1. NHS Fife Primary Care Emergency Service (PCES) Out of Hours Primary Care Outcomes of Service Review Open Meetings Meetings May 2013 Janette Brogan Lead Nurse

2. PCES Philosophy It is the aim of PCES to provide a safe and effective healthcare service for out of hours users To be person centered whilst working in partnership with patients and the public To build upon existing models of care, partnership working, expertise and experience through continuous development and assessment To reflect NHS Fife’s accountability

3. Role & Remit Provision of Out of Hours Primary Care Medical Services to the community of Fife & Kinross Provision of necessary communications systems to facilitate and support healthcare delivery Provision of appropriate visiting arrangements to support the healthcare delivery Maintain an overview of the local, national legal, clinical and operational requirements

4. Background 1996/97 Six Fife GP co-ops were formed 2002The six co-ops amalgamated into PCES 2003 PCES integrated with NHS24 2004 GMS contract allowed GPs to opt out of their OOH commitment 2007 PCES became a managed service by D&WF CHP 2010 Commenced review of current service provision

5. Current Fife PCES Configuration 4 Primary Care Emergency Centres 1800-0800 Mon-Fri and 1800 Fri -0800 Mon –St Andrews Community Hospital –Queen Margaret Hospital –Glenrothes Hospital 1800-0000 Mon-Fri and 0800-0000 Sat-Sun –Victoria Hospital Staffed by GP’s and Urgent Care Practitioners 3 Mobile GP’s for the Home Visiting Service Mon-Fri and a 4 th vehicle used from 0800-1800 Sat-Sun

6. PCEC Activity 2011/12 Postcode AreaTreatment CentreTotalHours covered CentralGlenrothes8,6226243 VHK6,8503304 WestQMH11,2406243 EastSACH7,3536243

7. Service Review The current Model of Care has evolved from these services. The identified variation between the provision at each centre regarding adjacencies required a review. The review utilised the following criteria: The Healthcare Quality Strategy for NHS Scotland (May 2010) The Provision of Safe and Effective Primary Medical Services Out of Hours (2004) NHS Health Improvement Scotland indicators for Primary Care Out of Hours Services (finalised Published June 2012)

8. PCES Proposed Option Criteria January 2012 To provide a safe sustainable and affordable OOH Service Immediate access to a multi skilled specialised workforce Increased facilities available to treat a wide range of presenting symptoms The ability to deal with emergency situations more effectively Minimise travel between services/sites Improved the quality of care/outcomes Potential to develop and enhance skills through closer joint working The provision of increased clinician resource at QMH Contribute to NHS Fife efficiency targets

9. Service Review Criteria Based on Healthcare Quality Dimensions Safe: Reduced clinical risk Effective: Improved quality of care and outcomes Person-centred: Patients are seen by the right person, in the right place within an appropriate timeframe Efficient: Seamless journey through unscheduled care Timely: There is no delay in receiving the care required. Equitable: All patients have access to a range of service provision

10. SAFE Review of actual/potential significant events Access to specialised skills and services Environmental safety for staff/patients Available facilities to treat/diagnose

11. EFFECTIVE Access to a wide range of services is available to diagnose and treat urgent presentations/emergency care. Care is delivered by clinicians who have had appropriate training to effectively and safely treat a wide range of presenting conditions. Access to records to maintain continuity of care.

12. PERSON CENTRED Care is delivered within an appropriate safe timeframe. The patient is seen by the right person in the right place. The quality of care provision meets the patient need. There is access to a wide range of appropriate services.

13. EFFICIENT The infrastructure meets the needs of the client group. Unnecessary journeys/inter-hospital transfers are kept to a minimum. The available workforce is skilled and responsive to meet the needs of the client group. The service is financially viable.

14. TIMELY There is no unnecessary delays in the required care being provided Any transfer is seamless following a recognised pathway and maintains the safety of the patient at all times Facilities available onsite meet the needs of the client group and complexities of presenting conditions

15. EQUITABLE Adjacencies of accommodation ensures a wide range of facility provision. Support and skills of staff are available to meet the needs of the patients attending. Care meets the standards, guidance and recommendations of strategic direction documents.

16. Outcome of Review and Options Do nothing and augment current service at Glenrothes/Dunfermline Partial Transfer of services Transfer all PCES services from Glenrothes

17. Glenrothes Activity 2011/12 Full Opening Hours 8,622 attendances 4,428 (51%) attendances from Glenrothes Postcodes (KY6/KY7) Less than 1 patient per hour from Glenrothes Postcodes (KY6/KY7) Midnight to 8am 1,181 attendances 387 (33%) attendances from Glenrothes Postcodes (KY6/KY7) 794 (67%) attendances from other Fife & Kinross Postcodes an average of 1 patient from Glenrothes postcode attending per night

18. Proposed Options and Costs Current Costs £ 4.27M (1) Do nothing £4.54M (2) Partial transfer of service from Glenrothes to VHK PCEC midnight to 8am £4.25M (3) Partial transfer of service from Glenrothes to VHK PCEC midnight to 8am and full weekends £4.13M (4) Transfer of full service from Glenrothes to VHK PCEC £4.02M (5) The establishment of a minor injury unit at Glenrothes Hospital Site. Direct additional clinical running cost £4.54M + £714k = £5.25M This does not include initial capital investment.

19. Conclusions The Options as detailed lead to a recent option appraisal this will now be discussed in more detail.