1. Urgent Care in Hawke’s Bay Workshop Welcome to…

2. STAGE 1 Stakeholder Engagement Recommendations to Board December 2013 Integrated Urgent Care Project Stages STAGE 2 Consultation STAGE 3 Implementation Listening Problem validation Option generation

3. An overview of the current system Key Findings from the 2010 Review Urgent Care Workshop

4.  Scope and Methodology  A tale of two cities  Analysis of ED growth  Some other urgent care services  Summary of issues What Will Be Covered

5.  Acute services becoming overwhelmed  Inconsistent after-hours provision  Disparities between Hastings and Napier  ED utilisation  Growth in attendance  Patterns of growth  Expiring contractual arrangements  City Medical  Hastings/HN GPs, DHB, PHO re Hastings overnight Need For Review

6.  Primary Health Care Strategy  Better, sooner, more convenient care  Primary/Secondary integration  Integrated Family Health Centres  Access to after hours primary care MOH Strategy

7. Definition - the range of services available to people who have, or perceive they have, an urgent need for advice, diagnosis, treatment or care Philosophy - Continuity of care with a General Practice or practitioner as the medical home for an individual is the desired model for a 24 hour integrated urgent care strategy. For urgent assistance:  95% of people will receive services within eight hours  99% of people will receive services within 12 hours  100% of people will receive services within 24 hours  100% of children under-six years will receive free after-hours services What is the Standard for Urgent Care Service?

8.  Study the overlap and relationships across the spectrum of acute primary care provision –Primary Care Services  GP Services  A&M Services –ED Services –Ambulance Service  Provide recommendations for getting these services working better together in a more consistent and coordinated way. Review – Terms of Reference

9.  Project established with broad representation  Secondment of GP – Alan Wright  19 stakeholder interviews  Survey of 150 GPs  Survey of 758 patients (MEC pathway)  Site Visit – Timaru Hospital  Literature review  Data analysis Approach

10.  Scope and methodology √  A tale of two cities  Analysis of ED growth  Some other urgent care services  Summary of issues What Will Be Covered

11. NAPIER 1. The Doctors and City Medical 2. Good buy-in to one roster 3. “Single” after-hours location (City Med) 4. Overnight cover currently in place 5. Radiology availability 6. City Medical  Lease on NHC until 2019  Currently works well, good volumes of work  Expensive Current Situation

12. Level 2 ED Services Provided in Napier

13. Triage 10.1% Triage 22.8% Triage 324.3% Triage 439.7% Triage 533.1% Volume3,323 Overnight (9pm – 8am) triage categories Analysis of Napier Volumes

14. HASTINGS 1. Hub and spoke model with ED as the hub 2. Problem with ED redirecting back down the spokes. 3. Patients confused by attending GP for half the day and ED for the other half. 4. Competition for A+M work 5. No collaborative approach 6. Telephone triage arrangement after 8pm with no GP available for back-up Current Situation

15.  Scope and methodology √  A tale of two cities √  Analysis of ED growth  Some other urgent care services  Summary of issues What Will Be Covered

16. Steady Growth in ED Presentations

17. Changing Patterns of Demand – Higher Growth in Less Urgent Patients

18. Changing Patterns of Demand – More People Self-Referring

19. Changing Patterns of Presentation Time

20. Is there a Social Gradient Associated with the Growth?

21.  Scope and methodology √  A tale of two cities √  Analysis of ED growth √  Some other urgent care services  Summary of issues What Will Be Covered ?

22. Telephone Triage Services

23. Minor Emergency Care (MEC)

24. Total 758 MEC

25. Acute Inpatient Service

26.  GPs are specialists in risk management. They have background knowledge which means they can limit the number of tests that need to be ordered.  ED practitioners need to be able to identify & redirect “GP” patients from ED to primary care The GP’s Role in Assisting the Emergency Specialist

27.  Scope and methodology √  A tale of two cities √  Analysis of ED growth √  Some other urgent care services √  Summary of issues What Will Be Covered

28.  Over the last 9 years, with one exception (2009/10) ED attendance growth has consistently outstripped population growth  Significant social gradient in self-referrals to ED  Varying patterns of urgent care service demand related to age, socio-economic status, proximity to services, access, etc.  Patient’s own perceptions of urgency, need and appropriateness are key drivers of service demand i.e. ED or GP  Huge and significant variation in closing times, extended hours and weekend arrangements across the district  Acute admission rate increases with age – Longer LOS – Greater complexity – High readmission rate Key Findings

29. Urgent Care in Hawke’s Bay Workshop ED Attendances

32. Age specific rates

33. Growth in attendances by Age specific rates

34. Ethnicity

35. Age specific rates by ethnicity

37. Growth in attendances by etnicity

38. Model Forecasts

39. ED Attendances Admitted