In implementing this procedure, managers must ensure all staff are treated fairly and within the provisions and spirit of NHS Fife’s equal opportunities policy. Special attention should be paid by ensuring the procedure is understood when using it for new staff to NHS Fife, by staff whose literacy or use of English is weak or for persons with little experience of working life.
In line with the Equality Act 2010 the procedure is committed to the fair treatment of its staff, potential staff and the users of the service, regardless of race, gender, religion, sexual orientation responsibilities for dependant’s age, physical/mental disability or offending background.
- This procedure relates to the provision of transport support for people accessing Out of Hours Urgent Care Centres across all localities of Fife who cannot access transport but whose clinical need can best be supported in a treatment centre.
- The function of this procedure is to:
- Ensure access to care in the most appropriate location
- Ensure efficient, effective and economical use of taxis to support safe and appropriate access to urgent care for people who are unable to access transport.
- Ensure appropriate clinical and operational use.
- Provide clear and concise guidance on the use of taxis in order to ensure consistent practice and to support correct use.
- It is expected that patients will generally make their own way to and from urgent care centres. The use of taxis must not be treated as the norm. All alternatives should be exhausted first.
- In exceptional circumstances transport may be requested to ensure timely access to urgent care where people cannot access transport themselves. This is arranged through the Urgent Care Dispatch Hub Fife and should be indicated by NHS 24 at the time of passing through the call.
- This procedure applies Fife wide to support access to care in the out of hours period 18:00-08:00 weekdays, all weekend and in public holidays.
- The responsibility for the application of the procedure rests with staff within and sessional GPs who have contract for services working with Urgent Care Services Fife.
- OPERATIONAL SYSTEM
- The procedure for determining if transport support may be required is detailed in this section.
- Patients should be encouraged to provide their own transport wherever possible by NHS 24.
- NHS 24 will confirm transport not available and advise the Urgent Care Dispatch Hub Fife of an Urgent Care Centre appointment where transport may be required. The outcome code ‘speak to clinician within 1, 2 or 4 hours’ will be applied. NHS 24 will indicate within the clinical summary ‘PCEC 1, 2 or 4 hours, possibly requires transport, speak to clinician 1,2 or 4 hours’.
- On receipt of calls indicating that transport support may be required the Urgent Care Dispatch Hub Fife will manage this as an advice call to ensure the most clinically appropriate support is arranged in Fife.
- The service will advise at the outset of a conversation about travel that there is the possibility that a bus ticket voucher will be provided for their journey home to support understanding. This will apply to patients with appointments between 8am - 8pm Saturday – Sunday who will be informed that there is a possibility they will be given a bus ticket voucher for their journey home. This will take into account patient safety, bus route availability and personal circumstances. If they have travelled with a member of their family, friend or carer they will also receive a bus ticket voucher.
- Procedure for Arranging Transport to an Urgent Care Centre or related out of hours provision (Flow chart given at Appendix 1)
- Where a patient requires to attend an appointment within four or two hours calls will be managed as an advice call initially to assure clinical appropriateness for taxi transfer. The clinician’s role is to determine the most appropriate location of care from a clinical perspective.
- Advice calls will be allocated by the Urgent Care Dispatch Hub Fife to:
- the Hub Clinical Co-ordinator (evenings and weekends)
- the session Clinical Co-ordinator (overnight)
- where the clinical co-ordinator is not available the call will be allocated to Senior/Advanced Practitioner or GP based on perceived need
- The Clinician must first check if the patient has a relative or friend who could provide transport.
- The clinician may:
- Confirm the clinical need for transport and pass the call to reception (or if not available the Urgent Care Dispatch Hub Fife) to arrange a taxi
- Provide clinical advice during the telephone call which negates the need for an appointment
- Arrange for a home visit review, based on presenting symptoms and taxi assessed as not being a viable option
- Refer patient for ambulance transfer if symptoms are assessed as immediately life threatening
- Where a patient requires to attend an appointment within one hour an advice call should be arranged as per above. The advice call would in the first instance make a clinical assessment of the 1 hour time scale allocation. If they assess the patient needs seen immediately within the hour then they should consider whether a home visit or a referral to the Scottish Ambulance Service is appropriate.
- The clinician undertaking the advice call will advise reception/call hander that a taxi is to be arranged for the patient. It will be determined if the patient has any person who is to travel with them as carer and any other support needed to ensure a safe and patient centred approach e.g. assistance to open the taxi door and wheelchair assistance to mobilise to the urgent care centre on arrival.
- The service will arrange the person’s appointment and confirm this with them and advise that a taxi will be booked. During the call they will determine if an accessible vehicle is required and if a car seat to ensure safe transfer of a child is required based on the legal requirements for transport for a child of that age (this will be the responsibility of the taxi provider to determine).
- Reception at the relevant Urgent Care Centre will make the taxi arrangements. The NHS Fife Taxi procedure will be accessed to support this (in terms of contract taxi contact details, which company pertains to the starting point of the patient’s journey and information to be relayed).
- Should a taxi not be available within the required timescales Reception will liaise with clinician to make a safety call to reassess the situation and make relevant arrangement e.g. potentially a Home Visit.
