Commissioners must come up with local solutions to tackle the overuse of A&E services. We profile three innovative ways of remodelling urgent care – for the benefit of patients and the budget.
1) Putting pressure on the acute trust's foundation application
Local GPs declined to support Croydon University Hospital's application for Foundation Trust status unless it agreed for primary care to take over the front end of casualty.
Dr Tony Brzezicki, Croydon GP and founding chair of the Commissioning 4 Croydon consortium, said the move was necessary because it was part of its QIPP plan agreed with its PCT.
Dr Brzezicki said local A&E use was disproportionately high: ‘Some 51% of the hospital's income is from A&E.'
‘The plan is now to have the "meet and greet" in casualty done by primary care staff.'
‘Meeters and greeters will basically send anyone who doesn't need to stay in hospital back to see their GP. The extra workload can easily be accommodated in primary care – for most practices, it will be one or two extra appointments a day.'
Dr Brzezicki said Commissioning 4 Croydon will carry the scheme forward as part of the overarching QIPP plan.
2) Changing the local nightclub's licence
An ambulance trust used evidence from its callout data to get a nightclub's licence changed – resulting in a 90% cut in callouts from the venue.
South Central Ambulance Service analysed the patient report forms completed by paramedics after each emergency response and scanned them into a clinical audit reporting system (CARS).
Data from the forms is used to audit and improve clinical performance and can be used to make commissioning decisions.
The system shows where emergency responses take place – which could be the address of an individual patient or a particular area or building.
When CARS revealed 60 responses to assaults and alcohol-induced emergencies at a single nightclub in a 12-month period, evidence from the ambulance service was submitted to court. The action resulted in conditions being put on the club's licence – plus a change of management at the club.
Emergency responses reduced by 90% to just six incidents in the following 12 months, South Central Ambulance Service said.
3) A practice in-house urgent care team
Appropriate Care at Point of Need based at the Birchwood practice in North Walsham, Norfolk, brings together a primary care paramedic, nurse practitioner and healthcare assistant, all under a dedicated GP's supervision.
The aim was to provide more appropriate immediate and emergency care in the local community by allowing the lead GP to decide who is seen, as well as where and when.
Pilot results showed the scheme had cut unnecessary emergency admissions by half.
Over an initial eight-month period, only 11 of the 305 patients who contacted the surgery before being seen by the paramedic needed hospital admission. Only five were transferred to A&E for minor injury assessment.
Unnecessary A&E admissions have reduced by half, while 80% of patients have been sent down more appropriate treatment pathways.
About £18,000 has also been saved through decreased ambulance use and unnecessary admissions.
Lead GP Dr Paul Everden said: ‘The scheme has resulted in a faster response to need, a better use of healthcare resources, more selective use of ambulances and – most importantly – a clear message from patients that they are more satisfied with the care given.'
The DH is now considering extending the scheme to other practices.
Three unusual ways to reduce A&E admissions Three unusual ways to reduce A&E admissions
