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Petra Westlake

BLOG: Urgent care vanguard: integration is key


Many services now provide myriad options for patients who are seeking emergency and urgent care. But as Toby Sanders pointed out last week in his blog for NHS England, just because a multitude of services are on offer, it isn’t the end of the story.

Getting it right for patients means making these services truly accessible by implementing a joined-up approach which helps the public to understand the choices available to them.

Toby Sanders is the managing director of West Leicester Clinical Commissioning Group, a partner of Leicester, Leicestershire and Rutland urgent and emergency care vanguard. Part of the reason this area was selected as a vanguard site is that they have already gained much traction in improving urgent and emergency care and it is clear that they are highly motivated to improve the service.

However, they still have a way to go, and the challenge for this vanguard site is to join up the cogs they already have in place and oil up the mechanism to get it whirring. This is true of many areas, where we see that individually many aspects of care are working really well in isolation. This is often down to individual staff members with a vision, passion and drive to create a service that really responds to local needs and delivers excellent care, but is not necessarily part of the overall commissioning strategy.

In order to take things to the next level like this vanguard site want to, not only do commissioners need to identify this excellent practice, but it also involves integrating these separate elements into a network to create a real synergy that patients will benefit from. The whole is greater than the sum of its parts.

Leicestershire has implemented a number of urgent and emergency care options for patients. These include an acute visiting service which can do urgent home visits, and a crisis response team which combines social, physical and mental health services, as well as specialist services aimed at older people. The challenge now as a vanguard site is to simplify what is on offer.

They are finding in Leicestershire that these service elements remain fragmented and people either don’t know about the available options, or don’t know how to choose the most appropriate option, which creates its own problems for patient access. This point is reiterated by staff too, who say that navigating this complex and disjointed system means they themselves struggle to make the right referrals.

The solution that the vanguard proposes is to create a 24/7 clinical care hub. This will be a ‘virtual front door’ as Toby describes it, which will seamlessly bring together all urgent care services across health and social care, so that patients in crisis can access exactly what they need from one point of contact. Crucially, this will also include full integration of mental health care.

"Our goal,” says Toby, "is that, wherever a patient accesses urgent services, we will have the facilities and staff in place who can treat any mental health issues with the same priority as physical ones”.

The vision to fully integrate urgent care service strands across health and social care is a bold one and no mean feat. The CCG has already made great strides in improving how patients are discharged from hospital to address issues it had with delayed transfers. Now as a vanguard site, the main challenge is to keep the momentum going to create an urgent care model that will inspire the rest of the NHS.

The work in Leicestershire just goes to show that integration is the hard nut to crack, because you can't simply establish new services in isolation - everyone needs to be part of it. This is why the integrated care pathways we have developed, which are built on stakeholder engagement to clarify the pathways and right information, are so valuable. Ultimately integration drives simplicity for the patient end user, which is what the Leicestershire Vanguard is trying to achieve.

It is worth noting that the vanguards in the East Midlands are supported and linked through the Academic Health Science Network (AHSN), as well as receiving ongoing support by NHS England’s New Models of Care team, centrally, alongside the 50 Vanguards across England. This regional support is helping all nine vanguards across the East Midlands AHSN footprint to develop a common set of KPIs, and support with their ongoing evaluation and sharing of best practice.

This is just one in series of blogs written by Petra Westlake at NHiS. To view more,

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