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

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.