Best Service Nominations

Birmingham and District GP Emergency Room (Badger) provides around 1.4 million people with out-of-hours and urgent care. They already operated an advanced platform for mainstream care delivery but saw the opportunity to improve the flow of patients and optimise their experience by using Ummanu’s Virtual Waiting Room (VWR). 

In February 2022 Badger launched a pilot alongside their existing patient management system, Adastra. 

Badger patients requiring a remote consultation are clinically prioritised in the Ummanu system. When a clinician connects to the dashboard, they see patients according to priority — the system having already dialled and connected with the patient. This means that clinicians have a steady uninterrupted flow of work.

This enhanced workflow process means that urgent cases go to the front of the queue.  In just 5 months, Badger had hit their target of 95% of urgent calls assessed within 20 mins. 

The predictive dialler reduces the administration burden on clinicians, as they no longer have to dial and redial patients (up to 35% of patients don’t answer when first called). It also means clinicians don’t need to review patient lists to identify which person to call next, saving the clinician’s precious time even further.

Clinicians move more quickly through the caseload.  The percentage of routine calls assessed within 60 minutes rose from 93% to 99% (against a target of 95%). The VWR also allows SMS messaging and voicemail to keep patients informed. It has proved very
popular:

• 98% rated SMS good or excellent
• 93% rated voice mail good or excellent
• 98% rated the overall virtual waiting room experience good or excellent.

Fay Wilson, Badger’s Medical Director, said: “I’ve never seen user feedback this high for a new service. By the time I’ve reviewed a case on Ummanu, prioritised it as urgent and come out of that tab there is already a doctor on the line to the patient. In fact, some of the feedback from patients asked: why we’d sent them a text message, when the doctor was already on the phone.”

Overall benefits of the service:

• Improved data security
• Improved work environment and employee morale
• Greater visibility of workload
• Electronic recording of consultationsReal time triage according to clinical priority
• Steady flow of work for clinicians delivered in order of clinical priority

Supporting video file: https://www.healthestatejournal.com/story/39417/disaster-as-opportunity-a-brighter-pathway-when-the-lights-go-out

At CHoC, we pride ourselves on being innovative and the success of the virtual treatment centre model has led to us receiving recognition locally, regionally and nationally with organisations from across the UK getting in touch with us to learn from our implementation. 

In late Summer 2020 following on from 4 years of conducting video consultations, we utilised a combination of NHS Pathways and the DOS to bypass traditional OOH case flows from 111 in identifying specific symptom groups and dispositions where video is more appropriate.  Virtual Receptionists contact patients who meet this criteria, book them a video appointment and provide assistance for any who struggle with technology. The video clinician would then undertake video appointments as part of the virtual treatment centre.    

So far the success of the VTC has led to the following for our patients and staff:

• 12% of total CHoC activity and 23% of total activity sourced from 111 is now undertaken on video equates to 14,905 patients
• The VTC is our 3rd busiest treatment centre out of 7 meaning less patients in hospital environments when they don’t need to and reduced infection risk
• Faster response time for patients (average 54 minutes time to video compared with 127 minutes time to base) 
• Reduction in carbon foot-print, travel costs to patients and increased convenience
• Patients are less likely to represent in CHoC or any other health service in the following 24 hours (11% represent rate compared with 19% represent rate for those receiving only a phone-call)
• Clinicians can perform these roles remotely, increasing staff convenience and widening our ability to attract clinicians to work for us

This service’s success has been built on our ability to fully digitise the traditional health workflow which has been incorporated throughout the NHS over the last 73 years.  The service ethos is built on the NHS RightCare principle that “the right person has the right care, in the right place, at the right time, making the best use of available resources”. 

In 2019 the Joined-Up Care Derbyshire (JUCD) integrated care system agreed to an End-of-Life strategy to address the county’s variation of service.  Its vision was to deliver consistent end of life care everywhere, achieving national standards and enabling people to die comfortably, with dignity, in the setting of their choice, including at home. 

With an innovative approach to respond to this vision, DHU’s community based PCURS provides an acute, multi-disciplinary palliative home visiting response.  With a dedicated car available 24/7, the team look after people whose wish is to remain at home, despite their urgent palliative healthcare needs.

Responding to crisis situations - staff can sometimes be the first ones to inform relatives that a patient has hours or days left to live - the service connects with health and social care partners, including hospital discharge and specialist palliative care teams, community nurses, GPs, hospices, therapists, Ambulance Services and NHS111. 

