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Assured performance: Commissioning to fill the urgent care gap |
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Health Minister, Department of Health |
Ben Bradshaw MP |
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Like a good friend, we rely on the NHS most in times of crisis and urgent need. Illness, accidents and ailments pay no attention to the time of day, so we must ensure patients get the right treatment, at the right time, at the right place. Not only is this a potential life-saver – one study suggests extended GP opening hours could save up to 500 lives a year from strokes – it’s also crucial for easing the burden on other parts of the system, particularly accident and emergency. However, as the Healthcare Commission has made clear, we’re still not quite where we need to be on urgent care. So how do we make the big breakthrough? The challenge In one sense, we are victims of our own success. The rich diversity of services providing urgent care – GPs, high street pharmacies, out-of-hours primary care, community services, A&E, NHS Direct, Walk-in-Centres and so on – is a big asset, massively expanding the options available out-of-hours. But this brings its own challenges. Patients can often be confused, unsure of where to access care when their GP surgery is closed. Multiple providers can introduce delays and duplication. Poor integration can create a disjointed pathway – with patients passed from pillar to post, repeating information to different providers. In addition, we know there are specific issues in urgent care: data sharing, compliance with out of hours medication, and reaching the most vulnerable and socially-excluded groups. Confronting these issues is vital, and it means rethinking the way we commission services. From pick’n’mix to whole pathway commissioning First and foremost, primary care trusts must start to look at urgent care not in terms of a ‘pick’ n’ mix’ selection of individual services, but rather as a whole pathway, focused on patient outcomes. This starts with a stronger understanding of local need and local provision. Commissioners really need to get under the skin of what local people want from urgent care, and how the local market can provide it. connections between out-of-hours and other services. Too often, out-of-hours providers get blamed for gaps in other services. We must therefore break down the distinction between the ‘mainstream’, 8 am to 6 pm services and after-hours care – and instead start thinking in terms of seamless 24 hour care from commissioning to commencement. Greater support I recognise none of this is easy, which is why my Department is doing a number of things to support you. On a general note, the World Class Commissioning programme, a key part of Lord Darzi’s Next Stage Review, will help PCTs build up the skills and capacity to make evidence-based commissioning decisions. More specifically, we now have a new benchmarking tool for out-of-hours services, allowing clear and consistent comparisons across different areas to help commissioners learn what works. Next year, we are introducing new performance measures to capture patient experiences of out-of-hours care, and PCTs will be able to use this feedback to improve their local services. And later this month [October], we are holding three events with the Healthcare Commission focused on improving PCT urgent care commissioning. Leading the change I know there is a huge desire for progress. It was a desire first reflected by the prominence given to urgent care in the Strategic Health Authority (SHA) vision documents for the Next Stage Review. And it is a desire now realised in areas like NHS North West strategic health authority, which is already looking at a single point of telephone access specifically for urgent care enquiries. So there is much already happening, but much still to do. The bottom line is you never forget a friend who helps in a time of need – and you never quite forgive one who fails you. That’s why urgent care is such a big priority for us all. |
