The system level solutions to make urgent care sustainable in the long term

As an acute trust chief executive who has grappled with the “urgent care challenge” for some years, it became clear that the problem was multifactorial and complex in nature.

‘The unavailability of suitable alternative services was a major factor leading to “unqualified” admissions’

There was no single cause and indeed, relatively minor shifts in activity could easily “tip” a system that was usually running hot with high levels of bed occupancy.

One of the main factors was daily discharges. It was clear that both overall numbers and the time of day at which they occurred were critical.

So the improvement effort must focus on facilitating timely and effective discharge, which means that alternative services for those who do not need medical in-patient care, but who do need some sort of care and support, are fundamental.

Such services also impact on admissions, because audit showed us that the unavailability of suitable alternative services, at the time they were needed, was a major factor leading to “unqualified” admissions.

The absence of such services is probably also a factor in the high readmission rates that are seen in many health systems.

The new integrated organisations, and collaborative arrangements, that are described in the NHS Five Year Forward View and Dalton review will offer options for providers, but all will require effective system working, and new service models that are designed around the needs of the patient and which transcend current organisational boundaries.

‘The payment and incentive arrangements will need modifying’

GP involvement will be critical too.

Finally, the payment and incentive arrangements will need modifying to enable accountable officers to fully commit to collaborative working at a local health system level.

Mark Newbold is a consultant in acute care