Download Out of Hours to RAF Leeming, RAF Linton-on-Ouse

CONTRACTS
Schedule 1 to
CTLBC/1752
CTLBC/1752
Schedule 1
Statement of Requirement
CONTRACT FOR THE PROVISION OF OUT OF HOURS
PRIMARY CARE SERVICES TO RAF LEEMING, RAF LINTON-ON-OUSE,
RAF FYLINGDALES & RRH STAXTON WOLD
CONTRACTS
Schedule 1 to
CTLBC/1752
STATEMENT OF REQUIREMENT FOR THE PROVISION OF OUT OF HOURS
PRIMARY HEALTH CARE SERVICE AT RAF LEEMING, RAF LINTON-ON-OUSE, RAF
FYLINGDALES AND RRH STAXTON WOLD
REQUIREMENT
1. The Contractor shall provide Out of Hours primary care treatment to personnel
registered with RAF Leeming, RAF Linton-On-Ouse, Population 900 and RAF Fylingdales
Regional/Station Medical Centres(R/SMC).
RAF Leeming,
RAF Linton-On-Ouse,
RAF Fylingdales,
RRH Staxton Wold,
Population 1801
Population 900
Population 79
Population 30
2. The Contractor shall be accountable to the Officer Commanding RAF Leeming, RAF
Linton-On-Ouse and RAF Fylingdales through the Senior Medical Officers.
3. This statement of requirement contains certain ‘Minimum Standards’, which must be
no lower than those of the local PCT-approved Out of Hours Provider (which are, de facto,
described in both DH1 and MOD2 policy). Additional, military or unit-specific, requirements
will be provided by the local PCT-approved Out of Hours Provider or, alternatively, from
unit resources or taken at risk following discussions with the Unit Commander and with HQ
AIR, ACOS Medical. Additional Military or Unit specific requirements are attached at
Annex B to this Schedule.
PRIMARY CARE TREATMENT – MINIMUM STANDARDS
4. The Contractor shall provide an Out of Hours primary care treatment service for
personnel registered with the R/SMC at RAF Leeming , RAF Linton-On-Ouse, RAF
Fylingdales whereby personnel will identify themselves by giving the Senior Medical
Officer (R/SMO) at RAF Leeming, RAF Linton-On-Ouse, RAF Fylingdales as their GP
address. The service shall include:
4.1 Telephone Service to triage all calls and to offer advice or arrange
consultation where deemed clinically appropriate by the contractor.
4.2 Consultations are to be carried out at the contractor's appropriately equipped
medical premises, a nominated Primary Care Centre, at the Station Medical Centre
(R/SMC) or at the home of the patient as deemed clinically appropriate by the
contractor.
4.3
Faxed or email notification is to be sent to the appropriate R/SMC before
08.30 hours the following day or sooner if required, detailing all activity involving
RAF service personnel registered at the respective R/SMC. Details of telephone
1
National Quality Requirements in the Delivery of Out of Hours Services – DH dated Oct 04 (reconfirmed in 06),
SGPL 17/04 Primary Medical Care Out of Hours Cover for Service Personnel and Civilians Registered with Service
Practices – dated 13 Dec 04.
2
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CONTRACTS
Schedule 1 to
CTLBC/1752
calls are to include action taken or advice given and consultations are to include a
summary of the consultation, diagnosis and treatment carried out.
4.4 The Contractor shall provide a contact number to enable SMC personnel to
communicate with the Contractor on any matter regarding the Out of Hours service.
5.
Primary Care treatment is to include the following:
5.1 Treatment for acute and emergency medical problems as assessed by the
contractor.
5.2
Onward referral to another service (Accident and Emergency, 999 etc) as
necessary.
5.3
Issuing sufficient medication to commence treatment until the patient can
report to their own SMC for continuance of treatment/care or providing full-course
treatment which the patient will pay for if not exempt from NHS prescription charges.
PERIOD OF COVER
6.
The periods of cover to be provided are as follows:
6.1
Weekends between 1800 hours Friday to 0800 hours Monday.
6.2
Weeknights (Monday to Thursday between 1800 hours to 0800 hours)
6.3
Bank holiday & Public holiday cover (0800hrs to 0800hrs – 24 hours).
6.4
Xmas and New Year cover 25, 26 Dec & 1 Jan (0800hrs to 0800hrs).
HOME VISITS
7.
The Senior Medical Officer(s) at RAF Leeming, RAF Linton-On-Ouse and RAF
Fylingdales will arrange for the Contractor’s personnel who are visiting patients out of
hours to have access to the site(s). To assist the Senior Medical Officer(s), Contractor will
supply the Senior Medical Officer(s) with up to date lists of names of its drivers and car
registration details. The Contractor will also ensure that its drivers carry their official NHS
photo cards when visiting RAF Leeming, RAF Linton-On-Ouse, RAF Fylingdales and RRH
Staxton Wold.
CLINICAL GOVERNANCE
8. The Contractor shall have in place an effective System of Clinical Governance. The
Contractor shall nominate a person who shall be responsible for ensuring the effective
operation of the System of Clinical Governance. The person nominated shall be the
Contractor's representative who performs or manages the services under the Contract and
who shall liaise with the Designated Officer as appropriate.
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CONTRACTS
Schedule 1 to
CTLBC/1752
QUALITY REQUIREMENTS IN THE DELIVERY OF OUT OF HOURS SERVICES
9.
The Contractor shall ensure that all professionals involved in out of hours care are
