A sense of urgency: setting up an urgent treatment centre

Setting up an urgent treatment centre in just eight months has been exhausting and inspiring, says Dr Sian Stanley

Our acute trust has an urgent treatment centre (UTC) and its contract with the current provider was put out to tender in March, for an integrated UTC to take over from November. It wanted a lead provider model, with a collaboration agreement between community providers and the acute trust. Some could call this a supercharged integrated neighbourhood team (INT).   

The contractual arrangements are complex, but in essence our PCN joined with the PCN next door and won the bid. You may have noticed that from first meeting until launch was only eight months.

We worked collaboratively with two community trusts, the acute trust, the out-of-hours provider and the integrated care board (ICB), and are all committed to bringing a new perspective to the UTC. The community trusts have recruited to substantive posts, the acute trust has given estate, the ICB contractual expertise and the PCNs have pulled it all together and developed the operational model. My role is medical director.

For those of you who have tried this sort of thing before, you will know that such an endeavour requires three perspectives. Primarily there is the clinical perspective, which I have been leading. There is the contractual perspective, done by our wonderful CEO who deserves a medal for wading through all the detail, rewrites and tracked changes. Then there is the operational perspective, which has been the biggest of all the curve balls with different orgnanisations, which employ people in different ways with different ways of working and different policies.

Clinically things don’t change that much. There are different ways of doing things, but essentially a good interaction between patient and clinician is at the heart of what we do. To my mind, patients want kindness and competence.

A contract is a contract. It is vitally important and protects all of us but in the end, it is a black and white document on which we all do, or do not, agree.

Operational models are fascinating, though. People always talk about relationships and these have carried us through. The time frame was so tight we have had to abandon some of the traditional management language and opt for the direct approach. This has not always made for easy listening. We have had to accept that each of us is as important as the other and that together we are better. The IT has been a hurdle that looked insurmountable but we found that each organisation has an expert who can do things with a computer system that you did not know were possible. 

As clinical lead I was dispatched to the ED to discuss exclusion criteria. What started as a group of clinicians who were wary of escalating workload became a group of people with similar experiences and a shared purpose.

So we are all exhausted but exhilarated, the madness that comes when you can see the destination. We have no idea where this will ultimately take us but we do know this has given us as a group of GPs a voice within the system and meaningful influence. We are working towards a common goal of making things better for patients, for ourselves and for the profession. We have made unlikely allies and created a microcosm of interorganisational harmony. It still might all go horribly wrong but so far we are doing okay.

Dr Sian Stanley is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire. Read more of her articles here.