The Abolition of Health Care in Yorkshire (2)

Yorkshire PCT "Unscheduled Care Practitioner"

Following yesterday’s article on the Abolition of Health Care in Yorkshire (see below) a flurry of emails has arrived from both doctors and patients in the area. I can best summarise the general drift of the correspondence by saying that Dr Janet Soo-Chung CBE should be grateful that her job is a nationalised industry sinecure and that she is not subject to re-election.

We saw yesterday that GPs are to be prevented from referring many of their patients to their hospital colleagues. Patients who cannot get timely hospital appointments, and who are in pain or distress, often try to short circuit the system and see a hospital doctor by taking themselves to an A & E department.

Sorry, guys, you cannot do that in North Yorkshire anymore. The PCT is one step ahead you. Another GP, who wishes to remain anonymous, has sent me the PCT commissioning plan “For Patients attending Accident and Emergency Departments”. It is an 800 word document, with a flow chart. I reproduce it in full below.

One of the great things about Word Processors is the facility to search for certain words. So I searched for the word “doctor”. I received the following message:

Find what : “Doctor”

Word found no items matching this criteria.

And so it is (or is going to be, if Janet has her way) in Yorkshire A & E departments. Instead, we have a new beast. “The PCT unscheduled care practitioner”. Will that be the UCP, I wonder?

Oh Dear!

I should have realised as much. There is a flowchart protocol and when you sack the organ-grinder and the monkey takes over, you do need a protocol. Actually, the word “protocol” is a bit last year. This year’s preferred expression is “pathway”. So now we have the “Patient Pathway.”

North Yorkshire and York Primary Care Trust
Draft 1.0

Commissioning Plan
For patients attending Accident and Emergency Departments

1.0 Introduction

1.1 The purpose of this paper is to outline the PCTs plan to commission a primary care service at the “front end” of the Accident and Emergency Departments in both York and Harrogate. This is in recognition that there are distinct requirements for patients with medical and surgical emergencies who require Emergency Care, who clearly need the expertise of staff working in Emergency Departments. Other patients with minor injuries and minor illnesses can safely be assessed, advised and cared for by primary care practitioners (Emergency Nurse Practitioner or GP). Their skills and expertise in assessing complex undifferentiated needs, identifying and managing clinical risks lend themselves to caring for this cohort of patients.

1.2 It is also recognised that we need to transform services for patients with unplanned care needs and wish to approach this in phases. We will take into consideration patient need, national guidance and local circumstances with an ultimate aim to see appropriate and sustainable clinical models commissioned.

1.3 This paper focuses on the immediate short term phase of providing patients with access to a discreet and largely separate primary care presence within A&E departments. The benefit of this in the first instance is that it will allow established operational models and clinical governance systems within primary care to be utilised bringing confidence to both patients and primary care practitioners alike.

2.0 Clinical Model – Initial Phase

2.1 Much work has already been undertaken by both Secondary and Primary Care providers in Harrogate and York and the operational detail of how the clinical models will work is to be progressed over the next 2-3 weeks.

2.2 The PCT wants to commission a service where all self-presenting patients attending A&E, except those who are clearly in need of Emergency Care as their needs are life-threatening, are triaged by the PCT provided primary care service. The clinical care for these patients is likely to include initial assessment followed by provision of advice, initiation of treatment, directing to other primary care services and transfer to the Emergency Department team where clinical needs warrant that.

In the initial phase the hours of operation will reflect all of the operational hours for the current Out of Hours Services,
18.00pm – 08.00am Monday to Thursday;
18.00pm on Friday night through to 08.00am Monday morning;
Bank Holidays and Public Holidays

although it is intended that this service will extend to a 24 / 7 service in due course.

Click to enlarge

2.3 An important aspect of the primary care service is for patients to be assessed in a clinical environment that is conducive to maintaining patients’ privacy and dignity, therefore access to consulting rooms to achieve this is imperative.

2.5 It is not anticipated that additional demand will be made of hospital based diagnostic services. This initial phase should be seen simply as a transfer of demand from A&E to the primary care services.

3.0 Expected outcomes

3.1 It is expected that a significant number of patients will be seen by primary care practitioners and this will result in a reduction in patients being seen within the current A&E departments. It is difficult to determine the exact numbers and implications for any providers but a review will be conducted within 3 months of initiation to help us understand the implications for patients, their care, satisfaction and clinical outcomes – including repeat attendees being flagged to the practice with whom they are registered.

3.2 Monitoring of the impacts of these changes will be co-ordinated by the PCT to inform future commissioning decisions.

3.3 It is also important for Practice Based Commissioning Groups to be increasingly involved in monitoring the impacts of any changes and we are currently trying to identify individuals from the local groups who can engage with us on this. A particular focus of their involvement will be to define the expected clinical outcomes. An example of this might include seeing a reduction in frequent attendees and fewer unplanned admissions to hospital as primary care practitioners will be fully aware of current and developing services within the community to support patients nearer their own homes.

3.4 As with current Out of Hours Primary Medical Services there are national quality requirements to be achieved and it is expected that performance against these requirements will be maintained.

4.0 Next Steps

4.1 Current service providers including secondary care, primary care and the ambulance service are asked to work together in preparation for implementation at the earliest opportunity.

4.2 The PCT will use this initial phase to build clarity about future service specifications based on feedback from patients, primary and secondary care professionals, ambulance service colleagues and managers alike.

+++++++++++

Once again, doctors will not need any guidance about this further abolition of health care, but a few pointers for patients.

“This is in recognition that there are distinct requirements for patients with medical and surgical emergencies who require Emergency Care, who clearly need the expertise of staff working in Emergency Departments. Other patients with minor injuries and minor illnesses can safely be assessed, advised and cared for by primary care practitioners (Emergency Nurse Practitioner or GP). Their skills and expertise in assessing complex undifferentiated needs, identifying and managing clinical risks lend themselves to caring for this cohort of patients.”

This begs big question. WHO DECIDES who the “other” patients are? Fellow GPs will also note with disgust the assumption of equivalent skills of an Emergency Nurse Practitioner and a GP.

It is also recognised that we need to transform services for patients with unplanned care needs and wish to approach this in phases.

In otherwords, phasing out doctors. Why do we not let these patients with “unplanned care needs” continue to be assessed by a doctor?

The PCT wants to commission a service where all self-presenting patients attending A&E, except those who are clearly in need of Emergency Care as their needs are life-threatening, are triaged by the PCT provided primary care service.

Yes, but WHO DOES THE TRIAGING? What is the “PCT provided primary care service”

An important aspect of the primary care service is for patients to be assessed in a clinical environment that is conducive to maintaining patients’ privacy and dignity, therefore access to consulting rooms to achieve this is imperative.

As opposed to what happened before?

Be under no illusion as to what is going on here. The front end of the hospital, the A & E department, is being dumbed down. The traditional system of all patients being seen by medically qualified Casualty Officers of SHO and Registrar grade (i.e. qualified doctors with a minimum of 7 years training) backed up and supported by a Casualty Consultant, is being replaced by a dumbed down system front-ended by nurses and ambulance drivers.

But it will save money.

Could Dr Crippen respectfully draw your attention to the fact that the A1M, and the A19 both give a means of rapid escape from Yorkshire to areas where hospitals are still staffed by doctors.

++++++++++++

Comments under the original article here please