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Urgent care services to work more closely

By Ian Cameron

Ambulance services, urgent care centres, pharmacies, social services and GP out-of-hours providers must work more closely together, a new Government review of urgent care services states.

Ministers are launching a consultation on proposals to standardise urgent care pathways between in-hours and out-of-hours care.

The discussion document, Direction of Travel for Urgent Care, said urgent and emergency services must become more responsive and efficient.

Among its recommendations are for clear treatment protocols to be written for entire health communities and that detailed care plans should be developed for at-risk patients, those with complex conditions, or those nearing the end of their lives.

It also says more use should be made of technology.

The Department of Health has also dropped the idea of a single national number for patients to call to access out-of-hours services. The proposal had been a cornerstone of the 1999 Carson Report into out-of-hours services, with NHS Direct meant to take the role on.

In an implicit criticism of its own policy since then, the document said earlier definitions of 'urgent', 'emergency', 'unplanned' and 'unscheduled' care, around which services were constructed, contained 'weaknesses and ambiguities'.

It also pointed to 'consistent concerns' around existing provision, including confusion among patients about what services were available and the fact providers did not measure or respond to patients' experience of their service.

Patients also tended to have to repeat giving basic information as they moved between different providers, resulting in 'disjointed' journeys in out-of-hours care, it said.

An Audit Commission report earlier this year found national standards were not being universally met.

Last week a coroner in London also called for the Government to conduct a review into out-of-hours arrangements following the death of a woman who was misdiagnosed by eight doctors.

Dr Mark Reynolds, former chair of the National Association of GP Co-operatives, said GPs should be proud the concept of a rigorous assessment appeared to have grown out of GP out-of-hours providers.

He said: 'It recognises that primary care triage at its best is a very cost-effective tool.'

Dr Paul Hobday, medical director of On-Call Care, an out-of-hours provider in Kent, said ministers had only paid lip service to a more integrated approach in the past.

He said: 'We would welcome closer links with psychiatrics and social services. As long as they don't stuff it full of bureaucracy, it sounds positive.'

A new definition of urgent care

• Urgent care is the range of responses that health and care services provide to people who require – or who perceive the need for – urgent advice, care, treatment or diagnosis.

• People using services and carers should expect 24/7 consistent and rigorous assessment of the urgency of their care need and an appropriate and prompt response to that need.

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