Urgent Care Centres: What works best?
A discussion paper from the Primary Care Foundation October 2012
Clinical commissioning groups are in many places looking at how to provide the government’s vision of integrated urgent and emergency care while at the same time NHS 111 services are being launched. They are doing it against a backdrop of the need to contain cost and considerable attention is given to driving down attendance at emergency departments (EDs), while meeting the rising expectations of the public.
Urgent care centres of various types have evolved as a way of meeting these needs. But we found little published evidence that they reduce attendances at A&E and some suggestion that they might increase the total burden on the NHS. Certainly many are meeting primary care needs (though some count these cases as urgent) and they are now firmly established. Many have the loyal support of local users who rally to defend their local centre when commissioners attempt to replace it.
This discussion paper looks at the different models for providing urgent care services and evaluates their impact. Through site visits to 15 urgent care centres (UCCs) and a literature review carried out by Warwick Medical School as well as the support of a reference group we identified some criteria that we believe define a good service, one that delivers high quality, clinically appropriate and cost-effective care.
We believe a good service is one in which:
- Care is provided promptly
- The patient’s urgent needs are met (including reassurance where this is appropriate)
- The scope of the service is clear
- There is clear governance and management responsibility for improving quality and cost-effectiveness
- The environment is appropriate for provision of good quality care and supports integration with other services
- The process used supports these objectives
- There are mechanisms for capturing and acting on patient experience and other feedback.
The paper looks at the extent to which the UCCs we visited measure up to these criteria. We found wide variation in the nature of the service that had been called an urgent care centre. There was also a lack of rigour in data collection so it was difficult to get a true picture of their effectiveness or cost. Finally, the paper offers some key thinking points for clinical commissioners to consider as they develop their plans for integrated, 24/7 urgent and emergency care.