Urgent and emergency care

Urgent and emergency care

This section describes work on urgent and emergency care being undertaken by various NHS organisations. This follows problems in late 2012 and early 2013 with the introduction of the NHS 111 telephone service and rising use of accident and emergency departments by patients.

PSNC promoted community pharmacy’s role in tacking the challenges in urgent and emergency care at the main party political conferences in Autumn 2013. The flyer below was used in the lobbying of the main political parties, but it can also be used by LPCs at a local level.

PSNC flyer on Urgent and Emergency Care (PDF)

NHS England review

At the beginning of 2013, NHS England announced a wide ranging review of the model of urgent and emergency services in England to improve these services in the future. The review, led by Sir Bruce Keogh, looked at how emergency care is currently provided, how it works with other NHS areas such as GP surgeries, community care and NHS 111, and assessing transfer processes.

The review aimed to set out proposals for the best way of organising care to meet the need of patients and to develop a national framework to ensure high quality consistent standards of care. The review is part of plans to offer more seven day healthcare services and NHS England wants to improve public understanding of the best place to go for care. Local commissioning is seen to be at the heart of the review and the proposals will support Clinical Commissioning Groups (CCGs) in shaping services for the future.

Detailed information on the review, including the proposals in the End of Phase 1 Report is available in PSNC Briefings 093/13 and 110/13 (see links at the bottom of the page).

A brief update on the work of the review team was published in August 2014.

NHS England and Monitor also published a discussion document on reimbursement of urgent and emergency care in August 2014. This considered options for reform of the way urgent and emergency care providers are paid, including a proposal for the use of a fixed element of core funding with additional volume and quality related funding. While this approach was largely focussed on changing the way hospital trusts are paid, the document also suggested the approach could be applied to primary care providers such as community pharmacies and GP practices.

Read PSNC’s response to the Monitor/NHS England consultation

NHS England webpage on the review

Winter Pressures Funding

With over 1 million more people visiting A&E compared to 3 years ago, 2012’s harsh winter put exceptional pressure on urgent and emergency wards. In early August 2013 the Prime Minister announced the release of new funding for A&E departments identified as being under the most pressure, with £250m being released this year and a similar amount being made available next financial year.

In early September 2013, Jeremy Hunt, Secretary of State for Health, set out proposals to fundamentally tackle increasing pressures on A&E services in the long-term – starting with care for vulnerable older people with complex health problems.

He said fundamental changes mean joined-up care – spanning GPs, social care, and A&E departments – overseen by a named GP. Many vulnerable older people end up in A&E simply because they cannot get the care and support they need anywhere else.

Overall, the number of people going to A&E departments in England has risen by 32 per cent in the past decade, and by one million each year since 2010. The over-65s represent 17 per cent of the population, but 68 per cent of NHS emergency bed use. They also represent some of the NHS’s most vulnerable patients, and those most at risk from failures to provide seamless care.

In the announcement the Health Secretary set out how £250 million would be used by 53 NHS Trusts this winter.

Of the £250 million:

  • Around £62 million for additional capacity in hospitals – for example extra consultant A&E cover over the weekend so patients with complex needs will continue to get high-quality care;
  • Around £57 million for community services – for example better community end of life care and hospices;
  • Around £51 million for improving the urgent care services – for example for patients with long-term conditions;
  • Around £25 million for primary care services – for example district nursing, to provide care for patients in their home, preventing them from being admitted to A&E;
  • Around £16 million for social care – for example integrating health and social care teams to help discharge elderly patients earlier and prevent readmission and;
  • Around £9 million for other measures – for example to help the ambulance service and hospitals work better together.

How community pharmacy can help

Community pharmacies can have an important role in managing demand for urgent and emergency care services and diverting patients away from A&E. In late November 2013, NHS England worked with PSNC, two LPCs, and representatives from a number of other organisations to collaboratively develop a collection of resources to help local commissioners to make better use of community pharmacies to support healthcare provision during the winter months. The documents were updated in November 2014.

Community Pharmacy – helping provide better quality and resilient urgent care provides a range of suggestions for how local commissioners (CCGs and local NHS England Teams) could make better use of community pharmacies. It includes detailed proposals for three services – ‘flu vaccination, emergency supplies of medicines and provision of self-care support for winter ailments – that commissioners could consider using locally.

Implementation plans and associated template documents have been developed for each of these suggested services, in order to facilitate rapid commissioning where a need is identified locally. NHS England and PSNC have also agreed suggested payments to community pharmacies for provision of these three services.

