The evidence to date is that urgent care centres (UCCs) remote from A&E departments do not reduce attendances or admission.
However, the unique nature of the Corby UCC does reduce A&E attendances and admissions.
This has the potential to be replicated around population centres of 70,000 or above to support local emergency services in delivering a high quality A&E service for patients that require the infrastructure and skills available at a DGH.
In 2011/12, NHS Corby was in the bottom 10% of all CCGs for A&E utilisation. The number of patients being admitted to hospital for less than 24 hours was increasing year on year, costing approximately £1.3m annually. The existing community-based urgent care services were not effective in curtailing A&E demand or reducing emergency admissions and costs were increasing.
In 2010, as an aspiring CCG, local clinicians developed a vision for urgent care, which would support clinicians to manage patients in the community more effectively, streamline services and improve cost effectiveness.
At the centre of this vision was a community-based urgent care centre (UCC) with a range of diagnostic facilities and an observation area.
The business case set out an ambitious plan to build a new UCC worth £2.6m, decommission all existing community-based urgent care services and recommission a UCC that would initially open from 8am – 8pm, 365 days a year with full diagnostic support during these times.
At the heart of the business case was a £500k annual saving, achieved through a reduction in A&E attendances and a reduction in 24 hour admissions to the local acute trust.
Subsequently, an 8am-8pm GP home visiting service was also commissioned and GP out-of-hours care is also provided during the opening hours of the UCC to support admissions, avoidance and enhanced treatment in the community.
The key restraint on managing more care in the community is the lack of access to immediate diagnostics and the ten minutes in which a local clinician has to make a decision.
The UCC allows the co-location of point-of-care blood testing, X-ray, ultrasound and observation couches where patients can remain for four hours.
This changes the ten minute GP consultation to an assessment, appropriate diagnostics organised by a senior clinician, observation of response to treatment in the observation couches and then either discharge, admission to a GP step up bed in the community or hospital admission.
The service is staffed by experienced local GPs and a combination of nurses and nurse practitioners. The clinical lead is also a GP who has an honoree consultant post in a local A&E department. Staff rotate through the A&E department and the governance and support for the local diagnostics is provided by our local hospital.
In essence the UCC can deal with about 70% of activity that now takes place in A&E departments safely and effectively.
What has been the impact?
The UCC is having a significant impact on the delivery of urgent care and supporting care in the community as close to home as possible.
In the first eight months of operation:
- A&E attendances have fallen from 350/1000 population to 171/1000 population, putting Corby into the lowest 10% of CCGs in the country for A&E attendances (note the A&E figure including a minor injury unit)
- there has been a 27% reduction in adult 24-hour admissions
- we have seen a 14% reduction in paediatric 24-hour admissions
- there has been an estimated full year saving of £685K per year – about £10 per patient/year. The UCC is contributing to the QIPP target of the CCG.
Selected ambulance cases are being diverted to the UCC and as part of a pilot an emergency care paramedic has recently been stationed at the UCC. This allows ambulances to be back on station at a fraction of the time taken at our local A&E department.
All patients have a clinical triage assessment within 15 minutes of arrival and the UCC has maintained a 100% four-hour target with most patients being seen and sorted within two hours.
From a personal perspective, the ability to manage patients who I otherwise would have admitted gives me great satisfaction and has added another dimension to my work as a GP.
Key to the success has been the focus on primary care, delivering the service with its ability to manage risk in the community, partnership working with other stakeholders and patients and engagement and support of local clinicians.
Corby is now in a strong position to develop more community-based services and expand the opening hours of the UCC.
Dr Peter Wilczynski is chair of Corby CCG