Dick Fitzpatrick Primary Care Emergency Service (PCES) Option Appraisal Open meeting – 7th May 2013

Workshop Participants NHS Fife Clinicians - 3 NHS Fife Managers/Other - 5 Public Participants – 5 Independent Observers (SHC) - 2

Option Appraisal Overview

Outline of Option Appraisal Process

The Role of Option Appraisal To assess what outcomes will be achieved through changing services and investing/reinvesting money To assess the potential benefits of different options against common measures To assess options as objectively as possible To focus on the ‘ends’ as well as the ‘means’ [SGHD ‘best practice’]

Why Hold an Option Appraisal Workshop? Conduct the decision-making process in an open and transparent manner Ensure that the views of stakeholders are taken into account in the decision-making process Enable the stakeholders to engage in the whole benefits appraisal process Determine the comparative level of benefits delivered by each option

The Core Elements of the Option Appraisal Rank Criteria Score Options Weight Criteria Benefit Criteria Ranking of Options Short listed Options Benefit Criteria

Example Buying a Car – Factors Influencing Choice (Benefit Criteria) Reliability Price Accessories Safety Performance Dealer Support

Benefit Headings & Key Feature Summary Person Centred Care is responsive and appropriate to patients needs and the patient is included in clinical decisions:- Access to appropriate services Availability of transport Care is delivered within an appropriate safe timeframe Equitable Providing care that does not vary in quality because of geography, location or socio-economic status:- Standardisation of facilities and access to a full range of service provision Access to staff who are suitably trained to meet the needs of urgent care and reduce the risk of harm Safe Avoiding injuries to patients from care that is intended to help them:- Staff are appropriately trained to deal with presenting conditions and emergency situations Support is available upon request to ensure urgent care does not become emergency care Appropriate facilities are available to meet the care needs of the patient including diagnostics Easy access to specialised skills and services is available Significant events are avoided The environment is safe for the clinicians/patients and there is easy access to security/assistance when required Efficient Avoidance of waste including energy, supplies, equipment, resources inc staff and ideas:- No unnecessary journeys or inter-hospital transfers Transfer to appropriate care provision is timely/appropriate All specialist skills are available to maximise care provision The available workforce has a range of skills and is flexible and responsive to meet the needs of the patients Integration of services allows access to an increased specialised skills base The infrastructure is designed to ensure that a wide range of presenting conditions can be safely/appropriately managed The service is financially viable and appropriate Effective Providing services based on scientific knowledge:- Range of services available to meet all presenting complaints Training provision is appropriate and there is access to a multi-skilled workforce Access to emergency treatment/drugs/investigations Access to medical records to ensure continuity of care Strategic planning and implementation to facilitate achievement of Quality Indicators Timely Reduction of harmful delays for those who give and receive care:- Seamless transfer to ensure care provision is appropriate Recognised pathway to appropriate care is documented agreed and followed. Specialist investigation and intervention is available onsite

Ranking and Weighting the Criteria

Background Some criteria will have a greater bearing on the outcome of the option appraisal than others Ranking provides a guide to the relative importance of each criterion Weighting provides an opportunity to quantify the relative importance of each criterion We need to rank the criteria before weighting

Final Ranking of Criteria CriteriaFinal Rank Person Centred3 Safe1 Effective2 Efficient4 Equitable6 Timely5

Weighting the Criteria Weighting of criteria is the opportunity to determine the relative importance of each Can be a complex exercise but we used a technique which simplifies the process We assured results and agreed outcome prior to moving on Last step in the process ahead of scoring options

Benefit Criteria 1V22V33V44V55V6ScoreWeight (%) Safe Effective Person Centred Efficient Timely Equitable Weighting

Final Rank & Weight of Criteria CriteriaFinal RankFinal Weighting Safe121.73% Effective220.64% Person Centred316.52% Efficient415.69% Timely514.12% Equitable611.30%

Appraising the Options

Summary of Results RankScoreOption Option 4: Transfer of full service from Glenrothes (PCTC) to Victoria (PCTC) Option 3: Partial transfer from Glenrothes (PCTC) to Victoria (PCTC) - Midnight to 8am and full weekends Option 5: Minor Injuries Unit Option 2: Partial transfer from Glenrothes (PCTC) to Victoria (PCTC) - Midnight to 8am Option 1: do nothing

Weighted score across all groups for each option

Average scores, public scores and NHS Fife Staff scores

Workshop Evaluation Feedback 24 persons attended 15 persons completed short questionnaire - included 5 members of the public 100% felt they were provided with the support needed during the option appraisal meeting 100% felt they had the opportunity to ask questions/for further information 93% felt their views were listened to during the option appraisal 100% felt they were made aware of how and when feedback will be received

Very Positive Feedback

Comments received Excellent process – clearly explained and well managed. Dick Fitzpatrick was an excellent choice and led the appraisal very well Well facilitated Interesting and challenging This was a very positive experience. Everyone was listened to and their contributions valued. Excellent facilitation made the process flow Appraisal form should not have been numbered. Too much carbohydrate lunch I felt the views of the public meeting held in Glenrothes & surrounding areas were not made known during this appraisal The whole process for service change needs to be reviewed. The process needs to be shortened for smaller services and Boards needs more clarity over Major Service Change vis-à-vis Service Change

Learning for the future Useful to have pre-meeting Clarity about what constitutes “major change” and “service change” Being clear about timescales Healthier lunch!