Best Collaboration Nominations

Recipient of the Special Award for Crisis Management

Birmingham and District GP Emergency Room (Badger) was working for a year with Ummanu to pilot a Virtual Waiting Room alongside Adastra when, on Thursday 4 August, a cyber attack caused a complete UK-wide outage of the main IT platform used by most NHS111, OOH and Urgent Care providers. 

Badger implemented their manual business continuity arrangements, a process that seriously impeded key filtering, prioritising and process monitoring but ultimately maintained service to their patient population of 1.4 million. 

As hours went by, Fay Wilson, Badger’s Medical Director, worried about patient safety, over the approaching weekend when demand could overwhelm manual service delivery. 

Meanwhile Ummanu immediately spotted the outage and offered help. The Ummanu C-suite team, including their interoperability lead, worked tirelessly around-the-clock to design, build and implement a work-around to bypass Adastra, bringing all the patients and their information straight from NHS 111 directly to the clinician. This cut out paper and enabled Badger to fast-track urgent patients. 

Fay discussed options with local commissioners, who agreed in these circumstances this was the only way to mitigate the risk to patient safety.  

The solution went live on Friday 5 August, and with a functional upgrade and added interconnectivity on Saturday - was fully operational just two days after the outage. Together the partners delivered a shorter patient journey, reduced delays, kept patients informed and enabled a calm clinical work environment with a steady flow of patients prioritised by medical need.

The outcome was achieved at speed through shared ambition. Badger embraced new methods of patient care and benefited from Ummanu’s excellence in developing solutions to meet the rapidly changing situation. West Midlands Ambulance Service (WMAS) stepped forward in the eye of the storm to enable Ummanu’s solution. 

This collaboration shows how a traditional approach to resilience was augmented with agility on both care delivery and system reconfiguration. 

Dr Wilson said: “Ummanu and WMAS worked so fast that while I was with commissioners seeking approval, they had virtually completed the build and got the interoperability functioning. Ummanu were straining at the leash from the start to help us find a solution. We couldn’t have done it if they were just another IT company waiting for us to tell them what to do. Together we were able to achieve a solution. It was a remarkable process. I’m sure it has saved lives and we estimate it will save us weeks of recovery.”

We asked Fay Wilson and Itzik Levy:

• What stood out to you about Ummanu as an IT partner?
• What was it about this collaboration that made it a success
• What impact has this collaboration had on the service, the
  staff, the patients.
• How did this collaboration support you during the outage?
• Did Badger's team on the ground meet with Ummanu?

Here’s what they said (click on this link for the video file):

Highly Commended:

Delay related harm in urgent and emergency care (UEC) and pan-system workforce challenges mandate new ways of working. The Bristol, North Somerset and South Gloucestershire ‘System Clinical Assessment Service’ (SCAS) is an integrated clinical hub, comprising a team of experienced Primary Care, ED, Mental Health, Urgent Treatment Centre and Paediatric clinicians. The clinicians remotely assess people who, without clinical input, would have been directed to ED or a Category 3/4 ambulance by NHS111. The paediatric clinician also takes calls from community healthcare professionals considering referral to the Children’s ED. Some people streamed away from ED can also be managed by the SCAS team. The bespoke digital training platform addresses the remote consultations skills and digital skills required to work in the SCAS.

Personalised care is supported by full access to patients’ longitudinal records. Comprehensive telephone clinical assessment, with video and photo options, enables definitive management including electronic prescribing, or digital onward referral if required. 90% of patients are managed without referral to ED or 999, and the SCAS completed the episode of care for 45% demonstrating a positive impact on system-wide UEC capacity. No adverse clinical outcomes, patient safety concerns or harms have been identified. 

The mental health presence in SCAS is just one element of the wider collaboration underpinning the Mental Health Integrated Access Hub (IAH). Incorporating mental health, VCSE, IUC, ambulance, police and fire services, the unique IAH model enables system coordination around the person in need, including liaison and support across physical and mental health at all levels of acuity.  

SCAS clinicians valued the opportunity to work across traditional organisational boundaries to provide quality patient care, with real-time case discussion, peer support, collective problem solving and learning. Although almost impossible to quantify, there is a tangible sense that the hub nurtures relationships and breaks down cultural barriers between different UEC services. 

