New Opportunities

For Practices to audit their appointments and

For local health systems to shape their integrated urgent care system

Overview: A&E Acute Admissions

The Primary Care Foundation was commissioned by the Department of Health in May 2009 to carry out a study across England of the different models of primary care operating within or alongside emergency departments. We were asked to provide a viable estimate of the number of patients who attend emergency department with conditions that could be dealt with elsewhere in primary care.  The work was carried out by drawing on expertise from a reference group, a literature review, undertaking visits to departments and also carrying out a web based survey with completion by emergency departments, primary care Providers working in or alongside emergency departments and the commissioners of these services. The report was released in March 2010 (click HERE)

The number of primary care clinicians based within or alongside emergency departments has expanded rapidly in recent years, promising better care for patients who do not need emergency department services and a reduction in admissions.

Primary care practitioners can enhance emergency departments by bringing vital skills and expertise to a multi-disciplinary team. To achieve this, managers and clinicians need to develop strong working relationships. Building mutual respect takes time, but it is vital if initiatives of this kind are to lead to a more integrated service. As one GP put it “if everyone is involved it becomes seen as a joint baby, not a primary care service in their midst”.

Successful schemes are the product of sustained attempts to test out new ideas, learn from each other and improve patient care, based on clear recognition of the skills of each group of clinicians and mutual respect. However, in practice there can be a clash of cultures, with staff divided by different training, approaches to managing risk, governance systems, language and their experience of different case mixes.

The stated reason for introducing primary care services is often to improve patient care.  Yet we found in many cases the main drivers are, in fact, reducing costs and helping to meet the four-hour waiting time target.  The argument is that the payment by results tariff is more costly than a consultation with a primary care clinician and that the higher tariff for a patient who is admitted can act as an incentive to admit, an effect magnified by pressure to meet the waiting time target. 

In this context, primary care clinicians may appear to represent a challenge to the financial viability of a hospital trust. Simply adding primary care practitioners may create short-term savings for commissioners but, without commensurate savings being made or other benefits being realised, there is no saving to the NHS or tax-payer. In contrast, services that are integrating urgent care and developing local tariffs, that incentivise all partners to work in the patients’ best interests, appear to be heading in a more promising direction. In time, an overall cost reduction may be achieved from this approach.

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay



Latest News

Healthcare Leader Forum

Henry Clay will be speaking at the upcoming Healthcare Leader Forum: Improving urgent and emergency care conferences on 14th September at the Hilton Birmingham Metropole and also in Reading on the 21st September. This interactive conference will give its audience vital insight into the delivery of streamlined, efficient urgent care pathways emerging from regional transformation partnerships and local initiatives. Speakers will explore the necessary steps to ensure the audience know how to guarantee their organisation is fully prepared and that services are properly resourced.


Are there any simple lessons for practices looking to improve access?

A new feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  


Integrated Urgent Care – how to make NHS 111 work

A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE


A new audit of potentially avoidable appointments in general practice – available to all practices at no cost

This audit was developed as part of our research for NHS England with the initial results - suggesting that 27% of GP appointments are potentially avoidable - published in ‘Making Time in General Practice’. NHS England are now committed to extending this work by funding support for practices - so there is no direct cost - of an App you can download on to your computer screen, making it really easy for you to see how many of your appointments might be avoidable and helping you explore how you might be able to do something about it. If you want to know more, download Frequently Asked Questions, the Governance Statement and the Application Form and take a quick look at a virtual tour or email us at This email address is being protected from spambots. You need JavaScript enabled to view it.


Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.


We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.