Gloucestershire PPG Network 8 June 2018 PPG Programme

Gloucestershire PPG Network 8 June 2018

PPG Programme 10 -12 noon Welcome, Housekeeping and Programme for the Morning: Becky Parish, Associate Director, Engagement and Experience, NHS Gloucestershire Clinical Commissioning Group NHS 111 Online and General Practice Online: Helen Brock (Urgent Care Commissioner) and Stephen Meadows (Primary Care Commissioner and Locality Manager for Cheltenham) This item will include two short presentations including a short film and a live demonstration. Questions and Answers Break Workshops to discuss today’s presentations Sum up, messages and Close: Becky Parish To be followed by Stroke Rehabilitation Workshop 12. 30 – 14. 00

Gloucestershire PPG Network NHS 111 Online Scott Parker – Associate Director of Commissioning Helen Brock – Urgent Care Commissioning Manager

Gloucestershire PPG Network What is NHS 111 online? • 111 online is a new service which helps you get urgent healthcare online. • It will be available in Gloucestershire later in the summer.

Gloucestershire PPG Network You can get medical help or advice at 111. nhs. uk using a smartphone, laptop or other digital device. You can: • • • answer questions about your symptoms get advice on what to do and where to go if necessary, get further advice from a nurse, doctor or other trained medical professional

111 online is: • free and easy to use • available 24/7 • up to 4 times faster than the 111 phone line* • helping to manage increasing demand on 111 telephone services *Average online triage time is 2 minutes 9 seconds compared with 7 minutes on the phone.

VIDEO

Gloucestershire PPG Network General Practice Online Stephen Meadows – Locality Manager

What is General Practice Online? • Online access to your Practice using a mobile phone, tablet, or computer • Self help symptom checking and advice • Submit administrative requests • Make a request for advice • Make a face to face consultation request • Submit condition self monitoring information

• This does not replace telephone access or clinical capacity • Free to use and available 24/7 • Long-term, we plan to integrate the system with 111 Online for ease of patient use. • General Practice Online will be available for early adopter practices later in 2018

Benefits • Improves patient access to the right service • Helps practices manage demand • Online triage makes the consultation more effective for doctors and patients • Potential for video consultations • Reduced waiting times and ‘DNAs’

VIDEO

Early Adopters • The following Practices have expressed an interest in being early adopters. • • • Church Street (Tewkesbury) Crescent Bakery (Cheltenham) Mitcheldean Surgery (Forest of Dean) Mythe Medical (Tewkesbury) Springbank Surgery (Cheltenham) Stow Surgery (North Cotswolds)

Procurement Panel • After early adopters trialled, countywide procurement required • Competition to identify shortlist of suppliers • 3 x Patient volunteers to support process • Please leave your name and contact details on a post-it note if interested – including if you would like to help support implementation with the early adopter practices

Gloucestershire Stroke Pathway The Clinical Case for Change for Bed Based Stroke Rehabilitation Please note: This information is confidential. Proposals detailed within this document are subject to consultation/involvement #glos. STP

Background • Rehabilitation is hugely important in helping people become as independent as possible following an injury or illness. Good rehabilitation also helps them self manage the longer term effects of that illness or injury. • Our intention is that people will be able to access their rehabilitation as close to home as possible. There a small number of patients who have more complex rehabilitation needs, which are better delivered by specialist teams which cover the whole county. • The county's rehabilitation services have been reviewed and indications were that change was needed for the county to provide consistent and high quality rehabilitation. • One area identified as having significant opportunity for improvement was stroke. #glos. STP

Why stroke? • There is good research evidence that shows we can provide the best opportunity for recovery from stroke if we provide the right service, at the right time, in the right place, by the right staff. “Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. ” Cochrane review 2013 (Stroke Unit Trialists Collaboration)” • The national audit that we participate in Sentinel Stroke National Audit Programme (SSNAP) showed that there was opportunity to improve what we currently do and benefit the whole pathway. • National guidelines show us what a good service should look like from beginning to end. This includes details about the type and number of staff we need to provide a quality service. #glos. STP

SSNAP Aug-Nov 2017 Total Score D Moved up from 44 to 57 (C=60 -69) 1 -4 Front door All domains improved – more to do 5 -8 Therapy / Rehab No changes made yet OT=C, Physio=D, SALT=E 9 -10 Pre-Discharge A/B - Excellent #glos. STP

VIDEO #glos. STP

Options considered 1. Do nothing 2. Increase therapy in Gloucestershire Royal Hospital 3. Enhance existing Early Supported Discharge Team into all community hospitals 4. One specialist unit based in a community hospital Modelling indicates 14 beds would be required in this setting #glos. STP

Site Option – The Vale Community Hospital, Dursley • Single Rooms • Flexible, available space to provide social areas, therapy gym and practice kitchen • Minimal building costs – value for money • Pleasant internal and external environment/setting • Able to be converted without a large time delay • Ability to expand if future requirements change #glos. STP

What are the benefits of the new service? Ø New Unit • • • Intensive specialist therapy available 7 days/ week. Single room en-suite accommodation. Rehab gym, kitchen, social space and outdoor facilities. Boosts morale for patients, carers and family Seamless links into the countywide Early Supported Discharge Team. Ø GRH • Improved availability of beds on the specialist ward for all new stroke patients. • Increased time with specialist therapists. • Reduction in extended stays in a medicalised environment Overall we will also improve our performance measured against national audit standards #glos. STP

What investment is needed? • There is an agreed financial investment of circa £ 450 k to mainly support the increase in specialist therapy staff required. • Increased levels of specialist rehabilitation increase the persons opportunity to regain maximum independence • Better outcomes mean people use health and social care services less reducing costs within the system #glos. STP

Conclusion A 14 bedded community specialist stroke rehabilitation unit based at The Vale Community Hospital as part of a comprehensive countywide stroke service will provide the best chance of recovery for the people of Gloucestershire. It will deliver benefits to patients’ health and reduce social care needs. #glos. STP

Next steps Feedback welcomed up until 19 th June 2018 either; • By telephone 0300 421 1689 • By email to debbie. gray 9@nhs. net Thank-you #glos. STP

Patient suffers stroke Hyper-acute unit GRH ≈ 72 hrs Step down acute stroke unit GRH ≈ 72 hrs to 5 days “Decision Making” Specialist placement or D 2 A bed Rehab potential not able to be assessed “Watch and wait” Rehab potential identified and requires bed based environment Less than 2 week stay in acute anticipated : Home +/- support from ESD/community services If not medically stable RIP or palliative Community Stroke Rehab unit For EOL, Fast-track or Community Hospital Community hospital (nonstroke specific) Placement or D 2 A bed Slow stream rehab at Wheatridge Access to 3 rd Sector Assets from all discharge destinations Remain in acute Home +/- support from ESD/community services Discharge pathways from all settings