treatment element of the UCC service model will be based on two main areas, in each case delivered by either a primary or secondary care professional:

Patients with minor injury or minor illness;

Patients that have a problem that may need further investigation or observation, but who are not regarded as requiring their Main Treatment in Majors (Adult or Children’s).

The UCC principal assessment / treatment area will be similar in style to those provided in primary care, in particular utilising individual consulting rooms to facilitate privacy and confidentiality. The detailed design of the UCC is contained in the Estates Design Specification document.

7.12 Children

There will be a dedicated UCC assessment / treatment area for children within the Children’s Department of the New SGH ED. This is part of a wider reconfiguration of children’s services at SGH which includes the establishment of a Paediatric Assessment Unit.

7.13 Diagnostics

The UCC will have access to exactly the same diagnostics and investigations that are currently available in the Existing SGH A&E Department.

7.14 Discharge

Where the UCC treats a patient, the UCC will pass the patient’s details, information of the care provided by the UCC and any further information (for example, the need for the GP to follow up with the patient) by 8am the next day to the patient’s own GP Practice (see Appendix 6).

Patients will be provided with a printed summary of their episode of care that summarises their presenting condition, diagnosis and the treatment that was provided. Patients should also be given appropriate printed materials relating to their specific condition.

If a patient has any questions once they have been discharged from the UCC they should call their own GP Practice.

7.15 Follow Ups

The Provider will provide a bookable appointment service for following up certain conditions. If further follow-up care is required, the UCC should transfer the patient appropriately (for example, to community beds, care at home or other intermediate care services), and will need to agree processes for this to happen.

7.16 Supply of Medicines

7.16.1 Overview

In the New SGH ED, medication will be available to patients via two methods:

7 For example, the Royal College of Paediatrics and Child Health (2007) Services for Children in Emergency Departments: Report

of the Intercollegiate Committee for Services for Children in Emergency Departments.



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a) Patient Group Directions (PGDs). Nurses can supply a range of medicines (pre-labelled pre-packs or single doses) without a prescription under an agreed PGD; or

b) SGH A&E prescriptions. Any doctor or independent nurse prescriber working within the UCC can use the SGH A&E prescriptions.

FP10 prescriptions will not be available to be used in the New SGH ED (including UCC). Only SGH A&E prescriptions will be available to doctors and independent nurse prescribers treating patients attending the New SGH ED. This rule applies irrespective of the geographical location within the New SGH ED where they are working (e.g. Adult Majors or Adult UCC) and includes any GPs provided by OOH providers to work in the UCC (see Section 7.18.2).

7.16.2 During SGH Pharmacy Opening Hours

The SGH pharmacy opening hours are as follows:

Pharmacy Monday – Friday Saturday Sunday

Lanesborough Wing 9am – 5.30pm 11am – 3pm 10am – 12pm

The patient (or representative) will take the SGH A&E prescription to one of these two SGH outpatient pharmacies to be dispensed. Normal NHS prescription charges will apply. A maximum of one week supply of medication will be provided to patients.

7.16.3 Outside SGH Pharmacy Opening Hours

Pre-labelled pre-packs can be issued by clinicians under a PGD. If clinically necessary a single dose of the medicine can be administered in the UCC and a SGH A&E prescription written which will be taken to the SGH outpatient pharmacy the following day. In addition there is an on-call pharmacy service for emergency supply from 8am to midnight 7 days per week.

7.16.4 Formulary

All medicines must be prescribed according to the SGH Formulary and some combination products may be issued as separate constituents as per SGH Formulary.

7.16.5 Private Patients

The SGH A&E prescription can be used as a private prescription to enable supply for non-NHS patients. The patient will be charged for these drugs where the normal prescription levy is not applicable. High street pharmacies (chemists) will treat hospital prescriptions as private prescriptions and private prescription charges may vary.

