NHS West Kent Clinical Commissioning Group The future of urgent care services in West Kent Out of hours and hospital at home service

NHS West Kent Clinical Commissioning Group West Kent Population & Urgent Care Needs West Kent CCG has a registered population is 466,000, 31% of the total Kent registered practice population. Local analysis shows that there are three groups where A&E attendance is disproportionately high: the under 5s, years and >80yrs. HES data shows that the proportion of people aged 65+ and over, who are admitted to their hospital from their own home, and discharged to residential and nursing care is relatively high for Kent compared to other parts of the country. Our data clearly shows that the largest proportion of urgent care activity is related to older people with health and social care needs linked to dementia, falls and perhaps end of life. This cohort is complex, has multiple morbidities requiring an integrated health and social approach which can be successful depending on a whole systems transformational change towards an integrated care team approach using risk stratification and patient empowerment methods through self-care and self-management.

NHS West Kent Clinical Commissioning Group West Kent CCG Mapping the future

NHS West Kent Clinical Commissioning Group West Kent Vision for new primary care

NHS West Kent Clinical Commissioning Group Five Year Urgent Care Strategic Vision We are working towards delivering a network of integrated services that are able to treat patients in their own home, preventing unnecessary hospital attendances. Critical to the success of any future service will be effective integration and collaboration, with all major providers playing a critical role. Commission a comprehensive service that delivers urgent care seamlessly and comprehensively, and which works effectively with other key providers of community and hospital based services The key elements of a future service would include the following: –Primary care front end assessment and, whenever appropriate, management of patients with urgent care needs –Integration of out of hospital provision with ambulance, primary care and community services working together as potentially a single urgent care service In order to achieve the long term vision the CCG agreed to a phased procurement approach.

NHS West Kent Clinical Commissioning Group Phase 1: West Kent 2 year strategy Commissioning a service that continues to focus on out-of- hours provision but which encompasses a broader provision of types of care available. The broader provision of care will be contained to: –Enhanced rapid response service (hospital at home) –Primary Care Clinicians assessing patients and treating those attending A&E with primary care needs. To integrate the services within one contract in order to improve integration and reduce fragmentation A care plan management system to facilitate the integration of the service around the patient and avoid duplication

NHS West Kent Clinical Commissioning Group Commissioning for Outcomes 1.Delivering high quality, safe and clinical sustainable services which meet required standards of care and are safe 24/7 2.Increasing social value 3.Continuity between in-hours and out-of-hours provision 4.Connecting urgent care services together more efficiently to reduce a fragmented and complex system 5.Reduction in the number of acute sector A&E attendances and emergency admissions 6.Ensuring patients receive the right advice at the right time and place

NHS West Kent Clinical Commissioning Group Urgent Care Service Deliverables The service will provide integrated care delivering both urgent primary care and hospital at home services for West Kent residents. The service will be based within primary care medical assessment units across West Kent. The team delivering the service must be multidisciplinary, in order to meet the requirements and needs of patients for both a primary care service and a hospital at home service. The primary care medical service element will not solely focus on out-of- hours provision but must extend to normal working hours in order to triage and treat primary care patients attending A&E both in-hours and out-of-hours The service must provide rapid response 24/7 (including weekends) to people who would otherwise face unnecessary admission to acute in- patient care or unnecessary prolonged hospital stays, long term residential care, or continuing NHS in-patient care

NHS West Kent Clinical Commissioning Group Procurement & contracting Procurement process & timetable –PQQ advertised in December 2014 –ITT advertised in February 2015 –Contract awarded in May 2015 –Mobilisation June – August 2015 –Service goes live 1 st September 2015 Contract value £4,675,000 per annum Contract length: 2 years

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