Overview: Commissioning Urgent Care

Breaking the mould without breaking the system: new ideas and resources for clinical commissioners on the journey towards integrated 24/7 urgent care, a joint report with the NHS Alliance (November 2011)

In one of the case studies presented in the report, GP Donal Hynes gets right to the heart of the challenge for the new clinical commissioners when he says we need to ‘break the mould without breaking the system’. The NHS Alliance, working in partnership with the National Association of Primary Care is committed to clinicians driving forward the changes we need, showing the bravery to think afresh and not accepting just because things have always been done this way, they always should. The aim is to be bold, but also to understand the complexity of the system, where actions can have unintended consequences; nowhere is this more the case than in commissioning urgent care.

Urgent or unplanned care – when any one of us feels the need to access care quickly – leads to at least 100 million NHS calls or visits a year. It represents about a third of the overall activity in the NHS and more than half the cost. Despite the scale of urgent healthcare, historically more attention has been paid to the way we manage planned activity, especially activity in hospitals (with the exception of the few previous national targets focussing on urgent and emergency care, in particular ambulance times and A&E waits). 

The last few years have seen an increasing focus on urgent care. Too often, rather than working together, health services have tended to work against each other to redirect activity to another part of the system – not deliberately or with ill-will, but in response to the pressures and incentives in the system. At the same time, central government initiatives have encouraged primary care trusts (PCTs) to set up new centres broadening access, although these are not always justified in terms of their overall benefit to the wider healthcare system. So while the last ten years has seen real achievements – with more resources and new forms of access – it has sometimes resulted in a more fragmented system that is difficult for patients to understand or navigate.

Currently there is a real opportunity for the whole network to think afresh about how to get the best possible urgent care system across a local community. Some things are different and distinctive based on the needs of the local population or specific geography, but many other features are common across all. 

This resource is not a blueprint for a commissioning strategy, nor do we believe any single blueprint would work in all localities, but it does make a series of suggestions about how urgent care of the future could be more joined up, provide better value for money and offer better patient care. Too often the incentives in the system encourage organisations to work against each other rather than as partners bound together to deliver the best possible care. The current pressure on budgets, combined with a fresh policy perspective from a new administration that is prioritising integrated 24/7 urgent care, makes it possible for commissioners to take a long, hard look at the current pattern of provision.

This is a practical guide for commissioners. It is the culmination of three years of reviews and innovation by the Primary Care Foundation for the Department of Health on different aspects of urgent care. This publication develops some of the ideas and thinking from this body of work, supported by the generous contributions of many people working in a range of services and has led to something we hope is more than the sum of the parts. It is intended to support your journey towards integrated 24/7 urgent care.


Michael Dixon

Chairman, NHS Alliance

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay



Latest News

New on-line registration for the potentially avoidable appointments audit

The Primary Care Foundation were selected by NHS England to further improve and automate the audit of potentially avoidable appointments. We are now building a new website with Method Analytics that will make it much easier for any practice to register online, will simplify data collection for clinicians, and will allow for instant reporting on results. The reports will be much easier to understand and will signpost other support. And it will remain free to use for all practices in England.

We are now ready to go live with a new ‘test’ site. We are confident it is already easier to use but we are keen to get any feedback from practices before the new website is fully up and running.

If you are a practice in England and you want to register, CLICK HERE  and click on ‘register here to create a practice audit!’ You will be guided through registration and how to set up your clinicians to take part in the audit.  This is a new test site, so if you notice anything that doesn’t look right, or could be made easier, just let us know.  And the same for your clinicians as they enter data – any feedback at the moment – good or bad – would be really helpful … just email us This email address is being protected from spambots. You need JavaScript enabled to view it.


What do we mean by an ‘avoidable appointment?

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice. It is available HERE and will also be published in Health Care Leader.


Are there any simple lessons for practices looking to improve access?

A feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  


Integrated Urgent Care – how to make NHS 111 work

A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE


Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.


We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.