7.16.6 OOH Provider

As described in Section 8.3, it may be that there are doctors employed by an OOH provider that are physically located in the UCC. These doctors will not be treating patients attending the New SGH ED but may be treating patients redirected to the OOH service (see Section 7.6.2). These doctors may use FP10 prescriptions. Doctors treating patients attending the New SGH ED will not be allowed to ask doctors treating OOH patients to write prescriptions on FP10s.

7.16.7 Advice

Advice on medicines is available from the SGH Medicines Information department on SGH extension number 1759 during weekdays from 9am – 5.30pm. Outside of these hours the on-call pharmacist can be contacted until midnight on SGH bleep number 6267.



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7.17 Patient Records

7.17.1 GP Patient Records

GP patient records will be able to be accessed on a “read only” basis and read by clinical staff (who have been granted access rights) at the New SGH ED through EMIS web (or similar IT software).

Where the UCC treats the patient, the relevant GP Practice will need to be informed electronically and by paper about the episode of care (with appropriate details) by 8am the next day.

7.17.2 Community Patient Records

A business case will be made to the Framework Partners Board to extend access to “Frameworki” (Wandsworth Social Services (WSS) and Community Services Wandsworth (CSW) OPNR shared record system). This would enable UCC staff to identify patients currently receiving care from WSS or CSW and what that care was.

7.18 Workforce

The Provider’s final staff model for the New SGH ED (including the UCC) will reflect the need for a strong primary care presence, from the clinicians doing the Triage), to the Navigator providing advice about alternative primary care services in the community to the clinicians in the UCC doing the main assessment / treatment.

7.18.1 Clinical Staff

The table below sets out the proposed full clinical staffing establishment in the New SGH ED at service commencement of the UCC. The skill mix for clinical staff haS been reviewed in light of the UCC development and includes 2.1 WTE GPs (see Section 7.18.2).

Clinical Staff Establishment in the New SGH ED

TriageInitial

Ass.Resus Majors

UCC

(adults)CDU Total

Majors UCC

WTEs WTEs WTEs WTEs WTEs WTEs WTEs WTEs WTEs

DOCTORS

Consultants (General) 6.7

Associate Specialist (General) 2.2

Primary Care Practioners (Minors) 1.7 1..7

GP (Paediatrics)* 0.0 0.6 0.9 2.1

Middle Grade (General) 11.9

Foundation Year 2 (General) 16.2

Specialist Trainee 1 (General) 19.9

Total 0.6 0.0 0.0 2.3 0.9 60.6

NURSES

Nurse in Charge (Band 7) 5.5

UCC (Band 8a) 1.0 1.0

Nurses, ENPs, NPs (Band 5,6 or 7) 25.8 27.3 25.1 11.0 125.0

Medical Assistants (Band 3) 5.5 11.0

Total 26.1 11.0 142.42

11.1

5.5

24.7

16.6 30.258.6

5.5

Children

* The GPs will be from an independent third party organisation - see Section 6.18.2.

6.7

2.2

11.9

19.9

16.2

56.9

0.6

0.0

0.0

0.0

0.0

0.0

Doctors will need to be moved between the different areas (depending on their individual skill set) of the New SGH ED to cope with fluctuating demand.



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It is also anticipated that the staff skill mix may change and include a wider range of practitioners with varying competencies as the UCC becomes established and protocols are implemented and reviewed. As part of the development of an integrated service the Provider will work closely with partner organisations to develop an appropriate skill mix of staff to ensure patients are seen, treated and redirected back to primary care core services for ongoing care.

7.18.2 General Practitioners

The Commissioner will specify as an additional requirement in the 2012/13 NHSW OOH specification (which is likely to be the subject of a competitive contract tender process) that 70 GP hours (or approximately 2.1 WTEs) will need to be provided into the New SGH ED. The GP hours will be deployed as set out in Section 7.18.1, however it is recognised that the GPs will need to move fluidly between Triage, Adult UCC, Children UCC and CDU to meet patient demand and utilize their skills in the best possible way.

