Environmental Issues in Dairy Plant Effluent Discharge
The organic components in dairy wastewater, such as proteins, lactose, and fat, impact the environment due to their biodegradability and solubility. The high BOD and COD levels in dairy effluent pose challenges as they contain soluble organics, suspended solids, and trace organics. This results in pollution effects on waterways, atmosphere, land, and solid waste. The discharge of micropollutants from treatment plants is a global concern, affecting aquatic ecosystems. Wastewater discharge contributes to organic pollution in rivers, leading to oxygen depletion and disturbances in river ecosystems.
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Presentation Transcript
Devon Urgent Community service framework Approach and testing initial development September 2018
Todays session Aims: - To provide an understanding of the current urgent care system in Devon - To understand the national/local drivers for change - To introduce the work in Devon to review Community Urgent Care Services - To provide initial public feedback on services - To test with members approach to engagement and how they wish to be involved along with the members of the public they serve
What is our Urgent Care System? Now includes 111 online Community urgent care - closer to home
Development of a Strategic Framework Aims: - To provide an overview of national and local drivers behind change - To provide an oversight of current services across Devon - To be clear on the rationale for change - To provide a set of parameters against which to test emerging care models in localities - To ensure that the population of Devon receive good and equitable care
Why review urgent community services? National and Local drivers: Urgent and Emergency Care review, UTC standards, Devon STP strategy Devon STP Model of Care Issues with current provision - Variation - Inequities - Inefficiency (e.g. consequences of unplanned temporary closure) - Impact on ED - Vulnerabilities in workforce Opportunity make best use of workforce and resources
The 7 Key Standards for UTCs/Community enhanced services GP not required to be present full time GP led service with other multidisciplinary clinical workforce Open for at least 12 hours a day seven days a week 365 days a year Direct booking from NHS 111 and other services Requires an IT solution Access to care records e-prescribing ability Access to simple diagnostics Access to x-ray facilities, with clear access protocols if not available on site Direct referral to x-ray on alternative site
Current service landscape North and East Devon Total cost of service (actual cost not tariff) Any other primary care services on site e.g. OoHs TC, general practice/GP input Other diagnostics Location ie colocated in community hosp/practice/stand alone? Total Attends 17/18 Long-term staffing issues/concerns Clinical system used Links with MH services Quality concerns MIU GP led Opening hours Bloods ECGs Urinary X- ray East ECG Service - funded by CCG in contract value Fracture Clinic - funded by RDE Castle Place Practice RDE Community Hospital, incl clinics and maternity unit INR test, bladder scanner Co-located with Tiverton Community Hospital (RDE), same site as Castle Place Practice Community and Acute Crisis teams M-F 9-5, Sat 12-4, Sun 2-6 GP arrangement potentially insecure Tiverton MIU N 7/7 0800 - 2200 Y Y Y 15,840 863,800.00 Adastra None Community and Acute Crisis teams. PLT at RDE M-F (2 full days, 3 half days) Co-located with Honiton Community Hospital (RDE), same site as Honiton Surgery RDE Community Hospital, incl clincs DDoc TC Honiton MIU N 7/7 0800 - 2200 Y Y Y N 10,859 457,220.04 None Patient First None Co-located with Claremont Medical Practice at Exmouth Health Centre, same site as Exmouth Community Hospital (RDE) Community and Acute Crisis teams Exmouth MIU Y Claremont Medical Practice 7/7 0800 - 2200 Y Y Y M-F 9-5 N 11,479 581,548.00 None System One None Community and Acute Crisis teams Mon - Fri 0800- 1800 Co-located with Axminster Medical Practice Axminster MIU Y Axminster Medical Practice Y Y Y N N 668 35,750.00 None System One None Community and Acute Crisis teams Mon - Fri 0800- 1800 Co-located with Sid Valley Practice at Beacon Medical Centre Sidmouth MIU Y Sid Valley Practice Y Y Y N N 1,518 116,690.00 None System One None Community and Acute Crisis teams Mon - Fri 0815- 1800 Co-located with Okehampton Medical Centre Okehampton MIU Y Okehampton Medical Centre Y Y Y N N 1708 100,000.00 None System One None Community and Acute Crisis teams. PLT at RDE Mon:Sat 