Urgent care engagement 2013-16 (closed)

Urgent Care Engagement 2013-16


Urgent Care engagemnet overview:

From September  2013, Herefordshire Clinical Commissioning Group (CCG) asked patients, community organisations and members of the public for their views on what kind of urgent care services they need - and whether the current network of services can meet their needs.

This engagement exercise was part of a wider review into how future urgent care services should be purchased to secure better outcomes and value for money for everyone.

Following this review, HCCG decided to change how it bought urgent care services by introducing an outcomes approach to commissioning and contracting - known as Outcomes Based Commissioning.

To view our urgent care engagement journey please see our handy infographic here

What is Outcomes Based Commissioning?

Outcomes Based Commissioning aims to shift the emphasis from what services a provider offers, to what outcomes they achieve for patients. This change in how we buy and contract with providers moves the focus from activities to results, and from how a service operates, to the benefits a service realises for patients.

By using this approach important factors such as patient experience and the quality and safety of services can now be built into future contracts.

How will patient and public views be taken into account?

We know urgent care services need to be improved – because this is what you told us. We listened to Herefordshire residents at seven interactive workshops in the market towns, an on-line survey and through discussions with community groups, patients, young people and families.

These are your urgent care services, and we want to continue the valuable feedback from this earlier engagement. HCCG is committed to working closely with all stakeholders to understand what is important to them concerning urgent care services.  Throughout the process, we will engage with patients, carers and families, providers and the voluntary sector.

Your questions answered

As HCCG introduces outcomes based commissioning, we want to make sure we can answer any questions you may have. 

A list of the latest Q&As will be available here soon.

What we did

  • 7 events - experience led  workshops (September - October 2013):
  • Hereford x 2, Bromyard; Kington; Leominster; Ledbury and Ross (125 participants made up of public/patients, family/carers, frontline teams)
  • Additional workshops and surveys (September - November 2013)
    • Hereford College
    • Wye Valley Trust A&E and Reception Area (mini survey)
    • Children’s Centres
    • Newton Farm Community Association
    • Primary Schools
    • On line survey

Total of more than 540 patient experiences were captured that involved 372.5 hours of co-design work with local community.

Work with partners

Healthwatch volunteers were facilitators at the public engagement events

Insights we created:

  • Deeper understanding of what ‘out of hours’ and ‘urgent care’ mean to people and carers
  • "What Matters Most” insights
  • “Change One Thing” insights
  • Maps of current and desired experiences of day time and out of hours urgent care from the perspectives of:
    • People who use services
    • Family carers
    • Front line teams

What you told us

What does urgent care mean?

  • The concept urgent care did not have any meaning for the public
  • Individuals described unexpected health issues
  • Individuals with Long Term Conditions described changes to their usual state of health
  • Time appropriate
  • Unexpected need
  • Getting care at weekends
  • Confusion, where to go, who to ask

What matters most so you can keep well and cope?

  • A healthy lifestyle (and wellbeing)
  • Understanding what’s available (and where)
  • Accessibility (to the system)
  • Trusted advice
  • Work/life balance with regular health checks

What adds greatest value/would support you to cope?

  • Support and reassurance
  • Being understood and listened to
  • Improved communication (across the NHS system)
  • Education, knowing how to manage things myself

What do people ‘perceive to be’ out of hours urgent care?

Majority said that urgent care should be a 24/7 continuum rather than considered to be delivered as ‘In Hours’ or ‘Out of Hours’. Consensus that night-time 8pm – 8am could be viewed as outside of usual hours but day time usual hours should include Saturday, Sunday and Bank Holidays.

What would make the biggest difference?

  • Redesign ‘first contact’ services to maximise reassurance and build confidence
  • Refocus urgent care services on education and preparing people for next time
  • Differentiate urgent care for people living with long term health issues; design a different experience which is focused on teaching people to spot the signs early; have anticipatory coping strategies; rapid access to GP; family carer involvement; social support; crisis prevention.
  • Work with rural communities and GPs to co-design sustainable local solutions that improve access eg community responders, internet based consultations, advice and support
  • Focus education around how to deal with unexpected issues (symptoms) rather than where to go (place)
  • Make primary care access an integrated part of urgent care thinking (especially for people with long term conditions)
  • Make development of social support networks for isolated, vulnerable people part of urgent care thinking
  • Develop experiential outcomes that reflect what the population say matters
  • Develop new ways of measuring outcomes and holding providers to account that are community led
  • Set outcomes around staff well-being as well as people and family experience

Suggested Initial Actions

  • Redesign first contact experience
  • Use the insights gathered during this engagement to set outcomes and continue exploration of community led measurement strategies
  • Engage the voluntary sector in this work
  • Bring together rural communities and GPs to explore solutions
  • Map assets around self-management and see how they can support urgent care to change its focus

Next steps

  • These initial conversations are the start of ongoing discussion with individuals and organisations across  Herefordshire so that we develop a robust, person centred, evidence based approach to outcomes based commissioning of local Urgent Care supports.
  • The summary report will be posted on the CCG website and copies made available to those who attended workshops and discussion groups.
  • We are submitting our experience of this public engagement activity to the NHS Patient Participation Awards. 

Urgent Care report:

Your Voice – A chance to shape healthcare in Herefordshire (2014)

NHS Herefordshire Clinical Commissioning Group (HCCG) continued the conversation on Urgent Care at an event on 25 March 2014. 

A Big 'Thank You!'

Herefordshire CCG would like to extend a big ‘Thank You’ to everyone who took part in our Your Voice event on 25 March 2014. Lots of people from across the county came together in the Hereford Room, Three Counties Hotel, Hereford to help shape urgent care services in the county.

The event was opened by Dr Andy Watts, Chair of Herefordshire Clinical Commissioning Group (CCG), who highlighted the importance of public and clinical involvement to capture the broad range of experiences and help the CCG develop its health strategies and service provision for the future.

Lots of discussion and listening took place with feedback captured in various forms including a large pictorial that developed from a blank canvas to ‘The Herefordshire Way to Wellbeing’.

Feedback from the event and the outcomes identified as most important are available pdf in this report (718 KB) . The CCG will use outcomes from this event alongside other sources to help shape decision making. 

Please take a look at our gallery of pictures from the Your Voice event.