Urgent Care Services provide care with the aim of preventing hospital admissions and/or increasing A&E diverts to reduce pressure on Emergency Services and Hospitals.
Historically, substantive resource had remained static despite peaks and troughs in demand and overall capacity and demand was not clear, in fact it was considered that you could not plan in these types of services.
The Executive team invited Meridian in to undertake a project following on from programme number one held in Community Nursing. With the aim to identify demand by base, reduce bank & agency spend and avoid incurring costs due to the implementation of a new Clinical Assessment Service (CAS).
There are 6 Urgent Care Bases, 1 County Wide Home Visiting Team, 1 Clinical Assessment Service and 4 separate GP Out Of Hours Services (OOHs) across the Trust which make up the Urgent Care Service.
The project was a continuation of work within the client organisation therefore an official analysis was never held.
Meridian worked with the management team within Urgent Care Services through a series of interactions, consisting of meetings and workshops. During these various sessions a new management control system was designed to ensure effective running of the service.
The key focus was to implement management controls to evidence the capacity that existed within each of the teams, so that this resource could be better applied across the county and teams to reduce Bank & Agency spend and minimise necessary cost incursions due to increased demand within CAS.
The new management controls installed helped the Trust achieve the following financial and operational results:
- Reduced Bank & Agency (B&A) spend from the original baseline by £487,728 annualised (07/10) as documented through the week by week tracking on spend, with £220,756 annualised confirmed through Finance month end (M5).
- Released 131.6 hours per week, equating to £175,639 of reinvested resource within the Day Home Visiting Team, which has been realigned to Urgent Care Bases. This has enabled training opportunities and support for Urgent Care Centres with the aim of further reducing Bank & Agency Spend and eventually will ensure the appropriate level of Clinical Assessment staffing once the Service goes live.
- Additional support for the Clinical Assessment Service (CAS) has been identified within the Out of Hours Service, resulting in CAS being supported by these staff, once the appropriate training has been provided (end of October). An average of 339.6 hours per week has been identified across 4 Out of Hours teams. The opportunity is valued at £415,573 when annualised based 2 upon the workforce operating at 100% utilised capacity.
- A large focus of the Trust is on the implementation of the Clinical Assessment Service which has been delayed. Through the program demand has been successfully forecast for the Service which is key when attempting to project the resources required. This will ensure no additional cost is incurred through its implementation.
- Seasonal Trends have been established within the Urgent Care Centres which show contrasting trends across teams. This knowledge when put to appropriate use is minimising the impact of peaks in demand on both staff, patients and finances.
- As a result, LCHS NHS Trust have realised more opportunity that the £345,187 originally proposed, £220,756 from B&A, £175,639 from day Home Visiting and a cost avoidance of £415,573. In addition 84% of the project costs have been recouped during the project length through reducing B&A and reinvesting Home Visiting staff.