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.
- 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.