SCAS is underpinned by a ground-breaking Integrated Governance Framework (IGF). This formalises all partners’ commitment to this new way of working and actively endorses an open culture of learning and shared ownership for improving patient journeys and safety. System-wide UEC oversight ensures that the development of the SCAS model is focused on addressing evolving patient safety concerns in UEC. We are ambitious for the future of this integrated, collaborative, physical and mental health model, including closer links with the ambulance, frailty and community services, virtual
wards and hospital at home. Together we can do so much. 

CHoC have been working in collaboration with the ICB’s and daytime practices as well as significantly with SERCO (notifying us of new arrivals, supporting to provide suitable environments for health checks, communicating with the asylum seekers re their appointments) and the home office in order to provide an asylum seeker health check service.

Since early 2022 CHOC have been involved in providing a health needs assessment for asylum seekers arriving in Cumbria. Initially this service was at a designated hotel for the asylum seekers in Barrow, but then extended to include a hotel in Carlisle and now another one in Whitehaven. The assessments involve an initial physical and mental health check; then registration and signposting to a daytime general practice. 

The health checks include vital signs, height/weight and a health questionnaire completed in the patient’s GP record via EMIS. This gives opportunity for asylum seekers to disclose/ discuss any physical or psychological health issues, safeguarding, issues/ violence they have experienced in their home country or on journey to UK, as well as any chronic or ongoing health needs. There are some awful stories of persecution, torture and violence but also a lot of resilience and acceptance of that is what happens, but looking for a safe place now.

The staff involved in the project have been totally committed to offering the best possible consultations for the asylum seekers; treating the men with warmth and kindness; non-judgemental in their approach; aiming to give information about accessing healthcare and overcoming the many barriers as they apply for asylum. The staff have also been very appreciative that they are able to do this work through CHoC. The small team of clinicians involved in supporting this service have shown dedication and have always gone the extra mile to attempt to meet some of these needs – referring to mental health, optician and dental referrals and making appointments – more than just completing the health checks and registering with new GP.

Local non health organisations (refugee and church groups) are also now responding by coming together to provide clothing, English classes, and sports provision. 

The assessments which have taken place were of a very high quality, extremely thorough with lots of information recorded. In addition to the information recorded in the chart above an assessment of teeth, covid status, life history and other issues were also often recorded providing a detailed picture of the person being assessed.

The Digital Care Home Service is a collaboration between CHoC, North Cumbria Integrated Care NHS Trust (NCIC), CCG, North Cumbria ICB, 34 GP Practices, Cumbria County Council and 74 other care providers across North Cumbria and is sponsored by NHS England and the AHSN for North East.  

The Digital Care Home service is a digital referral and remote monitoring tool accessed on a tablet, phone or PC which using the SBAR tool (Situation, Background, Assessment and Recommendation) captures key health and care information electronically and transmits into Health and Care systems for action.  The referral details are supplemented by remote monitoring measurements for the calculation of NEWS2 (National Early Warning Score) which is used to give an indication of how unwell the patient is and over a period of time can be used to indicate potential deterioration.

During the course of the project to implement, CHoC Digital team provided training and support to 90 care and residential homes across North Cumbria, this included training to non-clinical staff on how to take clinical observations and measurements from residents including the use of BP cuff and monitor, Oximeters and thermometers.  This information would be used to calculate the NEWS2 score.  

So far the project has:

• Reduced the number of telephone triage consultations required before arranging a home visit
• Reducing the time spent talking to health and care services by residential and nursing homes
• Increased the clinical information available to clinical staff across community, primary and urgent care services prior to making a decision
• Reduction in ambulance call-outs made by care and residential home staff 
• Increased satisfaction by care and residential home staff when describing patient’s condition, taking clinical observations and understanding clinical observations
• Increased satisfaction by clinical staff when receiving information ahead of telephone triage

Winner:

In the summer of 2021, health system leaders were told that neutralising monoclonal antibodies (antiviral treatments) for COVID-19 would be licensed for use within the extremely vulnerable patient population. Together with vaccination, this development was expected to revolutionise the management of COVID-19. From conducted trials, evidence suggested it would have a significant impact – with the potential to reduce hospital admission and mortality for this group of patients by up to 85%.

DHU Healthcare mobilised the COVID Medicines Delivery Unit (CMDU) for the Joined-Up Care Derbyshire (JUCD) integrated care system.  Led by the Executive Medical Director of the Derby and Derbyshire Clinical Commissioning Group, the system-wide collaboration also had representation from acute trusts, medicines management, primary care, mental health, community services and the ambulance service. The group were empowered to design a service that would deliver all the elements of triage and treatment safely and efficiently. 

