Report: Commissioning Urgent Care

Breaking the mould without breaking the system: new ideas and resources for clinical commissioners on the journey towards integrated 24/7 urgent care (November 2011)

The journey towards integrated 24/7 urgent care – a joint report with the NHS Alliance

In one of the case studies presented in the report, GP Donal Hynes gets right to the heart of the challenge for the new clinical commissioners when he says we need to ‘break the mould without breaking the system’. The NHS Alliance, working in partnership with the National Association of Primary Care is committed to clinicians driving forward the changes we need, showing the bravery to think afresh and not accepting just because things have always been done this way, they always should. The aim is to be bold, but also to understand the complexity of the system, where actions can have unintended consequences; nowhere is this more the case than in commissioning urgent care.

Urgent or unplanned care – when any one of us feels the need to access care quickly – leads to at least 100 million NHS calls or visits a year. It represents about a third of the overall activity in the NHS and more than half the cost. Despite the scale of urgent healthcare, historically more attention has been paid to the way we manage planned activity, especially activity in hospitals (with the exception of the few previous national targets focussing on urgent and emergency care, in particular ambulance times and A&E waits). 

The last few years have seen an increasing focus on urgent care. Too often, rather than working together, health services have tended to work against each other to redirect activity to another part of the system – not deliberately or with ill-will, but in response to the pressures and incentives in the system. At the same time, central government initiatives have encouraged primary care trusts (PCTs) to set up new centres broadening access, although these are not always justified in terms of their overall benefit to the wider healthcare system. So while the last ten years has seen real achievements – with more resources and new forms of access – it has sometimes resulted in a more fragmented system that is difficult for patients to understand or navigate.

Currently there is a real opportunity for the whole network to think afresh about how to get the best possible urgent care system across a local community. Some things are different and distinctive based on the needs of the local population or specific geography, but many other features are common across all. 

This resource is not a blueprint for a commissioning strategy, nor do we believe any single blueprint would work in all localities, but it does make a series of suggestions about how urgent care of the future could be more joined up, provide better value for money and offer better patient care. Too often the incentives in the system encourage organisations to work against each other rather than as partners bound together to deliver the best possible care. The current pressure on budgets, combined with a fresh policy perspective from a new administration that is prioritising integrated 24/7 urgent care, makes it possible for commissioners to take a long, hard look at the current pattern of provision.

This is a practical guide for commissioners. It is the culmination of three years of reviews and innovation by the Primary Care Foundation for the Department of Health on different aspects of urgent care. This publication develops some of the ideas and thinking from this body of work, supported by the generous contributions of many people working in a range of services and has led to something we hope is more than the sum of the parts. It is intended to support your journey towards integrated 24/7 urgent care.

Michael Dixon

Chairman, NHS Alliance