eligible to be employed within the relevant parts of the NHS including General Medical
Services and Personal Medical Services. All prescribing to be undertaken by:
9.1
a medical practitioner
9.2
a nurse prescriber
9.3
a supplementary prescriber
9.4
Out of Hours Nurse (working under approved Patient Group Directives
(PGD's)
10. The Contractor shall be entirely responsible for the relevant appraisal systems
developed by the Contractor.
11.
Service delivery quality requirements shall be no less than those set out in the NHS
National Quality Requirements for the Delivery of Out of Hours services as detailed at
Annex A. The Contractor shall provide regular reports to the Authority’s Designated
Officer on their compliance with the Quality requirements, including;
11.1
Report on consultations (paragraph 2 of Annex A). The Contractor shall
supply full clinical details of all consultations to the Senior Medical Officer at RAF
Leeming, RAF Linton-on-Louse and RAF Fylingdales as appropriate by 0830 the
next working day.
Faxed notification shall be sent to the Station Medical Centre,
RAF Leeming (fax: 01677 457 001),
RAF Linton-on-Ouse (fax: 01347 848 922) and
RAF Fylingdales/RRH Staxton Wold (fax: 01751 470 830)
at the latest by 0830 the next working day, detailing all interactions between the
Contractor and registered RAF service personnel. Details are to include the
following:
11.1.1
the diagnosis, treatment and disposal of the patient
11.1.2
the name of the attending clinic.
11.2
Audit Reports (paragraph 4 and 5 of Annex A). The Contractor shall
provide copy of audit reports to the Designated Officer.
11.3 Complaints (paragraph 6 of Annex A). The Contractor shall provide a copy
of complaint reports to the Designated Officer.
RECORD KEEPING AND AUDITING
12.
Patients are to be informed of timescale during the initial consultation, including
time to visit at home or appointment time at Primary Care Centre or Walk-in Centre, and
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CONTRACTS
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CTLBC/1752
always contacted if an agreed home visit is delayed or if an appointment at a Primary Care
Centre is delayed.
13.
The Contractor shall ensure that if a patient registered at the R/SMC is still awaiting
a face to face consultation prior to 0800 hours in line with the National Quality
Requirements, that the individual is referred to the R/SMC and the R/SMC is advised
accordingly to ensure that the patient is attended within the Visiting Standards. Similarly,
the R/SMC shall advise the Contractor of patients who require a Home Visit between the
hours of 1800 and 1930 hours.
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Annex A to
Schedule 1
To CTLBC/1752
National Quality Requirements
1.
Providers must report regularly to PCTs on their compliance with the Quality
Requirements.
2.
Providers must send details of all OOH consultations (including appropriate
clinical information) to the practice where the patient is registered by 0800 hours the
next working day. Where more than one organisation is involved in the provision of
OOH services, there must be clearly agreed responsibilities in respect of the
transmission of patient data.
3.
Providers must have systems in place to support and encourage the regular
exchange of up-to-date and comprehensive information (including, where
appropriate, an anticipatory care plan) between all those who may be providing care
to patients with pre-defined needs (including, for example, patients with terminal
illness)
4.
Providers must regularly audit a random sample of patient contacts and
appropriate action will be taken on the results of those audits. Regular reports of
these audits will be made available to the contracting PCT. The sample must be
defined in such a way that it will provide sufficient data to review the clinical
performance of each individual working within the service. This audit must be led
by a clinician with suitable experience in providing OOH care and, where
appropriate, results will be shared with the multi-disciplinary team that delivers the
service. Providers must co-operate fully with PCTs in ensuring that these audits
include clinical consultations for those patients whose episode of care involved
more than one provider organisation.
5.
Providers must regularly audit a random sample of patients’ experiences of
the service (for example 1% per quarter) and appropriate action must be taken on
the results of these audits. Regular reports of these audits must be made available
to the contracting PCT. Providers must co-operate fully with PCTs in ensuring that
these audits include the experiences of patients whose episode of care involved
more than one provider organisation.
6.
Providers must operate a complaints procedure that is consistent with the
principles of the NHS complaints procedure. They will report anonymised details of
each complaint and the manner in which it has been dealt to the contracting PCT.
All complaints must be audited in relation to individual staff so that, where
necessary, appropriate action can be taken.
7.
Providers must demonstrate their ability to match their capacity to meet