Most systems adopted an acute-led model of service delivery – JUCD partners agreed that a community-based option ‘close to home’ would be a better solution. It would integrate effectively with existing and successful DHU ‘Red Hub’ services at our sites in Chesterfield and Derby – and would reduce the impact on already stretched acute services.

The model is designed to be supported by Advanced Practitioners (APs) with GP oversight within the Hubs. Pathways were developed to ensure patients who were housebound, in residential settings or community hospitals, and within the prison service had equitable access to treatment. A ‘red taxi’ service was commissioned, and the patient transport service (PTS) supported travel for those patients unable to attend by their own transport.

The DHU service is thought to be one of only two in the country to operate outside of a hospital setting, within the places where people live.  By May this year (2022) it had already completed over 3000 triage calls, delivering these treatments:

• 670 doses of IV Sotrovimab
• 300 courses of oral Paxlovid
• 100 courses of oral Molnupiravir

In addition to being a productive local partnership the service is also part of a national group established for local CMDU services across the country - with regular webinar events enabling collaboration, learning and feedback. Research evidence and national data already demonstrates that through these facilities the risk of hospital admission, and therefore mortality, is reduced by up to 85% when a treatment has been received by someone in the extremely vulnerable group. 

The ethos of FCMS as a ‘not for profit’ health and wellbeing services provider is to be
passionate in its drive to ensure that patients, colleagues, and staff remain the central focus of all that it does. Throughout the pandemic we all experienced challenges either working or accessing health services. FCMS Head of Urgent Care, Amanda McLean saw this as an opportunity to support and collaborate with the wider NHS organisations where pressures were at their greatest. 

Supporting community service provider in the set up of the 2hour crisis response service, which was a national ask, MUTC provided a GP to support daily MDTs for a pilot period to allow the service to grow and develop whilst understand the staffing model required moving forward. 

MUTC staff were involved with practice resilience work, offer additional GP clinics to take pressure off general practices locally and increase access for patients.

Working with local commissioners to provide a COVID pulse oximetry service, monitoring COVID +ve  or previous COVID patient with significant long term conditions helping to manage health proactively and reduce the need for unplanned admissions to hospital. 

More recently supporting practices within the Lake District with the ever-increasing tourists accessing healthcare for minor injury or minor illness. FCMS have developed a tourist health information line. Patients on holiday call access clinical triage, care navigation, face to face appointments within local GP surgery or the MUTC.

All the projects have strengthened the partnerships providing better access to services for patients, help reduce and share health burdens and encouraged opportunities new ways of working for now and the future. FCMS are proud of the projects they have been lucky enough to be part of and will continue to have open conversations which have led to an increase in collaborative working, sharing learning and opportunities.

The Homeless Health Nurse Led Team in Blackpool works collaboratively with Delphi Medical ADDER team to deliver holistic care to individuals who are working with the ADDER Project (About Project ADDER - GOV.UK (www.gov.uk)) As a pilot site for the project the Blackpool Homeless Health Nursing Team were considered best placed to deliver the healthcare needs for these individuals who are facing multiple disadvantages and to work with the substance misuse service to reduce the impact on substance misuse in the lives of these individuals. 

The teams meet formally on a fortnightly basis to discuss cases and updates and share information to meet the needs of the individuals. The health team are invited to the new case discussions to provide their insight and be at the start of the process of assessment and delivery of treatment for the individuals. 

The Homeless Health team and Delphi medical established a pathway to provide a comprehensive health assessment at the point of referral into the project, for these individuals to assess and plan for their health and care needs, alongside the substance misuse recovery and social needs plan. 

Both teams have an effective and close working relationship so that the opportunistic and ad hoc nature of the individuals needs can be met by the healthcare team, such as impromptu outreach visits; drop in clinic
appointments; consultation and advice to keyworkers, via face to face or phone call at any point during the week. 

The Homeless Health Nurse Led team also have access to the information recording system of Delphi Medical, including safeguarding alerts and outcomes of health assessments so that there is a contemporaneous sharing of information between the two services to provide a seamless wrap around care to the these most marginalised of individuals. 

Both teams have a shared ethos strongly grounded in a trauma informed approach to working with these individuals and this makes the collaborative process unified in improving the outcomes for the individuals we are jointly working with.

