Minutes of Unscheduled Care Meeting
Cheere House, HHGH 25 September 2006

Meena and I attended a Large Meeting including representatives from St Albans, and North Herts, consultants, nurses, GPs, paramedics, social services, and patient groups.
North Herts have moved ahead and have found that most problems occur from difficulty accessing the service so has suggested a single point of contact (SPOC). Their urgent care centre is effectively an A&E “Minors”. Because patient care is streamlined, there is no “double counting” saving £££. They have also looked at Home visiting and getting discharge summaries to the responsible GP by 8am the next morning as per OOH standards. Clinical staff will probably be rotated between A&E and Urgent Care Centres to ensure reproducible, excellent clinical standards. The Unpicking/Unbundling of the GMS contract was also mentioned – this could have implications on access monies and funding for GPs.

The Group then divided into 2 working groups – 1 addressing the Bridging Proposal to get a GP into A&E as soon as possible and to co-locate Harmoni in A&E until the end of their contract in October 2007.  Meena went to the bridging group. The PCT would like to get harmoni at the a/e by 1/12/06, so that the harmoni doctors will see GP type patients thus reducing PBR cost to £10 per patient. There is much work to be done and it is proposed that we meet every 2 weeks. The hospital trust seem happy with the idea.

The Other Group worked on the Urgent Care Centre or provision of service.  I attended this group. Howard Borkett Jones suggested 4 models which were added to as the afternoon progressed. Essentially
1)	MIU as at SACH (staffed by ENPs)
2)	MIU + follow up and review clinics eg Fracture/hand clinics. (ENPs with consultant input)
3)	MIU + minor illness management (ENPs + GPs at some times)
4)	MIU + minor illness management + Medical presence on site (ENPs, A&E staff grade, ?GPs)

I then added my vision which Mark Jones and I had come up with which is essentially (3) + Remote GP triage. (Presentation to exec next week). Questions were asked as to what would happen to walk in patients needing triage and Steve Laitner suggested maybe “turning the triage idea on its head” and have then Nurse practitioners triaging.  The specification seemed to get more and more detailed suggesting Fracture clinics on site, OOH with GP on site, Diagnostics ((Bloods, Xray ?24hour cover), observation area, ECG, Resus equipment. THIS SOUNDS MORE LIKE A HOSPITAL!! Rapid assessment unit with 8 beds for staff grade Gerontologist assessment was also proposed. 

After the meeting, Meena, Lyn, Dee, Jackie and I met in a separate room and I presented my vision of triage and MIY to the PCT who thought “it was excellent and want to support it” according to an email I received this morning. I have stressed that this is a draft only and needs the Exec approval prior to going to more senior management.  Lynn and Dee reiterated that it is US who are commissioning the service at this point and WE decide on the specification. WHHT could be providers.

Next Meeting is Monday 30th October 2006 2pm at HHGH.