Attendances at Accident and Emergency Departments (A&E) have increased over the past three years. Research suggests that this is in part due to a lack of understanding of what services are available and challenges accessing appropriate services.
It is considered that approximately 20% of patients who self-present at A&E could be helped to access more appropriate services for their needs and often care that is closer to home. This is an important factor in this current climate of COVID-19 and need to maintain social distancing and prevent crowding in our busy A&E departments.
Keeping our A&E departments ready for life threatening emergencies is critical and access to this essential service has not changed. Neither has access to GP surgeries for all urgent care needs who remain your default provider of care.
During COVID-19 there has been a rapid and unprecedented reconfiguration of primary and community care services and healthcare professionals have been working together across acute and primary care and in partnership with NHS 24’s 111 service which has very quickly been reconfigured as an in-hours (as well as out-of-hours) route for COVID-19 triage for rapid access to care via the local COVID-19 assessment hubs.
The need for new ways of delivering services during COVID-19 has demonstrated what can be achieved to keep people safe and that there are a range of alternative ways to access NHS services which are available, in addition to traditional face to face care.
Redesign of urgent care
The Redesign of Urgent Care looks to build on these opportunities to support the public to access the Right Care in the Right Place at the Right Time. This new service went live across Scotland on 01 December.
Here you can find out what changes have been made:
- instead of direct access to A&E departments for non- life threatening conditions help will be firstly available through NHS 24 -111, available 24/7 for urgent care need - where conditions cannot wait to be seen at the GP practice
- NHS 24 will listen to your urgent concern and offer you the best advice on what care is required and where is the best place to access this. This can include self-care and support at NHSinform.scot; your local pharmacy who can prescribe treatments and offer advice. They may advise that the GP surgery is the best place to get care and to make an appointment there or if necessary they will refer you to the A&E clinical team
- each local health board has established a Flow Navigation Centre (hub) that will directly receive clinical referrals from NHS 24. They will offer rapid access to a senior clinical decision maker within the multidisciplinary team, optimising digital health through a telephone or video consultation where possible, minimising the need to attend A&E. Through this consultation they may again signpost to other services available to best meet health care concerns raised. They may decide that the GP practice is still the best place to manage your concerns
- if the senior clinical decision maker determines the patient needs to go to A&E, they may be offered an appointment to attend, and the team will know to expect them so they can be seen directly at that time.
- general practice will remain the principal access route for both routine care in-hours and urgent care 24/7. Where appropriate patients will be encouraged to contact their GP as their first point of contact
- keeping care as close to home as possible and avoiding the need to wait in a crowded ED waiting room and will help keep everyone safe
The Redesign of Urgent Care will not alter the way emergency care is accessed. If you have an immediate or life threatening condition please call 999 or go straight to A&E. All clinical teams are working very carefully to fully comply with the guidance given around social distancing and standard infection control precautions to ensure A&E is safe.
If you’re not sure what healthcare service you require, NHS Inform is Scotland's national health information service helping the people in Scotland to make informed decisions about their own health and the health of the people they care. NHSinform provides information on a range of service including self-help guides to guide you through your options for care, providing a range of healthcare advice.
Transforming the future of unscheduled care
Whilst this immediate service redesign is required to keep people and our NHS safe during winter, this is just the beginning and we will continue to look at the long term redesign of urgent and unscheduled care over the next two years to ensure patients continue to receive the right care, at the right place, by the right healthcare professional.
We recognise that many patients do not have access to technology and they must not be discriminated against. To support this we are currently undertaking a comprehensive communications and engagement approach ensuring these groups are appropriately targeted and are aware of the changes taking place.
Additionally we are undertaking a user-centred service design approach. This approach aims to amplify the voice of users and their experiences; specifically, those most susceptible to health inequalities. This will provide a strong foundation when moving forward with the development of the service and will support us to identify where pathways required refining to ensure this does not negatively impact on patient groups including those without digital access.
We are developing an Equality Impact Assessment (EQIA) on the redesign programme with key stakeholders. This will ensure equality issues are identified and actions put in place as early as possible in the redesign phase to reduce inequalities within the service. This will also ensure that the co-production and redesign of urgent care meets population need, reduces health-related inequalities and ensures that specific cohorts of the population are not disadvantaged by the change in service. The co-production process will deliberately engage disproportionately with individuals with a lived experience of poverty, deprivation and discrimination to ensure that emerging models, including the centralised triage process, reduce rather than increase inequalities. The EQIA will be available on the Scottish Government website early next year.
Programme vision and strategic aims
The vision for the Redesign of Urgent Care Programme is:
“Collaborating across the whole health and social care system to design and implement a safe, sustainable, patient and outcomes focused system of urgent care access, pathways and treatment in Scotland that delivers better health, care and life outcomes for our patients, staff and their families and the wider community in which we all live, grow, learn, work and play.”
The strategic aim is:
“Right Care, in the Right Place, at the Right Time.”
Read more at NHS Inform - right care right place.