- Procedure – Return Journey (Flow chart given at Appendix 2)
- Clinical staff must first check if the patient has a relative or friend who can provide transport.
- Where the appointment is between 8am- 8pm Saturday’s and Sundays prior to the patient attending; reception will check bus routes and advise the clinician if there is a viable bus route in advance of the appointment.
- The clinician will assess if this is appropriate (e.g. would a walk from the bus stop to home be clinically appropriate or would this acceptable if the person is physically frail or has a sick child). The clinician will advise reception of their assessment and indicate to the patient that a bus ticket voucher(s) will be arranged.
- Reception will arrange for a bus ticket to be available where this is a clinically appropriate means of transport home. These will be issued to the place the patient was picked up by taxi or address on file. Ticket vouchers issued must be for a single journey.
- Only after all alternative forms of transport have been checked should a taxi be authorised and arranged for a return journey.
- Procedure for Patient Transport Between an Urgent Care Centre and other NHS Facilities
- Where patients require to be reviewed at a further NHS facility onward transport will be assessed on the basis of clinical need.
- If the base is due to close (e.g. 30 minutes before programmed closure) staff can request a taxi to transfer patients to other NHS sites where they do not have access to transport and based on clinical need.
- Taxi transport should not be requested for any patient who is bleeding or vomiting.
- If the Scottish Ambulance Service is the appropriate option for this type of journey then this mode of transport should be utilised. If it is felt that Scottish Ambulance Service is not appropriate or cannot provide the service and all alternative modes of transport have been explored, a taxi may be used in such circumstances.
- In the event of the patient being referred to another service for a further opinion and then subsequently discharged responsibility for the journey home will rest with the patient/receiving service. In the event that the patient is admitted, transport will not be provided for relatives or carers to return home.
- Procedure for Cancellation of a Taxi Booking
4.9.1. If a taxi booking is no longer required, the reception from which the booking was made is responsible for cancelling the booking. If the receptionist is unavailable the Dispatch Hub should be requested to cancel the taxi.
- Relationship to NHS Fife Taxi Procedure
4.10.1.This procedure is closely related to the NHS Fife Taxi Procedure (GP/R5) in relation to the contracting and management of taxi services. This includes:
- managing the contract
- monitoring taxi use
- ensuring appropriate taxi use
- The details of these are outlined in the NHS Fife Taxi procedure.
- The General Divisional Manager (West Division) is responsible for ensuring the appropriate ordering of taxis in relation to Out of Hours Urgent Care, and will designate members of staff to be identified as Authorisers and maintain a current list available for audit.
- Approved Authorisers are responsible for authorising taxi bookings. They will be responsible for retrospectively checking taxi reports and confirming that the use of taxis was appropriate and that no alternative transport was available.
- Line Managers/Authorised signatories should:
- maintain sufficient records of all approved taxi journeys which have been undertaken, to enable the appropriate checks to be made (prior to authorisation) of any associated taxi invoices which have been presented for payment;
- ensure that the procedure is applied fairly and consistently applied.
- All employees must adhere to this procedure when considering the use of a taxi as a means of transporting patients on behalf of NHS Fife.
- The use of a taxi which is authorised for payment and is for personal use is an offence. Where it has been identified that a taxi has been used by a member of staff for personal use, disciplinary action may be taken.
- Operational System
- Taxi usage will be monitored and any concerns/queries will be raised with relevant managers/authorisers.
- Taxi reports can be accessed from Trust-Share(\\san1a\QMHData)(T:) Taxi Management Reports which PCES admin/Urgent Care admin will review as necessary to confirm appropriate use of service. Reports will also be reviewed by the Clinical Care Group.
- All bookings will be reviewed retrospectively and should it be determined alternative transport was available, this will be reported to the Directorate Manager and the taxi cost subsequently recharged to the department.
- Appropriate Use of Taxis
- Taxis can be provided where it is not practical or possible, after exhausting all options, for an alternative mode of transport to enable access to urgent care.
- Staff may be required to justify the reason for booking a taxi.
- The use of taxis must not be treated as the norm. All alternatives should be exhausted first and full justification given before authorisation is made. Only in exceptional circumstances may taxis be used. Individuals must ensure approval has been obtained for the use and payment of a taxi by NHS Fife from their nominated authoriser.
- RISK MANAGEMENT
- Operational risks are managed through clear contingency planning in relation to:
- communication - back systems are in place
- access – weather, roads, availability of taxi etc would be managed by a home visit
- deterioration of patient in transit – clinical assessment before arranging taxi and taxi company process to contact dispatch
- RELATED DOCUMENTS
6.1 Out of hours Urgent Care Services –Operational detailed Process and Scripting, available within the service
6.2 Out of Hours Urgent Care Service – Operational outline step by step process, available within the service
6.3 Appendix 1 -Arranging Transport to an Urgent Care Centre or related out of hours provision
6.4 Appendix 2 - Return journey
NHS Fife Taxi Procedure(GP/R5)
For example a voluntary sector service supporting people experiencing mental health crisis – always follows clinical assessment as per procedure for UCC appointments.