1. Key Findings in Doncaster& Bassetlaw November 2018
#System Perfect
Key Findings in Doncaster& Bassetlaw
November 2018

2. #System Perfect What was the focus?
This year we wanted to:
better understand peoples’ health and social care needs and behaviours
raise awareness about local services available in the area
understand why people choose to go to our A+E departments
focus on people aged 20-35
In addition, teams were keen to both support admission avoidance and discharge processes on both sites.

3. #System Perfect What did we do?
Public Engagement and Communications
An online survey was posted across social media and was also completed face to face  
A series of videos of clinicians has been shared, informing people about the different options for advice and treatment
The Health bus visited local town centres in Doncaster, Thorne, Mexborough with plans to go to Worksop
The team undertook visits to local large employers with teams spending time at DMBC, NEXT distribution centres and Greencore
The team spoke with staff and patients on our Doncaster and Bassetlaw sites

4. #System Perfect What did we do?
Doncaster Front Door Triage – FCMS/DBTH
The 2 day trial aimed to establish whether an alternative triage tool would be more effective at streaming patients away from A&E and in to urgent primary care or other alternatives.
Bassetlaw Front Door Streaming and supporting discharge – NHFT/DBTH
A core team of staff from Local Partnerships Division – Bassetlaw locality provided support and in reach to Bassetlaw Hospital to ascertain if there was potential to increase the percentage streamed into primary care services in and out of hours and to support the discharge of patients.
Direct Booking trial with Newgate Practice and positive engagement with primary care hubs.
Doncaster Primary Care practice audit - PCD
We had agreement from between 5-10 practices that they would try to collate some primary care data about on the day appointment availability, appointments not used and DNAs to help understand how patients use the urgent care system.
Support in ED and in-reach onto wards – RDaSH/DBTH Respiratory Specialist to in reach on to Respiratory ward for board rounds
Frailty team (OPMH and Physical Health) to attend wards for joint ward round
Physical Health staff to in-reach to DBHFT facilitate early discharge of patients
To attend daily operation meeting when as and required.

5. #System Perfect Response
The response to social media has been extremely positive reaching 100,000 people in total. 
Adding to this, we have received over 2,500 responses to the survey.

6. OUR DEMOGRAPHIC PROFILE
#System Perfect Demographics
OUR DEMOGRAPHIC PROFILE
Gender
Age Range
Ethnicity
1,349 female
516 male
199 undisclosed
14-19 years old: 285
20-29 years old:311
30-39 years old:373
40-49 years old: 390
50 to 59 years old:328
60+ years old:178
1499 white British
9 Polish
7 Asian
3 Black Caribbean
3 Mixed race
2 Black African
2 Indian
1 Portuguese
1 Lithuanian
1 Slovak
1 Thai
1 New Zealand

7. #System Perfect Results
Graph to demonstrate how people react when they are ill or injured
GP %
Rest %
Hospital/ %
Depends! % %
Google %
Walk in %
Parents %

8. #System Perfect Results
Awareness of Local Services:
99% are aware of GP practices
97% are aware of the Emergency Department (I’d suggest the discrepancy in this not being 100% is terminology – Emergency Department to Accident and Emergency and people simply leaving this blank by accident)
97% have heard of pharmacies and chemists
91% have heard of NHS 111
85% have heard of GP Out of Hours (people weren’t always sure how to access this service)
72% have heard of the Minor Injuries Unit ( some people thought this was at DRI)
62% have heard of the Doncaster Same Day Health Centre
56% have heard of NHS Choices (some people heard of it but unsure what it was)

9. #System Perfect Results
Reasons given for patients attending ED:
lack of GP capacity, difficulty in making an appointment or an individual not being registered with a GP
instantaneous service which is available 24/7
a visit to ED acts to reassure that there is nothing serious
a visit to the ED is dramatic, an event to post on Facebook, to attract likes, comments and attention

10. #System Perfect Findings
Doncaster Front Door Triage – FCMS/DBTH
The findings show that the outcomes were comparable in >84% of the triages
This suggests that both methods of triage are equally successful in streaming to the most appropriate place.
Opportunities for further joint work to explore and consider ways to enhance existing streaming
Bassetlaw Front Door Streaming and supporting discharge – NHFT/DBTH
Variation in streaming was recognised
Streaming figures in excess of 20% were able to be achieved
Joint community nurse and ED nurse model was successful
Current out of hours capacity is insufficient
Out of area patients continue to require more intensive case management
Staff were energised to work in partnerships through out system perfect and to challenge the status quo
Doncaster Primary Care practice audit - PCD
There were on the day appointments available within Doncaster Practices
DNA’s represent a significant issue for the practices in lost appointment time
A number of practices are keen to continue to work with us to understand some of the issues this System Perfect focused on
Support in ED and in-reach onto wards – RDaSH/DBTH
Patients were identified who could be supported at home if increased support were available
Joint working between teams supported patient discharge

11. #System Perfect What Next?
To increase awareness of services available to support patients at home for all health and social care professionals
To raise awareness of local support and services available to the public in times of urgent need
To involve patients in the design of new models of care
To simplify and promote Urgent and Emergency Care pathways
Ongoing joint work with primary care in both Doncaster (PCD) and Bassetlaw to understand demand, capacity (in and out of hours), profiles and appointment utilisation
To explore and consider ways to enhance existing streaming
Embed community in-reach where found to be most effective
Explore the challenges faced with out of area patients
Future system perfect to potentially focus on Mental Health with greater patient involvement
Ongoing link with local businesses and organisations regarding health promotion and educational opportunities
To explore ways to engage with minority groups including those for whom English is not their first language

12. #System Perfect What Next?
System Perfect continues to be an effective way of working together to better understand the system and to test new initiatives using recognised improvement methodology.
The outcomes and learning from this work will inform the Doncaster Area of Opportunity, developing Urgent and Emergency Care strategy and future service models.

13. #System Perfect 2018
Any Questions?