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Blog: What next for urgent care?

29 May 2013

NHS Alliance chief executive Rick Stern puts forward an answer to making integrated care work, even including unpopular non-urgent care number NHS 111

NHS Alliance chief executive Rick Stern puts forward an answer to making integrated care work, even including unpopular non-urgent care number NHS 111

It’s been a busy time for urgent healthcare. A couple of months ago in March, I wrote a piece for the NHS Alliance’s manifesto for primary care that outlined important steps which need to be taken if urgent care is to be made effective. It stressed the need to simplify an overly complex and fragmented system that too often proves difficult for us to navigate as patients when we have an urgent health problem. 

'Politically driven timetable'
Since March, there has been intense media focus on the state of urgent care in England, but, instead of meaningful and informed debate, we have seen only criticism thrown in the direction of primary care. In April, for example, Jeremy Hunt publically blamed general practice for a rise in patients presenting at A&E, stating that poor primary care provision and the changes to the GP contract in 2004 were to blame for the rise in emergency admissions. Mr Hunt’s berating of GPs has since continued – with a particular focus on out-of-hours care – regardless of a determined backlash by representative bodies. It was hardly a productive start to the process.
We have also seen the stalled launch of NHS 111. As a flagship government policy designed to alleviate problems in the urgent care system, NHS 111 dramatically collapsed in a number of areas very soon after going live. The NHS Alliance raised concerns about the system long before April, predicting that, despite years of planning, many areas would be underprepared for the transition, not least because they were in the midst of the largest restructuring in the history of the NHS. Nonetheless, a politically driven, rigid timetable did not allow for delay.
Since then, in a key speech, the Secretary of State has talked in more constructive terms about the central role for general practice and primary care as a whole.  
'Saints and sinners'
So where does this leave urgent care?  The reality is that it is not a question of saints and sinners. Demonising GPs or throwing resources at A&E departments will not provide an enduring solution.  It is tempting to look for the 'magic bullet' that will rebalance the system and improve care.  But the reality is that complex problems tend to have a series of complex solutions. 
General practice does have its role to play, with many practices having plenty of scope for improving access and identifying potentially urgent cases. The ambulance service needs to work more closely with primary care to keep people out of hospital.  Many hospitals need to tackle the blockages that mean that too many people are stuck in A&E rather than getting the treatment they need elsewhere in the hospital. If NHS 111 is to survive and potentially thrive it must effectively link to the system that sits beneath it … and so on.  Good health systems look at all these problems and many others as part of a whole and work out how to tackle them together.  
In the end, as patients, we care about our overall experience not a series of separate interventions.
It is more important than ever for all parties in this debate to adopt a shared commitment to improving patient care, putting aside political, organisational and professional interests.  The answer to making urgent care work lies in making each of the individual parts in this complex system work effectively; only then can we hope to attempt to join it all together.

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