Urgent care services - Near Me in NHS Greater Glasgow and Clyde's flow navigation centre: good practice example

Context

Many people access urgent and unscheduled care through a route that may not be appropriate to their actual needs. This can often result in unnecessary hospital admissions, investigations and delays. An over-reliance on unscheduled care results in the health and social care system being reactive rather than proactive in effectively managing the patient journey.

Prior to COVID-19, Emergency Department (ED) attendance within Scotland had increased year on year, with total attendance in the calendar year 2019 4.3% higher than in 2018. This was 5.9% higher than in 2017 and 6.3% higher than in 2016. The reasons for this are complex but, in part, are due to a lack of awareness of services, challenges in other areas of the system and potential reluctance to wait for care. This can lead to poorer clinical outcomes and increased workforce stress.

The COVID-19 pandemic has had a profound effect upon the delivery of NHS services and the behaviour of the general public in the way they access healthcare. The 'lockdown' of the population to control the spread of COVID-19 resulted in a sharp reduction in ED attendances nationally, which for a short period were less than 50% of historical levels seen prior to March 2020. Research has previously suggested that approximately 20% of patient who historically have attended EDs can be managed in an alternative and clinically appropriate way.

The need for new ways of delivering services during COVID-19 has demonstrated what can be achieved to keep people safe and improve access to healthcare. Therefore in 2020, a national Redesign of Urgent Care Programme was launched to ensure that patients were seen in the most appropriate clinical environment for their healthcare to minimise crowding of EDs and to reduce the risk of nosocomial infections.

The new national programme commenced with a pathfinder site provided by NHS Ayrshire and Arran in November 2020, followed by wide implementation launched nationally in December 2020. The first phase of implementation focused on:

• 1. A single national number for all urgent care NHS 24 / 111 - this first step offered clinical triage and signposting to the most appropriate care – self-care, GP in or out of hours, pharmacy, dentist, optometrist, flow navigation centre or direct to the Emergency Department
• 2. Flow Navigation Centres - these were established in every Health Board across NHS Scotland to offer clinical triage and virtual assessments with early access to a senior decision maker
• 3. Technology Enabled Assessment – utilising telephone consultation or Near Me, the clinician can assess care needs without the patient having to leave the safety of their own home
• 4. Scheduling – managing variation in attendances and avoiding surge offers the patient an opportunity to attend when it is safe to do so and can be seen without delay. Where possible attendance is scheduled for the next day when the department is quieter, diagnostics are available and rapid assessment can be planned

In preparation for successful wide scale implementation, a national work stream was initiated to ensure dedicated expertise and resource which supported the development of Near Me services in the new Flow Navigation Centres.

The Scottish Government provided funding to each Health Board to meet the 'scale-up challenge' and to support the rollout of Near Me within urgent care services.