Introduction and Purpose
The purpose of this policy is:
- To document the BrisDoc approach to forward planning for service delivery of Severnside Integrated Urgent Care service over the Winter months.
- To ensure that early warning systems are in place to identify risks to service delivery.
- To ensure that a robust action plan is in place to manage risk pro-actively and provide service resilience.
- To ensure that business continuity plans are in place to provide a swift and commensurate response to capacity pressures, severe weather conditions and epidemic disease.
- To ensure that systemic relationships are established with other healthcare providers in BNSSG to allow effective escalation and partnership working.
Data Analysis and Activity Forecast
BrisDoc takes a proactive approach to capacity planning throughout the year:
- Activity data is reported on a weekly basis and measured against plan.
- Delivery of KPIs is monitored monthly to determine if resourcing is sufficient to meet patient demand in an effective, efficient and resilient manner.
- The clinical rota is reviewed quarterly against observed patterns of demand and ability to deliver KPIs. Clinical resource is changed dynamically as required using established algorithms to match available appointment numbers to demand profiles.
Operational Readiness
Staffing resilience
Clinical staffing at BrisDoc is provided through a combination of employed staff and regular self-employed locum staff, with approximately 200 GPs, Nurses Advanced Paramedic Practitioners and Pharmacists providing a regular contribution to the Out of Hours rota. Local GPs from practices within BNSSG provide the majority of medical cover Nurses are all Nurse Practitioners and most are qualified to prescribe.
This large pool of clinicians provides an ability to flex the service capacity up and down to meet demand, reacting within days, or even hours if necessary. Additional capacity is provided via two locum agencies, if necessary.
There is a pool of clinicians who are set up to provide additional hours on an on-call basis working at home. This option is contingent on all systems being available to provide an equitable level of safety and governance (ie secure systems and telephone recording) as for on-site workers, so all clinicians providing remote triage must have be set up on the cloud based phone system Synety.
All clinicians are subject to rigorous recruitment and induction procedures as well as ongoing clinical audit utilising our Clinical Guardian system.
Operational staffing is provided from a pool of approximately 100 staff. In addition to those who work regular hours, we also have a small “bank” of casual staff who can be called upon to provide cover for sickness or annual leave.
Wherever possible these members of staff are also multi-skilled and can be deployed as drivers, call handlers or hosts as the need arises.
Christmas and New Year Period
Annual leave is restricted for a two week period over the Christmas and New Year period. Exception leave requests from staff for the Christmas period are not considered until all rotas are filled for the Bank Holiday period, to ensure that approval is co-ordinated with the needs of the service and the ability to provide resilient cover.
The staff bank of casual staff and overtime will be used to provide cover for additional bank holiday shifts and annual leave during this period.
Adverse weather planning
Business Continuity plans are in place for the sustainability of the service during severe weather conditions. Contingency plans include:
- Staff information collated and filed regarding ability to walk to a service base in adverse weather.
- Staff briefing distributed detailing action in adverse weather conditions.
- Four wheel drive vehicles strategically located at bases across BNSSG and used to collect essential staff unable to drive to work, as well as carry out home visits.
- Remote working arrangements scoped to allow clinical advice telephone calls to be made without travel to base.
- Special arrangements to be made to cope with increased patient demand due to cold weather, e.g. respiratory infections.
Treatment Centre Capacity
In the event of additional capacity being required for clinics and consultations, BrisDoc has the flexibility to provide this across five BNSSG locations. This enhances capacity, flexibility and choice for patients, and will provide sufficient resilience in the event of a base being unavailable for use due to staffing or other constraints. Bases currently used for service delivery are:
- Greenway Community Practice
- Cossham Hospital
- Clevedon Hospital
- 168 Locking Road, Weston Super Mare
- Marksbury Road Surgery
In addition, Osprey Court Head Office is used for call handling, remote assessment and as a control room for the Shift manager, W&CCs and senior clinicians. This provides additional capacity and contingency locations should one of the bases not be available.
Senior management support and escalation
Severnside IUC has an established on- call procedure for the provision of senior management and executive support at all times. Clear criteria for escalation are in place and at times of additional pressure, further senior support will be provided during the out of hours period.
At all times first and second line managers on-call are experienced operational members of staff with extensive knowledge of the service and the urgent care systems.
