A doctor speaks to an elderly man

Somerset Treatment Escalation Plans (TEP)


The challenge:

At the beginning of the COVID lockdown in March 2020, Somerset CCG needed a solution to transmit patient’s Treatment Escalation Plans (TEPs),

which indicate their desired resuscitation wishes, from the hospital where this information has been recorded to their GP practice, in a timely manner, i.e., within 24 hours. Due to the prevailing circumstances, the solution required that TEPs be emailed directly to practices, for upload into patient’s Care Record.

The stakeholders were: Yeovil District Hospital; Taunton & Somerset Foundation Trust and Somerset Partnership (both now part of Somerset NHS Foundation Trust); and St Margaret’s Hospice.

In partnership with the project team and Somerset CCG, the Somerset TEP service was set up at short notice, run mostly by SCW IT trainers, and was initially envisaged to be a short-term solution. SCW is still providing the service some 14 months later.


What we did:

Corinne Raymont, SCW Senior IT Trainer, co-ordinated the work to set up the Somerset TEP Service by ensuring that the following were in place:

  • Organised access to the NHS Spine portal via a Smartcard, allowing SCW staff working to ascertain the patient’s GP practice.
  • A log of all activity to capture information regarding the receipt and transmission of the TEPs, which was saved in a secure way.
  • A colour coding system in Outlook, enabling SCW staff involved to “own” each TEP.
  • An up-to-date list of the email addresses for each surgery, which is regularly updated. Each practice was individually contacted to ascertain the correct email address to use.
  • Regular updates to the CCG, with data presented in visual as well as tabular form.
  • Scrutiny of each TEP to ensure they were legible, had a clinician’s name, signature and date, before logging each TEP to capture whether entries of certain fields within the TEP had been completed.
  • Reports to the quality lead at the CCG provided on a regular basis.
  • Regular meetings with primary care and SCW CSU representatives, to look at the processes and agree next steps.


The outcomes:

  • To date, over 5,500 TEPs have been processed and sent to 60 Somerset practices and 67 practices out of area.
  • Virtually 100% of TEPs received are processed and sent to the patients’ surgeries within 24 hours of receipt during a working weekday.
  • This work represents a positive example of where collaboration between Somerset CCG, SCW, the stakeholder trusts and St Margaret’s Hospice has resulted in patients’ resuscitation wishes being transmitted in a timely fashion.


Some of the comments from stakeholders included

“Fantastic news – well done everyone”

“Wonderful work, we should all be incredibly pleased with this achievement”
           Consultant Psychiatrist from Somerset FT

“Fantastic news and fantastic work … the benefit to patients is phenomenal – thank you everyone for your hard work!
           Clinical Director, NHS Somerset CCG

“Thank you, Corinne, and all of the SCW CSU colleagues who have worked on this service”
           Head of Digital Transformation, Somerset CCG

“I would like to thank you for the tireless efforts of Corinne Raymont, who has co-ordinated this service since day 1 and is responsible for validating and processing the vast majority of the TEPs generated, before forwarding to GP practices in Somerset as well over the county borders.”



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