Taking a hard look at urgent care

Published on Tuesday, 22 November 2011 11:57
Written by Scott Buckler

Creating an integrated urgent care, which is fit for purpose and delivers the best care for patients, requires a hard look at the current system and full involvement of general practice and clinical commissioners, a new report reveals

According to Breaking the Mould without Breaking the System: New Ideas and Resources for Clinical Commissioners on the Journey towards Integrated 24/7 Urgent Care, produced by the Primary Care Foundation with the support of the NHS Alliance, commissioners need to look at six crucial themes:


  • Building care around the patient, not existing services;
  • Simplifying an often complicated and fragmented system;
  • Ensuring the urgent care system works together rather than pulling apart;
  • Acknowledging prompt care is good care;
  • Focus on all the stages for effective commissioning, and
  • Offering clear leadership across the system, while acknowledging its complexity.

Over the last few years, too many myths around urgent care – such as much of the care being delivered in A&E is primary care; patients misuse urgent care services; it is safer for patients and better for services to assess and triage everyone –have misled some of the assumptions on how to improve the system.

The report argues that, rather than perpetuating these myths, the system needs to be integrated and simplified, giving patients quick and prompt care. It states: “Patients are confused about where to access care. In addition to NHS Direct, general practice, emergency departments and the ambulance service, a host of new facilities, including walk-in centres, urgent care centres, polyclinics, equitable access centres and GP-led health centres, all offer a slightly different range of services available at varying times.”

Rick Stern, Rick Stern, urgent care lead, NHS Alliance and director of the Primary Care Foundation, said: “We need a system that everyone understands and which gives easy and prompt access to patients. Creating an extra layer, by sending everyone to triage before a full consultation, is simply not effective or desirable, from the point of view of patients whose conditions can change dramatically within a short period of time.”

Dr Michael Dixon, chairman, NHS Alliance, added: “With the development of clinical commissioning, now is the time and opportunity for the whole network to think afresh about how to get the best possible urgent care system across a local community. We need to bring the system together and challenge the way urgent care is being currently delivered - we need to break the mould and find new ways to ensure that the system is fit for purpose and that our patients get the care they need and deserve.”

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.

Breaking the Mould without Breaking the System also emphasises that general practice is the bedrock of any urgent healthcare system. “There is a need for greater emphasis on ensuring individual practices respond rapidly and effectively to patients with an urgent need. If all practices improved the speed and effectiveness in responding to same day requests, there would be a substantial beneficial effect on the wider healthcare system; all commissioning strategies for urgent care should start by addressing the key role of general practice.”

Mr Stern believes that clinical commissioners have a great opportunity to bring the system together and develop a clear local vision for integrated urgent care. “Fragmentation puts both staff and patients at risk. We need an integrated service that is simple, accessible, efficient and effective. Clinical commissioners will be best placed to create a focused system based on their local needs.”

Breaking the Mould without Breaking the System will be formally launched at the NHS Alliance Conference in Manchester on 1st December.

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