Prime Minister's Challenge Fund

In October 2013, the Prime Minister announced the £50m Challenge Fund to support GP practices to trial new and innovative ways of delivering GP services and making services more accessible to patients.

Twenty sites were awarded money from the Challenge Fund in April 2014 and a number of the sites include community pharmacy within the proposed developments. PSNC is supporting networking and information sharing between the LPCs in those areas. Further information on the Prime Minister’s Challenge Fund can be found by clicking here.

Role and establishment of urgent and emergency care networks

In June 2015, NHS England published Role and establishment of urgent and emergency care networks, which forms part of a suite of guidance documents and tools entitled Transforming Urgent and Emergency Care Services in England. These documents promote best practice and support commissioners and providers in achieving a fundamental shift towards new ways of working and models of care.

Urgent and Emergency Care Networks are based on the geographies required to give strategic oversight of urgent and emergency care on a regional footprint, ensuring that patients with more serious or life threatening emergencies receive treatment in centres with the right facilities and expertise, while also ensuring that individuals can have their urgent care needs met locally by services as close to home as possible.

System Resilience Groups (SRGs) will retain responsibility for ensuring the effective delivery of urgent care in their area, in coordination with an overall urgent and emergency care strategy agreed through the regional Urgent and Emergency Care Network.

The networks will cover populations of between 1 million and 5 million. Their purpose being to improve the consistency and quality of urgent and emergency care by bringing together SRGs and other stakeholders to address challenges in the urgent and emergency care system that are difficult for single SRGs to address in isolation. This will include coordinating, integrating and overseeing care and setting shared objectives for the Network where there is clear advantage in achieving commonality for delivery of efficient patient care (e.g. ambulance protocols, NHS 111 services, clinical decision support and access protocols to specialist services such as those for heart attack, stroke, major trauma, vascular surgery and critically ill children).

The Urgent and Emergency Care Network should ensure appropriate representation from key organisations across the network geography, whilst maintaining a lean core membership. It is not expected that all organisations will sit on the network, but the following should be present or clearly represented:

  • system resilience groups;
  • clinical commissioning groups, including the lead commissioner for ambulance services);
  • all acute hospital and urgent care centres;
  • at least one health and wellbeing board;
  • at least one NHS 111 provider;
  • at least one GP out of hours provider;
  • at least one ambulance service;
  • at least one community provider;
  • at least one mental health trust and provider of health based place of safety;
  • at least one local authority;
  • community pharmacy services;
  • Health Education England through the local education and training board;
  • local Healthwatch; and
  • commissioned independent providers.

New models of care - Urgent and emergency care

The new models of care programme has reached phase three, having announced eight new urgent and emergency care vanguard sites at the end of July 2015.

The programme will focus on leading-edge systems that are making the strongest progress and those local health systems experiencing the very greatest operational challenges, for example, on the A&E 4 hour standard.

In August 2015 NHS England published Safer, faster, better: good practice in delivering urgent and emergency care a practical  summary of the design principles that local health and social care communities need to adopt to deliver safer, faster and better urgent and emergency care. These principles are drawn from good practice, which have been tried, tested and delivered successfully by the NHS in local areas across England. The report highlights the valuable contributions that community pharmacies can make to local health communities’ urgent care programmes and provides examples of community pharmacy services that can reduce pressure on general practice and enhance patient safety.

Further information on the new models of care can be found by clicking here.

More information and resources

Information on NHS 111

PSNC Briefing 110/13: An update on NHS England’s Urgent Care Review and NHS winter planning (December 2013)
This PSNC Briefing provides an update on the work being undertaken by NHS England to review urgent and emergency care. It also provides a summary of the resources that have recently been developed to facilitate commissioning of community pharmacy services to support urgent and emergency care services this winter.

PSNC Briefing 093/13: Urgent and Emergency Care (September 2013)
Urgent and emergency care in England is currently under review.  This Briefing has been issued to assist LPCs in their discussions on urgent care at local level to promote community pharmacy’s role in tacking these challenges, and to highlight key areas where community pharmacy can support the provision of care and reduce demands on GPs, NHS 111 and A&E.

PSNC Briefing 092/13: Business Case for Minor Ailment Service (September 2013)
This Briefing provides an evidence based business case for a Minor Ailment Service which LPCs can use at a local level and is intended to assist in making their negotiations more efficient.

Centre for Pharmacy Postgraduate Education (CPPE) interactive e-learning programme on urgent care (December 2014) 



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