The NHS Benchmarking Network is pleased to present the findings from the fifth phase of Network’s national Urgent Care benchmarking project.
The urgent care system is arguably the most high profile of all NHS services in providing a rapid response to immediate and urgent needs for a wide range of patients. The volume of patients treated is high with more than half of the UK population coming into contact with urgent care systems each year. Although the sums of money invested in urgent care are highly material there is limited national benchmarking information available on the service beyond profiling of waiting times and demand levels.
Urgent care is a complex care pathway with many facets across the NHS. This project focuses on the commissioner perspective and reviews the provision of ED services as well as alternative community based services such as walk in centres, community services, primary care out of hours services, 111, urgent response mental health services and ambulance services. The aim of the commissioner project is to test the effectiveness of the health system in managing demand for urgent care, and providing safe, effective, and good value services.
The 2016 project received contributions from 54 commissioning organisations. The project is carried out in tandem with the Emergency Care project for providers which has received contributions from 97 services this year. The provider project covers both Type 1&2 Emergency Department services as well as Type 3 and walk-in services.
As well as a national report, including examples of good and innovative practice that has been successful in helping managing ED demand/attendance, and online toolkit, available to all Network members, for the first time this year, bespoke reports are available for participants.
Highlights from 2015/16
- All participants commission a range of services across all sectors of the NHS. The balance of investment in the component parts of the health system and how well they interact will influence how the system works and how demand is managed. The urgent care system when viewed as a whole generates around 127,000 patient contacts per 100,000 population confirming the scale of provision and importance for commissioners and providers
- Most commissioners have implemented some form of emergency care demand management schemes to avoid unnecessary ED attendances and admissions; 95% have community admission avoidance schemes and 86% have residential care home schemes.
- On average, around 37% of ED activity relates to walk-in and minor injury facilities with the balance of activity being through Type 1 A&E services or Type 2. Major A&E departments are still the largest providers of services although walk-in facilities are delivering an important contribution every year.
- Along with in-hours primary care, the Out of Hours (OOHs) primary care services play a key role in managing the whole system effectiveness of urgent care. Primary care OOHs providers often cover 113 hours of the 168 hour week on average, acting as a first line of response to patients and play a key role in managing total system demand.
The key messages from the 2016 urgent care project are the increasing pressures on the system as evidenced by worsening performance on waiting time targets and the large volume of contacts that 111 now receives. In light of the pressures, the strong performance on patient experience should be recognised as a significant achievement by ED staff.
The next iteration of the benchmarking project will take place in 2017. The NHS Benchmarking Network would like to hear your views on how we can improve the project and which aspects of urgent care you would like to investigate further.
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