In the first of a three part series focusing on urgent care, Lynne Heald, Senior Manager at Attain, talks about the current agenda to develop a more integrated urgent care system.
The concept of integrated care is not new but the increasing pressure on the NHS and local authorities and the need to do something different to ensure sustainability has led to development of system wide transformation programmes that seek, amongst a variety of other things, to look specifically to integrate urgent care.
In September 2015 NHS England published Commissioning Standards for Integrated Urgent Care (IUC). These standards are designed to build on NHS 111 (which is seen as an effective gateway into urgent care) and help deliver the benefits for patients set out in the Urgent and Emergency Care review led by Sir Bruce Keogh.
The aim is to develop a functionally integrated 24/7 urgent care system which will be the ‘front door’ of the NHS providing the public with access to urgent treatment and clinical advice when needed, whilst at the same time reducing pressure on emergency departments where possible. This integration will connect NHS 111 providers, primary care services, community services, ambulance services, emergency departments and social care across the 24hr period 365 days of the year.
The drive to improve sustainable urgent care systems has two primary focuses:
- the reduction in demand for high cost, high intensity resources by ensuring that only those patients requiring that level of treatment intervention are referred into it; and
- delivering care closer to home and increasing the incidence and capacity of patients to ‘self-care’.
The way to achieve this is through a ‘single’ entry point to a fully integrated urgent care system in which organisations collaborate to deliver high quality, clinical assessment, advice, treatment and where required ongoing referral using shared standards and processes, underpinned by clear accountability and leadership. The ambition is that contacting NHS 111 to access urgent care services will become the norm, but there will still be the ability to dial 999 or contact an individual’s own GP surgery – however there will be greater standardisation to the assessment at all these access points.
Currently contact with NHS 111 is through the 111 number but users will soon be able to contact NHS 111 through other digital means i.e. on line or mobile app’s. Once the system is accessed (by whatever mechanism) then integration across the whole system will ensure that the patient is clinically assessed and either:
- provided with appropriate self-care advice; or
- arrangements made to be seen by the most appropriate service/ health or social care professional
This will help to ensure the most effective and efficient utilisation of services in the best interest of patients.
NHS England have an intent for IUC systems to be in place across the whole of the country by 2020. There are interim targets of achieving fully IUC system across parts of England before this through the Urgent and Emergency Care Vanguard and ‘Accelerator’ sites supported by the vanguard funding and other supportive resources made available through NHS England. There are 17 criteria by which a system can be measured as delivering integrated urgent care that have been identified by NHS England with eight of those having been identified as particularly indicative of there being a functioning IUC system in place.
Some areas of the country are already making great strides into IUC but in other areas of the country progress hasn’t been as quick. If we accept that the integration as described above can reduce duplication, streamline services and improve patient outcomes and the patient experience overall (not to mention the ambition for 2020 national coverage) commissioners and providers across the country have to start working rapidly towards this goal.
This is a fast moving and innovative area which has real potential to make sustainable and meaningful change that will bring huge benefits to patients/service users if executed correctly. At Attain we have a strong track record supporting both commissioners and providers in the urgent care arena. Our multi-disciplinary teams have a wealth of experience in procuring, mobilising and managing these services. We have worked extensively in the ‘remote triage and assessment’ environment and have seen and been closely involved with the development of these innovative services (including the digital offer). Additionally we have maintained an active relationship and involvement with the IUC National Project Team and the ‘early implementers’ of IUC to ensure we remain current in our knowledge and thinking in this area.
Specific examples where our teams have made an impact for clients includes provision of procurement support for a number of integrated urgent care services, guiding and advising re the procurement options, development of service specifications and KPIs and then leading on the procurement process itself. We worked with a group of CCGs to mobilise their Integrated NHS 111 and Primary Care OOH Service following a successful procurement process. This mobilisation received very positive feedback from NHS England in respect of the level of detail, robustness and rigour with which that was delivered.
Most recently we have worked with a network Urgent and Emergency Care Vanguard to develop their integrated urgent care solution and two other collaborations of CCGs to provide pre-procurement advice and support to develop an integrated urgent care solution that meets all national and local requirements.
 Sites asked by NHS E to expedite the move to an integrated urgent care system primarily with the early development of Clinical Advice Hub and the meeting of the 95% A&E target. Awaiting a definitive answer on the measures but early indication is compliance with 95% A&E target and increase of NHS 111 calls going to clinical advice initially to 30%.
For more information on our experience or to discuss your local challenges please contact Lynne Heald or Gareth Hartley.