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Urgent and Emergency Care Programme

Suzanne Hughes, Urgent & Emergency Care Programme LeadJohn Adams, Director of Post Graduate Hospital Training

Neil McLauchlan, Associate Head of Education & Commissioning



Background & Programme DevelopmentSuzanne Hughes, Urgent & Emergency Care Programme Lead


Strategic Context• HEE Strategic Framework 2014-19

– Kings Fund recommending fewer centres– Supporting care at or closer to home– Adaptable skills in Emergency Care

• HEE Mandate 2014-15– Tackling historic shortages in emergency medicine– Upskilling and training paramedics to deliver more treatment in the

community and deliver onsite triage and treatment in emergencies• HEE Business Plan 2014-15

– Additional emergency medicine trainees and consultants– Focus on NHSE and CCGs service policies, pathways or settings of care

(Transforming Primary Care, 24/7 services and Emergency Medicine)


Strategic Context• NHS 5 Year Forward View report

– More appropriate use of primary care, community mental health teams, ambulance services, and community pharmacists

– Developing linked or networked hospitals – linking emergency centres with specialist emergency centres

– Access to 7 day services where this makes a clinical difference to outcomes– Proper funding and integration of mental health crisis services, including liaison psychiatry– A strengthened clinical triage and advice service– New ways of measuring the quality of urgent and emergency services

• NHS England Urgent & Emergency Care Review– Supported by HEE through EMWIG (Emergency Medicine Workforce Implementation Group)

with specific projects on Medical Workforce, Physician Associates, Advanced Clinical Practitioners, Paramedics and Pharmacists

– Distinguishes between those with urgent but non threatening needs (care outside of hospital as close to peoples homes as possible) and those with a more serious or life threatening emergency needs (treated in centres with the very best expertise and facilities)

– Two levels of hospital based emergency centres (Emergency Centres and Specialist (Major) Emergency Centres) supported by a wide range of primary and community urgent care support services


Operational Impact• Major issues across the whole workforce and

not just medical• National issue – decades of targets and

pressure• Recruitment & retention issues• Reliance on locums and agency• Impact on theatres, critical care, ICU, HDU,

A&E an EM


Workforce Plans by LWEG

Cumbria and Lancashire

• Vacancies Emergency Medicine Middle Grades and Consultants; development of nurse consultants

• A&E and unscheduled care nurse shortages: recruitment & retention, % international recruitment, % newly qualified workforce



Greater Manchester

• Vacancies Emergency Medicine Middle Grades and Consultants; reliance on locum cover; looking to international recruitment

• Complex care recruitment issues; development of advanced practitioners

• Impact of Healthier Together on the location and number of specialist and generalist centres



Cheshire & Merseyside

• Theatre workforce – shortage of skilled staff nurses in ED, Critical Care, Coronary Care and Theatres

• Newly qualified nurses filling most band 5 vacancies posing a risk to specialist areas

• Remodelling emergency care where possible and considering wider workforce in service transformation

• Impact of downgrading critical care advanced training posts

• Paediatric ED workforce issues• High % international recruitment

make stability of service difficult


Programme Development• Establish current baseline of issues• Develop suite of solutions through engagement,

pilot work and evidence based practice• Develop a Leadership Forum to guide, challenge

and provide expertise to the development and delivery of the programme

• Develop a portfolio of projects dedicated to delivering the vision and blueprint of the future


Investment• Forerunner Funds:

– Lancashire economy clinical portfolio careers to recruit and retain medics and clinical staff across urgent, emergency, intensive, critical, unscheduled and other care sectors

– North Lancashire to develop and deliver a programme of education across to support Primary Care Development by addressing identified skills gaps within General Practice staff, supporting future sustainability and maximising workforce development.