The cumulative impact of this exemplary service shows that it provides compassionate, high-quality and timely patient care from a cost-effective model.  It has adapted to work throughout the COVID-19 pandemic, receives many accolades from patients’ families, and staff have been keen to join the team, learn new skills and work collectively for the patient.

Evaluation (from its first six-months) showed that:

• >90% of patients are triaged within one hour of the visit request. This may be by phone call or visit.
• >80% of people are seen within target times based on need. DHU use a referral system. 65% of urgent (two hour) referrals are seen within two hours. Calls are triaged/expectations managed. 76% of routine referrals (six hour targets) are seen within four hours. 
• Aim: >85% of people seen are cared for in their preferred place of care - 95% achieve this
• Aim: >85% people seen die in their preferred place of death: 95% achieve this
• Aim: >75% of service users who provide feedback are satisfied/very satisfied with their care: 96% achieve this. 
• Aim: >75% staff who provide feedback are happy with the care they can provide: 100% satisfaction

“My aunt passed away in the early hours on April 4 2022. Over the two weeks she was at end of life the team came out after calls to 111. I just wanted to pass on our gratitude. The compassion and understanding they showed to our family was above and beyond and very much appreciated.” Mrs S

Recipient of the additional award for Addressing Health Inequalities:

The Homeless Health Nurse Led Team in Blackpool was established as a pilot project to meet the needs of those in the community who are homeless or due to other multiple disadvantages are at risk of homelessness. These disadvantages include previous unhealed trauma; substance misuse; offending behaviour; mental health & physical health problems; domestic abuse, and social care needs. 

The team was initially established due to the very tragic and preventable death of a patient in the homeless and recovery community from a bacterial infection. The primary response was to manage the wound care needs of those rough sleeping; in poor or temporary accommodation and those at increased risk of infection due to continued IV injection use. 

The team offered am opportunistic, assertive outreach and drop-in approach to the clinics to reduce the barriers that the community faced when accessing other mainstream urgent healthcare services. The team are a friendly, non-judgemental service with an open door, flexible policy and very strongly grounded in a trauma informed approach, even down to the calming colours and decoration of the clinic rooms to create a safe space to promote health and wellbeing. 

It was clear from the onset that the team was in a position to deliver much more holisitic care to the patietns and offer a comprehensive health assessment at point of entry, including a referral to the team’s non-clinical care navigator who can ‘hand-hold’ clients into ongoing primary and secondary care appointments for acute or long term needs, as well as manage social care needs and other risks such as domestic abuse. 

The team work collaboratively with the acute trust hospital link team and the ED navigator team as well as the substance misuse service to ensure that any referrals and discharges into and out of secondary care are managed effectively to reduce repeat episodes and reduce failed discharges. 

The team are assertive and proactive in their approach and will actively seek patients out that the wider third sector agencies and social care teams have identified as needing care, as they are unlikely to prioritise their own healthcare needs and attend existing primary care services. 

The team is small but effective and have already offered wider health initiatives such as cervical cancer screening; bacterial infection monitoring and decolonisation regimes; LARC offer as well as joint working with Hep C screening and treatment and increasing Covid & Flu vaccination take up. 

Mini Health Checks and Ear Syringing Bus – we have been providing this service since March 22 with an initial target set by the CCG of seeing 500 patients.  Within the initial month we saw 1700 patients and now nearly had 6000 patients on the bus. This initiate was set up from underspend of winter funds money, the CCG approached us to see how we could best utilise this money.  We decide to look at what was important and what patient care was not being delivered during and since the pandemic.  

Upon designing the service, we wanted to offer screening that left the patient with an on the day assessment which includes BP checks, one lead ECG trace, COPD 6 recording, pulse and SP02 recording. Health promotion for smoking cessation, obesity, and alcohol intake could also be offered.  It was becoming very apparent that several providers were charging various amounts of money for what should have been a free service of ear syringing as this has a huge impact on quality of life for patients, relatives, and carers alike.  Time was taken to consider locations and accessibility to ensure the whole of the Fylde Coast benefited from this service.  

From day 1 feedback from patients attending the service has been extremely positive –
patients have left feeling reassured that all is ok and if not, problems (new AF, raised BP) had been identified with guidance of what to do next be it on the day at a Urgent Treatment Centre to routine follow up with their GP.  Those having had their ear syringed left “with a spring in their step” and full of gratitude at being able to hear for
the first time in years.

Examples of patient feedback:

• Amazing idea
• Good idea, great service 10/10
• Great service covered everything, loved face to face care
• Would highly recommend the service. Excellent I wouldn’t have gone to the Doctors
• What a fab idea please do lots of locations weekly will really help the community

As well as patients, GPs benefited greatly from this service as it reduced pressure on routine appointments and helped achieve some of their annual quality indicators.  We work closely with the practices to ensure the data was fed directly into the patient record via EMIS.  Any actions required would be followed the next day with the GP practice to ensure patient safety. 

