Urgent Care over the Holiday Season

Christmas is a very challenging time for our urgent care system. The middle of winter is the busiest time and many of our patients will be poorly and some of them may need to be admitted to hospital. Also our A+E department always comes under significant pressure with ever increasing demand.

GPs, urgent care service, ambulance service, hospital, community services and social services have been working hard to ensure patients are safely cared for. We recognise the importance of all parts of the system working effectively together to maintain system flow so patients can move smoothly and safely through the system. We would like to highlight some of the areas the CCG has been working on in order to ease the pressure and support the system.

  • Admission/A&E avoidance: Minor Injuries LES; High Impact Team for care homes; ambulance non-conveyance (hear and treat, see and treat or refer to GP); RAIT Team
  • In hospital: Ambulatory Emergency Care unit(AECU); increased staffing; Improving flow through the system including offloading from ambulances; morning consultant ward rounds and regular board rounds; more weekend working
  • Discharge: Increased Staffing inDischarge Planning Team; additional rehab beds in the community; Home to Stay Team

There are also other areas where we willbe making further improvements:

  • Common front door for A+E and Urgent Care Service
  • Frail elderly - Improving pathways within the hospital and services in the community
  • 7 day working – health and social care
  • Extending the hours of Ambulatory Emergency Care Unit (AECU)
  • Refining the planning process for winter 2014

To support these efforts I need you and your practice team’s help. As you will know the hospital has been under considerable pressure resulting in “Black Alerts”. We will continue to inform you when the system is under such pressures as you are a vital part of the system whose actions can genuinely help to alleviate some of these pressures. For example, prior to referring toA&E or the hospital for urgent care, you can review the other options available to manage the patient safely in their own home. In order to help with this, I attach a list of Community Health Services that can help.This includes information regarding opening hours over the holiday period. Delaying an admission for a few hours (where it is safe to do so) or ideally using an alternative such as a hot clinic or RAIT team where appropriate can buy a bit of time to free-up beds to allow the sickest patients to be seen and assessed safely. If you feel that speciality assessment or possibly admission is required, you can refer to the AECU via the hospital switchboard on 01908 660033, asking for bleep 1699. You can then discuss the patient and identify the best route forward.

Many thanks for your on-going assistance with this. I am confident that, with the whole system working together, from GPs through the hospital and community and social services, we will be able to make a positive impact on patient care.

Have a Happy Christmas and a Healthy New Year!

Dr Nicola Smith

Clinical Chair – Milton Keynes CCG

Admission Avoidance Services

Service/Description / Tues 24th Dec / Wed 25th / Thu 26th / Fri 27th / Sat 28th / Sun 29th / Mon 30th / Tues 31st / Wed 1st Jan / Thurs 2nd Jan
RAIT
Referrals Via Single point of access
(SPA)01908 363070
Out of hours direct GP line
07917 173081
01908 660033Hospital bleep 1923 (for A/E Nurse/Therapist)
RAITTherapy and Nursing interventions to support Admission avoidance and support early discharge (includes admission to WICU/Orchard House)
HTSTNurses supporting Hospital discharge for 30 days to prevent re admission (patients may self refer) / Nurse/ Therapy
9am to 5pm
Nurse 5pm
To 9pm
A/E 9am to 7pm / Nurse and A/E cover
9am to 7pm / Nurse and A&E cover
9am to 7pm / Nurse/ Therapy 9am to 5pm
Nurse 5pm to 9pm
A/E 9am to 7pm / Nurse and A/E cover 9am – 7pm
Weekend Therapist
9am – 5pm / Nurse and A/E cover
9am to 7pm
Weekend Therapist
9am – 5pm / Therapy
9am to 5pm
Nurse 5pm to 9pm
A/E 9am to 7pm / Therapy
9am to 5pm
Nurse 5pm to 9pm
A/E 9am to 7pm / Nurse and A/E cover 9am to 7pm / Nurse/ Therapy
9am to 5pm
Nurse 5pm to 9pm
A/E 9am to 7pm
Intermediate Care
Referrals Via SPA01908 363070
Providing short term reablement at home to support clients to regain independence with personal care tasks. / Normal
Service
7am to 10.30pm / Normal Service
7am to 10.30pm / Normal Service
7am to 10.30pm / Normal
Service
7am to
10.30pm / Normal
Service
7am to 10.30pm / Normal
Service
7am to 10.30pm / Normal
Service
7am to 10.30pm / Normal Service
7am to 10.30pm / Normal Service
7am to 10.30pm / Normal
Service
7am to
10.30pm
Orchard House
Referrals Via SPA01908 363070
Social Care reablement bedded unit / Normal Service / Normal service
No therapy / Normal service
No therapy / Normal Service / Normal Service
No Therapy / Normal Service
No Therapy / Normal Service / Normal Service / Normal service
No Therapy / Normal Service
Service/Description / Tues 24th Dec / Wed 25th / Thu 26th / Fri 27th / Sat 28th / Sun 29th / Mon 30th / Tues 31st / Wed 1st Jan / Thurs 2nd Jan
Windsor Intermediate Care Unit
Referrals via SPA 01908 363070
Nurse led reablement bedded unit / Normal Service / Normal Service
No Therapy / Normal Service
No Therapy / Normal Service / Normal Service
No Therapy / Normal Service
No Therapy / Normal Service / Normal Service / Normal Service
No Therapy / Normal Service
District nursing
07741015045 / 07799898632
Nursing service for house bound to GP practice populations, seven days a week, 8.30 a.m.-5.00 p.m., liaising closely with other professionals and statutory and voluntary organisations.
Also provide home IV service in partnership with MKHFT. / Normal Service / Bank Holiday arrangements – slight reduction in staffing numbers / Bank Holiday arrangements – slight reduction in staffing numbers / Normal Service / Normal Service / Normal weekend service / Normal weekend service / Normal Service / Bank Holiday arrangements – slight reduction in staffing numbers / Normal Service
Twilight DN Service
An extension of the day time district nursing service, operating from 7.00 p.m.-2.00 a.m. every night. / Normal Service / Normal Service / Normal Service / Normal Service / Normal Service / Normal Service / Normal Service / Normal Service / Normal Service / Normal Service
Community Matrons
07771340168
Work together with GP and patients to identify and improve management of health and social care issues which impact on an individual’s ability to cope with a complex long term condition. / Normal Service / Bank Holiday arrangements as per weekend / Bank Holiday arrangements as per weekend / Normal Service / Normal weekend Service / Normal weekend service / Normal service / Normal Service / Bank Holiday arrangements as per weekend / Normal Service