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Summary note discussion items urgent care crisis response pathway


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CLINICAL COMMISSIONING FORUM – THURSDAY 3 SEPTEMBER 2015

SUMMARY NOTE

DISCUSSION ITEMS
URGENT CARE - CRISIS RESPONSE PATHWAY

The Crisis Line gives City and Hackney residents a single point of entry to support patients before they reach crisis. This gives them access to a professional with knowledge of local services. This will be launched in October 2015 and details will be brought back to a future CCF.


To improve the response to crisis in the community a whole joined up system with accessible care plans is required. One Hackney and City are working on a card with numbers for patients and carers to call for urgent help. They are also trying to improve the care plan presentation so it is more visible and available in patient’s homes. There was an Urgent Care Workshop on 1 July attended by a variety of people providing different services to discuss this.
LAS receive a lot of crisis calls and confirmed that 90-95% of these could be managed in Primary Care. Members were advised that there will be more calls made by Paramedics to Duty Doc and encouraged GPs to answer their calls speedily.
There are some reports of District Nurses calling an ambulance before phoning the patient’s GP and more work will be done to link in with carers and District Nurses to prevent them calling unnecessarily. Please use your duty of candour alerts if you come across incidents where Community Nurses called an ambulance when you think they should have contacted the GP.
The timetable for next steps was discussed and is on the CCG website.
A Catheter audit is being done as too many patients with blocked catheters are attending hospital. IV therapy would help in Nursing Homes.
50% of the meeting confirmed they are receiving faxback requests and it would help communication if the Hospital Doctor phoned before making an admission. Geriatricians are not phoning but there is a meeting soon to discuss this.
LAS confirmed it was helpful to know about the pathways and for ParaDoc to be on board.
HOMERTON MATERNITY SERVICES

Dr Martin Kuper, Medical Director at the Homerton, was present for this part of the meeting.


The Maternity Unit had a CQC inspection in April 2014 which was rated as good. This was after the 3rd unexplained death. Following the 5 unexplained deaths the Maternity Unit had an unannounced inspection in March 2015.
The CQC report highlighted three areas found to be inadequate and warning notices were served:


Martin confirmed that the Homerton had not been blamed for the 5 deaths and felt some of the comments were unfair but agreed that some elements could have been better. Lots of recommendations were made which are now in place. An action plan was produced and implemented.


Following the improvements the Homerton asked the CQC to return in April but they have received no response to their requests.
The loss of faith in the Maternity Unit is a big risk and will make outcomes worse. The number of patients has not dropped and there has been no loss of staff. Where issues have been flagged improvements have been made. The Homerton Maternity Unit serves lots of high risk patients and some need to go to ITU.
There is a joint meeting this month with the CQC, NHSE and Monitor who will continue to scrutinise the service.
Martin subsequently left the meeting to allow further discussion.
Clare advised that the CCG need to ensure the service is safe. The main danger is that the morale of the Maternity Unit crumbles although no staff have left so far.
NHSE have called a Risk Summit which is taking place at the end of September.
The CCG are continuing to look at and monitor to ensure a safe service. Kirsten confirmed that she will keep everyone updated and asked members to contact Martin or her directly. Feedback from patients would be helpful.
INFORMATION ITEMS
CITY AND HACKNEY MENTAL HEALTH CRISIS LINE

The City and Hackney Mental Health Crisis Line has been operational since the beginning of August. This will enable residents to talk to someone at night. Posters are going out to practices giving the contact details. The Crisis Helpline is open 24/7 and managed by a trained Crisis Specialist. Access to the record system gives a more informed response to the crisis but this is not a referrals line. The Crisis Line will notify community teams so there are clear lines of communication.


Most of the callers are known patients although there are some new and anonymous callers.
The Crisis Line aims to prevent A&E attendances.
LUNG SCREEN UPDATE TRIAL

Mamta Ruparel talked through the Lung Screen update trial. CT screening for high risk people are the hardest group to engage and the trial is keen to improve uptake. Mamta is going into practices to help prepare the mail out packs. Mamta asked for expressions of interest from practices to join the lung screen update trial and asked practices to contact her directly.


NATASHA BUGEMBE, MARAC LIAISON NURSE FOR PRIMARY CARE

Mary Lee, CCG Safeguarding Nurse, introduced Natasha Bugembe. Natasha is the MARAC Liaison Nurse for Primary Care. Natasha explained what MARAC was and practices confirmed they had received a referral form. Natasha advised that she uses the generic practice account when contacting practices and the turnover times are very short but Natasha will phone when needed. Practices were encouraged to complete the referral forms which will help with future consultations. The CCG will ensure all information is available on the website.


NEW SERVICES FOR CANCER SURVIVORS

The team introduced themselves and advised members to refer to the Macmillan Social Prescribing Service as there are now longer survival rates for cancer patients. Long term management is becoming more important but patients are often lost how to navigate services or receive support.


The new services enable referrals to be made as easily as possible and patients can self-refer. This is not on the cancer review template yet but work is being undertaken. There are drop-in services available at St Joseph’s Hospice (full details on the CCG website) as well as an outreach service.
Support on offer includes telephone advice to signpost patients to face to face sessions at a community location. Ascertaining needs and interests are a key part of the role.
The service is open to all patients over 18 with any cancer type. These don’t have to be newly diagnosed patients and can include patients in remission. Patients can be referred after needs are highlighted during a Cancer Care Review.
All referrals should be made via the Family Action Hackney Social Prescribing referral form, listing the cancer diagnosis under the “relevant medical conditions”. The Family Action wellbeing co-ordinators email these directly to the Macmillan Social Prescribing team who contact the patient directly.
IRIS TRAINING AND MODEL

The GP role is very important with identifying domestic abuse. IRIS had conducted a 3 year trial from 2007-2010 which is the first of its kind in Europe. It was piloted in both Hackney and Bristol and is now a national project to help reduce domestic abuse and the homicide rate. This has been reported as 2 per week and is now recognised at Government level.


80% of women will seek help from a health practitioner and trust that the GP can help. The overall annual cost to the health economy is £1.7 billion. There are huge costs to the NHS which can be reduced by working together.
Hackney has seen a 20% increase in the number of violent crimes and abuse and a 6.5% increase in domestic abuse. This is the highest rate for domestic abuse across all London boroughs.
Tanisha offered refresher training to practices to help link patients with the appropriate service. This will reduce the number of times patients need to see a GP.
Tanisha advised that the referrals need to be maintained and increased to continue to receive funding from Hackney Council. Patients can self-refer and the service accept referrals from GPs.
Practices were asked to ensure that the referral form is embedded in EMIS and to continue to refer to the service.

September 2015


Chair: Dr Clare Highton Chief Officer: Paul Haigh




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