0800- 1600 Sun: 1000- 1600 Co-located with NDHT sexual health service Sidwell St (Walk in Centre) N Y Y Y N N 13,848 348,300.00 None Adastra None North Whole Day Closures 2018 = 3 Early Closures 2018 = 2 *Not Including Snowmagedon* Co-located with local community hospital PLT at NDDH Ilfracombe MIU N N/A 7/7 0800 - 1800 Y Y Y M-Th 1-5 N 4278 223,560 TrakCare None Whole Day Closures 2018 = 9 Early Closures 2018 = 2 *Not Including Snowmagedon* M,T,Th 9-1 F 2-5 Co-located with local community hospital, same site as local practice PLT at NDDH Bideford MIU N Bideford Medical Centre on site 7/7 0800 - 2000 Y Y Y N 7010 228,926 TrakCare None Co-located with local community hospital and local practice at Lynton Health Centre M-F 0800 - 1800 S-S 1100-1600 Lynton Resource Centre N Lynton Health Centre Y Y Y N N 365 Not Available None TrakCare Via practice None
Current service landscape South and West Devon South See note below: CQC rated the services as good - no issues Staff rotate across sites, no significant issues GP oversight to hospital inc MIU via Barton Surgery, co-located Weekday morning EMIS Symphony Dawlish MIU N 7/7 8.00-20.00 Y Y Y N Community hospital 386,564 No 5,999 CQC rated the services as good - no issues Staff rotate across sites, no significant issues EMIS Symphony Newton Abbot MIU N OOH TC on site 7/7 8.00-20.00 Y Y Y 7/7 9.00-17.00 N Community hospital 1,029,813 No 20,427 CQC rated the services as good - no issues Staff rotate across sites, no significant issues Weekday afternoon EMIS Symphony Totnes MIU N OOH TC on site 7/7 8.00-20.00 Y Y Y INRs Community hospital 650,698 No 7,954 West staff vacancies within a small establishment create challenges to opening times and skills consistency of opening times South Hams MIU (Kingsbridge) N 7/7 0900 - 1700 N Y Y M-F 0900 - 1700 Doppler Community hospital 352,740 System One NO 4,695 Staffing currently under review to match capacity with demand reflecting their support of primary care in Plymouth. Co-located with community hub, outpatient clinics, dental services, primary care proactive and pharmacy 1,825,079 Cumberland Centre (Plymouth) N 7/7 0830 - 2100 N Y Y 7/7 0830 - 2100 N 34895 System One NO NO staff vacancies within a small establishment create challenges to opening times and skills consistency of opening times Tavistock MIU N 7/7 0800 - 2200 N Y Y M-F 0900 - 1700 N Community hospital 6615 255,126 System One NO
Initial testing with the public (Devon wide exercise June 2018) Key themes - what people value Continuity of GP GP service Pharmacist advice MIUs Speedy attention Out of Hours availability Accurate advice and direction on where to go for help Services relatively close to home Consideration and respect NHS staff
Initial testing with the public (Devon wide exercise June 2018) Key themes - issues and concerns Waiting times for appointments with GPs are too long NHS 111 service misdirecting people and wasting time for everyone NHS 111 service process lengthy and irrelevant questioning Concerns about lack of expertise/knowledge in nurse-led services Lack of information on choices regarding non-urgent care Travelling distance Requirement for travel when housebound by condition Limited Out of Hours provision Need for MIU Limitations on the range of illness or injury dealt with Privacy not wanting to have to share details with GP receptionists
What does good look like? What could good criteria look like? Can these be weighted? Reasonable Access times Clarity of service offer Consistency in outcomes Workforce Sustainability Trusted information- full use of Digital offer Clinical standards Value for Money Integration Quality of care Prevention
Next steps - Milestones Consider all current and previous engagement on urgent care services across Devon Agree the engagement plan for the strategy for Devon to include all; Counsellors, OSC/HWBB, health and social care commissioners and providers, Clinicians, public, patients, carers, community groups, voluntary sector, regulators and regional/national experts Finalise strategy based on all engagement Devon system and CCG sign off of strategy In parallel to above review current landscape, gaps, alignment to latest guidelines and public feedback Develop options for future service delivery specific to each part of Devon
Questions How would elected members like to be involved? We are developing engagement plan - How do we best involve the public, patients, carers, staff? Do the parameters look reflective as they stand how can they be improved? What are the key things that members already know are important?