predictable fluctuations in demand for their contracted service, especially at periods
of peak demand, such as Saturday and Sunday mornings, and the third day of a
Bank Holiday Weekend. They must also have robust contingency policies for those
circumstances in which they may be unable to meet unexpected demand.
1A-1
Annex A to
Schedule 1
To CTLBC/1752
Initial Telephone Call
8.
Engaged and abandoned calls:
8.1 No more than 0.1% of calls engaged.
8.2 No more than 5% call abandoned.
9.
Time taken for the initial call to be answered by a person:
9.1 All calls must be answered within 60 seconds of the end of the
introductory message which should normally be no more than 30 seconds
long.
9.2 Where there is no introductory message, all calls must be answered
within 30 seconds.
Telephone Clinical Assessment
10.
Identification of immediate life threatening conditions
10.1 Providers must have a robust system for identifying all immediate life
threatening conditions and, once identified, those calls must be passed to the
ambulance service within 3 minutes.
11.
Definitive telephone clinical assessment
11.1 Providers that can demonstrate that they have a clinically safe and
effective system for prioritising calls must meet the following standards:
11.1.1 Start definitive clinical assessment for urgent calls within
20 minutes of the call being answered by a person.
11.1.2 Start definitive clinical assessment for all other calls
within 60 minutes of the call being answered by a person.
12.
Providers that do not have such a system, must start definitive clinical
assessment for all calls within 20 minutes of the call being answered by a person.
Outcome
13.
At the end of the assessment, the patient must be clear of the outcome,
including (where appropriate) the timescale within which further action will be taken
and the location of any face-to-face consultation.
Face to Face Clinical Assessment
14.
Identification of immediate life threatening conditions
1A-2
Annex A to
Schedule 1
To CTLBC/1752
14.1 Providers must have a robust system for identifying all immediate life
threatening conditions and, once identified, those patients must be passed to
the most appropriate acute response (including the ambulance service)
within 3 minutes.
15.
Definitive Clinical Assessment
15.1 Providers that can demonstrate that they have a clinically safe and
effective system for prioritising patients, must meet the following standards:
15.1.1 Start definitive clinical assessment for patients with urgent
needs within 20 minutes of the patient arriving in the centre.
15.1.2 Start definitive clinical assessment for all other patients
within 60 minutes of the patient arriving in the centre.
15.2
Providers that do not have such a system, must start definitive
clinical assessment for all patients within 20 minutes arriving in the centre.
Outcome
16.
At the end of the assessment, the patient must be clear of the outcome,
including (where appropriate) the timescale within which further action will be taken
and the location of any face to face consultation.
17.
Providers must ensure that patients are treated by the clinician best
equipped to meet their needs, (especially at periods of peak demand such as
Saturday mornings), in the most appropriate location. Where it is clinically
appropriate, patients must be able to have a face to face consultation with a GP,
including where necessary, at the patient's place of residence.
18.
Face to Face Consultations (whether in a centre or in the patient's place of
residence) must be started within the following timescales, after the definitive
clinical assessment has been completed:
18.1 Emergency: Within 1 hour
18.2 Urgent:
Within 2 hours
18.3 Less urgent: Within 6 hours
19.
Patients unable to communicate effectively in English will be provided with
an interpretation service within 15 minutes of initial contact. Providers must
also make appropriate provision for patients with impaired hearing or
impaired sight.
1A-3
Annex A to
Schedule 1
To CTLBC/1752
1.
Additional, military or unit-specific, requirements which will ideally be provided by
the local PCT-approved Out of Hours Provider or, alternatively, from unit resources or
taken at risk following discussions with the Unit Commander and with HQ AIR, ACOS
Medical.
CASUALTY NOTIFICATION
2.
The Contractor is to ensure that all personnel employed as part of the OOH team
are familiar with the following terms used in casualty notification by the MOD:
2.1
Very Seriously Ill (VSIL): a patient is termed “very seriously ill” when his
illness or injury is of such severity that life is imminently endangered.
2.2. Seriously Ill (SIL): a patient is termed “seriously ill” when his illness or injury
is of such severity that there is a cause for immediate concern but there is no
imminent danger to life.
PRESCRIBING IN AIRCREW
3.
If aircrew are prescribed OOH emergency medication, the contractor shall advise
the individual(s) to discuss their treatment with a Station Medical Officer during normal
working hours and prior to flying again. Additional guidance shall be available from the
Station Medical Officers.
The contractor shall note the following medications related to Aircrew:

Antihistamines -
Loratadine is the only approved antihistamine.

Antiementic -
Cinnarizine the only approved antiementic.

Antibiotics -

URTIs

Eye Conditions
Most antibiotics are compatible with full flying duties, except
minocycline and aminoglycosides. However, the condition
for which they are ever prescribed usually precludes flying
duties.
Avoid cough and cold remedies as they tend to contain
belladonna alkaloids, ephedrine, dextromorphan or
antihistamines and are incompatible with flying duties.
Drops should be prescribed in preference to ointments.

Steroids

Psychotropics

Temazepam

Anaesthetic or
drug induced
Oral steroids are generally incompatible with flying. Topical
steroids (skin or nasal spray) are permitted.
Incompatible with flying duties.
Seek advice from the RMC before prescribing if the aircrew
member is expected to fly within 3 days.
 Aircrew should not fly for 48 hours after a GA, spinal or
epidural anaesthetic or drug induced sedation.
1A-4
Annex A to
Schedule 1
To CTLBC/1752
sedation
 They should not fly for 24 hours after LA or dental
anaesthetic.
* Note: the above list is not a complete list of medications that may be restricted to aircrew
personnel.
AVIATION MEDICINE ADVICE
4.
Aviation medicine advice will always be available from RAF Unit(s) medical
resources.
OCCUPATIONAL MEDICINE ADVICE
5.
Occupational Medicine advice should enable personnel in to specific occupational
groups to be reviewed by their own Medical Officer before returning to work.
MENTAL HEALTH CONCERNS FOR MILITARY PERSONNEL
6.
The contractor is to ensure that OOH doctors considering admitting a Serviceman
or woman for mental health reasons are aware of the Department of Community Mental
Health (DCMH), Contact Admissions Hotline 07970 578704 (09:00– 17:00) or Hospital
Coordinator 01785 -25788 (17:00- 09:00).
The DCMH on-call service is a Military (tri-Service), national, out-of-hours service provided
each day of the year by a Community Psychiatric Nurse (CPN), drawn from one of the UK
mainland DCMHs.
If a patient requires admission under a Section of the Mental Health Act, the patient is not
to be admitted through this on-call number or the In-Patient Service Provider, but through
the local NHS admitting process.
The purpose of the out-of-hours on-call service is to:
a. Provide administrative/procedural advice or assistance to the In-Patient Service
Provider (ISP – South Staffordshire & Shropshire NHS Foundation Trust).
b. Provide referring clinical staff with alternative case-management options,
where required, including arranging for a patient to have an urgent appointment
made at his/her local DCMH the next working day.
c. Maintain an accurate log of actions occurring during the period of duty and
pass information to a patient’s unit, local DCMH or the ISP, as appropriate on the
next working day.
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