7.18.3 Triage Staff

The Triage will be operated 24 hours / 365 days a year. As set out in the table in Section 7.18.1, the Triage will be done by a combination of GPs, Primary Care Nurses and A&E Nurses with support from Medical Assistants.

7.18.4 Non-Clinical Staff

The table below sets out the proposed non-clinical staffing establishment for the UCC at service commencement. This is the same total WTE non-clinical staff establishment that is currently in place (as at 28 February 2011) in the Existing SGH A&E Department and the TWiC, with the exception of the Navigator (see Section 7.18.5).

Non-Clinical Staff Establishment in the A&E ED

Band 5 1.0

Band 4 2.2

Band 3 14.9

Total 18.1

RECEPTIONISTS

As can be seen in the table above there will be no dedicated security staff operating in the New SGH ED. If security staff are needed they will be provided by the general SGH security services.

7.18.5 Navigator

The Navigator will be employed from Monday to Friday 09.00 to 18.30. The Navigator is a non-clinical role but nevertheless a crucial role in helping patients who are identified for redirection by the Triage clinicians (see Section 7.6). This includes advising and helping:

Unregistered patients to register at a GP Practice of their choice;

Registered patients book a GP Practice appointment;

Patients understand how and when to contact their OOH provider;

All patients to access other community services or resources e.g. dentists, optometrists; and

Signpost other key services such as welfare rights advice, social services, expert patient programmes, drug and alcohol advice services, virtual wards, health telephone numbers (e.g. NHS Direct, 111), local authority homeless unit and other voluntary agencies etc.



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The Navigator will have the required training and information tools to provide the above help and advice and will be responsible for keeping up-to-date details (e.g. opening hours, telephone numbers etc) of all these community based services.

Clinicians doing the Triage and other clinical staff in the New SGH ED will direct patients to the Navigator, if the patient needs help or advice or assistance for any of the above.

The Navigator will be responsible for recording details of all help and advice they provide. In particular they will be responsible for recording details (e.g. time, date, name, age, presenting complaint, GP Practice, the reason why a GP Practice appointment could not be made etc) of all successful and unsuccessful attempts to book a GP Practice appointment. These details will be collated on a monthly basis and fed back to the GP Practices in question (see Appendix 5).

7.18.6 Overall Management of UCC

The overall management of the New SGH ED (including the UCC) will be undertaken by the Provider.

7.18.7 Clinical leadership

The Provider will be expected to develop a model for clinical leadership and clinical governance, consistent with the existing SGH internal clinical governance arrangements. As part of this, a local, designated Primary Care Clinical Lead (either one of the senior TWiC nurses or one of the independent GPs working in the UCC) will be assigned by the Provider for the UCC. The Primary Care Clinical Lead will take responsibility for all GPs and nurse practitioners working in the UCC that treat patients autonomously. The Primary Care Clinical Lead will also take responsibility for the development, approval and implementation of care pathways and protocols within the UCC. The Primary Care Clinical Lead will be ultimately accountable to the New SGH ED Clinical Director (currently Dr Phil Moss).

7.18.8 Integration, Training and Development

The Provider will need to successfully integrate the staff in the Existing SGH A&E Department and the staff in the TWiC.

The Provider will be expected to develop the capacity for staff training for all staff or contractors operating in the New SGH ED.

7.19 Estates and Facilities

This section should be read in conjunction with the Estates Design Specification document.

7.19.1 Wider SGH Reconfiguration

SGH has identified four major schemes as priority estate projects for 2011/12. The site locations for these four major schemes are all based in or around the footprint of the Existing SGH A&E Department. The UCC building work, for its proposed location (see Appendix 3 and 4), will need to be scheduled within these four major schemes which, even with careful planning and scheduling of works, presents a risk of delay in the completion of the UCC building work.