An additional flexi clinician rota is also put in place for weekends to respond to key gaps.
Partnership working
Severnside is committed to building strong partnerships and joint working arrangements with other providers. BNSSG urgent care network meetings will be the vehicle for ensuring that key risks have been evaluated and for co-ordinating robust contingency strategies.
Ambulance service
Calls from SWAST paramedics represent the largest percentage usage of BrisDoc’s healthcare professional line service. This service provides a valuable advice and safety net function, and facilitates effective risk management when exploring alternatives to hospital admission. Paramedics callas are prioritised to ensure a timely response and reduce wait times.
Community
Calls from District Nurse and Rapid Response teams are also supported by BrisDoc’s healthcare professional line. As with paramedics this service supports colleagues with decision making and risk management, with a particular emphasis on palliative/EOL patients.
In-hours GP
BrisDoc has a robust process for ensuring that there is clear communication of special notes and important clinical information to patient’s own GP practices, and has a dedicated e mail address for practices to communicate with the IUC Service. The Practice Liaison system ensures that patients who have accessed the service are flagged by telephone to the practice early the following morning when the patient needs urgent review or follow up by the practice.
System working
Severnside takes part in the both the daily System call and the Seasonal Planning calls, to ensure we working as part of the local system and providing patients with the appropriate access to the right care, first time.
BrisDoc’s Clinical Toolkit enables IUC clinicians to access relevant local guidance, policies and all community services and pathways to inform decision making by clinicians.
Preventative measures
BrisDoc encourage all staff to be vaccinated against flu. If they are not able to access this from their own GP we will make internal arrangements for staff to be vaccinated. We will make sure that the option is available to all employees, and will actively promote the importance of front line staff receiving the vaccination.
Staff members who choose to be vaccinated at high street pharmacy outlets can be reimbursed for the cost of the vaccination.
BrisDoc’s Infection Control policy outlines best practice with regard to managing outbreaks of infectious disease, eg Norovirus, and is embedded below.
Communications
Patient information
Patients who bypass 111 or other healthcare provider to access the Out of Hours service will be redirected if appropriate. Appointments will only be provided for “walk in” patients if an assessment is considered immediate and necessary.
Information stands are located at all IUC treatment centres with patient information leaflets to advise on seasonal risks and prevention measures.
Contact List of Key People
| TITLE | NAME | NUMBER |
| Managing Director | Nigel Gazzard | 07903 857557 |
| Medical Director | Dr Kathy Ryan | 07833 507628 |
| Urgent Care Deputy Medical Director | D Anne Whitehouse | 07855 949965 |
| Programme and Service Director | Deb Lowndes | 07753 447068 |
| Director of Nursing, AHPs and Governance | Rhys Hancock | 07503655911 |
| Head of Nursing and Allied Health Professionals – IUC | Renuka Suriyaarachchi | 07557 823615 |
| Head of Integrated Urgent Care | Lucy Grinnell | 07717 360438 |
| Severnside Shift Manager Phone (out of hours only) | Shift Manager On Duty | 07748 931309 |
| Workforce Manager | Mike Duncan | 0117 9370900 |
Change Register
| Date | Version | Author | Change Details |
| August 2011 | 2 | Sonia Brown | Change to content |
| August 2011 | 3 | Traci Clutterbuck | Change to content |
| August 2011 | 4 | Becky Brown | Change to format |
| October 2011 | 5 | Becky Brown | Updated Key People and Duty Manager task list |
| August 2012 | 5.1 | Traci Clutterbuck | Demand profiling updated, remote working updated, PCC capacity updated, pandemics or extreme demand updated, duty manager intervention updated, call management updated, contact list updated |
| September 2012 | 5.2 | Helen England | Review and revisions following BNSSG Winter Simulation Event and feedback from PCT urgent care lead. |
| August 2013 | 5.3 | Gillian White | Revised for new BNSSG service model |
| November 2014 | 5.4 | Gillian White | Updated to reflect recent changes |
| November 2015 | 5.4 | Gillian White | Updated |
| November 2016 | 5.6 | Gillian White | Updated |
| October 2019 | 5.7 | Lucy Grinnell | Updated |
| 03.05.2023 | 6 | Lucy Grinnell | Review and update |