Access to Care (AtC)

Access to Care (AtC) became operational on the 2nd July 2007. The Board of Wiltshire Primary Care Trust had agreed a vision for the future based on the delivery of a new style health service across the county and the development of a comprehensive Single Point of Access offering referral management support was an essential component of these changes.

Access to Care was initially an interim project to develop and implement a Single Point of Access for Wiltshire. The main focus was managing referrals into the newly formed Neighbourhood Teams. Gradually, the scope of the service has broadened to incorporate the roles outlined elsewhere.

In 2010 Medvivo (formally known as Wiltshire Medical Services) was awarded the contract to provide a Wiltshire wide SPA in conjunction with a county wide GP Out of Hours service. At this point Access to Care became a fully established service key to the delivery of community services across the county.

Access to Care (AtC) is the professional Single Point of Access (SPA) serving Wiltshire. The service has been commissioned by the Wiltshire Clinical Commissioning Group.

AtC is available 24 hours a day, seven days a week supported by our Single Point of Access Coordinators.

Between the hours of 8.30am - 9pm (Monday to Friday) and 9am - 5pm (Saturday, Sunday and bank holidays) the integrated care hub is fully manned by dedicated AtC clinical staff including Nurses, Physiotherapists, Occupational Therapists and Paramedics. Outside these core hours the service is provided by Medvivo’s Out of Hours clinical staff.

The philosophy underpinning Access to Care is:

"the delivery of care realised through the provision of person-centred services which are accessible, consistent and responsive, of the highest quality and are delivered as close to home as is appropriate, tailored to meet individual need.”

Key Role

• Referral route from primary care into Community services, Community hospitals and Intermediate Care
• To source and recommend alternative pathways avoiding inappropriate acute admissions
• To provide health and social care professionals with a 24/7 gateway into their relevant Community Team
• Manage all referrals into Community Hospital and Intermediate Care beds within Wiltshire
• Facilitates the discharge process from acute trusts and community hospitals
• Whole system overview – escalation planning
• Urgent Care @ Home 
• Acute Trust Liaison role at the 3 acute hospitals serving Wiltshire
• To innovate, test and develop future pathways to prevent acute admissions in the future

Admission Avoidance

The Single Point of Access plays a pivotal role in identifying pathways to ensure that patients are treated in the most appropriate location thereby avoiding unnecessary acute hospital admission. In doing so the Single Point of Access acts as an interface between health and social care providers.

Although the term ’admission avoidance’ is often used it is important to remember that saving money is only one reason behind this process. All of us have a duty to try and make sure that wherever possible, patients are treated within their own homes or as near to them as practicable.

AtC Case Management

One of the primary purposes of the Single Point of Access is to act as a referral mechanism into both the neighbourhood teams and the community hospitals. It is far more than a simple signposting service, the clinical staff planning the management of each case in detail before sending it to the receiving agency.

Cases can be referred using the following methods:

Telephone 0300 111 5818
Fax 0300 111 5919
Email mg.referralaccesstocare@nhs.net

Acute Trust Liaison

Seven days a week Medvivo's Access to Care Clinicians ‘in reach’ at the three main acute hospitals serving Wiltshire (Royal United Hospital, Great Western Hospital and Salisbury Hospital).

Our clinicians provide:

• An impartial pro-active presence to pull patients from the acute hospital
• A patient centred approach
• Liaison with patients own GP/care coordinator/community team/social services
• Expert guidance in the services/pathways available within Wiltshire
• Support to hospital staff in establishing the most appropriate pathways for patients

Urgent Care @ Home (UC@H)

Medvivo has been jointly commissioned by Wiltshire CCG and Wiltshire Council to deliver an integrated rapid health & social care response service, Urgent Care @ Home (UC@H) for service users in crisis in their own home. The service focuses on supporting service users to:

• Access appropriate assessments in the right place at the right time
• Remain at home with additional support
• 'Step up’ to a community hospital or Intermediate Care bed
• Expedite return to home with additional support following acute assessment

UC@H Assessment and Coordination

The Medvivo Single Point of Access (SPA) Team assess and coordinate support for service users who have been directly referred to the service or have been identified as appropriate within other pathways. If required, part of this assessment process is the provision of an UC@H crisis response, within one hour from receipt of referral. The UC@H crisis response can assist with further assessment and actively support the patient in the short term and is provided by the Medvivo Telecare Response Team operating from three bases spread across the county.

If required, the SPA then coordinates urgent domiciliary care support in order to ‘hold’ the patient in the community until standard care & support provision can commence. The SPA arrange and coordinate any required assessments e.g. a visit from the service users’ own GP and actively refer onwards for any continuing assessments or support required. Where it is not appropriate for service users to be supported at home, the SPA arrange their ‘step up’ admission into an Intermediate Care Bed, a Community Hospital or an Acute Hospital. If a service user has required acute assessment the SPA team can help to expedite their return home.

UC@H Domiciliary Care Provision

Often it is appropriate for service users to remain at home but they require an increased level of domiciliary support to enable them do so. When traditional/mainstream services are unable to provide this support quickly enough to prevent inappropriate admission, the SPA coordinates a dedicated UC@H Domiciliary Care Team. The Team deliver the required urgent care support until standard provision can take over (for up to 72 hours). Support provided ranges from one off support visits up to 24 hour care.

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