CCGs 'must rethink urgent care provision'
CCGs have been urged to focus on developing ‘fully joined up’ urgent care rather than commissioning services separately, to address ‘wide variations’ in the current system.
A new report from the Primary Care Foundation, which offers quality assessment services in primary and secondary care, said the current set-up was characterised by urgent care centres providing an ‘inconsistent’ set of services, causing confusion among the public, patients and even health professionals about ‘which service to use when’.
The report found evidence of the same centres treating patients with different conditions at different times of the day, and reported vastly different opening hours from centre to centre, ranging from 12 to 24 hours.
It also reported that some centres treat only routine cases that could be managed in primary care while others had a full range of diagnostic services on offer.
Despite one of the objectives of urgent care centres being to reduce attendance at A&E, the report said that ‘none was able to demonstrate that savings had been delivered to the taxpayer’.
The report also found that some urgent care centres do not provide a rapid response, and allowed ‘significant queues to build up’.
The Foundation said the report showed CCGs need to clearly define expectations of all services and measure their impact across the whole health economy, specify and analyse data required to demonstrate the impact, and to integrate urgent care services with the wider primary and secondary care system.
It also advised CCGs to promote the use of ‘see and treat’ processes rather than ‘triage and wait’, to develop a consistent approach to governance that drives quality and cost effectiveness, to collect patient feedback consistently and coherently and act on it, and to describe services accurately for the NHS 111 Directory of Services to provide clear information for patients.
Summarising the need for greater integration, the report said: ‘We frequently found services co-located with GP out-of-hours services, but did not always find an operational link between the two separate services. This is strange as often the only difference between the groups of patients treated was how they had chosen to access care.
‘Where services are (or could be) co-located there will be opportunities for integrated working that will make balancing the workload easier and increase the range of conditions that can be treated. Commissioners and providers need to work together to realise these benefits - in particular to define who has the responsibility for reallocating resources or redirecting patients at peak times whilst recognising the impact on the performance measures of the individual services.’
Foundation director, Henry Clay, said: ‘This report demonstrates the importance of fully joined up commissioning of urgent care rather than commissioning services separately as has sometimes happened in response to centrally driven innovations. There is a need for local commissioners to take a clear strategic view of all their urgent care services and develop an integrated approach that includes primary care.’
He added: ‘The public are confused about the range of terms we use and the lack of consistency across services. It is time to develop a core set of services, minimum standards and a consistent terminology, so that patients can recognise where to go and have greater confidence about the range and level of service they can expect.’
Dr Agnelo Fernandes, a GP in Croydon and RCGP urgent care lead, who led the College’s guidance on commissioning urgent and emergency care last year, said many of the Primary Care Foundation’s recommendations were already being put into practice, but said the guidance was ‘still relevant’.
He said: ‘It illustrates such huge variation. There are lots of things here that resonate, and in terms of recommendations I would support them. Integrating urgent care with the wider primary and secondary care is exactly what we said in the RCGP guidance.
He added: ‘Commissioners who have done things in isolation need to have a much more holistic approach. In Croydon we redesigned the whole system together rather than little bits of it, so 111, out-of-hours, urgent care and an urgent care centre in the front end of ED
‘Redesigning A&E which is where the biggest impact is. Where it doesn’t work is just having an urgent care centre on the side of A&E, really you need it at the front end to be the gateway and to be able to stream quickly people who need the emergency department and those seen in the UCC.’