- The Dorset Integrated Urgent Care Service is in crisis. Dorset Clinical Commissioning Group has set up a Working Group with monthly meetings to look at the issues & come up with solutions.
- The Integrated Urgent Care Service is on the agenda of the Dorset Healthcare NHS Foundation Trust Annual Members’ Meeting, 3-5.30pm, 23rd October at the Allendale Centre, Wimborne.
- Hopefully Dorset people will turn up and demand full and truthful information about what’s going wrong with the Dorset Integrated Urgent Care Service.
Dorset Healthcare – which is the Lead Provider for the troubled Dorset Integrated Urgent Care Service – say all are welcome but places are limited.
Here is where you can book a place at the meeting.
Dorset Healthcare must come clean with Trust members about the “crisis” in the service, which they are the Lead Provider for
From their press release about the Annual Members’ Meeting, the Governors seem unaware or unbothered by the Dorset Integrated Urgent Care Service mess.
It quotes Lead Governor Jan Owens as saying that the Dorset Integrated Urgent Care Service is:
“a really good example of how all your local health services are working closely together to make sure people can access the right service at the right time.”
This oversight or omission looks like serious negligence on the Governors’ part.
Since the Integrated Urgent Care Service is supposed to be a key means of reducing A&E attendances and admissions, the mess it’s in is bad news for the proposed A&E cuts/centralisation in Dorset.
It makes it likely that the single A&E will be unable to cope with the numbers of patients who need it.
This is just another example of the madness of NHS marketisation and the contracting it requires.
The crisis in the Dorset Integrated Urgent Care Service is multi-faceted
For starters, in the past one Trust (South West Ambulance Service) ran the Urgent Care Service.
With the new Integrated Urgent Care Service, it’s gone to 5 “partners” – the Dorset Healthcare community and mental health services trust together with local GPs, Dorset’s 3 acute hospitals and South West Ambulance Service Trust
The Lead Provider for the Integrated Urgent Care Service, Dorset Healthcare trust, has apparently:
- screwed up Out of Hours GP pay from Day One,
- reduced GP shifts,
- failed to recruit additional Advanced Nurse Practioners / Emergency Care Practitioners,
- can’t keep LTCs stocked with essential equipment / meds and has been pretty rubbish engaging & communicating with out-of-hours GPs.
And South West Ambulance Service Trust have pulled out of the contract, saying staffing levels for NHS111 were the root of their problem.
Under the Integrated Urgent Care Service contract, NHS 111 has radically changed
Formerly, it was an “assess and refer” service – patients phoned NHS 111, and NHS 111 told them where to go.
But in the Integrated Urgent Care Service, NHS 111 is “consult and complete”.
In other words, you phone NHS 111 and they hand you off to a phone Clinical Advice Service. Their mandatory target will be to complete at least 50% of phone consultations (driven by algorithms in the form of a Clinical Decisions Support System), without referring the patient elsewhere.
NHS England’s NHS111 urgent care workforce development webpage says:
“Staff have to be ready to deliver these changes. They need the right framework to support them in making these changes effective and safe for patients. This need is recognised, and a joint programme of work between NHS England and Health Education England is in place to develop an optimal Integrated Urgent Care workforce.”
That’s the theory. In practice, it looks as if it’s not worked out for South West Ambulance Services Trust. This must call into question Dorset CCG’s contract procurement process.
If the service fails, what will happen to patients who need it?
The problem may be with the contract specifications set out by NHS England, combined with underfunding and understaffing.
NHS England required all areas of England to introduce an Integrated Urgent Care Service in April 2019. Here’s some info about this from us.
In West Yorkshire and Harrogate, the Joint Clinical Commissioning Committee admitted the Integrated Urgent Care Service contract specifications were so complex they didn’t know how to procure the contract and had to pay £238K to the management consultants Attain to do it for them.
The Dorset Integrated Urgent Care Service is a lead provider contract which is probably unworkably complex and/or transfers too much risk to the providers.
Previous lead provider contracts have ended in tears – eg Cambridgeshire End of Life services, Staffordshire cancer services.
NHS England’s 2014 guidance “Innovative contracting for integrated care: What are the risks and benefits of various contracting methods?” identified that Lead Provider contracts:
- significantly shift risk from the commissioner to the provider
- have limited proof of concept in the NHS
- have minimal evidence base or evaluation in the NHS
- have a major problem with deferred funding (don’t know what this means)
Since then things have not gone well with NHS Lead Provider contracts, with spectacular failures in Cambridgeshire and Staffordshire.
So why is the NHS still using them? Looks like more “disruptive innovation” woo to us.