Urgent Care Services for the Trust

Summary<br/>General<br/>BHT is looking to contract for the provision of Urgent Care Treatment Centres and Out of Hours Service at its acute hospitals. <br/>The Trust wishes to contract for a short period to prepare for a longer-term provision to be agreed within the BOB ICB. The contract under discussion will last until 31/3/2026 and will not be extended.<br/>The Most Suitable Provider Process under the new Provider Selection Regime is selected to establish a contract.<br/>The contract is to provide the UTC services at the entrance of the emergency department at Stoke Mandeville and Wycombe General hospitals.<br/>The required services shall:<br/>• simplify urgent care at the entrance of the hospital<br/>• relieve the emergency services from handling uncomplicated care<br/>• have to cooperate with other care providers<br/>• be able to flex capacity to meet demand<br/>• Work consistently across both sites and as other NHS providers in the region<br/>• be resilient and meet predictable and unpredictable surges in demand<br/>• Demonstrate value for money<br/>The provider will demonstrate the core objectives:<br/>• Achievement of nationally and regionally mandated KPIs and quality measures for an Urgent Treatment Centre. <br/>• Contribute to and support the local and ICB strategies to reduce Health Inequalities and ensure equal access to urgent care services. <br/>• Establish good working relationships with other key organisations across Buckinghamshire and the wider BOB ICB.<br/>• The Provider must receive referrals from 111 and provide clinical assessment for patients who: <br/>o Are registered with a Buckinghamshire General Practice (GP). <br/>o Are unregistered and are calling from the geographic area covered by the contract. <br/>• Adhere to national guidance and participate in local Information Governance agreements in respect of gaining and respecting patient consent. <br/>• Utilise electronic booking into endpoint services or other onward referral methods if otherwise agreed by the Commissioner. <br/>• Onward referral where clinically appropriate.<br/>• Be CQC registered for the delivery of urgent care services.<br/>The Buckinghamshire Urgent Care Services Provider will deliver the following outcomes:<br/>• Ensure patient journey is as seamless as possible by minimising the points of contact. <br/>• Provide onward referral to primary care, urgent care and emergency care as required in line with the three Place pathways, including ICB commissioned services including Place-based Clinical Assessment Services. <br/>• Nurture a culture of self-help, education, and self-management. <br/>• Ensure Directory of Services (DoS) entries are accurate and maintained in partnership with DoS leads and local systems, to facilitate timely and appropriate levels of care. <br/>• Ensure early identification of calls that would benefit from access to a clinical adviser. <br/>• Develop and maintain clear pathways of care which ensure safe and optimal transfer of patients’ care where additional or specialist care is required. <br/>• Reduce the risk of harm to patients by ensuring patients are referred to the most appropriate service at the earliest opportunity along the pathway, using robust patient information transfer systems. <br/>• Ensure patients and the Buckinghamshire population are equipped with the tools to choose the right care, at the right time, including but not limited to self-care, AskFirst, Community Pharmacies, and 111.<br/><br/>Clinical Assessment Service <br/>A Clinical Assessment Service 24/7 to receive all 111 Primary Care Dispositions for Buckinghamshire GP registered patients for clinical assessment to determine the most suitable outcome for the patient.<br/>Urgent Treatment Centre at Stoke Mandeville Hospital<br/>An Urgent Treatment Centre co-located at Stoke Mandeville Hospital 24/7 where all self-presenting ED patients (Buckinghamshire and Out of Area) will be assessed by the Streaming Team provided by the Urgent Care Service and determine the most appropriate pathway for the patient, including the Urgent Treatment Centre. The premises will be provided by Buckinghamshire Healthcare Trust as per lease arrangements.<br/>Urgent Treatment Centre at Wycombe Hospital<br/>A standalone Urgent Treatment Centre that will provide a walk-in service 8am to 8pm 7 days a week (Buckinghamshire and Out of Area). The service will triage and prioritise patients accordingly using the same appointment-based approach as the Urgent Treatment Centre at Stoke Mandeville Hospital.<br/>Home Visiting<br/>Home Visiting for patients who are referred to the Clinical Assessment Service from 111 for Primary Care Dispositions Out of Hours who are then clinically assessed through the Clinical Assessment Service as requiring a Home Visit.