Healthcare standards

Urgent and unscheduled care

Urgent care refers to the need for medical treatment for a condition or injury which is not considered to be imminently life threatening but could worsen if left untreated and unscheduled care describes the need for unplanned medical care often as a result of an accident.

Traditionally, accident and emergency (A&E) has been seen as the primary location to receive urgent and unscheduled care. However, for many, A&E will not be the right place for their healthcare need. NHS Scotland provides for the urgent and unscheduled care needs of the population through a variety of services including; GP practices, minor injury clinics and pharmacy treatment.

The need for new ways of delivering services during COVID-19 demonstrated how the use of video calls and other technologies can help to provide access to a range of NHS services, in addition to traditional face to face care. 

National Urgent and Unscheduled Care Collaborative

In June 2022 the former Cabinet Secretary for Health and Social Care, Humza Yousaf, announced the launch of the Urgent and Unscheduled Care Collaborative. This whole system approach is part of the Scottish Government’s wider Recovery Plan which seeks to reset NHS services following the Covid-19 pandemic; with the understanding and renewed commitment to making the necessary system changes to modernise the NHS in Scotland.

The Urgent and Unscheduled Care Collaborative Programme remains focused on 5 key recovery areas:

• improving urgent care pathways in the community and improving links across the primary and secondary care interface
• ensuring patients receive the right care in the right place by optimising Flow Navigation Centres and increasing the routes for professional to professional advice and guidance, signposting  and scheduling of appointments to A&E where possible
• improving access to Hospital at Home services by supporting Boards and partnerships to adopt evidence-based best practice
• optimising assessment and care in our Emergency Departments by improving access to ‘same day’ services, the use of early and effective triage, rapid decision-making and streaming to assessment areas
• reducing the time people need to spend in hospital by promoting early and effective discharge planning and robust and responsive operational management

This programme of improvement activities will be driven forward by the Centre for Sustainable Delivery (CfSD), which has been commissioned to support Health Boards to implement a range of measures to reduce A&E waiting times and improve patient and staff experience. In addition, the CFSD team will lead collaborative groups developing a pipeline of innovative and emerging good practice with national implications.

The collaborative allows for a national focusing of priorities and the sharing of ideas and good practices between health boards. However it also allows health boards to operate autonomously, implementing system changes in a way that best works for them and the communities they serve.

Redesign of urgent care

We launched the Redesign of Urgent Care Programme in December 2020. Through this redesign, Flow Navigation Centres are now operating in every mainland health board to ensure rapid access to a clinician and scheduled appointments. The further development of these Centres remains a central focus for this Programme.

The Redesign of Urgent Care Programme sits under the Urgent and Unscheduled Care Collaborative and forms part of our approach to improving our urgent and emergency care services.

The strategic aim of the Redesign of Urgent Care is to support the public to access the “Right Care in the Right Place at the Right Time.” 

The Redesign of Urgent Care has changed the way urgent care services are accessed in Scotland. Instead of direct access to A&E departments for non-emergency cases, help is first available through NHS 24 -111, available 24/7 for urgent care, where conditions cannot wait to be seen at the GP practice.

By assisting the public to access the most appropriate service for their needs, we aim to ensure that A&E resources and the valuable skills of frontline staff are available for those that need emergency care and minimise delays for patients waiting to be seen and treated.

If you’re not sure what healthcare service you require, NHS Inform is Scotland's national health information service and is available to help people make informed decisions about their own health and the health of anyone they may care for. NHSinform provides information on a range of services including self-help guides to guide you through your options for care, providing a range of healthcare advice.

Hospital at Home (H@H)

Hospital at Home is one of five portfolios of work which sits under the National Urgent and Unscheduled Care Collaborative Program. The Scottish Government has been focused on building Hospital at Home capacity in the healthcare system since the beginning of 2022, in order to manage ongoing pressures on acute care and support recovery towards a sustainable future

By ensuring there is enough capacity within the community to provide care closer to home, we are able to provide treatment for conditions that would traditionally require patients to experience a hospital stay. We recognise that there are many occasions where a hospital admission is not necessary and in these instances, delivering care at home or in a community setting, is to the benefit of patients.

There is significant evidence that initiatives that reduced hospital activity, such as admissions avoidance pathways and supporting people to manage their own care, have the potential to improve patient experience and overall health outcomes. For example, Hospital at Home has consistently delivered improved levels of patient satisfaction compared to in hospital care, and remote monitoring has reduced mortality for heart failure patients. Care is structured around the person’s needs provided by multi-disciplinary teams. Qualitative evidence demonstrates that patients valued being in the comfort and familiarity of their own home, and reduced disruption to daily routines.

This work currently focuses on five priority pathways:

• Hospital at Home: General and Older People
• Hospital at Home: Community Respiratory Services
• Hospital at Home: Outpatient Intravenous Antimicrobial Treatments (OPAT)
• Hospital at Home: Heat Failure
• Hospital at Home: Paediatrics

More areas than ever now either have an Older People’s H@H service or are working with Healthcare Improvement Scotland to develop a service. This includes some of the most remote and rural areas of the country. Read more on the older adult’s pathway. 

Contacts

Unscheduled Care Team: UnscheduledCareTeam@gov.scot