Highly Commended:

The Cornwall 111 Integrated Urgent Care Service (IUCS), run by Kernow Health CIC (KHCIC), has a proud history of innovation within the area of ambulance, emergency department and minor injury unit validations. 

Moving further with this ethos and after many years of discussions, papers and consideration – KHCIC were able to design, develop and implement a service to test the
hypothesis that in streaming 999-generated Category 3 and 4 calls to the Cornwall 111 IUCS CAS for clinical validation, a reduction in on-scene activity to SWASFT could be achieved in the same way that NHS 111 category 3 and 4 ambulance, ED and MIU dispositions are reduced through validation. This in turn reduces the volume of lower acuity demand on SWASFT (therefore improving response times for category 1 and 2 calls), reduces the number of conveyances to ED, and associated non-elective admissions by helping patients to receive the right care in a more appropriate setting.

This ‘first of type’ service which KHCIC has implemented in partnership with SWASFT and Kernow CCG, now means that a designated and trained a collective of advanced clinicians actively have access to a remote SWASFT laptop within our local Truro HQ to
assess and take appropriate category 3 and 4 ambulance calls from the live SWASFT queue and transfer them via an ITK link into the IUCS queue where alternative care pathways are organised for the patient. 

The initial phases of the pilot have shown a clear demonstration of positive outcomes for patients, with a 71% downgrade rate to date since implementation (5 March 2022). This
means 71% of all calls taken away from the SWASFT queue by our KHCIC clinicians are downgraded into other areas of our healthcare system with a number of positive associated patient and SWASFT response outcomes resulting from this. 

To our knowledge, this ‘pull’ model (IUCS colleagues accessing a live ambulance queue to transfer calls into a live IUCS queue within a separate organisation) is an innovation
of huge proportion for both patient care, organisational partnership and system flow. 

Allied to this service is an IUCS-led rapid response falls service, meaning alongside telephone triage based downgrade of calls, our IUCS clinicians can pull non-injury falls form the live SWASFT call stack and send a falls response car manned by a Paramedic,
thus further diverting calls which would otherwise be responded to in a currently untimely way by our overstretched emergency ambulance service.

We have received multiple plaudits from across the system on the success of this
role out which required huge input from our programme management and executive teams to implement. In addition, we have evidence of excellent patient outcomes,
reduced time to a clinician ‘on scene’ with patients and positive feedback from clinicians who actively see the huge positive impact of this service. 

I would like to nominate the Technology Enhanced Living service (TEL) for the UHUK Best Service award as they demonstrate an exceptional service at its best. This service has been operational since 2019 when we first launched our virtual ward in Stockport. It’s been a trailblazing innovative example of the art of the possible long before technology and virtual wards had been nationally promoted.  It’s managed over 2000 patients on the virtual ward, and it is down to its highly skilled clinical team that we have
been recognised by the HSJ, network awards and Healthcare business award as well as successfully biding for a Small Business Research Initiative (SBRI) to expand the service into an additional locality area.  

From the moment the service was commissioned the team have had positive feedback from both patents and carers. The service has been operational for nearly 3 years and has managed a variety of clinical pathways in adults and paediatrics with NO negative patient feedback reported.

It’s a responsive service and can rapidly flex up to patient need which has the bonus of supporting the wider health and social care system. We not only flex up, but the team coordinates a clinical pathway or management plan which provides some key governance to a complex situation. Our caseload capacity is 80 but we have the capability both within our team and the digital platform to stratify the caseload to safely take on additional patients when necessary. An example of this is when we were managing complex early supported discharges from hospital and were at full capacity. A significant event in Greater Manchester involving a pregnant covid positive lady required a quick change in practice across the system and the need for all Covid positive pregnant ladies to have their oxygen saturation monitored. We were able to flex up even though our caseload was full. We offered to manage all these patients across Stockport and Trafford which had a huge impact on primary care and freed up their capacity as they had originally been asked to coordinate this model of care.  They have not only influenced patient care locally they have influenced care at a national level after being part of the NHS evaluation of virtual ward 2022 commissioned by NHSI/E. 

We are very proud of what the team has achieved not only over the last few years but also during a pandemic and we would like them to have the recognition they deserve. 

