http://www.dh.gov.uk/en/Healthcare/Emergencycare/Modernisingemergencycar...

A vital part of Reforming Emergency Care

Introduction

Emergency care networks are a vital part of Reforming Emergency Care. This framework aims to clarify their purpose and makes suggestions for membership and terms of reference.

It must be emphasised, however, that the network size/scale is for local determination. These are suggestions only, the important thing is that the network makes sense locally and enables local delivery.

Aim:

a. to optimise the emergency care of all patients in the locality
b. ensure that the patient perspective and quality of care are the priorities in planning emergency healthcare in the local health and social care community
c. to ensure ease of access to appropriate services at the appropriate time without unnecessary duplication for the patient and in line with national standards.
d. to co-ordinate emergency health care across all organisations in a community
e. to ensure the engagement of external organisations whose services contribute to the effective delivery of emergency care
f. to work with health and social care commissioners to determine priorities in emergency care
g. to promote knowledge of developments in emergency care amongst health and social care professionals and users
h. developing and maintaining improvement work including that initiated by the Emergency Services Collaborative
i. to agree and develop local standards and protocols to facilitate comparative audit and training.

Membership of EC Network

Suggested membership - For local determination/agreement:

Acute Trusts
Ambulance Services
Community Paediatric Services
Dental Services
Other networks/collaborative leads
Intermediate Care
Local council
Mental Health Trusts
Minor Injury units
NHS Direct
OOH Providers
PCT
Pharmacy (NHS and retail)
Social Services
Independent Sector - nursing and residential care homes
Strategic Health Authority
User representation (or a patient/carer forum that feeds into this group)
Nursing/Residential Home Representation
Older People's Champions
Police (e.g. mental health issues, security issues)
Walk-in Centres
Workforce confederation

Membership should include clinical and managerial staff and represent a broad spectrum of disciplines.

Example of Terms of Reference

The Network will specifically look at standards in the NHS Plan and develop whole systems solutions to achieving these standards. In particular the following standards will be considered and monitored at each meeting:-

* ambulance response times
* ambulance turnaround times
* primary care access (including OOHs)
* total time in A&E
* thrombolysis
* delayed transfer of care rate in acute Trusts

In order to achieve these the following measures may also be considered at each meeting:-

* service usage (PC, Ambulance, A&E)
* bed occupancy in acute Trusts
* capacity plans
* breaches of local and national standards within the local community
* untoward incidents

The network is responsible for issues across existing organisational boundaries. (The ECL is responsible for issues within an organisation).

Networks should ensure that if a patient presents at a location that currently does not provide the required services that the user can be transferred to the appropriate carer without unnecessary delay or duplication of work.

Network Checklist

The network will refer to the A&E target checklist issued in January 2003 and each organisation will report to the network meeting on any areas within this that are not undertaken by the relevant organisations - click on the link below to visit the A & E Plans page.

1. Direct access from primary care, ambulance services and A&E to the following services are available:-

Community nursing

* Community nursing and therapy services
* Rapid assessment teams (particularly for older people)
* Social care support in the home
* Intermediate care - residential
* Intermediate care - rapid response service
* Mental health services
* 24 hour pharmacy

2. Primary care have direct access to:-

* Urgent senior medical opinion from secondary care
* Social care assessment & services
* Urgent diagnostic services with same day reporting
* Minor injury units and W/Cs

3. A&E should have direct access to:-

* Urgent appointments in primary care
* Outpatient appointments within 72 hours
* Respite nursing home and residential beds
* Emergency social care access

4. Ambulance services have direct access to:-

* Primary care centres and OOH centres
* Urgent appointments in primary care
* Senior medical opinion
* Minor injury units and walk-in centres
* Rapid assessment team for older people
* Night sitting services

5. Bed management systems cover all beds in primary, secondary and continuing care. Systems should prevent delays in transfer between any of the beds. Capacity is planned to match expected emergency admissions (predicted on a daily basis) with elective and respite activity.

6. Residential and nursing home bed availability is mapped against expected hospital, primary care and community requirements.

7. Systems are available to allow appropriate distribution of emergency care workload taking account of clinical need, system workload and time constraints. Capacity can be managed in a dynamic operational way as well as strategically.

8. Systems are present, wherever possible, to achieve referral via guidelines rather than via traditional gatekeeper roles.

9. Documentation (paper and electronic) assists in avoiding duplication.

10. Data transfer is optimised between organisations. Information is shared to the benefit of the users, including outcome data to allow effective audit.

11. Patients not registered with a GP can initiate their registration from all sources of emergency care.

12. Users and carers are involved in all stages of planning and provision of emergency care.

13. Facilitate development of new working practices including looking at how individuals and groups can work across organisational and professional boundaries. Encourage autonomous practise rather than increase restricted and protocol bound practise.

14. Facilitate development of guidelines and care pathways that work across the whole network.

15. Ensure that any developments by one organisation do not adversely affect patient experience in another organisation or affect another organisation's ability to provide quality care. Ensure that delays are not occurring at interfaces.