The Primary Care Support Team was developed as a response to the Covid pandemic in March 2020 and has grown significantly in the last 2.5 years.

Initially created as a response to mutual aid requests from the CCGS across L&SC  for swabbing communities at high risk of contracting covid.  The team rose to the challenge putting aside any of their own fears, anxieties, and concerns to deliver a high-quality service to these patients.  Following this we worked with the CCG to deliver the anti-body testing for health care workers including care home staff to ensure on going safety for staff and patients across the Fylde Coast. As we continued through the pandemic, we worked with our local trust providing PCR testing for all preoperative patients and healthcare workers. We continued to do this work for over 2 years.  As life started to return to normal the local council approached us to develop LFT sites across a variety of locations across the Fylde Coast.  In June 2021 we enhanced our working relationship with the council and pharmacy colleagues to collaboratively create a roving vaccination service. This included a 7-day service at several hard-to-reach locations where vaccine uptake had been particularly low. This service continues today with staff who are as committed as they were on day 1 to deliver the autumn booster/flu campaign. 

Alongside the above, the CCG approached us again to develop a remote home monitoring service for people in the community with covid. This was to offer daily contact to vulnerable patients and offer assurance through the technology of the team at Docobo to monitor oxygen levels and general wellbeing.  The team often went above and beyond the expectation for the service offering support with shopping, medication pick up to just saying “hello “whilst patients were isolating for long periods. This service has grown immensely having cared for over 4000 patients.  As a further development
and collaborative working with the trust, council, and community teams we now provide remote home monitoring for patients with Acute respiratory problems, patients on the cardiac waiting list, post STEMI / EP patients and housebound patients with long term conditions.

This team demonstrates the following attributes: responsive, enthusiastic, caring, dynamic, flexible to any working condition and environment.  Above all they have supported each other during the most challenging times of anybody’s carer always putting the patient at the forefront of their intentions. 

The Greater Manchester Urgent Primary Care Alliance CIC (GMUPCA or ‘Alliance’) is a tour de force of patient centric, social value, partnership delivery. 

In 2017 Mastercall, gtd Healthcare and Bardoc, 3 out of hospital competitive providers (accounting for 80% of the Greater Manchester ICS footprint) came together under an MOU (and later ratified a 4th corporate entity the GMUPCA) to delivery transformational change in Urgent and Emergency care in Greater Manchester. Today the GMUPCA is a nationally recognised exemplar of Integrated Urgent Care and North West exemplar of Clinical Assessment Delivery, regional data integrated and emergency care impact.

The GMUPCA galvanised around 3 problem statements:

• Urgent and emergency services in Greater Manchester are facing an unprecedented challenge, to maintain quality services within a restricted financial envelope, whilst the complexity, acuity and quantity of urgent and emergency cases continue to increase. This is not sustainable. 
• Current pathways are often fragmented and complex, resulting in confusing care journeys for the many patients experiencing them. 
• Lack of digital connectivity across the ICS with provider duplication. 

The GMUPCA now holds 3 innovative (and nationally recognised) GM contracting ‘answers’: 

1. GM CAS
2. GM Dental Urgent Telephony, and;
3. UEC ICS level Adastra (1 system EPR allowing booking from NWAS to CAS to all EDs and primary care) providing seamless patient journeys, economy of scale and combined best practice.

Here are the headlines:

GMCAS:

• C200,000cases p.a.; 82% of 999 ‘hear and treat’ in GM is delivered by the GM CAS and 37% of all of the Northwest resulting in a record breaking CAT 2 ambulance performance year for NWAS (given successes in CAT 3 and 4 999 work).
• -140 patients a day from needing an ambulance response
• 63,875 ambulance response hours released a year

GM Dental:

• c146,000 calls handled p.a.
• 99.9% appt fill rates

GM UEC Adastra Programme:

• C170,000 Adastra patients heralded and booked to EDs and UTCs using Adastra from 111 or CAS across all 10 EDs in Greater Manchester.
• C18,000 clinical safeguards in the GM ICS for ED DNAs

Wider Alliance benefits are ‘at scale, Integration, simplified routes of access and Social Value delivery’ including:

1. Reduction of duplication through access to pooled knowledge, learning and experience. 
2. Maximise financial efficiency by working collaboratively (infrastructure, systems, staffing and wider economies of scale) 
3. Enhanced patient experience through standardisation of shared best practice. 
4. Reinvesting surpluses into patient care as a social value CIC.