The four major schemes are:

A&E resuscitation expansion (completed September 2011);

CDU development (CDU is currently not compliant with single sex requirements and building works will be undertaken to make the necessary changes prior to or in conjunction with the UCC building works);



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Children’s Department development (sited in the existing Fracture Clinic this New department will accommodate Children’s Majors patients, Children’s UCC patients, high dependency rooms and a Paediatric Assessment Unit (PAU)); and

Richmond Ward development (complete refurbishment and expansion from April to December 2011).

In order to accommodate the above four major schemes a number of other department moves are also required to be made as a matter of urgency if the programme schedule is to be maintained. Work is currently underway considering the various options available (see Estates Design Specification document).

Some indicative programme plan options for the above four schemes are set out in Appendix 4. These are draft and subject to change.

7.19.2 TWiC

The existing TWiC (based at Clare House) will be physically relocated and incorporated into the UCC.

7.19.3 Physical Layout

The proposed layout of the New SGH ED is attached in Appendix 3.

The UCC will have a waiting area for approximately 40/50 people and approximately 20 consultation spaces (which will be a mixture of rooms with doors and spaces with curtains).

The detailed design of the New SGH ED is contained in the Estates Design Specification document.

7.20 Information Technology

This Section should be read in conjunction with the IT Requirements document.

7.20.1 IT System

The same Integrated Clinical Information Programme (iCLIP) software will be used throughout the New SGH ED (including the UCC). This will allow the consultant in charge of the floor to properly monitor patient activity across the whole of the New SGH ED (including UCC) as a fully integrated service area and move doctors around within the New SGH ED as required. It will also mean that patient data is seamless between the two departments (for example, if a patient is transferred between the UCC and Adult Majors). This may also be needed for payment purposes (see Section 12).

7.20.2 Training

All staff will need to undergo appropriate IT system training.

8 Integration with Other Services

The UCC, as part of the wider unscheduled care system, will be expected to develop strong links with other stakeholders in the local healthcare economy.

8.1 SGH

The Provider will be expected to agree direct referral pathways from the UCC to additional specialist services and clinics within SGH. Where an admission is required this will be made



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directly from the UCC (or if necessary via Majors) to the specialty concerned. Patients will not be referred back to, for example, Adult Majors, for diagnostics or admission.

8.2 GP Practices

GP Practices in NHS Wandsworth, NHS Sutton and Merton and NHS Lambeth are critical to the success of the UCC service and in particular its ability to redirect patients (see Section 7.6). GP Practices will need to make sufficient “same day” appointments available to patients being redirected from the New SGH ED. A GP Practice engagement plan will be a key part of the external stakeholder engagement plan referred to in Section 16. In addition NHS Wandsworth are implementing a GP Practice “Access LES” to facilitate availability of redirection “same day” appointments.

8.3 OOH Provider

OOH Providers in NHS Wandsworth, NHS Sutton and Merton and NHS Lambeth are critical to the success of the UCC service and in particular its ability to redirect patients (see Section 7.6). From April 2012, the South West London Sector will be responsible for commissioning OOH services across South West London and the requirements of the OOH Providers will need to be agreed.

It is envisaged that in addition to providing the external GPs in the UCC (see Section 7.18.2), the NHSW OOH provider will also have one of its physical “hubs” in the UCC (see Appendix 2).

8.4 LAS

8.4.1 Placements

The Provider will provide placement opportunities in the UCC for London Ambulance staff.

8.4.2 LAS Handovers

The LAS “patient handover” process in the New SGH ED is set out in Appendix 7. There should be a significant reduction in the LAS Patient Handover time as a result of this new process.

8.5 Mental Health

8.5.1 Adults

Patients with suspected mental health problems who present at the Existing SGH A&E Department are initially assessed by an Adult Majors nurse using the “Mental Health Risk Assessment Matrix”. In most cases the patient is then referred directly to the Liaison Psychiatry team (provided by South West London and St George's Mental Health NHS Trust (SWL MHT)). Those patients who require a physical assessment in addition to a psychiatric assessment (e.g. where the patient has attended following an overdose) will be assessed by a clinician prior to, or concurrently with referral to the Liaison Psychiatry team. The psychiatric liaison service operates 24 hours / 365 days per year.