<br/>Activity<br/>The service is expected to undertake the following proposed activity:<br/><br/>Urgent Treatment Centres:<br/>The provider is expected to assess all 111 Urgent Care dispositions prior to booking patients into slots. However, recognising that there are currently 60% of total activity walking into Wycombe Hospital UTC.<br/>Overall Activity:<br/>The table below highlights the anticipated activity across the Buckinghamshire Urgent Care Services broken down.<br/> <br/>Delivery<br/>The Buckinghamshire Urgent Care Services is a core service supporting people with urgent care needs to get the right advice in the right place, first time. The service provider will ensure (the list is not exhaustive):<br/> <br/>• It is available and accessible 24 hours a day, 365 days a year (366 days in a leap year). <br/>• It is available for the Buckinghamshire population, all ages.<br/>• It is free and accessible for all. <br/>• See both booked and walk-in patients in the Urgent Treatment Centres.<br/>• See both minor illnesses and minor injuries in the Urgent Treatment Centres.<br/>• Accept appropriate ambulance conveyances into the UTC and ambulance referrals into the CAS.<br/>• All walk-in patients to the Urgent Treatment Centres will have an initial assessment within 30 minutes of arrival and children will be within 15 minutes of arrival. <br/>• Report as a Type 3 daily from the UTCs on ECDS.<br/>• There is equity for patients with specific health needs such as, mental health and long-term conditions. <br/>• Have current DoS profiles. <br/>• Patients’ medical records will be available and transferrable with them throughout their journey. <br/>• Regular and consistent communications to patients, partners and key stakeholders about the service and pathways, including via provider website.<br/>• The service’s performance will be measured by national Key Performance Indicators (KPIs) and quality measures. <br/>• Appropriately skilled clinical support for patients and carers. <br/>• Ability to transfer patients into the most appropriate service including: <br/>o Primary care through GP Connect working with Bucks GP practices to ensure appropriately timed slots are made available.<br/>o Urgent Treatment Centre at Wycombe or Stoke Mandeville Hospital <br/>o Pharmacies, <br/>o SDEC, <br/>o Community services, including Urgent Community Response<br/>o Urgent dental services<br/>o Other services as they become available. <br/>• Availability of special patient notes (SPNs) and Anticipatory/Advance Care/End of Life (EOL) Plans supports delivery of appropriate care and for example, working with high intensity service user patients. <br/>• Interoperability with all relevant existing and future patient shared care record systems and allow read/write access to GPs' patients records (where appropriate). <br/>• Ability to flex at periods of surge in line with requests from the ICB and Buckinghamshire Healthcare Trust.<br/>• Clear pathways of care are developed and maintained alongside strong governance processes which ensure safe and optimal transfer of service users’ care in instances where additional or specialist care is provided. <br/>• Relevant and key information is shared in real time between the Acute Trust and ICB to support the patient journey, safety of staff, and efficiency of NHS services. <br/>• People with mental health needs must be able to access the service, but services should have agreed protocol in place to deal with exacerbations and acute mental health presentations. <br/>• Be responsive and adaptive in aligning to emerging or future regional / national innovations and developments. <br/>• Actively engage with our population including patient advisory groups to understand and act upon patient feedback using innovative ways to engage and receive the patient perspective.<br/>• The provider is required to work collaboratively and proactively on the development of local care pathways, to identify gaps in service, inform commissioning and ensure local service outcomes create seamless referral methods and processes. <br/><br/>Exclusions<br/>The list below highlights those core functions that will remain outside of this service specification: <br/>• Emergency Care services.<br/> <br/>Location<br/>The Urgent Care Services Provider will be expected to meet the requirements of this service specification from the following locations:<br/>Urgent Treatment Centre at Stoke Mandeville Hospital<br/>Buckinghamshire Healthcare Trust:<br/>Stoke Mandeville Hospital<br/>Mandeville Road<br/>Aylesbury<br/>Buckinghamshire<br/>HP21 8AL<br/><br/>Urgent Treatment Centre at Wycombe Hospital: Buckinghamshire Healthcare Trust:<br/>Urgent Treatment Centre<br/>Queen Alexandra Road<br/>High Wycombe<br/>Buckinghamshire<br/>HP11 2TT<br/><br/>Both locations will act as out of hours bases for those primary care dispositions requiring a base visit as directed by the Clinical Assessment Service. Additional information: Decision makers<br/>The decision to award is the responsibility of the Chief Operating Officer and the Care Group Director Integrated Medicine.