Published on March 11, 2014
Managing Demand, Planning to Avert a Crisis JP Nolan UK Adviser on Acute, Emergency & Critical Care President, British Anaesthetic & Recovery Nurses Association
Aims • List guiding principles • Reflect on demand • Define service spec • Focus on capacity • Consider models of care • Outline workforce potential • Test against guiding principles www.rcn.org.uk 2
Guiding principles • 1.Provides consistently high quality and safe care, across all seven days of the week; • 2.Is simple and guides good choices by patients and clinicians; • 3.Provides the right care in the right place, by those with the right skills, the first time; • 4.Is efficient in the delivery of care and services. www.rcn.org.uk 3
RCA of current issues • Core remit • Evolution • Service spec • Accessibility • Nomenclature • Ad Hoc change • Incentivised HSCIC Focus on A&E www.rcn.org.uk 4 The evidence base for the national review DIRECT SPECIALITY TRIAGE STREAMING URGENT CARE MEDICAL ASSESMENT SURGICAL ASSESSMENT MAJORS RESUS MINORS CATH LAB HASU AEC FRAIL ELDERLEY ASSESSMENT
Goal directed intervention www.rcn.org.uk 5 • Integrated • Intuitive • Accessible • Consistent • Flexible • Interoperable • Intelligent • Incentivised Your results: You need to go to your GP Surgery. A list of suitable services is listed below. This is something your GP can help with - they are first port of call for non-urgent, ongoing illnesses or injuries Sorry your postcode is out of our catchment area – please go to www.nhs.uk for information about services near you
What is different about this review? • Clinicians are leading • Old boundaries sidelined • Commissioner support • Scale of change proposed • Educationalists engaged • Truly population centred • Longer timeline www.rcn.org.uk 6
Achieving the aims • One agenda - which is population centred • Defining a new NHS service specification – 24/7 • Planning its capacity and facilitating its interoperability • Improving information management • Incentives linked to patient outcomes not system KPIs www.rcn.org.uk 7
So what? • Professional agendas must be secondary to the agenda of the patient and the population. • Sector boundaries and labels, now outdated, must be removed. • Physical and mental healthcare must forge stronger links with social care and the third sector • We will all need to change how we work – 24/7 – Cross boundary – Co-owned responsibility for unscheduled need – Multi-professionally www.rcn.org.uk 8
The workforce implication The challenge • Staff must cater to unscheduled need in their patient population 24/7 • Boundary overlap between professions threatens core functions of each profession • The need to ensure a supply of skilled generalists while catering to specialist and sub-specialist practice The opportunity • Responsive specialist care directly accessible by providers • A structured approach to innovative roles ensures safety • A regulatory approach to education and clinical practice fit for our time www.rcn.org.uk 9
The single point of contact works if... • It utilises the whole workforce available • Can make decisions or mobilise a decision maker • Can identify capacity in the system - and use it • Is linked to specialist services directly • Reaches dispositions based on the need of the caller - without delay www.rcn.org.uk 10
In summary • The patient should be seen promptly by a professional competent to cater to their individual need, regardless of the location of the patient. • The nomenclature, scope of practice and regulation of the professions needs to improve and reflect the changing ways in which they work. • Appraisal and revalidation processes may require an element of adjustment to keep pace with these changes. • The intellectual and clinical capital in the workforce can be the solution to our current problems if unlocked and safely operationalised. www.rcn.org.uk 11
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