– Royal Manchester Children’s Hospital and North West & North Wales Paediatric Transport Team (NWTS) to improve paediatric trauma care through targeted onsite simulation and crisis checklist implementation – “a child and hospital centred Paediatric Trauma Program”

• HEI Innovation Fund



Medical Workforce in Emergency MedicineJohn Adams, Director of Post Graduate Hospital Training


Emergency Physician (retired)


The annual headlines on A&E pressures are becoming almost a winter tradition. Solving this deep-rooted problem extends far beyond the front door of local emergency departments.

A&E and ambulance services are the 24-hour frontline part of this system – and get this scrutiny as the most recognisable “brand”, but we ignore at our peril the role that community nurses, pharmacists, walk-in centres and GPs can play in delivering a sustainable and consistent urgent care service.

David Colin-Thome Guardian 27 Nov 2014


A&E figures 'show NHS in winter crisis’Daily Telegraph

Record number of A&E patients kept in hospital... and overcrowding crisis sees four-hour waits double in a yearDaily Mail

More patients wait on trolleys as crisis looms in A&E unitsThe Times


The Issues• Address current staffing shortfall

• Make EM a specialty which is professionally satisfying ( and NW the place to be )

• Facilitate entry into EM

• Retain the work force


National Initiatives


National initiatives

• Run through training in EM• Increase the intake to ACCS(EM)– 12 additional starters in 2014

• Recognition of transferable competences– Defined route of entry (DRE-EM)

• HEE/CEM overseas development programme– Work, learn and return


HENW initiatives

• PG dean paper to LETB (Dec 2013)

• Training leads meeting (April 2014)


HENW initiatives

• Reduce long hours of duty and long duty runs• Support development of non training grades• Recruitment of non training grades• Develop a culture of patient focussed diagnosis

and management• Review the quality of ACCS placements and

promote those that offer a learning culture• Support for trainees at CT3 , a key transition

point


HENW initiatives

• Facilitate a break in training– Run through with OOP may help



Non-Medical Workforce SolutionsNeil McLauchlan, Associate Head of Education & Commissioning


Short Term Solutions• CPD Strategy to support and develop existing and facilitate the flexibility of

the wider workforce• Leadership Development – commission a programme to support leadership

capacity and capability for emergency care.• Paramedics - review current education provision to ensure it is fit for future

role requirements• Mental Health training for non-mental health staff • Physical health, and long term conditions training, for mental health

practitioners • Utilise the flexibility offered by the Advanced Practitioner Programme to fast

track staff to gain specialist skills and competencies• Increase in Primary Care Nursing, 30 CSP plus implementation of new

foundation programme and 11% increase in District Nursing• Actively support and invest in return to practice campaign


Medium Term Solutions• Advanced Practitioners – increase by 20% to 136 to enable development of

emergency care practitioners and other advanced practitioner roles• Piloting a programme for training Physician Associates• Piloting a new training programme for 10 sonographers • Scope the wider workforce including AHPs and paramedics supporting Urgent and

Emergency Care Departments.• Emergency Care Pharmacists – pilot the development of a specialist pharmacy role • For existing staff the funding for CPD will allow access to specialist education and

training including:• Continued funding for the Critical Care Institute in Greater Manchester for staff

working in critical and high dependency care settings including the AIM programme.

• Develop a workforce transformation and competency framework for urgent and emergency care supporting transferability


Long Term Solutions• Nursing – an increase of 125 Commissions representing a 7.2%

increase since 2012/13 to give 3,322 commissions in 2015/16• Operating Department Practitioners – increase by 10% (20) to 219• Maintenance of the dual direct and technician entry to Paramedic

training with NWAS• Increases in Healthcare Science at STP and PTP to support

diagnostic capacity• Continue to closely monitor and performance manage

improvement in student retention to increase outturn• Ensure initiatives design to enhance commissioning support

emergency medicine including, pre-degree year of care,• Widening Participation Strategy, Care Certificate, TEL


Any Questions?

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Documents

emergency care hee mandate

settings of care

critical care

comhenorthwest urgent

threatening needs care

comhenorthwest workforce

qualified workforce

quality of urgent