New Opportunities

For Practices to audit their appointments and

For local health systems to shape their integrated urgent care system

Executive Summary

Urgent care in general practice matters. It matters to patients, who may be harmed or distressed if diagnosis and treatment is delayed. It matters to the NHS as a whole, because urgent care arrangements which have not kept pace with other operational changes within the NHS place pressure on the rest of the system, driving people towards A&E and avoidable hospital admissions. It matters to practices, where workloads can become unmanageable if urgent care is not handled well. It also affects the reputation of the service – unhappy patients tell their family, friends and colleagues about their experience.

This report shines a spotlight on what actually happens on the ground. It describes our work with practices across five very different PCTs, outlining key lessons for improving urgent care.

The report and recommendations are designed to support all organisations delivering general practice services including GMS, PMS, PCTMS, APMS and the new GP led health centres. Other services, such as walk in centres, that deliver aspects of general practice should look to apply the principles contained in the document within their operating model and framework.

We focused on three simple questions concerning care for patients who contact their practice with an urgent need:

  • Will they get through?
  • Will they be identified?
  • Will they be seen rapidly?


For staff in general practice

This report aims to help practices answer all three questions with an emphatic ‘yes’. We outline tried and tested ways to improve patient safety while reducing workload, with real-life case studies showing what can be achieved. In fact many of the practices featured focused on urgent care in order to tackle an intolerable workload.

Our research led to 10 recommendations across a number of areas listed below. These recommendations are aimed at practices because this is not an area where one size, one approach or one answer can fit all.

The different operational processes within each individual practice will dictate the best way for that practice to achieve these goals.



Practices should:

  • Address the urgent needs of a patient, whether they choose to access the service by phone or in person.
  • Match capacity to demand – both in responding to the initial call or visit from a patient and in recognising the different demand patterns for same day and advance appointments.
  • Ensure that the full range of cases that might need urgent attention will reliably be recognised by staff when the patient rings or presents in person and that the process is understood.
  • Set deadlines for assessment and intervention and measure performance against these, paying particular attention to the needs of those requesting home visits where the chances are that the case may be more acute or complex.
  • Review and audit the processes to refine the way that they operate.

For the full recommendations, go to Chapters 4 to 6, in the full report.

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

Healthcare Leader Forum

Henry Clay will be speaking at the upcoming Healthcare Leader Forum: Improving urgent and emergency care conferences on 14th September at the Hilton Birmingham Metropole and also in Reading on the 21st September. This interactive conference will give its audience vital insight into the delivery of streamlined, efficient urgent care pathways emerging from regional transformation partnerships and local initiatives. Speakers will explore the necessary steps to ensure the audience know how to guarantee their organisation is fully prepared and that services are properly resourced.


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

A new 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


A new audit of potentially avoidable appointments in general practice – available to all practices at no cost

This audit was developed as part of our research for NHS England with the initial results - suggesting that 27% of GP appointments are potentially avoidable - published in ‘Making Time in General Practice’. NHS England are now committed to extending this work by funding support for practices - so there is no direct cost - of an App you can download on to your computer screen, making it really easy for you to see how many of your appointments might be avoidable and helping you explore how you might be able to do something about it. If you want to know more, download Frequently Asked Questions, the Governance Statement and the Application Form and take a quick look at a virtual tour or email us at This email address is being protected from spambots. You need JavaScript enabled to view it.


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.