Lessons for Commissioners and Providers

There are a number of areas that commissioners and providers need to address if they are successfully to establish primary care clinicians within or alongside emergency departments.  This is an extract from the full report – for more detail, please access the full report HERE.

Ensuring early clinical engagement

Clinical leads should be focused first on devising workable approaches that provide good care for the different groups of patients. Checking that sufficient cases will justify the involvement of primary care clinicians and also that there is sufficient flexibility in the process to balance the workload.

Establishing working groups

Working groups should be set up that allow primary care practitioners and emergency department clinical staff to develop services together to meet the requirements of commissioners. The absence of dialogue between commissioners and both groups of clinicians appears to be a barrier to improving care.

Creating models and an ethos of care

The objective should be to break down the barriers between primary care and emergency care clinicians, between the different organisations that employ the staff, and that promotes good joint-working.  However, this must be based on absolute clarity over the strengths that each group has, how they are best deployed in or alongside the emergency department and what each group is expected to do.  Only with this clarity will it be obvious to the clinician involved in a consultation when the expertise of another group needs to be drawn on to meet the needs of that patient.

Addressing all aspects of the service

By using the principles contained within this document and examples of good practice to improve care for patients and manage the risks are inherent in any chosen model commissioners and providers should put patients at the core of the service.

Recognising that there are no quick solutions

Whilst some changes can be made reasonably quickly it takes a long time for confidence to be earned by a any new group of staff operating in an area that is as safety critical as an emergency department. Commissioners should recognise that a degree of caution is healthy – whilst the existing processes and ways of working have their flaws these are understood by the staff involved, who can manage the risks associated with them. The challenge of introducing a host of new elements such as:

  • New staff with a different clinical approach from a new organisation

  • New processes, protocols and governance arrangements

  • New payment mechanisms and incentives

  • New operational layouts

is significant.  These have to be thought through carefully and jointly developed over time to ensure the system is safe for patients. They will take considerably longer to become fully effective.

Improving and linking IT systems

It is important to consider the role of IT in supporting these developments.

Exploring more collaborative ways of funding

Services that encourage clinicians and managers to work together, including working to develop local tariffs that integrate urgent care while also aligning financial incentives will allow clinicians to focus on what is right for the patient without having to overcome perverse financial     incentives.

Looking at the urgent care system

It is important that commissioners see any initiative of this kind within the broader context of the full urgent and emergency care pathway.

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.