Health Service Focus

Whole system commissioning in urgent care

Henry Clay, director of the Primary Care Foundation, discusses a new review into the challenges and opportunities around urgent care.

Significant variation has been uncovered in Urgent Care Centres (UCCs), which have the potential to effectively reduce attendance at A&E and create savings for the NHS, a new report has found.

Such variation can be confusing for patients, and the Primary Care Foundation (PCF) has highlighted the need for commissioners to consider the whole urgent care system when procuring services to avoid this.

Evidence for UCCs reducing attendance at A&E was found to be scarce, and as such required careful consideration to secure ‘see and treat’ processes, a consistent approach and integration of the centres with the wider primary and secondary care system.

NHE spoke to PCF director Henry Clay about the lack of standardisation around urgent care and how this was affecting outcomes.

He described a range of definitions for UCCs, from a walk-in centre to a mini-A&E: “I think that leads to very different models, very different staffing levels and probably a bit of confusion in the public’s mind if they even recognise the term at all.”

Clay added: “I’m not necessarily saying that every commissioner or provider looking at an urgent care centre is confused – it’s just that the NHS generally has become confused.”

The terminology internally could differ from organisation to organisation, Clay said, but emphasised the importance of having a clear, consistent definition for the public to understand.

Urgent care

The report indicates that some UCCs are not delivering care quickly enough; belying the very definition of ‘urgent’. Clay said that clinical quality indicators, such as time to treatment and the time to sending the patient home or admitting them where necessary “is something that they should be looking at in terms of the 50th percentile and the 95th percentile, not just looking at how many people did they do in four hours and comparing themselves with others”.

Since those indicators were introduced in April 2011, organisations have started to collect that data, and while some are “much quicker than others”, gathering such information is the first step, he reiterated.

Local solutions

The term UCC could also include services that are separate from A&E and are filling the gap between A&E and the GP practice. Clinical commissioners need to consider regional variations when choosing services, Clay said, rather than implementing a ‘one-size-fits-all’ approach.

“When we’re talking about urgent care, it can happen at any time, so you need to design your urgent care facilities to recognise that.

“That doesn’t mean that every urgent care service needs to be open in the red-eye shift at 3am. It depends on the geography of the area.”

Clay added: “The solutions in somewhere like Norfolk or Northumberland are going to be very different to the solution in a city or around London where lots of A&E departments are relatively close by.”

Education campaign

He explained that patients can attend urgent care services for convenience, or panic, and that directing these people to the most appropriate place can be difficult.

This is something that goes beyond an awareness campaign at the normal level, and can depend on the reasons for attendance.

Clay proposed that emphasising the importance of continuity of care was essential. He concluded: “There’s a different solution in each case.

“I’d love to believe it’s possible to put out a grand education campaign to teach people when they should go where but the reality is people make these decisions when they make them. At that stage, however many leaflets you’ve sent them, it doesn’t make a lot of difference.

“If we really wanted to change how people use urgent care centres then we probably ought to teach them in school.”