Cornwall & Isles of Scilly Urgent Care update Tryphaena Doyle & Dr Rob White NHS Kernow Clinical Commissioning Group

Urgent care update Have publicly outlined strategic intent for urgent care services which sits within broader context of developing integrated community services in three integrated care areas and 7 integrated care communities. Overview and Scrutiny committee have supported – recognise an enhancement on current provision. Key issue for Emergency Departments Not too many people walking in with minor injuries and illnesses, but too many people especially frail older people arriving, often by ambulance later in the day. National specification for Urgent Treatment Centre published in 2017 Local enhanced specification developed by clinicians in December 2017 Provide enhanced range of services compared to Minor Injury Unit. Delivered by multi-disciplinary team including GPs and other Medics, able to see broader range of people including those who are frail with complex needs. Access to short stay assessment beds and enhanced diagnostics (x-ray, ultrasound, point of care testing, CT-scanner). Wave 3 co-production events with wide range of stakeholders reviewed and considered the specification. Also previously shared with Clinical Senate. Learning - Cornwall & Isles of Scilly needs mixed and networked model of provision because of rural geography and insufficient clinical need to have an Urgent Treatment Centre on every site. Will include NHS 111, 111 online, GPs providing minor injury services, pharmacies, links with improved access to general practice. Suite of modelling tools also developed to aid decision making – enabled comparative ranking of all current sites according to different criteria (historic activity, activity which could be pulled from acute, transport times)

Urgent care services – proposed model   Aligned with NHS 111 and 111 Online Out of hours primary care treatment centres Extended primary care appointments GPs offering services may increase

Urgent treatment centres Location Rationale Penzance, West Cornwall Hospital Urgent Care Centre NHS England already “designated” as UTC as exceeds national specification. Testing frailty assessment service. Requires only formal name change (requested by NHS England). Can continue to enhance service offer over time. Truro, Treliske site Can be achieved through reconfiguration of GPs already employed in Emergency Department, minors pathway in place, Acute GP, Out of Hours Treatment Centre, Same Day Emergency Care clinic. Aim to ease pressures on Emergency Department and improve access, quality and experience. Anticipated can be achieved within existing resources and this will be tested as implementation plans developed. Bodmin Proximity to A30 provides good access for public and ambulances. Ambulance service advised had potential to pull activity away from Derriford. Longer term would be site for fifth CT scanner for county. Demand for CT would come from elective and planned care pathways as well as urgent care services. Co-location with mental health services provides potential benefits too. Additional workforce and long term estates work to cater for CT scanner will require additional investment. Development will be incremental and in collaboration with partners including pharmacies and GP practices. Provides a service in each of the three integrated care areas. All services close to 100 hour pharmacies

Next steps Road signs to West Cornwall to change Bodmin – incremental development needs to align with other plans to develop the campus. Some simple changes to better integrate what’s there already first. Point of care testing equipment to follow. Then bring in GPs. Beginning to construct business case for CT scanner. Waiting feedback on national capital monies bid. League of Friends already want to start fund-raising! Truro – positive and quick pace of change since October announcement. Contracts torn up! Clinicians engaged to drive change. Safety & quality at centre of redesign. 2 phases: 1) what can be done now up till January 2019 – TWO doors only: 1. Ambulance (A for Resus and Majors) 2. Both walk-in and ambulance ‘fit to sit’ will arrive through the UTC (current Same Day Emergency Care Door) Minors /walk in relocated to UTC to increase capacity and support integrated working Increased GP presence Improved flow for medically expected patients Development of system wide MDT 2) what we will be planning for from January 2019. A 24/7 GP led UTC optimising multi disciplinary team working. Maximise our potential for same day emergency care and avoid admissions