Reforming urgent care in Buckinghamshire

ImPACT logoThe NHS and partners in Buckinghamshire are working to ensure that that all patients get timely access to urgent care seven days a week, and where possible 24 hours a day.

We also want to ensure that care is quality-driven and that each patient deserves the highest quality of care, through the best use of the resources available.

At the moment, too many people:

  • Attend A&E with minor injuries and illnesses which could be treated elsewhere
  • Are admitted to hospital when they don’t need to be, if sufficient services were available in the community
  • Stay too long in hospital because of a lack of resource to support them at home. 

By creating care closer to home, we can make sure that patients get the right treatment at the right time in the right place.  We have 18 work programmes developing new ways of caring for people.

Who is involved?

The ImPACT Programme is overseen by a Board comprising health, social care and partner organisations across Buckinghamshire. It meets monthly, and is chaired by Sir Jonathan Asbridge.

Representatives from the following organisations are involved in one or more aspects of the programme:

  • Buckinghamshire County Council
  • Buckinghamshire Healthcare NHS Trust
  • Buckinghamshire Urgent Care
  • Buckinghamshire LInKs
  • Buckinghamshire Primary Care Collaborative
  • NHS Buckinghamshire
  • Oxford Health NHS Foundation Trust
  • South Central Ambulance Service
  • The Ridgeway Partnership
  • The Practice PLC
  • United Commissioning.

An overview of the changes the ImPACT programme is introducing:

  • In addition to regular check-ups from by their GP practice, more vulnerable patients will receive support from community-based teams, helping them to stay out of hospital
  • Some patients will be provided with telehealth equipment to help them and professionals to be more pro-active in managing the condition, preventing acute crises
  • More patients will be supported to maximise their independence, including learning how to better self care
  • When they have an urgent need for health or social care, patients will be able to dial ‘111’, and receive appropriate care
  • More patients will have an acute crisis managed in their own home
  • Those who do need to be hospitalised will stay in the acute hospital until they are stabilised; a wider range of ‘next step solutions’ will help to reduce the length of stay
  • Some of the inpatient care that has traditionally been provided in the acute trust will be provided either in a community inpatient bed, which need not necessarily be in a community hospital, or in patients’ homes
  • Community teams will provide ongoing support to enable more recently discharged patients to stay at home.

How is ImPACT being developed?

There are 18 separate workstreams which are developing the changes to urgent care services.  The workstreams are listed below.  Some are already well advanced, while others are about to start.

1. Transformed integrated care teams:

Community teams based in seven localities in Buckinghamshire will provide 24/7 care for patients, as close to home as possible. A separate briefing on the work of the teams is attached.  The transformed service will be launched in April this year.

2. Health and well being of the older person

This workstream, yet to be launched, will look at ways of developing ill health prevention, and early support to ensure that older people keep well.  Initiatives may include

wellbeing check-ups, night responders for non emergency health or social care problems, and information about services provided by the voluntary sector

3. Community inpatient services

This service will ensure that people who are not able to stay at home without assistance  are provided support in a ‘safe haven’ environment

4. Primary care-led ‘front door’ service at Wycombe General Hospital emergency medical centre.
Plans are being developed to integrate the primary care-led ‘front door’ service at Wycombe General Hospital with the emergency medical centre, if difficulties regarding the premises can be resolved.

5. Primary care-led ‘front door’ at Stoke Mandeville Hospital A&E department

Plans are being developed for a primary care-led ‘front door’ service in the A&E department at SMH. This means that following assessment, patients are referred to / provided the right level of care appropriate to their need.  It is hoped that this service can be launched shortly.

6. Community support for people with deep vein thrombosis (DVT)

Through development of primary care based diagnostic and treatment services, this service will ensure that people can be better supported in the community, and avoid unnecessary hospital admissions

7. Outpatients’ Antibiotic IV service

This service, which is already in place, provides support to people in their own homes who need intravenous antibiotics on discharge from hospital, meaning that they can go home more quickly

8. Locality-based urgent care services

GPs in Buckinghamshire are grouped into seven localities.  This workstream will be looking to develop a wider range of urgent care services within each locality

9. Improved service for patients with chronic obstructive pulmonary disease  (COPD)

This service for people with long-term obstructive lung diseases offers patients support in their own homes rather than in hospital.  It is currently being piloted.

10. Improved service for people with heart failure

This service will look to provide similar support as that outlined for patients with COPD, but for people with heart failure.

11. End of life care

At the moment, too many people die in hospital when they would rather die at home.  This workstream is designed to ensure that Buckinghamshire patients can access the care they want and need through a single specialist assessment service. 

12. Dementia care

This service is looking at improving care for people with dementia, working across primary, social and acute care

13. Improved urgent care in care homes

This project, working with care home staff, will seek to review how patients with urgent care problems are supported in care homes, to help them to stay out of hospital

14. Integration of health and social care teams

Health and social care practitioners will work in integrated teams so that patients can have access to a seamless service.  Over time, these teams will also include mental health practitioners

15. Single point of access or ‘111’ number

The ‘111’ number, which is being piloted elsewhere in the country, will give patients access to urgent (as opposed to emergency) care on a 24/7 basis.  The provider will assess the needs of callers and refer them to appropriate local services

16. Teleheath

Telehealth equipment can help people with COPD and heart failure be monitored in their own homes so that they get help quickly when they need it, helping to avoid unplanned admissions and to support earlier discharge. This is currently available on a limited basis and plans are being developed to extend it.

17. Managing primary urgent care demand pilots

The work to create a GP led ‘front door’ at Stoke Mandeville Hospital will ensure that A&E staff see fewer people with minor injuries and ailments.  At the same time, GPs see a lot of patients with minor conditions who could treat themselves.  The aim of this project is to look at ways to help GP practices educate patients about self-treatment and appropriate use of care, and to work with them to develop ways of managing minor illnesses.

18. Winter resilience
This workstream has a sharp focus on how we can better work together during the winter months to respond to the greater demands on health and social care services during winter.

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Published: 1 February 2011

Updated: 5 April 2011