Aim

To redesign unscheduled care services to:

·    provide a, straightforward and consistent, single point of entry to unscheduled care services for patients

·    make maximum use of the skills and expertise of staff

·    support patients to remain in their owns homes thus reducing emergency admissions

Methodology

Pembrokeshire Local Health Board (LHB) has developed Care on Call - an 'Out of Hours' (OoH) primary care provision that includes call handling and nurse triage providing referrals to:

·    Salaried OoH General Practitioners (GPs)

·    Paramedic practitioner

·    OoH nurses

·    District nurses

·    Social care rapid response team

·    Emergency mental health team

·    Accident and Emergency (A&E).

This is a regional approach, with a Service Level Agreement currently under negotiation to provide call handling and nurse triage for Ceredigion.   The Full Business Case for an Integrated Emergency Care Centre was approved by the Welsh Assembly Government in September 2006. As part of the Business Case, an integrated Unscheduled Care service model has been agreed. This development is cutting edge and is leading the way in Wales whilst complementing the Welsh Assembly Government's Draft Delivering Emergency Care Strategy. The model will include the incorporation of all aspects of the existing Out of Hours service with A&E, resulting in the physical integration of Emergency Care leading to a more straightforward easily accessible service. The integration will be incremental, commencing in summer 2006, with total integration of services by summer 2008, culminating in the opening of the new Emergency Care Centre at Withybush Hospital. The integration of Social Care within the new model is also a first in Wales.

Results

Last year a total of 38,500 calls were logged through the existing service. Almost 10,000 patients were seen at the Care on Call treatment centres at Withybush, Tenby and South Pembrokeshire Hospitals, and a further 2,500 were given advice by our GPs over the telephone. Care on Call Triage nurses assessed a total of 23,500 patients over the telephone and gave nurse advice to over 8,000 of these patients.  Work on the new integrated model is underway with an unscheduled care taskforce convened to develop and oversee implementation.

Evaluation

Consistent quality of response, regardless of where, when and how patients contact the service.  Clear, consistent and measurable standards which cover each element of the service and the whole of the patient's journey. Reducing inappropriate A&E attendances and hospital admissions.