1. Mutuality, A&E and Primary Care Dr Adrian Baker Clinical Lead Nairn & Ardersier

4. Carers & Voluntary AHP’s / Pharmacy Nursing GP’s Community Hospitals Secondary / Tertiary Care 99 ? OR 999

5. Nairn and Ardersier c1997 The service has been in operation since March 1997. PCEC250-400 calls to the service each month. A&E100 – 300 attendances a month There is minimal use of protocols, referring instead to guidelines or a more experienced opinion when necessary. National guidelines are utilised when possible. Each nurse uses their own clinical judgement and defines their own level of competence (and doctors respect this). The PCEC service is fully integrated with A&E

6. Localities / Parish ?

7. Integrated response GP SAS / Home care alerts / telecare A&E / PCEC integrated Nurses for palliative care Care plans, Alerts, Integrated IT (Vision) Community Support Team / NHS Home Care, OOH home care Patients call single number

11. Journey of Dependence Home Care - £6,000 per case per year (34M hours, 69,000 clients) NHS 24 - £36.67 per call OOH PCEC £68.00 GP in hours contact £30.00 District nurse / Health Visitor £40.89 A&E £92.50 Admission (Ave 10 days) £2,784 51x and other dispossessed patients Long stay care £ 20,111 a year

12. EEA by practice for Highland

13. Pyramid to Oil Tanker

14. EEA rates by Locality (>65, >75, >85)

16. Local vs National system Local nurse talks to patient Same number – one point of contact 24/7 Can See & treat Local Knowledge - ALERTS Can discharge Can call in extended local Primary Care Team & Social Services Very Close, consistent working with GP’s Remote nurse American Algorithm 7% UK GDP vs 14% USA Advice Or GP Or A&E Or Ambulance Ice cream High cost (Effective?) Remote working

17. Since Opt Out NHS 24 1.5M calls a year A&E increase 6% a year Cost NHS 24 = £55M = £10 a patient Lochaber / Nairn & Ardersier = £150,000 With a locally based Telephone triage system could this money be put to better use? (NHS Highland £3.3M)

18. “If difficult…..

19. …….Don’t…….

20. …….Do”

21. Vision Equity of funding and service Local services to ensure local response Clinically and socially appropriate response. Mental Health Ability to stabilise and transfer to secondary care when necessary Integration with Social Services