Lessons for Commissioners and Providers

There are a number of areas that commissioners and providers need to address if they are successfully to establish primary care clinicians within or alongside emergency departments.  This is an extract from the full report – for more detail, please go to …..

Ensuring early clinical engagement

Clinical leads should be focused first on devising workable approaches that provide good care for the different groups of patients. Checking that sufficient cases will justify the involvement of primary care clinicians and also that there is sufficient flexibility in the process to balance the workload.

Establishing working groups

Working groups should be set up that allow primary care practitioners and emergency department clinical staff to develop services together to meet the requirements of commissioners. The absence of dialogue between commissioners and both groups of clinicians appears to be a barrier to improving care.

Creating models and an ethos of care

The objective should be to break down the barriers between primary care and emergency care clinicians, between the different organisations that employ the staff, and that promotes good joint-working.  However, this must be based on absolute clarity over the strengths that each group has, how they are best deployed in or alongside the emergency department and what each group is expected to do.  Only with this clarity will it be obvious to the clinician involved in a consultation when the expertise of another group needs to be drawn on to meet the needs of that patient.

Addressing all aspects of the service

By using the principles contained within this document and examples of good practice to improve care for patients and manage the risks are inherent in any chosen model commissioners and providers should put patients at the core of the service.

Recognising that there are no quick solutions

Whilst some changes can be made reasonably quickly it takes a long time for confidence to be earned by a any new group of staff operating in an area that is as safety critical as an emergency department. Commissioners should recognise that a degree of caution is healthy – whilst the existing processes and ways of working have their flaws these are understood by the staff involved, who can manage the risks associated with them. The challenge of introducing a host of new elements such as:

• New staff with a different clinical approach from a new organisation

• New processes, protocols and governance arrangements

• New payment mechanisms and incentives

• New operational layouts

is significant.  These have to be thought through carefully and jointly developed over time to ensure the system is safe for patients. They will take considerably longer to become fully effective.

Improving and linking IT systems

It is important to consider the role of IT in supporting these developments.

Exploring more collaborative ways of funding

Services that encourage clinicians and managers to work together, including working to develop local tariffs that integrate urgent care while also aligning financial incentives will allow clinicians to focus on what is right for the patient without having to overcome perverse financial     incentives.

Looking at the urgent care system

It is important that commissioners see any initiative of this kind within the broader context of the full urgent and emergency care pathway.