Highly Commended:

NEMS Community Pathfinder is a service to Health Care Professionals in Nottinghamshire designed to reduce avoidable attendances and admissions to Acute Trusts. The service was launched in 2017 and has successfully avoided over 30,000 ambulance dispatches to ED in this time.

This service is used by healthcare professionals such as ambulance paramedics, ED staff and care home staff. The service is accessed by telephone and provides a ‘clinician to clinician’ discussion aiming to identify a care pathway or management plan that will enable the patient to remain safely at home (or in the care home), with appropriate support or planned follow up. Referrers do not need to know which service they require or keep abreast of all the many and varied options across the City and County, as NEMS staff will find the right service on their behalf. Where necessary, the home intervention team will visit the patient, assess and treat in the home.

The outstanding feature of this service is the exceptionally high attendance avoidance rate achieved, on average 96% of all cases received are managed in ways that avoid the patient being conveyed to ED in an ambulance.  

EMAS (East Midlands Ambulance Service) is one of the main users of the service and feedback from their clinicians is very positive, with comments such as “NEMS are an absolutely amazing asset to patients in the Nottinghamshire area”, “NEMS are outstanding. Need any help or advice; just call them. They are very quick and very helpful”, “Superb! You notice the difference when you go out of area & there’s no alternative pathway”.

As an example of how the service works, consider the following typical patient journey:  Elderly patient at home alone calls 111 (they rarely prioritise themselves as 999 even if it becomes apparent they needed to). 111 assess the patient and dispatch an ambulance. A rapid assessment is facilitated therefore at the patient’s home. The crew on scene consider that ED is not in the patients' best interests after considering a number of factors. They ring NEMS Comm Path and receive a timely call back from a clinician who is able to arrange a home visit. NEMS GP attends the patient and is able to
commence treatment and arrange follow up in order to keep patients in the comfort of their own home.

Greg Cox, EMAS Divisional Director for Nottinghamshire, said in support of our nomination, “I am pleased to say that all our clinicians hold this service in the highest regard and importantly, have extreme confidence that it provides an appropriate and safe pathway for our patients. NEMS and EMAS have developed an excellent working partnership across both organisations, at both a strategic and operational level which ensures our patients receive the right care first time.”

I would like to nominate our Call Centre Team, our Out of Hours (OOH) Clinical Team and Operational Leadership Team for the Best Service Award 2022 for providing an excellent service in response to Operation Silver Puncture.

Adastra, our OOH clinical system, experienced a Cyber Attack on Thursday 4th August 2022 and remained offline for 4 weeks. As this caused a significant disruption to our operational delivery, we instigated our Business Continuity Plan (BCP) at this point.

The outage of Adastra and initiating the BCP involved a manual process for dealing with patients and consultation, requiring a multi-service approach within Primary Care 24. Everybody involved in Operation Silver Puncture, paused their existing workloads, and were re-deployed to support the Call Centre to provide additional capacity and support to the team.

In particular, I would like to highlight the following:

• The Call Centre Team, Out of Hours Clinical Team, and the Leadership Team giving up their days off and week-ends off to support their colleagues
• The rapid recruitment and training of a temporary workforce (within 24hrs) to support with the increased workload
• The continuous daily and weekly review, learning and improvement of the process
• The Operational Leadership Team who ensured the wellbeing of their colleagues with motivation and provision of food and refreshments.

This has been a really challenging time for the whole team here at PC24. I have been really proud to lead them through the response. They have kept the patient at the centre of every decision that has been taken and they have upheld the fantastic patient care that they are famous for throughout the disruption.

Winner, and recognised for Addressing Health Inequalities:

Since 2019, local authorities in North East London have housed refugees and homeless populations in local hotels. These individuals and families often did not have access to any healthcare facilities. Towards the end of 2019, PELC started an outreach service, and we now cover 10 hotels across three boroughs. A particular strength of our service is that we offer holistic health and social care support through collaborative working within primary, secondary, mental health and social care services. 

We conduct initial health assessments, identify safeguarding concerns and manage acute conditions as-well as practising preventative medicine. We offer flu vaccinations and support the COVID programme and work in partnerships with voluntary sector organisations to provide responsive care. We collaborated with ‘Positive East’ for managing sexual health and with the ‘See & Treat’ service for TB screening. We also provide advocacy services. Working with ‘Migrant Help’, we successfully challenged the
ages of some of our clients classed as adults. Our assessments determined them as children, who were then appropriately rehoused. Working with ‘Forrest Medico-legal Services’, we support cases when children are denied access to schools or offered inappropriate distant placements. Working with ‘Social Workers without Borders’ we provided clarification to social services, when they refused to co-operate for lack of clarity around ‘No Recourse to Public Funds’ status.

