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How do we improve urgent and emergency care?

How do we improve urgent and emergency care?
By Angela Sharda
1 September 2017

Major changes are on the way to tackle growing pressures and inconsistency in urgent and emergency care. They raise important questions:

  • How can we make the new NHS 111/Integrated Urgent Care Clinical Assessment Services a safety valve?  Or will they act as a demand escalator
  • Will they cost more?
  • What can they help with? Where do the ambitions look more problematic?

It is too early for clear answers – but these are vital issues to discuss. And plenty of more detailed questions follow. What will be the impact of extended hours primary care? How much will this reduce demand on NHS 111? Demand for the helpline is very low during the working week – so will out of hours fall to the same level of demand? 

Winning trust

It may not be easy for the Integrated Urgent Care Clinical Assessment Service (IUC CAS) to take on the assessment of those 999 calls that do not require an ambulance immediately. How much will the ambulance service trust that appropriate care and guidance is provided to these patients? 

The clinical lead will be ultimately responsible for safety – certainly in the eyes of the press and public and possibly in the eyes of the law too. How can they make sure the system is so strong that they will be able to sleep at night?

Opportunities for success

There are some answers and opportunities. Done right, an integrated urgent care front end, including seeing patients face to face, can meet the same demand as the existing 111 and out of hours (OOH) service. And be delivered for the same cost envelope.

Increasing clinical involvement early in the process will reduce the pressure on downstream primary and secondary care services. But how do we identify which cases will be best assessed by which group? And how do we establish which cases need no further clinical phone input but can be directed by the call-handlers?

We know too many patients do not follow the advice that they have been given over the phone. But when a clinician has had the time to provide reassurance and to check the patient understands the agreed plan is much more likely to be followed.

During the in-hours weekday periods the demand is so low that providing a full mix of skills is difficult. The service will operate very differently at different times in the week. So how can we ensure a consistent and appropriate response?

Bringing services together

How can the range of face to face services (walk-in centres, OOH services, MIU, UCC etc.) be brought together to avoid the inefficiencies from being fragmented?

How can they balance the need to provide bookable as well as walk-in slots? 

How can the patient be directed to the right skill group to minimise the chance of needing to see more than one clinician face to face?

These are some of the questions that I am looking forward to discussing. I’m keen to get your views.

Henry Clay will be speaking at the Healthcare Leader forums in Birmingham, 14 September, and Reading, 21st September.

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