The ‘Operation Silver Puncture’ outage of Adastra resulted in many organisations nationally having to revert to paper based contingency measures for several weeks.  Operating in this way is vastly more time consuming and increases risk to patient safety and safeguarding through not having access to electronic records for patients at the time of their consultations.

Additionally, the resource required to restore paper records to digitised form is enormous – national estimates put the effort at four hours of restoration and recovery effort for each hour of outage.  The outage lasted three weeks for most organisations resulting in a massive task for the organisations affected. 

However, due to a well-developed and strong collaboration between NEMS and partner organisations across the Nottingham & Nottinghamshire ICS, NEMS has been able to eliminate these risks and avoid this massive burden.

NEMS’ IT provider, NHIS*, worked with NEMS and community provider Nottingham CityCare Partnership, to develop and set up a temporary but effective alternative clinical system in just one day.  

The collaboration on this urgent programme started with a simple phone call on the Thursday of the outage from the Director of NHIS to NEMS asking what they could do to help if the system was going to be down for some time. After some reflection overnight in both organisations, a concept was formed to modify SystmOne (the clinical system used by most GP Practices in Nottinghamshire) to replicate in basic form the way patients flow through the Adastra system.  This would mean that clinicians could continue to have full access to patient records, enter their notes at the time of the consultation, and electronically prescribe. It also ensured that GP Practices and community services were aware of the patient outcomes.

To build this at the speed required meant modifying an existing SystmOne unit.  NEMS did not have one at the time so NHIS approached CityCare to seek their approval and participation in modifying their own system, and to set up the appropriate technical and governance infrastructure to operate it safely and securely.  

The following day a team of eight people across the three organisations quickly came together in one room for six hours to design the full solution.  The personal commitment to the task was admirable; one of the NHIS team was already on her way to visit family for the weekend but turned the car around on learning of the issue and immediately joined the team so that NEMS could get set up before the start of the weekend. The new system was installed on the Friday evening and NEMS was able to run with it for the entire three-week period of the outage.  We understand that we are the only system nationally to have been able to achieve this.

Over the course of the outage, these three organisations continued to optimise the system daily so that NEMS could provide its urgent care service to a high level of effectiveness, dealing rapidly and effectively with issues as they came up. The system has now been stood down with the re-introduction of Adastra at NEMS, and the three
organisations continued to work closely day and night through this phase so that the transition back to BAU took place with no risk to patient safety. 

(*Nottinghamshire Health Informatics Systems)

Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) and PELC, jointly provide the Urgent and Emergency pathway, predominantly for the population of three boroughs in North East London. The services are offered from two from two co-located sites; Queen’s hospital and King George Hospital. Both organisations operate within a limited workforce market. Post-covid, both organisations anticipated an inflated influx of patient and a possibility of a new Covid variant. Therefore, a review of the whole UEC pathway was conducted; from the front door to discharge. Along with identifying a requirement to increase workforce capacity to meet demand, it also offered opportunities to improve the pathway.

The two organisations had distinct remits in the UEC pathway. PELC provided initial assessment of patients, streaming them to appropriate treatment destinations; Emergency Department (ED) or Urgent Treatment Centre (UTC), plus treating patients with urgent care needs. BHRUT provided treatment to patients, requiring emergency treatment. It was identified that there is an avoidable repetition. Patients who reached ED, were triaged again once they arrived. Some of the record keeping activities were manual. All these added time to patient’s journey leading to poor patient experience. 

In the autumn of 2021, BHRUT and PELC came together to form a precursor to ‘place based partnership’. The shared purpose of this collaboration was to create a single pathway, covered by joint governance process for joint ownership of risks and accountability. Clinical, operational and project management colleagues made a collective concerted effort to develop and implement a seamless pathway. This was achieved by:

1. creating a ‘joint front door’, staffed by clinicians from both BHRUT and PELC, 
2. a single assessment function, combining the elements of streaming and ED triage,
   to create what we call an ‘initial clinical assessment’ (ICA) and 
3. digitalisation of manual process 

The ICA model was piloted at Queen’s hospital in May 2022, and rolled out to King
George Hospital in June 2022. 

We are still testing elements of the model, recognising and mitigating risks and improving the model. Even though we have yet to formally evaluate the model, we know we have removed non-value adding steps from the pathway and freed-up staff from the triage function in ED.  Front line staff from both services have a better understanding of the pathway now, leading to a better integration between ED and UTC services and engaged resolving issues mutually. We are looking to now build upon the success of the ICA model with a collaborative vision to treat up to 80% of walk-in activity at the two acute sites within our UTCs.

