Urgent care services - Near Me in NHS Greater Glasgow and Clyde's flow navigation centre: good practice example
The redesign of urgent care programme in partnership with the National Technology Enabled Care Programme and NHS Greater Glasgow and Clyde have developed this good practice example for the delivery of Near Me video consultations as part of urgent care services.
Good Practice Example
Flow Navigation Centres (FNCs) are just one of the key national changes in the NHS Scotland wider Redesign of Urgent Care Programme. The FNCs seek to minimise the need to attend Emergency Departments (EDs) and bring an element of scheduling to the traditional unscheduled emergency care.
As of the 1st December 2020, Scotland's Health Boards implemented FNCs which could receive NHS 24 direct referrals. Instead of direct access to EDs or stand alone Minor Injury Units (MIUs), the new approach would see non life threatening conditions directed to NHS 24 as the first point of contact for support; available 24/7 for urgent care needs in circumstances where patients could not wait to be seen by their GP.
Following the initial telephone consultation with NHS 24, the patient is provided with either self care advice, referred to their local FNC or, where necessary, advised to attend their ED. Each FNC receives clinical referrals from NHS 24, offering access to a senior clinical decision maker within the multidisciplinary team.
Optimising digital health through either a telephone or video consultation via Near Me the senior clinical decision maker, who has expertise in emergency medicine, will engage in a consultation with the patient and based on that consultation will either discharge with an appropriate management plan or will arrange a scheduled appointment for the patient at an ED or MIU
The FNC for NHS Greater Glasgow and Clyde is staffed by Advanced Nurse Practitioners (backgrounds in both emergency medicine and minor injuries), Consultants in emergency medicine and General Practitioners. Initially the service only offered two pathways of referral, ED or MIU. However the FNC team have been working closely with other services / specialities to provide additional pathways and as such direct access.
When a NHS Greater Glasgow and Clyde patient contacts NHS 24, the NHS 24 practitioner conducts a thorough triage and as a result assigns the patient a specific code on the appropriate course of action. Patients who are suitable to be referred to the FNC are then routed via an unscheduled care clinical management patient software program (Adastra) to a local administration hub with the assigned code . This hub is situated within Paisley and is staffed with 3 Clerical Assistants and one Clerical Supervisor.
The Clerical Assistant will use the code to add the patient to the ED or MIU expected attendance list or they will schedule the patient to have a virtual consultation via the FNC. For all NHS 24 referrals, this is copied into the patient's electronic record for the clinical team to read prior to any consultation. For patients being referred to the FNC, the Clerical Assistant will contact the patient directly to determine whether they wish to have a telephone consultation or one via Near Me. The patient is then advised of their appointment time. If the patient has opted for a Near Me consultation, they are sent an electronic link and advised to join 5 minutes prior to the scheduled appointment time. When a patient is scheduled for an appointment with the FNC they are allocated to a 'quick book clinic' on Trakcare (electronic patient management system). This is known as a ward attendees list and all staff within the FNC are able to see the allocated patients and prior to the patient's consultation, the clinician is able to view the NHS 24 referral to understand the background.
Engagement with all key stakeholders early in the implementation of the model was key to ensuring that the defined process was successful. By providing a simple approach / option for patients to access virtual consultations, the Health Board has provided a person centred approach to scheduling urgent care and reducing the number of patients requiring to attend their EDs.
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