Principles: Commissioning Urgent Care

The following core principles apply across the urgent care system.

Core principles for the urgent care system:

• patient safety is the priority
• capacity is closely matched to real demand
• clear objectives are set for all component services being commissioned
• clinical and  operational governance must apply consistently to all patients and pathways
• changes to services should be evidence-based
• commissioning must be clinically-led and include the involvement of clinicians from the key component services
• quality must be measured and proven, not asserted – quality should be measured both within and across component services
• activity and outcome data should be produced in as close to real time as possible

The 12 guiding principles for a healthcare system:

Building on the core principles, we have developed a set of 12 guiding principles designed to be a starting point for a healthcare system aiming to develop its urgent care strategy.

1. Patients’ needs will be at the heart of the strategy – in particular, the safety of the patient must come first in considering any changes to the urgent care system.

2. The urgent care system should be considered as a whole: each constituent service has to work well, but also has to work with others, if the whole is to function properly. Processes and services should be easy for patients and health professionals to use and should provide good quality care in an appropriate, safe environment. Attention should be paid to relationships between individuals and between sectors, so that mutual understanding and co-operation is actively nurtured.

3. Decisions about the location, remit, scope and need for specific services should take into account:

• the availability of, and impact on, other services across the local health community
• the actual or projected demand for the service
• accessibility, particularly for ‘hard to reach’ patient groups, and the need to provide an equitable service across the area, while recognising individual solutions may differ depending on the locality’s needs
• the availability of back-up and support services, especially for patients whose condition is more acute
• the need for individual services to be of a sufficient size – this allows good governance, enables good use of services’ skill mix and for staff to experience a sufficiently diverse range of cases to provide good quality care

4. Care should be prompt, minimising the risk of exacerbation and providing early relief to the patient so that, if the condition is found to be more severe than initially identified, appropriate action can be taken.

5. Design care pathways to minimise hand-offs – where responsibility for patients passes from one staff member or organisation to another – while ensuring the patient is seen by the right health professional with specialist skills to provide optimal care.

6. Where it is necessary for responsibility for a patient to be passed from one health professional to another, or from one provider organisation to another, the systems should support a seamless process so that, as far as possible, the patient does not see the join. The process should avoid the patient having to repeatedly provide their details.

7. Decisions about pathways and services should be based on evidence of good practice and proven beneficial outcomes.

8. The urgent care system includes different services; patients and health professionals should be clear what types of condition each service treats, with patients free to choose whatever service they believe will meet their need. The resources offered should be available throughout the services’ opening times: a minor injury service should have suitably qualified staff and x-ray services available to deal with possible fractures throughout its opening hours, not just for part of the day.

9. Services that reduce demand on the urgent care system by minimising the acute exacerbation of a condition through supporting patients in the community are a valuable part of the strategic approach. Community services should be structured in such a way that they can work with the local GP practices to provide this type of preventative care and support patients after an urgent care episode.

10. Clinical staff will be involved in the development of the pathways and services. They have invaluable experience from their day-to-day observations of hundreds of patients; the views of patients are also valuable, but typically informed by less experience.

11. As part of collecting information on individual services, a number of common measures of quality, referrals, outcomes, timeliness, care and patient perception should be collected from all services to understand the operation of the urgent care system as a whole.

12. Providing a cost-effective urgent care service is critical. Urgent care systems providing prompt good quality care and aiming to provide support within the community if possible will be less costly and more cost-effective than those operating with delays, hand-offs and duplication.