In the New SGH ED, the Triage will inform the sorting and prioritisation of mental health patients (see the Clinical Guidelines for Assessment of Patients in St George’s Hospital A&E Department document).

Appropriately qualified staff in the New SGH ED (including the UCC) will then use the Mental Health Risk Assessment Matrix to assess the patient in more detail before deciding whether referral to the Liaison Psychiatry team is required.



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8.5.2 Children

The process as described above for adults will also apply to children.

8.6 Community Services

There will be an intranet based service directory for all CSW services for UCC staff to use to confirm services available and referral systems.

There will be a one step, 24 hour referral process for all CSW services that will support discharge from the UCC (e.g. community nursing, intermediate care, specialist nurses, community matrons and community wards (formerly known as “virtual wards”). The one step referral process will also support referrals to routine and preventative community health services e.g. falls service, primary care therapy team.

GPs and community matrons from the Community Wards will attend the UCC on a planned basis to facilitate identification of patients suitable for discharge to community services.

Community health staff will provide training on a planned basis for UCC staff to develop improved understanding of community services

9 Quality Standards and Clinical Governance

The Commissioner requires that the quality of the service to be provided is of a consistently high standard and all professionals abide by the guidance of their professional self-regulatory body. The Provider will be expected to outline clinical governance mechanisms to be applied when concerns about the quality of the service is raised. The UCC will be an integrated part of the New SGH ED and operate within a common framework of standards and governance. The Provider will deliver the services in accordance with Good Clinical Practice, Good Healthcare Practice, and will comply with all clinical standards, recommendations, policies, procedures and legislation as set out in the Acute Contract.

The Provider will implement mechanisms for managing risk, including disaster recovery, contingency and business continuity plans as set out in the Acute Contract.

All incidents (both clinical and non-clinical) will be reported by staff (using the SGH Datix system) and managed appropriately as set out in the Acute Contract.

10 Service Commencement

The target service commencement date for a fully operational and integrated UCC within the New SGH ED is 6 August 2012.

Some indicative high level programme plan options for the UCC are set out in Appendix 4. These are draft and subject to change.

11 Performance Management

11.1 Management Board

It is very important to Commissioners that the service model in the New SGH ED (including UCC) is effectively evaluated and refined over time where necessary.



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There will be an operational management team consisting of the responsible managers from Adult UCC, Adult Majors and the Children’s Department. This team will report to an overall Performance Management Board (PMB) chaired by the Commissioner which will meet once a month. The PMB will be responsible for monitoring and managing overall performance and deciding how the New SGH ED (including UCC) service model will develop over time.

11.2 Activity Reporting

The Commissioner requires that there is clear separation of data reporting between the UCC and other areas of the New SGH ED. The activity reporting requirements for the UCC are set out in Appendix 5.

11.3 Performance Measurement

The Commissioner requires that the performance and success of the UCC service will be measured against a series of operational and quality indicators to be reported by the Provider. These are set out in Appendix 6.

12 Payment Model

See the UCC Business Case for full details of the payment model. A summary of the key elements is provided below.

12.1 Trial Period

The payment model described in this Section is for a Trial Period from service commencement until 31 March 2013. After the Trial Period the payment model will be reviewed based on actual activity and performance metrics.

12.2 In Year Operational Payment Model

There shall be one operational payment model for the whole of the New SGH ED (including UCC) (excluding CDU) which will be used to calculate payments from the Commissioner to the Provider during the Trial Period.

The operational payment model will use the National Payment by Results Chapter VB Emergency and Urgent Care HRG v4.0, with the only variation being changes to the Band 3 and Band 5 tariffs.

12.3 Payment Ceiling and Floor

There shall be a maximum total payment amount that the Commissioner will pay during the Trial Period (the Payment Ceiling). This is required in order to mitigate the risk to the Commissioner over the volume of redirections and the percentage of activity within each HRG v4.0 Band (especially with TWiC migrating into the HRG v4.0 Band system).

