All integrated care systems will be required to have a community-based falls service that covers the whole region and operates 8am-8pm seven days a week by the end of this year.
These should include ‘clear routes for onward referral’ into primary care, NHS England has said.
Under NHS England’s new plans for winter resilience published yesterday, ‘rapid response’ community falls services should be available as an alternative to double-crewed ambulance response for all level one and two falls for all adults at home and care homes.
Some services are already operational but access is variable and ICBs have been asked by NHS England to map current provision and establish new community fall response services where there are gaps by 31 December.
Emergency admissions for falls are increasing year on year with a significant impact on the NHS and patients, NHS England said.
The plan said: ‘All local systems should have a community-based falls response service in place between 8am and 8pm for people who have fallen at home including care homes. The service should be in place by 31 December 2022 and be available as a minimum 8am-8pm 7 days per week.’
ICBs must have whole system responses in place including ‘clear routes for onward referral’ to primary and community care, falls prevention and rehabilitation services, it added.
And ‘ongoing support to the community-based responder service for escalation, onward referral or discharge as appropriate’ must also be in place, it said.
Initial assessment would normally be coordinated by advanced practitioners based in the ambulance control room who would despatch the appropriate service and have clinical oversight.
Other proposals from NHS England to reduce significant pressures on health and social care services in what will be a ‘very challenging winter’ include ‘active consideration’ of acute respiratory infection hubs to provide additional capacity.
It follows modelling that suggests cases of Covid, flu, pneumonia and acute bronchitis could fill up to half of NHS beds this winter.
It is unclear who would staff any acute respiratory infection hubs that are put in place.
But details of how services might operate included an example of a paediatric respiratory hub run by a PCN in Sandwell last winter to boost capacity in primary care and staffed by two GPs, which reported that less than 1% of the more than 1,000 patients seen ended up being referred to A&E or a paediatric assessment unit.
NHS England guidance on acute respiratory infection hubs
Hubs, which would care for adults and children, will support patients through same-day access to assessment and specialist advice and could include point-of-care testing and other diagnostics, NHS England said.
GPs would be able to refer patients to the hubs, potentially with ‘direct booking by non-clinical roles to reduce pressure on clinical staff’, and would be kept informed following their consultation, it added.
The goal is to reduce ambulance call-outs, A&E attendances and hospital admissions for patients that can be managed in the community as well as reducing the burden of acute respiratory illness in primary care, NHS England said.
But it added that while the hubs should manage patients ‘identified through an initial remote/triage consultation as requiring face-to-face assessment but not as requiring hospitalisation’, some ‘more complex patients’ may ‘benefit from continuity of care in their general practice setting’.
Services may look different depending on local systems but build on the experience of hot hubs set up during the pandemic.
The plans said: ‘Primary care, secondary care and NHS111 will need to work together to prevent large numbers of children and older patients with breathing difficulties from being triaged with the outcome of an emergency ambulance, as many of these patients do not need to be admitted and can be looked after in the community.’
The NHS England plan also said:
- Local commissioners should decrease the rates of ambulance conveyance from care homes, including by mapping the provision of the PCN care home enhanced service by November. One case study around additional support outlined a ‘care home hub response’ staffed by a GP clinical lead and advanced clinical practitioners
- There should be increased use of virtual wards
- PCNs and commissioners should ‘consider’ implementing ‘targeted proactive’ support for patients who are frequent attenders
NHS chief executive Amanda Pritchard said the NHS was facing a combined impact of flu, Covid and record NHS staff vacancies.
She said: ‘It is right that we prepare as much as possible – the NHS is going further than it ever has before in anticipation of a busy winter and today we have set out further plans to step up these preparations – building on our existing plans to boost capacity set out in August this year.
‘Whether it be new services to support people who have fallen at home, hubs to treat respiratory infections or system control centres helping us to navigate pressures across the entire country, every one of these initiatives will make a real impact on the ground – helping to relieve pressure on frontline staff as well as seeing patients quickly and directing them to where they can receive the best possible care.’
The plans follow confirmation from NHS England’s primary care chief that there will be ‘no additional winter funding’ to support GPs over the next few months.