Salford Primary Care Together (SPCT) has worked very closely with Salford Care Organisation (SCO) to implement an innovative primary care streaming model at the Emergency Department (ED) front door. 

Care navigators screen ambulatory patients attending the front door of ED between 0800-2200 and can book patients directly into various primary care streams or into the ED. This included the option for face-to-face appointments, remote consultations, referrals direct to speciality and sign posting to other community services etc.

The service is underpinned by a memorandum of understanding regarding governance, and responsibility of the patients at each stage in their journey. There are weekly operational meetings between SPCT and SCO to discuss the service, outcomes, pathways (co-designed and co-produced), and complaints and a joint wider monthly governance meeting with all stakeholders and partners to share data and learning with a focus on quality and governance including audits and quality improvement projects. This ensures that the care provided is of the highest quality, with an aim of providing the right care, right place, right time. Learning is shared widely across the organisations and locality. 

There is a strong focus from both organisations on patient engagement and education with excellent patient satisfaction levels. Non-acute, non-urgent presentations are directed back to their own GP so that this service doesn’t not bypass usual primary care provision.  

The service has been effective and streams on average 65 patients a day from the front door of ED, which is approximately 25-30% of the walk-in attendances to the department. 33% of cases are closed following a remote consultation, the pass back rate to ED is consistently low at 3% and the referral back to own GP is minimal at less than 1%.  

This demonstrates the effectiveness and impact of the service, relieving pressures on the ED, avoiding additional work for primary care colleagues in the community. The service is co-ordinated by the digital clinical hub which also hosts the LCAS. We have recently presented to NHSE and are optimistic that this model demonstrates an innovative co-located UTC, delivering on all the UTC standards. We feel that this is partnership working at its best delivering the very best for our patients with an ambition to constantly improve the care we deliver.

SELDOC began working with Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in 2011 when we co-designed and launched a highly innovative/unique ‘Virtual Ward’ (VW) for Southwark patients. The aim of the VW was to reduce the number of patient admissions and was staffed by SELDOC GPs and Guy’s nurses. Clinicians worked remotely by phone to manage patients in their homes, visiting patients with complex needs or at signs of deterioration.

The success of the service, including the breadth of clinical care and support the joint team was able to provide to patients, led both to its expansion in 2013 to include patients living in Lambeth and, in 2014, to GSTT and SELDOC working in partnership to introduce a primary care service within Guy’s Urgent Care Centre. 

In 2014 we re-named the VW to the @Home service in recognition of increasing care delivered by the team in person within patients’ homes. 

In recognition of the team’s expertise in managing very unwell patients in the community, the @Home service increased its clinical remit in 2015 to support palliative care patients overnight in an emergency. We had jointly identified a gap in overnight service provision for this patient cohort who were being taken to ED. We therefore co-created the overnight service which enabled LAS and the OOH service to refer patients into and avoid hospital admissions. 

Suffolk GP Federation has provided an ED streaming service at the hospital for about five years. Over this time, we have responded to the needs of the ED by changing and increasing our hours for provision of this service.

During COVID, the hospital approached us, the Federation, to see if we could support the front door streaming role for a short period. We accepted this ask and then went on to continue to staff this front door role through the whole of COVID and continue to on a permanent basis 

The hospital has demonstrated their respect of our service by approaching us when they have an identified problem with a service provision, they think we may be able to support. An example of this, in addition to taking on the front door role, the Federation took on seeing and treating patients on the community DVT referral pathway. Historically, these patients would have been managed on the medical unit but we were able to set up and provide this service throughout the COVID pandemic. This involved us liaising closely with medical team, the ultrasound team and their transformation team to get this up and running in a very short time frame.  

We have shared governance with the hospital for our services and meet monthly and have forged strong working relationships. This has led to us having a pivotal role in the development of the UTC planned for Ipswich Hospital. The Federation has provided the project manager and are leading on workforce and service planning. This illustrates their respect and trust in the service we provide.

The level of trust is best illustrated by the discussions we have facilitated into the IT system to be used by ED.  We recommended using SystmOne which would enable an integrated approach with daytime and out of hours general practice and the hospital team have listened to our views.  

The Federation work closely with the hospital to trial, audit and implement changes and improvements to the existing service and moving forward to a UTC module.