The Payment Ceiling shall only be used if the operational payment model results in a payment during the Trial Period by the Commissioner of an amount greater than the Payment Ceiling.

There shall be a minimum total payment amount that the Commissioner shall pay during the Trial Period (the Payment Floor). This is required in order to mitigate the risk to the Provider of the redirections policy being extremely successful.

The Payment Floor shall only be used if the operational payment model results in a payment during the Trial Period by the Commissioner of an amount less than the Payment Floor.



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13 Activity

13.1 By HRG

The following table sets out the anticipated patient activity volumes in the New SGH ED by HRG (see the UCC Business Case for more details):

13.2 By Geography

The following table sets out an example of the potential distribution of patients in the New SGH ED (it simply assumes that the UCC (excluding redirections) = A&E minors + TWiC):

14 Procurement and Contracting

14.1 Main Contract

There will be a main contract between NHSW (as Lead Commissioner) and SGH to provide the UCC. As this is essentially a reconfiguration of the Existing SGH A&E Department and the TWiC there is no requirement for a formal public procurement process to be followed for the main contract.

14.2 Sub Contract

As part of the main contract there will be a condition that specifies that the Commissioner will commission an independent third party to provide the GP resources in the UCC as part of the NHSW OOH contract for 2012/13 (see Section 7.18.2),



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The Department of Health Procurement Guide for Commissioners of NHS-Funded Services (July 2010) will need to be followed in respect of the procurement of this contract.

15 Public Consultation

From 27 May 2009 to 7 September 2009 a formal public consultation entitled “Improving Health in South Wandsworth” took place. The outcome of the public consultation was full public support for the proposed UCC at SGH.

16 Communication and Stakeholder Engagement

16.1 Provider Internal Stakeholders

As part of the reconfiguration to the New SGH ED there will be a number of estate moves (see Section 7.19), including incorporating the TWiC within the New SGH ED.

The Provider will need to ensure that internal stakeholders are kept formally informed of plans and developments.

16.2 External Stakeholders

The Commissioner and Provider will need to work together to produced an external stakeholder engagement and communication plan.

16.2.1 Media

Communication messages will need to be developed to deal with media interest in the UCC development.

16.2.2 Healthcare Stakeholders

A communication plan for healthcare stakeholders will need to be developed.

Stakeholders that will need to be considered are:

GP Practices and emerging GP Consortia (especially in South Wandsworth);

Patient Groups (LiNKS etc);

Other PCTs that use SGH;

Community Services in Wandsworth, Sutton & Merton and Lambeth Community;

LAS;

South West London & St George’s Mental Health Trust and South London;

Local Authorities.

16.2.3 Patients

There will be no active external marketing of the UCC to patients. Throughout the patient experience at the UCC, patients will be educated on other healthcare services in the community and actively encouraged to use their own GP Practice (or register with a GP Practice if they are unregistered).

Once patients do present at the UCC there will be a series of marketing materials (for example on waiting room TV screens) to explain how the New SGH ED operates.



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16.2.4 Tooting Walk-in Centre

A communication plan for integration of the TWiC into the UCC will need to be developed as part of the overall planning process of integrating the TWiC into the UCC.

This communication plan will need to explain how the general public will be educated about the integration of the TWiC into the UCC, especially given TWiC current marketing materials promotes the use of TWiC to avoid attending the Existing SGH A&E Department.



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APPENDIX 1: SUMMARY PATIENT FLOWS



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APPENDIX 2: REDIRECTION PATIENT PATHWAY OPTIONS

The following process diagram describe the possible outcome options for patients presenting to the New SGH ED with presenting conditions that are suitable and appropriate for direction to the Navigator (as per the Clinical Guidelines for Assessment of Patients in St George’s Hospital A&E Department):



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NHS Sutton & Merton has agreed in principle that a charge will be made for patients attending St Georges UCC and seen by the OOH service commissioned by NHS Wandsworth. The final detail of charges, payment mechanisms and reporting arrangements however have not, as yet, been finalised.

