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NHS England plans to reform urgent care 'inadequate'

MPs have criticised plans by NHS England to reform urgent care and have called on the Government to refrain from imposing a ‘single blueprint’ on primary care to solve the crisis in A&E departments.

In its report on urgent and emergency care, the House of Commons Health Committee said that the service structure needed to deliver accessible, high quality urgent care was different to that needed for core GP work. Because of this, local commissioners should be allowed to develop their own ways of providing urgent care, the MPs recommended.

This is contrary to England-wide plans developed by NHS England, which recommend same day, every-day telephone, web or email contact to a primary care team integrated with patient’s own GP practice and GPs/out-of-hours teams to have easy direct access to same day opinion from hospital specialists among other things.

Stephen Dorrell, the chair of the committee, referred to the NHS England review, which is being conducted by medical director Sir Bruce Keogh.

He said: ‘The committee conducted this review in the knowledge that Sir Bruce Keogh is currently conducting his own review of urgent and emergency care on behalf of NHS England. We hope that our recommendations will be reflected in his findings.

‘We were not convinced that the plans presented to us represented an adequate response to the challenges the system faces.’

The report said that the committee’ strongly believes’ that primary care was important for delivering ‘accessible, high quality urgent care’.

But it said this role required a different structure to the core role of general practice as defined by RCGP chair Professor Clare Gerada in her evidence to the committee.

The report said: ‘The service structure required to deliver this objective is different from the structure required to deliver “care to patients with complex needs and deal with uncertainty in acute conditions”. The committee does not favour a single blueprint from the Department or NHS England.’

Instead, NHS England should allow local area teams to develop their own plans, the MPs said: ‘The committee recommends that NHS England (as the commissioner of GP services) should seek innovative proposals for the development of community-based urgent care services in each area. These proposals should include consideration of step–up and step–down care and they should be properly integrated into the rest of the urgent care system in that area. NHS England should be open-minded about how such a service should be provided.’

The committee also urged the Government to transfer funding from the acute sector to primary care and criticised the rollout of NHS 111, and said that there should be clinical involvement earlier on in the triage process.

The MPs said: ‘In the long term, a transfer of funding from the acute sector in to primary care is required. Better signposting for patients is likely to stimulate demand in primary care and this transfer of resource will be required to provide the necessary capacity.’

On NHS 111, the committee said that there should be earlier access to a clinician. The report said: ‘We recommend that, as part of its workstream examining the future strategic direction of NHS 111, NHS England attributes a higher priority to the principle of early clinical assessment.’

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