We adapt to meet emerging needs. During the pandemic, we modified health assessment forms to support partnership working with social care, DAAT and mental health services. Digitalisation of our assessment form will allow an ongoing channel of communication translating the vulnerability of the patients to colleagues in other services. We empower patients to take control of their health by educating them, dispelling myths and by providing posters informing clients of public health measures in identified ethnic languages. We don’t simply serve to manage acute symptoms, we engage in our own social prescribing. We run sessions for the children in collaboration with sports coaches and also arrange reading sessions and art classes. Recently, a successful and well received Sports Day was organised for our clients, which contributed to their mental well-being and improved self-esteem.

Anecdotally, a significant decline in the use of urgent and emergency services is noted by hotel staff and the CCG, attributed to our weekly sessions. 

PELC Outreach is a small, dynamic, forward thinking team providing ever expanding list of services. Our success lies within our drive to act as the patient’s advocate in every respect of their health and well-being.

To view the video submission, please download the file: Download file

Salford Primary Care Together (SPCT) has delivered the EPiC 24 model which brings
together all primary urgent care services including GP out of hours, primary care streaming, locality clinical assessment service and other same day urgent care services. The service is co-ordinated by a digital clinical hub which is able to operate flexibly to ensure that surges in demand across the service can be managed effectively. 

The EPiC 24 model aims to minimise duplication and work closely with primary care colleagues, acute care colleagues, health and social care and mental health teams to ensure that patients receive the right care, right place by the most appropriate person. The focus is on integration of service to realise economies of scale, provide flexibility of clinical staff and collaboration across the locality to ensure pathways reflect the best possible patient journey. 

The model allows pathways to cross over between the services, so that, regardless of
where the patient presents (NHS111 or ED) the patient can be booked into the most appropriate service. The service has an operational manager from 0800-2200 daily supported by a senior clinical team leader. 

Clinical governance and quality are key priorities for the service. The EPiC 24 governance meeting has membership from primary care colleagues, acute care colleagues, community nursing, commissioners, LMC, VCSE and mental health teams. Service level data, operational issues and updates are discussed along with any complaints and significant events.

The service uses clinical guardian for clinical audits and regular feedback is provided to
staff. Monthly reports are generated against locally agreed KPIs. Monthly clinical meetings are an opportunity to share learning, quality improvement projects and overall feedback with all staff. 

The EPiC 24 model has been effective, streaming on average 65 patients a day from the front door of ED. The LCAS service helps minimise patients being referred onto an ED
(cica 75% of calls avoid ED) and the referrals to ED and back to the patients own GP are minimal. The impact of the integration of these services has helped relieve pressure across the urgent care system in the locality. Patient satisfaction has been high and engagement has been supported by Health Watch. 

This model – although delivered by SPCT – is a reflection of the true integrated / collaborative work across the Salford locality, based in string relationships between providers aiming to deliver the very best care possible.

This service is an excellent example of how flexible a team which primarily delivers Out of Hours urgent care can be.  The service was a collaboration between the Suffolk GP Federation’s Urgent Care team, Suffolk County Council’s Public Health and the integrated contraception and sexual health service (iCASH).

The service started as a response to the lack of contraceptive services availability during COVID.  This had caused a huge back log in primary care and at iCASH clinics.  Public Health approached the Federation for ideas of how the backlog could be reduced, in particular the fitting and removal of implants and coils.

The Urgent Care team were eager to help and developed a service proposal that could be implemented quickly and would make an immediate impact. The service was up and running within a month of the initial request to help. This included:

• Using existing staff from the Out of Hours team who already possessed the relevant qualifications and skills. This did not give us sufficient clinicians so we agreed a plan to train two additional members of staff to fit whilst the service was running.
• The service giving local clinicians the opportunity to maintain their fitting skills during COVID and since, skills they may have lost otherwise
• Offering appointments in the evening or weekends as this reflected when we had staff available but also meant the service was very accessible to our client group who, in the majority, were working age and thus did not need to take time off work for appointments
• Utilising existing clinical space so mobilisation was not affected by premises constraints. The service ran across 2 sites covering the West and East of the county.
• Training Urgent Care administration staff to act as HCA in the service.  We worked-out the training could be completed very quickly.
• Working flexibly without the restraints that other services faced. For example, we
• were happy to see patients requiring IUS for menopause and heavy menstrual bleeding, whereas iCASH could not usually provide this in their service.

The service was really successful and undertook 1,730 fittings and removals which made a big difference to the waiting list.  We received 100% positive feedback from patients and no clinical incidents reported.