1. Welsh Ambulance Services NHS Trust
Brendan
Welcome and introduction:
Introduce Yourself, Executive Medical Director
Introduce Grayham Mclean, Unscheduled Care Lead
Building A Relationship With Primary Care

2. Aim of our Presentation:
Introduction
Aim of our Presentation:
To engage with Primary Care, as a key partner in delivering sustainable patient care.
To provide background information on our service, and it’s transition to a clinically focussed organisation.
To share key service issues for both Primary Care & WAST.
To identify potential opportunities to work collaboratively with Primary Care colleagues.
Brendan
Going to talk about a relationship that has significantly changed over the last 10 Years between Primary Care & WAST
WAST recognise that to provide sustainable services, within the context of Prudent Health Care, we must work collaboratively with Primary Care colleagues.
For this reason, therefore, we are delighted to have the opportunity to present to all colleagues at this key strategic event.
The aim of our presentation is shown on this slide – refer to the bulleted points on the slide.
Essentially, we are here today to learn how we can contribute, and work together with colleagues, to implement your Primary Care Plans.

3. Background
Brendan
Simple reference & description of this slide

4. 1 2 3 Background – 3 Service Lines
2016/17 LDP JP
Background – 3 Service Lines 1
Emergency Medical Services (EMS) and Urgent Care Services (UCS) underpinned by our 5 Step Clinical Model. 2
Non Emergency Patient Care Service (NEPTS) - non emergency/elective patient transport.
Brendan
Simple reference & description of this slide
Note – the next slide gives the data / info on our activities 3
NHS Direct Wales (NHSDW) - providing skilled nurse triage and health information 24/ days a year.

5. Brendan
Simple reference & description of this slide
Highlight that we are a National service with a number of ‘strings to our bow’ including: EMS, NEPTS, & NHSDW
So, we have capabilities to respond to a whole range of patients from: critical care, to clinical telephone triage / advice, to safe to scheduled transport to outpatient appointments, and to website health advice.

6. Five Steps – Ambulance Care Pathway
2016/17 LDP JP
Five Steps – Ambulance Care Pathway
Commissioned by the Emergency Ambulances Services Committee (EASC).
New Response Model – commenced October 2015.
Independent review commissioned by WG – following 12 month pilot, and now operational.
Brendan
This new model has enabled WAST to become a clinically focussed organisation
It has attracted interest on a National level, with a number of fellow ambulance services now attempting to replicate the Clinical Model we are testing.
WAST has been through major change over the last 12 months.
We have seen the introduction of the Commissioning & Quality Delivery Framework, and we are now working closely with both the Chief Ambulance Services Commissioner, and the Emergency Ambulance Service Committee (EASC) to ensure that our important framework agreement translates into demonstrable service improvements for the people of Wales.
WAST is, therefore, on a rapid improvement journey, and the next 3 years will be critical in ensuring we are able to provide a highly effective & clinical focussed ambulance service.
Today, we are very interested in ensuring that we plan changes and service improvements together with Primary Care colleagues.
Get ready to Handover to Grayham – who will provide the audience with the detail of the work he has been doing relating to our Clinical Model, and more recently the engagement he has had with Primary Care Clusters

7. Step 3 – Come to see me: Response Categories
2016/17 LDP JP
Step 3 – Come to see me: Response Categories
Grayham
The major changes in the 2015 CRM pilot were to:
 categorise emergency calls based on the clinical need of the patient;
 remove time-based targets for all calls except highest priority ‘RED’ calls;
 measure clinical achievement using clinical indicator data (measuring the quality of the care the patient received) rather than time-based data alone; and
 introduce a new concept of ‘dispatch on code’ for emergency calls other than the highest priority RED calls. Allowing the ambulance service to decide exactly what help is required rather than just dispatching an ambulance to the address.

8. Situation (what is going on now)
WAST’s IMTP has a clear aim to develop our services in alignment with the needs of Primary Care.
Public Health Wales’ evaluation of the Pacesetter Programme.
Health, Social Care & Sport Committee’s Inquiry into Primary care
Supporting info:
PowerPoint – 1000 Lives Pacesetter presentation
Health, Social Care & Sport Committee’s Inquiry into Primary care – TERMS OF REFERENCE.
Submission from Primary Care Hub to Health, Social Care & Sport Committee.
Submission from Directors of Primary Community & Mental Health (DPCMH) to Health, Social Care & Sport Committee.