NHS Sutton & Merton will soon be undertaking a procurement process for the OOH service and depending on the outcome there may need to be some flexibility in the model to accommodate the potential of a different provider to ensure patient experience and patient journeys are not compromised.

OOH NHS Lambeth patients will be redirected to the Gracefield Practice.



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APPENDIX 3: NEW SGH ED LAYOUT



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APPENDIX 4: PROGRAMME PLAN

NB There will be a 1 week commissioning period for the UCC after the UCC building work completes from 4 May 2012 to 11 May 2012. Target service commencement date is therefore 14 May 2012. Revised expected commencement date is 6

th August 2012.



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APPENDIX 5: ACTIVITY REPORTING

National Activity Reporting Requirements

The Provider is required to report A&E department activity in line with their national DH reporting requirements.

Local Activity Reporting Requirements

The Provider and Commissioner will work together to agree any additional local activity reporting requirements. As a minimum the following local activity reporting will include:

a) Redirections

The Provider shall produce a monthly report which details successful and unsuccessful patient redirection attempts by the Navigator. This shall be in a format suitable to be emailed to local GP Practices. For example, this may include for every GP Practice:

Patient details (name, DOB, presenting condition, GP Practice);

Time and date of redirection attempt by the Navigator during the month;

Outcome of redirection attempt by the Navigator;

If redirection was unsuccessful, the reason for this;

Attempts to register unregistered patients and outcome.

b) GPs in the New SGH ED

Measuring the value of the independent GPs commissioned by the Commissioner to work in the New SGH ED is very important to demonstrate value of money when evaluating the success of the UCC. The Provider shall produce a monthly report which details activity and performance of the GPs in the UCC during the one year trial period. An example of what the GP evaluation report may look like is set out below:



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c) Frequent Flyers

The Provider shall send to Commissioners a list of those patients who attend the New SGH ED more than 3 times in a calendar month, including, as a minimum, the details of their attendances, their name, their address and their GP Practice.



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APPENDIX 6: PERFORMANCE MEASUREMENT

The performance and success of the UCC service will be measured against a set of national and local performance indicators set out in the tables below.

National Performance Indicators

The following indicators are set out in the Department of Health A&E Clinical Quality Indicators: Data Definitions (December 2010) document and are applicable to all A&E departments in England:

Short Title Full Title

Ambulatory care

(Indicator 1)

Ambulatory care for emergency conditions: the percentage of A&E attendances for cellulitis and DVT that end in admission.

Ambulatory care sensitive conditions: the number of admissions for cellulitis and deep vein thrombosis (DVT) per head of weighted population.

Unplanned re-attendance rate

(Indicator 2)

Unplanned re-attendance at A&E within 7 days of original attendance (including if referred back by another health professional).

Total time spent in the A&E department

(Indicator 3)

The median, 95th

percentile and single longest total time spent by patients in the A&E department, for admitted and non-admitted patients.

Left without being seen

(Indicator 4)

The percentage of people who leave the A&E department without being seen.

Service experience

(Indicator 5)

Qualitative description of what has been done to assess the experience of patients using A&E services, their carers and staff, what the results were, and what has been done to improve services in light of the results.

Time to initial assessment

(Indicator 6)

Time from arrival to start of full initial assessment, which includes a brief history, pain and early warning scores (including vital signs), for all patients arriving by emergency ambulance.

Time to Treatment

(Indicator 7)

Time from arrival to start of definitive treatment from a decision-making clinician (someone who can define the management plan and discharge the patient).

Consultant Sign-off

(Indicator 8)

The percentage of patients presenting at type 1 and 2 (major) A&E departments in certain high-risk patient groups (adults with non-traumatic chest pain, febrile children less than 1 year old and patients making an unscheduled return visit with the same condition within 72 hours of discharge) who are reviewed by an emergency medicine consultant before being discharged.



