Taking Care 24:7 brings organisations closer to 2009 compliance

New ways of working over the 24 hour period can help organisations to achieve WTD compliance. Five NHS organisations were awarded pilot status in October 2006 to introduce 24 hour working to reduce junior doctors hours.

Taking Care 24:7 – Skills for Health - Workforce Projects Team third group roll out of pilot work – looks at the development of different models of service provision that focus on the way in which healthcare is organised over the whole 24 hour period seven days a week. The aim is to support healthcare organisations across the NHS refocus ways of working and the use of different staff to reduce the dependence on junior medical staff or to restructure the way they work so that compliance with the 48 hour week for junior doctors can be achieved.

The successful schemes are looking at new initiatives ranging from a new model of redesigning the management of people with acute illness, through to the reconfiguration of teams in teaching hospitals and a mental health trust to adopt a Hospital at Night team working model for the full hospital day.

The ‘Taking Care 24:7’ pilots are latest group of WTD 2009 pilots following the award of four ‘cooperative solutions’ pilots in January 2006 and nine ‘teamworking, handover and escalation’ pilots in July 2006.

A key focus on the pilot working is the dissemination of lessons learnt in order for other organisations to benefit.

The pilots...

West Dorset health community

This pilot project involves West Dorset General Hospitals NHS trust, Dorset Primary Care Trust, Dorset County Council Social Services, NHS South West Ambulance Trust, practice based commissioning GP’s and NHS South West. The health community has been developed to redesign the management of people with acute illness in West Dorset through a whole system approach. West Dorset health community will provide an enhanced range of community alternatives to hospital admissions. This will be achieved in a variety of ways including the extension and enhancement of the roles of a wide variety of staff, reducing non-elective admissions by treating them nearer to home, redesigning the patient pathway for ill children where advice at hospital or assessment is required and commissioning an academic partner to develop a programme of skills assessments and competencies required to develop new patient pathways.

Guy’s and St Thomas’ NHS Foundation Trust

Guy’s and St Thomas’ NHS Foundation trust is the largest teaching hospital in London and employs over 9000 people. At the Trust, the development of planned patient pathways in both acute and emergency situations will provide opportunities to ensure staff have the correct skills and competencies at all stages of their care.

To achieve this and to comply with WTD 2009, different models of service provision are being developed including the introduction of planned care management teams and an acute response team building on the Hospital at night model.

East Sussex health economy

East Sussex Hospitals NHS Trust provides acute hospital services from two major sites based in the towns of Eastbourne and Hastings. Hastings and Rother PCT is on the south-east coast of England and serves a population of approximately 170,000 people. East Sussex Downs and Weald PCT was established for Eastbourne and the Lewes and Wealden districts, around 326,000 people live in the area.

The GP Out of Hours service (GPOOH) run by South East Health is based at each of the two hospitals, adjacent to the A&E departments. Although this service has enabled the streaming of primary care patients from A&E, there is scope for closer working. A multi-disciplinary Hospital at Night team is in place at each site and the Medical Assessment Unit (MAU) in Hastings is adjacent to A&E. Medical admissions currently seen and assessed in A&E will be reassessed in MAU and this suggests that joint working will benefit patients and reduce workload.

The aim of this project is to develop a new approach to the provision of emergency care with Urgent Care Centres that combine the skills and resources of A&E, MAU, Hospital at Night, the surgical team and GP Out of Hours service.

Homerton University Hospital NHS Foundation Trust

Homerton University Hospital is based in the east London borough of Hackney. It provides general hospital services to Hackney and the City of London, and specialist care in obstetrics, neonatology, fetal medicine, laparoscopic surgery, fertility and neuro-rehabilitation across east London and beyond. At the Homerton, all medical staff finishing their shift currently meet and handover significant problems to the incoming replacement teams, including the Clinical Site Management (CSM) teams. CSMs are nurses with at least five years experience in acute specialties (ICU, CCU, A&E etc) with a portfolio of extended nursing skills. They co-ordinate and deliver care overnight. The multidisciplinary handover currently has no equivalent in the mornings and this project aims to change this and develop a handover procedure.

The approach will be consultant led and provide improved educational standards and supervision to the acute team. Attendance will be required by CSM and Critical Care Outreach teams and therapy staff in addition to the medical staff. This will provide a sustainable improvement in the particular issue of multidisciplinary handover and the impact of this on WTD 2009.

Manchester Mental Health and Social Care Trust

Manchester has a population of over 450,000 and is served by three psychiatric hospitals. Each is attached to one of the three acute trusts in Manchester which each have an Accident & Emergency department. Currently, psychiatric emergency services in Manchester are based around three medical on-call teams. WTD compliance could be achieved by combining existing rotas and work patterns. However, this compliance would be at the cost of doctors’ working shifts with relatively low workloads and poor educational opportunities. It would also lead to pressured day time hours with difficulty in providing specialised training in psychological skills, audit skills, research and management.

The PEARL project will provide junior medical staff with explicit educational support from consultants and other professionals built into the model of working, and allows a much clearer path for achieving competency in emergency psychiatric care.