The health service reforms have seen GP commissioners quickly identify urgent care as an area on which to focus, not least because of the large potential savings that can be made. Henry Clay of the Primary Care Foundation explores what urgent care involves.
The term ‘urgent and emergency care' is used to describe everything from life-saving treatment for people who suffer strokes, heart attacks or trauma through to the apparently simple process of providing reassurance to the worried patient or carer.
In urgent care systems that work well, patients know which service to access and receive care in a timely fashion. Further, the services operate in an integrated and consistent manner that emphasises that general practice is the foundation of the NHS.
In this way the system provides appropriate care and addresses the rising costs of urgent and emergency care – for example by providing paramedics with primary care support (both in and out of hours) for patients who might otherwise need to be admitted to hospital.
To make this happen commissioners need information about their local system. Anne Talbot describes NHS Bolton's clinical dashboard on page 20, demonstrating clearly how information is collated and available the next day to help individual GP practices understand which urgent care services their patients have used. It is a powerful tool to support general practice in meeting the needs of their patients.
The whole picture
GPs and PCTs often lack a rounded picture of their urgent care system as many hospitals cannot yet provide reliable information for each of the recently published A&E clinical quality indicators,1 although this is improving.
We at the Primary Care Foundation are supporting PCTs and newly formed commissioning groups to understand their local urgent care system by using such data together with that from other urgent care services like walk-in centres.
An unusual example of action being taken based on data analysis is that of South Central Ambulance Service (page 22), which is using the information that it has derived to submit evidence to the licensing authorities about a night club.
Alongside an analysis of the data, commissioners must also consider whether the patient pathways used in their urgent care are appropriate and clearly defined. Commissioners should start with the most used and most expensive pathways, which in practice means focusing particularly on the care provided to the elderly, but also considering children as they too are heavy users of urgent care.
Effective approaches
The approach adopted by the Birchwood practice (page 23) puts GPs at the front of the process so that they are in a position to make effective use of the mix of skills within a practice.
Commissioners and GPs also need to consider the new 111 number currently being piloted.
There is some uncertainty about how many patients will dial 111 because of actual or perceived difficulty in accessing care through their GP practice, but the feature on page 18 shows how 111 can act as the ‘glue' to integrate an urgent care system.
However, imposing a 111 service in an area where there are failings in an individual urgent care service, where services do not operate in an integrated way or where there are too many practices that patients find difficult to access could well just add to the difficulties and this will be a challenge for GP commissioners to grapple with in the future.
Henry Clay is director of the Primary Care Foundation (www.primarycarefoundation.co.uk). He has compiled a list of relevant documents for those involved with the commissioning of urgent care services.
Focus on... urgent care Focus on... urgent care
