Health - redesign of urgent care: evaluation - technical report

13 NHS Staff Focus Groups: Topic guide

Introduction [5 mins]

• Introductions and thanks for time
• Briefly explain who Picker are and background to the evaluation
• Re-check they have read the Information Sheet and signed the online consent form (or take verbal consent if not completed)
• Emphasise it is an informal chat to understand their views and experiences
• The focus group will take about one hour – but they can stop anytime and take a break/finish early

Purpose of the discussion

• The purpose of the discussion is to help us to understand the experiences and understandings of staff involved in the delivery of urgent and unscheduled care as a result of the redesign of urgent care pathway being introduced. [Note that we are capturing the experiences of patients via a survey]
• The RUC pathway introduced 24/7 access to NHS 24 111 as the single point of access to urgent care. Flow Navigation Centres were implemented in each Health Board which receive clinical referrals from NHS 24 and can signpost patients to appropriate services and schedule non-emergency attendances at A&E/MIU to manage waiting times.
• We want to find out about your experiences of the Redesign of Urgent Care pathway, including any challenges or benefits to staff or patients that you have perceived or encountered, and any key learnings you feel are important.
• We are carrying out 3 discussion groups with staff from a range of clinical and managerial roles within urgent care across Scotland
• We are keen to understand what the Redesign of Urgent Care system is achieving and lacking - so please be honest about your experiences.
• Remind participants that during transcription and reporting they will be anonymised
• This information will be used to evaluate the programme – we will produce a report on behalf of the Scottish Government to present the key findings.

Consent

• Does anyone have any questions before we begin the focus group?
• Ask for their permission to record the discussion – we will destroy recording after reporting.
• Inform interviewee(s) when the recording function is turned on.

[Turn on recording function]

Ice breaker

• Ask participants to introduce themselves and explain their roles

Background and understandings [5 mins]

What do you understand the overall aim of the RUC pathway to be?

[If needed reiterate purpose of RUC as outlined in the purpose of discussion bullet point]

Key impacts [15 mins]

• The overall purpose of the RUC programme is to reduce self-presentation attendances to A&E. How do you feel the RUC programme is measuring up against its purpose?
• Thinking about the RUC programme specifically, what impacts have there been on staff from the implementation of this? [Ensure focus is on impacts of RUC on staff and not other impacts]
• - Can you describe how it’s had a positive or negative impact on staff?
• Have you received any feedback from patients regarding RUC? If so, to what extent has it been successful (or will be successful) in improving the experiences of patients/service users?
• {If improvements} Can you describe how it’s had a positive impact?
• {If not improved} Why do you think it’s not had the expected impact?
• In your opinion what have been the impacts, if any, on local communities?
• In your opinion has access to and/or use of urgent care changed (improved or deteriorated) for certain groups?
• What impact, if any, has the RUC programme had on any equality and equity issues?

Key learnings, changes and challenges [20 mins]

• What factors have helped with implementing the RUC pathway so far?
  • Has it been harder or easier than expected to implement?
  • What do you feel has gone well?
  • How did COVID-19 affect the implementation of RUC pathway?
• Could you talk about any challenges that the implementation of RUC has created in the delivery of urgent care?
  • In what ways, if any, have these challenges affected your working practices or wellbeing?
  • How, if at all, have these challenges been resolved?
• Since the RUC pathway was introduced in December 2020, have you noticed changes in how your colleagues implement the pathway?
  • If so, how and why were changes made?
• Have there been any unintended consequences from the redesign of urgent care?

(If struggling to answer then give examples - such as losing staff from A&E to staff FNCs or creating a new caseload that would have previously sought care elsewhere)?

• [For NHS 24 call handlers, FNC staff and managerial] Can you describe the pathways available after the Flow Navigation Centre to patients within your Health Board?
  • Do you feel there are enough – or perhaps too many - alternative pathways available?

Support from the Scottish Government [5 mins]

[This section is for the group with staff in managerial roles]

• Please describe the support (if any) you and your colleagues have received from the Scottish Government through the process of implementing the RUC pathway
• What did you think about the fortnightly engagements/update sessions?
• What were the guidance materials like?
• Going forward, what would you change, if anything, in the support you/your organisation receives in implementing the RUC pathway?
  • What type of support would be helpful?

Measurement of impact [5 mins]

[This section is for the group with staff in managerial roles]

• What ways (if any) is the value or success of the RUC pathway being measured in your service/Health Board?
  • Impact on resourcing
  • Impact on patients – experience and care outcomes
  • Impact on staff
• How do you feel that the RUC programme should/could best be measured, at an organisational or national level?

Overall and closing [5 mins]

• How should RUC evolve? What could be done to improve the RUC pathway?
• If you could say one thing to the Scottish Government about the RUC pathway, what would you say?
• Is there anything we haven’t ask you that you think we should know for this evaluation?

Facilitator to wrap up with summary of learning, importance of gathered information for evaluation, and thanking participants for their involvement. Check that it will be okay to get back in touch with staff if necessary to clarify anything.

How to access background or source data

The data collected for this social research publication:

☐ are available in more detail through Scottish Neighbourhood Statistics

☐ are available via an alternative route

☒ may be made available on request, subject to consideration of legal and ethical factors. Please contact dlhscbwsiawsiaa@gov.scot for further information.

☐ cannot be made available by Scottish Government for further analysis as Scottish Government is not the data controller.