SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

A proportion of transfers to ED will involve high acuity patients who have presented with
conditions that are out of scope for the UCC. It is therefore important that UCC staff possess
the training, equipment and facilities required to stabilise patients in the event that their
condition deteriorates before transfer can take place (e.g. resuscitation training and
equipment).
Specialist input
Where a patient is not moved, but expertise is given by another organisation (e.g. expert
wound management by an ED consultant or a radiology report) it is important that there is
clarity as to who retains overall responsibility for the patient. The GMC guidance „Good
Medical Practice‟ on working with colleagues is relevant here.
The provider is responsible for working with Trust colleagues to put in place arrangements
for remote specialist input. This may require a contractual arrangement in the event that
specialist advice is provided by a separate organisation.
Working across organisational interfaces
It is recommended that all policies, processes and procedures relating to organisational
interfaces are developed jointly between the UCC provider and the relevant hospital Trust
prior to implementation. These interfaces should be kept under review and regularly
discussed at Joint Clinical Governance Group meetings.
However, on their own, formal governance structures are not sufficient to deliver a genuinely
integrated service model. Evidence suggests that strong informal working relationships
between ED and UCC managers and clinicians are a necessary pre-condition for effective
joint working 6 . This is especially true where UCC and ED services are operated by different
provider organisations.
Feedback from providers indicates that most barriers to inter-organisational working are not
structural, and could be resolved more effectively via the fostering of strong, day-to-day
relationships between provider organisations. In many instances, potential issues can be
pro-actively identified and addressed without the need to resort to formal escalation.
Patient Involvement
The UCC provider will make arrangements to carry out regular patient experience surveys in
relation to the service and will co-operate with such surveys, including surveys of the ED that
may be carried out by the Commissioner or hospital Trust. In discharging its obligations
under this clause the provider shall have regard to any Department of Health guidance
relating to patient experience.
The UCC provider will be expected to demonstrate evidence of having used patients‟
experience of using the service to make improvements to service delivery. CCGs and UCC
providers should consider collaborating to develop a standard Patient Experience
questionnaire to allow service comparability across NW London.
Accountability
The UCC provider will be accountable to the appropriate local Clinical Commissioning Group
as commissioners of the service.
6 Primary Care and Emergency Department Primary Care Foundation 2010
7b. Work of the Emergency and Urgent Care CIG 166