04.11.15
Further calls for co-locating urgent care services with A&E departments
Out-of-hours urgent and emergency primary care services should be co-located with A&E departments as diversion schemes have both been “costly” and “ineffective”, The Royal College of Emergency Medicine (RCEM) and Urgent Health UK have reiterated.
Recent research by the RCEM revealed that between 15-20% of patients attending A&E departments could be more effectively treated by other healthcare professionals such as out-of-hours primary care practitioners, community pharmacists and mental health teams.
Speaking at today’s Urgent Health UK's 2015 Annual Conference, Dr Chris Moulton, vice-president of RCEM, will say: “There is also some evidence that the specialist skills of GPs can help more people to be cared for in their own homes rather than being admitted to hospital.
“We therefore believe that these primary care skills should be brought into A&E departments.”
He added that this is not about “off-loading A&E work on already busy colleagues” but about sharing expertise for the benefit of patients.
“Many years of trying to discourage people from attending A&E departments with less serious conditions have proven these “diversion” schemes to be both very costly and completely ineffective,” said Dr Moulton.
His calls come after NHS England recently announced that NHS 111 and general practice Out of Hours services have been brought together under a new 24/7 urgent clinical service set to offer advice and treatment to patients.
The service is expected to provide a “new front door” to urgent healthcare services by streamlining the way these services are delivered nationwide as part of NHS England’s ongoing Urgent and Emergency Care Review.
At the time, Prof Keith Willet, NHS England’s director for acute care, who is heading the review, said: “A fundamental redesign of the NHS urgent care ‘front door’ is much needed and now underway. This includes A&E, GPs, 999, 111, Out of Hours, community and social care services.
“Most patients access urgent healthcare through their own GP practice in the daytime and we expect this will remain the first point of contact in the future. But around the clock, the ‘111’ number will find you GP and other urgent healthcare advice – so it makes sense to align the GP out of hours calls behind the same ‘111’ number.”
Co-location of primary care services with A&E department was first recommended 15 years ago in both the Carson Report and Reforming Emergency Care, noted Dr John Horrocks, CEO of Urgent Health UK, the federation of Social Enterprise Unscheduled Primary and Community Care Providers.
“Co-location represents a tried and tested and moreover cost-effective means of helping patients with primary care needs who present to A&E departments,” he said, adding that existing barriers, such as financial disincentives, must be broken down.
Back in July, NHS England announced eight new ‘Vanguard’ areas had been created to transform emergency care services by bringing together A&E, GPs, pharmacists, and the NHS 111 telephone service in an effort to provide better integrated urgent care for patients.
As part of the work, emergency care is to extend beyond just hospitals to be delivered by out-of-hours GPs, minor injuries clinics, pharmacists, community teams, ambulance services, NHS 111, and social carers, as well as through educating and supporting patients on effective self-care. It will be delivered seven days a week to facilitate access to urgent help.
Also earlier this year, Health Education England (HEE)-led the national emergency department (ED) pharmacy pilot, which started in March with 53 acute trust ED teams taking part. However, the evaluation of the project’s overall results is still ongoing, despite a final report originally being expected in October.