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Local Performance Indicators

Origin Quality Requirement Threshold Method of Measurement

Consequence of breach

UCC Patient Volumes

Minimum proportion of total adult patients presenting at the New SGH ED (either walk-in or by ambulance) that are either:

immediately redirected8

with no further treatment at SGH; or

directed to the Navigator at their Triage; or

directed to the UCC at their Triage.

60%

Minimum proportion of total children presenting at the New SGH ED (either walk-in or by ambulance) that are either:

directed to the Navigator at their Initial Assessment in the Children’s Department; or

directed to the Children’s UCC at their Initial Assessment in the Children’s Department.

60%

GP Practice Notification

Proportion of patients for whom a summary of episode of care is communicated to patient’s GP Practice by 8am on the next working day

100%

Proportion of patients under 18 for whom a summary of episode of care is communicated to the HV or School Nurse by 8am on the second working day

100%

8 “Triage 7” in the Clinical Guidelines for Assessment of Patients in St George’s Hospital A&E Department document.



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Origin Quality Requirement Threshold Method of Measurement

Consequence of breach

Other

Maximum number of patient safety incidents per month

5

Number of serious untoward incidents

0

Adherence to Complaints Procedure including timescales

100%

Proportion of positive patient survey results

70%

Number of falls recorded by the service

0



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APPENDIX 7: LAS HANDOVER

25% to 35% of total patient attendances at the Existing SGH A&E Department arrive by ambulance. It is therefore critical to the success of the New SGH ED that these patients are dealt with as efficiently as possible.

“LAS Patient Handover” means the moment when a patient has been both clinically handed over to the Hospital Trust and LAS equipment (e.g. trolley, chair etc.) has been returned to LAS crew in order that the ambulance can depart. The LAS Patient Handover time is formally recorded by SGH staff clicking the “Handover” box on the web based “LAS handover application” on a SGH computer. The LAS handover application will be accessible from computers in every area of the New SGH ED.

Patient Group 1 – “Blue Light” Patients

Ambulance arrives on a “blue light” with a seriously ill patient;

Ambulance will be met at the ambulance building entrance by SGH staff (either Triage nurse or nurse-in-charge and a staff member from Central Reception);

Patient will be taken into Resuscitation and transferred to a hospital bed;

LAS will carry out a clinical handover to a nurse in Resuscitation;

The nurse in Resuscitation (Area 1) will click “handover” on the LAS handover application which will formally complete the LAS Patient Handover;

LAS will give the appropriate section of LAS PRF to the staff member from Central Reception in Resuscitation.

Patient Group 2 – Patients not able to get off LAS Trolleys

The patient will be presented by LAS to the Triage clinician at the dedicated LAS Triage station;

The clinician will Triage / discuss the patient with LAS and will carry out a clinical handover with LAS;

Depending on how many ambulances are arriving at the time, the Triage clinician will either:

a) accompany LAS and the patient to the nurse-in-charge of the designated area; or

b) give LAS the patient’s Triage paperwork and let LAS take the patient to the nurse-in-charge of the designated area;

The nurse-in-charge will be given the patient’s Triage paperwork and will assist LAS in transferring the patient from the LAS trolley to a SGH trolley;

The nurse-in-charge will click “handover” on the LAS handover application which will formally complete the LAS Patient Handover;

LAS will leave the appropriate section of the LAS PRF in the LAS tray in the designated area.

Patient Group 3 – Other Patients (who are ambulatory)

The patient will be presented by LAS to the Triage clinician at the dedicated LAS Triage station;

The clinician will do Triage / discuss the patient with LAS and will do a clinical handover with LAS;

The Triage clinician will click “handover” on the LAS handover application which will formally complete the LAS Patient Handover;

The patient will be directed (with Triage paperwork and the appropriate section of the LAS PRF) by the Triage clinician to the Central Reception to formally register themselves.

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