A single point of access (SPoA) within ICSs will help to relieve primary care pressures, new guidance from NHS England has said.
The document outlined guidance around SPoA services, which were set out in principle in the operational planning guidance for 2024/25 and the emergency care recovery plan update 2023/24.
These said that ICSs must create a single point of access to provide an integrated care coordination service.
This new guidance, published 28 August, said these services would improve patient access and optimised care alongside reducing pressures on primary care and minimising health inequalities.
It stated that while there is ‘no single right way to establish a SPoA model’, that there are foundation components that all systems must have in place by winter 2024/25 ‘as an absolute minimum’.
These foundations include an operating model, core multidisciplinary team, system collaboration across services, and system integration and technology in place (see box for details).
Services must then be developed further and have ‘full case management’ by March 2025. Requirements for this include:
- Providing advice and management for patients with urgent and complex needs to avoid ambulance call outs and/or transfer to hospital
- Supporting general practice and integrated neighbourhood teams by:
- Managing escalation of care and avoiding ambulance call outs
- Planning for the inclusion of social care as an integral partner
- Reviewing opportunities to further reduce duplication between clinical teams; for example, alignment with care transfer hubs or CAS supporting NHS 111/999.
- Learning and improvement cycles.
- Technical development areas such as developing a digital platform or having real-time visibility of capacity and demand in sending and receiving services.
The guidance said that systems may choose to build on existing SPoA models or expand integrated urgent care services, but duplication ‘must be avoided’.
It added: ‘SPoA implementation is part of the approach to improving patient flow by providing more care to patients outside of hospital settings. SPOAs can also help to ensure patients receive hospital-level care at home by increasing referrals to urgent community response (UCR) and virtual ward (VW), also known as hospital at home.
‘Timely access to expertise from across the health and social care system means that patients can be managed in the community or booked directly into the right acute care setting – for example, direct to same day emergency care (SDEC) – supporting a “right care, right place, right time” ethos for patient care and better outcomes for patients.’
It follows a report which said ICSs have too many targets that ‘constrict’ progress on inequalities and called for a smaller set of outcome-driven targets to address a widening health expectancy gap.
Foundation components of SPoA
Operating model
- System (integrated care board) level or place based as agreed locally
- 7 days a week, 365 days a year. Hours should align to locally agreed need and typically be at least 12 a day
- Provides clinical assessment, with access to a senior clinical decision-maker (in person and /or virtually)
- Referral into a range of receiving services, with activity and subsequent outcomes captured.
- System in place to monitor and act on referrals into receiving services that are rejected
- Senior clinical decision-maker, for example advanced clinical practitioners (ACPs)/nurse consultant or doctor
- Clinical team with representation from community, acute, ambulance and social care services
- GP and/or frailty consultant/geriatrician and/or Emergency Department (ED) clinician involvement to enable referral to the most appropriate setting
Connected teams (in person/hybrid/virtual)
- Co-located/connected teams to maximise relationship building, skills/knowledge sharing, joint working and referrals to partner services such as VW and UCR. Physical/virtual links should be developed where appropriate with services such as NHS 111/CAS
- System partnership working across urgent and emergency care (UEC), hospitals, ambulance, primary care, community care and social care services to ensure full involvement in the MDT and maximise referral opportunities
- Clear leadership agreed to ensure robust governance, risk management and patient safety
- Ensures timely transfer of appropriate patients from ambulance stack into alternative receiving services by improving interoperability, for example implementing interoperability toolkit messaging as a minimum
This requires:
- Visibility of patients waiting for an ambulance dispatch
- Access to shared records
- Ability to transfer a case between MDT members as required
- Visibility of appropriate waiting lists and real-time capacity
- Ability to book directly into and referral to key services
Technological limitations should not be a barrier to practical solutions, for example sharing of information among those working in the MDT.
- Locally agreed referral pathways into community and hospital receiving services and trusted assessor models
- Priority receiving services should include, as a minimum, UCR, VWs, SDEC and UTCs
Senior clinical decision-makers
- Capability to manage clinical risk appropriately and ‘hold’ clinical risk while arranging appropriate diagnostics and/or follow-up and care for patients, in collaboration with other services including VW and UCR
- The SPoA should ensure that ambulance crews can handover the patient case to the SPoA to manage and then leave the ‘scene’
- The ability to take clinical responsibility for sub-acute patients in real-time marks the start of care co-ordination.
Source: NHS England
