NHS Ayrshire and Arran - redesign of urgent care - pathway finder programme: rapid external review

Annex 1: Terms of reference

1. Purpose

The Chief Executive of NHS Scotland has commissioned an external review of the implementation of the Redesign of Urgent Care Programme Pathfinder site to inform decisions on the proposed national roll out of the programme from 1 December 2020 to all territorial NHS Boards throughout Scotland.

It is anticipated that there will be a number of impacts across the whole care system. The evaluation process will help to inform risk mitigation steps required and further improvements to the agreed RUC model before proceeding to national roll out.

Evaluation of NHS A&A Pathfinder site

The review will offer independent advice to the Chief Executive NHS Scotland, the Health and Social Care Management Board (HSCMB) and the Cabinet Secretary for Health and Sport to inform decisions to proceed with a national rollout on 1 December 2020, as previously envisaged, or otherwise, including any suggested amendments.

2. Background

The Redesign of Urgent Care (RUC) programme promotes a significant change in how we best serve the people of Scotland to provide safe and effective urgent and emergency care on a 24/7 basis.

The RUC programme potentially offers the potential of significant benefits to modernising our wider unscheduled care pathways to ensure the public have access first time to best clinical advice and care from the right professional.

The RUC Programme also carries significant risks to successful implementation, Scotland-wide. Outwith NHS A&A, not all territorial Boards will be in the same prior state of readiness as NHS A&A - baselines differ. A straightforward comparison and recommendation to proceed across Scotland will not be readily possible, so a careful balance of judgements will be required.

These include: The readiness of staff, trained and available to provide new and enhanced services. These new pathways of care will require the readiness of multidisciplinary clinical and support colleagues from both acute and primary care sectors to rise to, and contribute to the occasion and at times depart from former agreed and well understood roles in non-Covid-19 times.

Regarding the care needs of the people of Scotland - guiding and supporting public behaviour to access the right urgent care, in the right place, at the right time, on a 24/7 basis.

Professional concerns have been expressed about the viability and sustainability of existing urgent care services in the light of these proposed (RUC) reforms. Primary care clinical professionals have been to the fore in this regard, both in terms of in-hours and out-of-hours (OOH) services.

Diversion of self-presenting attendees at Emergency Departments (EDs) and Minor Injury Units (MIUs), albeit prioritised and filtered, beyond self-care, will impact on both in-hours OOH general practice/primary care services.

Moreover, there might be over time, a societal change in help seeking behaviour, which may detract from day-time general practice services as being the prime source of urgent care during normal working hours towards NHS 24 111. This should be recognised and closely monitored, with agreed mitigations in place.

Due to the variation across Boards in the reported sustainability of local GP OOH's and COVID assessment centres, a local pathfinder approach is being undertaken which enables one Board to be supported to implement and act as a pathfinder site for boards across Scotland.

3. Pathfinder Site

NHS A&A offered to become the first Board to implement the full specification of the RUC programme from 3 November 2020. NHS 24 will begin testing the system on Monday 2 November 2020 to prepare for launch. NHS A&A will provide a local flow navigation centre with the ability to receive clinical referrals from NHS 24 for all previous self-presenting attendances. To support this change in behaviours they will test the components of the national public messaging campaign at a local level.

The NHS A&A - Redesign of Urgent Care (RUC) Review Group will closely monitor the implementation process as a test of change to inform further roll-out in territorial Boards throughout Scotland. The key focus of this review will be on monitoring, in the short time available, the potential impacts of this redesign of urgent care service provision, particularly where the change may risk to overwhelm other existing urgent care services; ensuring where redirection occurs there is sufficient capacity in other parts of the system to deal with the demand. This will include assessing the initial behaviour change from the public at a local level while taking cognisance of the planned national campaign which will reach a much wider audience. This will inform areas for further improvement and any risk mitigation that needs to be considered before wider roll.

The National Programme team will provide on-site support and support real time evaluation of the pathfinder to inform NHSS Chief Executive and Strategic Advisory Group of progress.

4. National Readiness

All NHS Boards are now working toward a proposed national roll-out date of 1 December 2020 with agreement to implement the de minimis specification that presents a national public access to NHS 24 with transfer of clinical referral to a local Flow Navigation Centre providing early access to a senior clinical decision maker within a multidisciplinary team. Utilising all opportunities for digital consultations and scheduling of attendances where possible.

To inform the decision to progress a full understanding of the wider capacity and capability will need to be considered across NHS Scotland. Each Board submits a readiness assessment on a weekly basis and contributes to the Implementation Leads network sharing progress and compliance with the minimum specifications.

The summary of the readiness assessments are considered by the RUC Strategic Advisory Group.

5. Role and Remit

• Identify issues arising in the NHS Ayrshire and Arran recommendations for national implementation of the Redesign of Urgent Care Programme
• To identify and explore any early changes in public behaviour
• To explore the impact of the Redesign of Urgent Care on all parts of the healthcare system
• Use data to help identify if individual members of the public are receiving optimal care

Although outwith the immediate remit of the Review close collaboration with the SG Officers supporting the Unscheduled Care Programme will be required to support the Review, which will explore overall impact and provide a quality improvement approach.

6. Leadership and support

The Review will be chaired by Professor Sir Lewis Ritchie with support from

(i) Core team:

• Katie Morris, Acting Programme Director, Scottish Access Collaborative, Scottish Government
• Karin Agnew, Project management and secretariat

(ii) Other expertise as identified by the team

7. Governance

The Review reports to John Connaghan, Chief Executive NHS Scotland. The Review will investigate and implement any activity within its Terms of Reference. It is authorised to seek any information it requires from organisations across Scotland where necessary to deliver the purpose agreed in the Terms of Reference.

8. Meetings

The Technical Reference Group (Workstream 1 Core Group Meeting) will meet weekly to review data and management information from across the system.

The Ayrshire and Arran SG Internal Review Group will meet twice weekly to discuss key aspects of the evaluation and receive updates from Scottish Government personnel.

The Redesign of Urgent Care Advisory Group (Calum Campbell, Angiolina Foster co-chairs) will be consulted with during the 3 week initial review period.

The Chair will report to the NHS Scotland Chief Executive weekly on progress.

9. Outputs

The Review will report to John Connaghan, NHS Scotland Chief Executive on 23 November 2020 to provide cumulated advice on an anticipated national rollout on 1 December 2020, or if any alterations and or amendments are recommended to proceed.