Urgent and emergency care

Many people believe that A&E is a convenient place to go if you have a problem with your health, as it is seen to offer the highest level of expertise, with access to diagnostic equipment such as x-rays. However, medicine has changed – GPs, ambulance staff and people working in a wider range of services can and do provide urgent and emergency care.

We wanted to find out why people use A&E as a first port-of-call. As a member of our partnership, Healthwatch Kirklees carried out an exercise to find out why people use A&E and you can find out what they discovered by reading the engagement report.

Our vision for urgent and emergency care is that we should provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families.

You can read lots of examples of how we are already taking new approaches to urgent and emergency care close to home.

The West Yorkshire Acceleration Zone (WYAZ) was set up to deliver improvements in urgent and emergency care delivery across our area. WYAZ is the only urgent and emergency acceleration zone in the country.

The Next Steps for Urgent and Emergency Care (UEC) was appropved by the UEC Programme Board in July 2018.  This document outlines our three key priorities and deliverables.

We have already been leading some great work in West Yorkshire and Harrogate to make some changes to local health services to take the pressure off urgent and emergency care. This aims to make sure that people receive the right treatment at the right time in the right place.

Pharmacy Urgent Repeat Medicines Service

If a person does not have a prescription for repeat medication and they need emergency supplies, they can pay for them at a local pharmacy. However, that costs a lot of money and that means that people often choose to contact an out-of-hours service or accident and emergency department if they feel the need for their medicines is urgent. During evenings and weekends, we've found that 2% of urgent care consultations are made up of clinical staff prescribing repeat medication to people and these increase  4% over bank holiday periods and as patients will recognise this takes up a lot of  clinical time.

NHS 111 previously has had no way to send people requesting supplies of emergency repeat medicines directly to a local pharmacy. To ease pressure on the urgent and emergency care system, the Pharmacy Urgent Repeat Medicines Service was  introduced to allow NHS 111 staff to send people to pharmacists to provide repeat medicine.

This scheme has influenced similar projects across England. This service has now been replaced by the national NHS Urgent Medicine Supply Advanced Service (NUMSAS).

Direct booking

Previously, if a person wanted a GP appointment they would contact their GP surgery for an appointment. While this service will still be available, a GP might not be the best service to contact for a certain medical condition, and it has been felt that there needs to be a greater focus on people being treated in a better healthcare setting.

Local research showed  that a high ratio of people seeing their GP for a health complaint shouldn’t have been seen by a GP and they could have been given the right advice and treatment somewhere else. This was for example speaking to a pharmacist or with a nurse).

A new system has been created so that going forward people will be able to ring NHS 111 and an expert will find out about the health condition and decide who would be best to provide advice and treatment. If NHS 111 agrees that a GP appointment is the most clinically appropriate outcome then NHS 111 will be able to book an appointment directly into a GP surgery (between 8am – 6pm). However if it is not appropriate they will be advised to, for example, visit their local pharmacy. This is a major step forward and will save people time, by not having to make several phone calls, and will also ensure that they are directed to the most appropriate place to meet their health need.

Multi-disciplinary teams and care homes

We have found that a high number of people who live in a care home in West Yorkshire and Harrogate call 999 if they have an issue with their health. We noticed, having reviewed the data, that the kind of medical cases or conditions being treated in hospital could very well have  been dealt with at the care home itself.

A lot of people are  being sent to hospital unnecessarily so we set up a multi-disciplinary team between the care home, Mid Yorkshire Hospitals NHS Trust and the Older Peoples Mental Health Teams to look at how we could stop this from happening. The team members were trained to make sure that they were working together to ensure that people living in a care home receive care in a place that is most appropriate for their medical condition. These improved changes have ensured that patients have still been treated for their acute condition but not had to undergo unnecessary travel, a stay in hospital and stress and upheaval. It has also helped to see a reduction in unnecessary attendances at A&E by 12%.

The Leeds Care Record

One of the main frustrations for NHS health professionals and people is that peoples' medical records aren't available to view or share between organisations. This means that if a person is referred to another service for treatment, that service won't know a person's medical history and the person will need to give them information about it.

A new virtual system has been set up in Leeds to make sure that Leeds Teaching Hospital Trust has access to the Leeds Care Record. Medical records are held on a secure computer system and this includes GP records, hospital records, mental health records and social care records. A number of pieces of patient information sources are pulled together to form a single, comprehensive patient care record.

All authorised NHS health professionals at Leeds Teaching Hospitals are able to access the Leeds Care Record. The benefits of this for the person include NHS clinical staff being able to make better informed decisions about a person's care, which in turn offers better clinical outcomes for the patient. Importantly, a range of health professionals have access to this so that a person does not have to repeat their medical history to different health professionals.

Measuring the impact of innovation

There are 44 Health and Care Partnerships around the country and these need to make sure that they are making the right transformation of services to ensure that local people have an improved experience when accessing health services.

Part of this is the need to analyse what happens in the local health and care system to see what is working well and what improvement or initiatives can be put into place to make sure that people are receiving a high quality service. This also has to be balanced with offering better financial management for organisations.

To make sure that organisations are not affected by local innovations in urgent and emergency care services, NHS England has created a tool to help health care organisations to measure the impact of change initiatives. Health care systems are encouraged to use these tools to gain a better understanding of the 'system wide effect' (understanding how changes in one part of the system impact on other parts), price vs cost (how finance is affected by moving funds from one setting of care to another) and offering a focus on effectiveness (measuring the difference a service change can make to the patient journey given the resources at the teams’ disposal