1. Unplanned Care Workstream Emerging plans for 2019/20 CCF, July 2018

2. We have 4 main areas of transformation
Neighbourhoods
Integrated Urgent Care
Discharge

3. Neighbourhoods? North East 1 North West 1 North East 2 North West 2
South East 1
South West 1
South East 2
South West 2
Note that co-located premises have been separated on this map for clarity

4. Neighbourhoods
We are continuing to develop the neighbourhood model across City and Hackney
Neighbourhoods will
improve the overall health and wellbeing for the City and Hackney population
reduce inequality of access to services and reduce inequalities in health and social outcomes for the City and Hackney population
focus on the wider social and economic determinants of health for the whole population enhancing early intervention & prevention models
coordinate and plan services with residents around their individual needs
create empowered communities who are better able to support themselves, prevent ill-health and increase their ability to sustainably manage their own wellbeing
listen to and act on what matters to residents and patients
will improve the quality of care received and patient experience in a sustainable way
How will we do this
Continue to work with the neighbourhoods clinical leads and GP practices to develop the neighbourhoods identity
Develop a neighbourhoods integrated data profile and risk stratification tool to help each neighbourhood better understand their population, identify areas for improvement and track their progress;
Work with other partners – social care, mental health, community nursing, school health, childrens centres to develop how we integrate services around each neighbourhood, this will be through a series of test and learn sites
A specific model for high risk, vulnerable patients will be implemented across all neighbourhoods
Currently, the model is about service delivery rather than commissioning, however, we will align new contracts to the emerging neighbourhoods model as it emerges

5. Integrated Urgent Care
City and Hackney plan to continue to deliver quality urgent care services to meet patients’ and residents’ needs. Our emerging priorities for 2019/20 are:
To ensure that we get best use out of the new North East London (NEL) 111 service. This goes live on 1st August 2018.
111: will provide patients with a single point of telephone access (accessed by dialling 111) to range of urgent care services, replacing direct calls to GP practices outside of Practice opening hours. Patients will have access to a range of clinicians in the Clinical Advice Service (CAS) via this telephone line
CHUHSE will cease operating after March 2019, so we will have a new model for GP out of hours from this point– we will ensure that this is integrated with existing services which provide a similar function
In Q4 18/19, following 6 months of the new 111 service we will undertake a review of duty doctor to see how this service fits with changes to the wider urgent care landscape
We will review the new ambulatory care unit at the Homerton to ensure that it is delivering best outcomes and value for the system.
We will evaluate how successful the new pro-active care service has been to inform future commissioning decisions.
We will continue to improve our falls pathway, particularly our falls prevention services. We will evaluate the new paradoc falls service, and are looking to pilot a home based exercise service. We are working with public health who are reviewing the current contract for exercise programmes.
We are developing a proposal for a dementia crisis hub to support dementia patients with urgent needs
We are looking to pilot a new hospice at home service to provide urgent response to patients in their last months of life from a community based palliative care team. This will be provided by St Josephs and will initially run as a one year pilot.

6. The new 111 Service Glossary:
GP extended access – Since April 2108 we have had 5 extended access hubs open in the borough. Individual hub opening times vary but between them provide GP appointments in the North and South of the borough until 2000 on weekdays and on weekends.
PUCC: Primary Urgent Care Centre –primary care led walk in service based at Homerton emergency department
UTC: Urgent treatment centre – generic name for primary care led walk in services
ED: Emergency department

7. Discharge
We are working with the Homerton, LBH and the voluntary sector to improve patients discharge from hospital and ensure that patients can access any ongoing health or care services that they require quickly. Key areas for improvement are:
Improving in hospital services including planning patient discharges early, we are exploring how duty doctor could help with this
Creating cross agency, multi-disciplinary teams that work together to support discharge
We will be evaluating the discharge to assess pilot to see if we want to continue this going forward
Continuing to expand the range of out of hospital services that operate with seven day access
Ensuring we have designated staff (‘Trusted Assessors’) who assess patients in hospital or the community to minimise delays for patients waiting for assessments for individual services
Ensuring patients have choice in their how they are cared for, how long they stay in hospital and where they are discharged to
Enhancing our service offer in City and Hackney care homes (termed Enhancing Health in Care Homes), including plans to
Enhance our primary care support to residents in care homes
Ensure the correct range of clinical and professional support is available in care homes
Provide short term care in patients homes (reablement) and more bespoke and intensive rehabilitation where appropriate
Ensure our end-of-life care and dementia care are high quality and patient focussed
NHSE have recently launched a focus on reducing long stay admissions to hospital, and are about to publish a good practice guide, we will look to implement the recommendations from this across the system