9. Data Analysis – Specifically on Health Care Professional Calls (HCPs)
Health Care Professionals (HCP) call volume = 58,281 number of Verified Incidents during 2015/16 (1st Oct 2015 to 30th Sep i.e. the timeline for the new clinical model).
HCP's - highest presenting call volume (12.6% of all demand - 462,414):
0.01% (3) RED Calls: Unscheduled demand & responded to as part of WAST's Emergency Medical Services (EMS - Blue lights).
1.6% (92) AMBER Calls: Unscheduled demand & responded to as part of WAST's EMS - Blue lights.
98.4% (57,358) GREEN Calls: Predictable (or scheduled) demand for pre-arranged patient admissions, and do not need EMS - Blue light responses .
Grayham
Explain that if a HCP identifies their call as being life threatening, they are call handled in line with all other 999 calls for consistency & equity of service.
If a HCP requires a patient transported with an agreed / specified timeframe, then there is a specific call handling protocol for them – in other words WAST have developed a ‘bespoke’ service for HCPs in recognition that they are highest presenting call volume.
Data shows that WAST services are used very responsibly by HCPs, who primarily request scheduled transport – refer to slide….

10. HCP GREEN Calls – Predictable Call Demand
2016/17 LDP JP
HCP GREEN Calls – Predictable Call Demand
Grayham
HCP GREEN Calls are where the HCP has requested routine transport within an agreed timeframe of 1 to 4 hours.
Graph depicts all Wales data, however, each of the 7 Health Boards have almost the identical shape.
This re-enforces the conclusion that the demand for the admission of low acuity patients is very predictable.
Peak Period is Monday to Friday
Peak Times are between 10:00 to 18:00 Hours
Height of demand is 13:00 hours Monday to Friday

11. Recommendations (what is our offer)
Welsh Ambulance Services NHS Trust
Community - based Paramedics
Advanced Paramedic Practitioners to be part of Multi-Disciplinary Teams (rotational posts)
Shared new estate / premises – WAST working directly with Primary Care
Supporting info:
Power Point presentation – ‘Building a relationship with Primary Care’
Patient flow procedures for low acuity (predictable) admissions
Patient Care Plans for Pre-hospital care

12. Example of an Improvement by Joint Working – The ‘Community Paramedic Scheme’:

13. The Impact of this Testing and Illustration of Prudent Health
Primary Care
17, 000 (283 hours) minutes of GP time saved
Secondary Care
Only 36 patient admissions from 226 home visits (16%)

14. WAST’s Second Request / Offer – ‘Pacesetter (MDT working)’
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
WAST’s Second Request / Offer – ‘Pacesetter (MDT working)’
Paramedic – home visits to assess and report back to the GP
Advanced Paramedic – home visits to assess, treat, refer / resolve.
Current trial in Western Vale
Current trial in St John’s Medical Practice.
Ongoing service with General Medical Services Team in Hywel Dda
Out of Hours Services in CT & AB (tbc)
Immediate Offer:
Interim data of the Western Vale Model has been positive, and due to workforce plans, WAST can offer this model to Primary Care in the first instance. There have been expressions of interest, to date from: AB; ABM; CT; HD and Powys.
Next Steps:
Agree finances with Primary Care (key dependency), and if feasible, put in place an operational model.
Full evaluation of the Advanced Paramedic Scheme in January 2018, in conjunction with the Bevan Commission, to determine opportunities for this level of clinician to work in other Primary Care Services, as well as home visiting (e.g. Primary Care Hubs).
WAST to align the development of the Community Paramedic Scheme to the College of Paramedics Career Framework.

15. Key Messages from our presentation:
Summary
Key Messages from our presentation:
We wish to develop services jointly through engagement with Primary Care.
We wish to address variation, and develop solutions for improved patient care / experiences collaboratively.
We seek opportunities to work directly with Clusters via our Heads of Operations and Clinical Leads.
We wish to retain staff, and develop joint contracts to enable colleagues to work in both Primary Care, and for WAST.
Brendan
Refer to the key messages on the slide.
Highlight:
WAST have a Head of operations in each of the Health Board Areas, and there is great opportunity for Cluster leads to ‘plug’ directly into WAST via this structure.
WAST are very interested in the Multi – Disciplinary Teams (MDTs) that the Clusters will be developing, and we would welcome conversations on how colleagues see WAST contributing actively & productively to patient care as part of these MDTs.
WAST wish to avoid, wherever possible, the creation of an ‘internal market’. This is where Paramedics or Nurses are developed to a high level of clinical practice through educational programmes, but are then employed by individual Practices, as opposed to undertaking rotational roles that would benefit the whole Unscheduled care & Primary care systems – WAST retain the contracts of employment, and colleagues working across both Primary & Emergency Care.

16. Questions and Observations Welcome
Thank You
Questions and Observations Welcome
Direct Contacts:
Dr. Brendan Lloyd, Executive Medical Director -
Grayham Mclean, Unscheduled Care Lead –
Brendan
Facilitate any questions – Grayham here as your full back to answer as many questions as possible!