Urgent Care and the Five Year Forward View Next Steps

A quick post picking out bits from the Five Year Forward View Next Steps paper that are most relevant to urgent care.

NHS England have just released the “Next Steps on the NHS Five Year Forward View“, which is an follow-on from the original “NHS Five Year Forward View” which was published in 2014.

Given my current focus on Urgent & Emergency Care technology, I have pulled out some of the sections I felt most likely to affect my current work, or which are relevant to the Integrated Urgent Care programme so that I can easily refer to them.

EXECUTIVE SUMMARY (Page 4)

“4. That’s why over the next two years the NHS will take practical action to take the strain off A&E. Working closely with community services and councils, hospitals need to be able to free up 2,000-3,000 hospital beds. In addition, patients with less severe conditions will be offered more convenient alternatives, including a network of newly designated Urgent Treatment Centres, GP appointments, and more nurses, doctors and paramedics handling calls to NHS 111. (Chapter Two)”

Chapter Two – URGENT AND EMERGENCY CARE (Page 14)

“Some estimates suggest that between 1.5 and 3 million people who come to A&E each year could have their needs addressed in other parts of the urgent care system. They turn to A&E because it seems like the best or only option.”

What’s been achieved in England over the past three years? (Page 14)

  • Boosted the capacity and capability of NHS 111, which now takes 15 million calls each year, up from 7.5 million three years ago.

Key Deliverables for 2017/18 and 2018/19 (Page 14)

  • Every hospital must have comprehensive front-door clinical streaming by October 2017, so that A&E departments are free to care for the sickest patients, including older people. (Page 15)
  • Enhance NHS 111 by increasing from 22% to 30%+ the proportion of 111 calls receiving clinical assessment by March 2018, so that only patients who genuinely need to attend A&E or use the ambulance service are advised to do this. GP out of hours and 111 services will increasingly be combined. By 2019, NHS 111 will be able to book people into urgent face to face appointments where this is needed. (Page 15)
  • NHS 111 online will start during 2017, allowing people to enter specific symptoms and receive tailored advice on management. (Page 15)
  • Strengthen support to care homes to ensure they have direct access to clinical advice, including appropriate on-site assessment.
  • Roll-out of standardised new ‘Urgent Treatment Centres’ which will open 12 hours a day, seven days a week, integrated with local urgent care services. They offer patients who do not need hospital accident and emergency care, treatment by clinicians with access to diagnostic facilities that will usually include an X-ray machine. We anticipate around 150 designated UTCs, offering appointments that are bookable through 111 as well as GP referral, will be treating patients by Spring 2018.

Chapter Ten – HARNESSING TECHNOLOGY AND INNOVATION (Page 64)

Specifically, during the coming two years we will implement solutions that:

  • Make it easier for patients to access urgent care on line.
  • Enable 111 to resolve more problems for patients without telling them to go to A&E or their GP.
  • Simplify and improve the online appointment booking process for hospitals.
  • Make patients’ medical information available to the right clinicians wherever they are.
  • Increase the use of apps to help people manage their own health.

Technology to support the NHS priorities (Page 66)

Urgent and Emergency Care

  • NHS 111 Online. Throughout 2017 we will be working to design online triage services that enable patients to enter their symptoms and receive tailored advice or a call back from a healthcare professional, according to their needs. We will be testing apps, web tools and interactive avatars in local areas and using detailed evaluation to define the best approach. By December 2017 all areas will have an NHS 111 online digital service available that will connect patients to their Integrated Urgent Care via NHS 111.
  • NHS 111 Telephone: Clinical decision support systems are well used throughout the health system. They have supported our ambulance services and urgent care services for many decades. The developments in technology mean these systems are improving exponentially – becoming more personalised and intelligent and able to process more data in real time. From summer 2017 we will be developing and testing new specialist modules of clinical triage for Paediatrics, Mental Health and Frailty and demonstrating the impact of risk stratification. By March 2019 an enhanced triage will be available across integrated Urgent Care, with the potential to also support Urgent Treatment Centres, Care homes and Ambulance services.
  • To ensure that patients get the right care in the most appropriate location, it is also important that clinicians can access a patient’s clinical record. By December 2017 every A&E, Urgent Treatment Centre and ePrescribing pharmacy will have access to extended patient data either through the Summary Care record or local care record sharing services. We will also have access to primary care records, mental health crisis and end of life plan information available in 40% of A&Es and UTCs.
  • By December 2018 there will be a clear system in place across all STPs for booking appointments at particular GP practices and accessing records from NHS 111, A&Es and UTCs supported by improved technology APIs and clear standards.
  • During 2017 we will begin the work with vendors to seamlessly route electronic prescriptions from NHS 111 and GP Out of Hours to pharmacies via the Electronic Prescription Service (EPS). This will speed up the supply of medicines, and significantly reduce the time and cost involved.

Note: I haven’t extracted the full sections – I’ve hand-picked specific paragraphs. If you want the full context of the material you should read them in the original document.

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