The fact that hospitals are overwhelmed and are not always the best place to navigate certain types of patients is not new information, and with NHSE’s latest single point of access (SPoA) guidance requiring systems to meet SPoA foundation components by winter, the need for smart urgent emergency care pathways (UEC) is at an all-time high. That’s why four NHS leaders from across the UK shared insights into how they’ve set up proven UEC pathways at our recent panel discussion. Chris Morrow-Frost, National Clinical Advisor to hospitals and co-chair of NHS England’s Hospitals’ UEC Clinical Advisory Group, chaired the discussion and, in light of the recent Darzi report, reiterated the importance of working together to get patients to the right place.
Read on to learn more, or click below to quickly navigate:
‘Call before convey’ in NHS Tayside
‘Tayside is a wide geographical area with two main hospitals: Dundee and Perth. Therefore, the nearest ED for a patient can be a few hours away. A two-hour ambulance transfer is not always appropriate, and there are more suitable locally available care options.
‘Access to a senior clinical decision-maker in A&E in Tayside has always been available, but it wasn’t until we started routing our calls via Consultant Connect in 2018 that we could quantify these queries. Consultant Connect gave us the ability to listen back to calls as needed and leave outcomes to track patient pathways. This has been paramount to demonstrating the benefits and impact of navigating patients away from our EDs.
‘When a national re-design of urgent care was announced in 2020, there was an onus on Health Boards to act on the demand of activity and schedule more care. We used funding to expand and better support our Prof-to-Prof* services. Since then, we have set up an emergency medicine consultant-led provision which operates seven days a week and is job-planned.
‘The Consultant Connect call data allowed us to map the job planned activity for when the calls are most frequent. This allows external partners within the ambulance service, NHS24, and primary care to have rapid access to senior clinicians to discuss where patients are best placed. Admittedly, when this was first introduced, some colleagues were hesitant, but as it’s become business as usual, the benefit of supporting community partners and showing that ED is not the right place if you don’t need it has become evident.’
‘Since the redesign, our call volumes have more than tripled. Along with the emergency medicine line, we’ve expanded the Consultant Connect offering to support more specialties, all with the idea of navigating a system to allow for the best patient care.
‘We have the lowest ambulance conveyance rate in Scotland, and, compared to the national average, this means we have 15 fewer patient attendances a day, freeing up our clinical capacity, saving the ambulances time in conveyance and handovers, and ultimately, giving the patients a better experience.’
– Jamie Morrison, A&E Consultant and Clinical Lead for the Flow Navigation Centre in NHS Tayside.
* Known as Advice & Guidance in England and Wales.
Hear more from Dr Jamie Morrison in this short audio clip from our recent panel discussion:
The frailty pathway in Coventry & Warwickshire ICB
‘Before the implementation of Consultant Connect, we weren’t getting much traction through the traditional Advice & Guidance methods, so after liaising with the local GPs, our frailty pathway officially launched in 2016 as a WhatsApp group. When Covid hit in 2020, the need to keep frail patients at home was greater than ever, so we decided to route the service via Consultant Connect. This revolutionised the pathway: it provided one direct line that could be accessed by GPs, paramedics, district and frailty nurses, community ACPs, and urgent emergency response teams. The service is pre-programmed in the Consultant Connect App, making it easily accessible for clinicians wherever they’re based. All calls are recorded, which is beneficial for training purposes, as it means we can assess the advice given and identify learning opportunities. The service employs a rota-based system, meaning it routes to the next if the first consultant can’t answer. For the advice seeker, it’s one simple phone call, and they don’t need to hang up and try alternative contact methods.
‘We can see our performance data; for example, we know that calls are answered within 20 seconds on average, and the statistics so far have shown that 57% of calls result in patients being able to stay in their own homes. Not only does this have a knock-on effect on ED’s capacity, but we know that when frailty patients are admitted, their length of stay increases due to deconditioning, so the ‘home first’ mindset is vital for patients’ welfare. Our pathway has also positively impacted our ambulance service, as 95% of handovers are completed in less than 30 minutes.
‘Using the frailty service to keep patients home has meant we’ve closed a surge ward. Staffed entirely by temporary and locum clinicians, its closure has saved us £1.7 million, so it’s sustainable for the future. The surge ward has now become the medical day case unit, so the effects benefit elective care too.’
‘Creating an open dialogue between primary and secondary care ultimately led to better collaboration. It’s about listening to the staff, discussing what is achievable and delivering it for patients.’
– Rachel Williams, Associate Chief Operating Officer at South Warwickshire University NHS Foundation Trust.
Hear more from Rachel Williams in these short audio clips from our recent panel discussion:
Surgical SDEC in Cardiff and Vale University Health Board
‘In 2019, after being overwhelmed with unfiltered referrals, we introduced a surgical SDEC line. We routed this via Consultant Connect because it offered us insightful and granular data which we could use to monitor our service levels. Now, we take all our referrals via Consultant Connect, and the calls are answered by nursing practitioners, with clinical input provided by an SDEC consultant if required.
Implementing Consultant Connect gives us control over our flow and intake; we can direct patients to specific units, patients referred late in the day are booked into HOT clinics, and we can direct patients to have diagnostics undertaken before attending SDEC. It’s a time-saver for patients and speeds up the process of receiving care. When the surgical SDEC line was first introduced, we saw a 20% reduction in overall attendances, with a 40% reduction in GP referrals. Because of this, we’ve reduced our surgical bed base and are expanding the pathway across other surgical specialties.
‘We see around 1,200 patients per month who are discharged with follow-up calls, sometimes returning to HOT clinics if necessary. In surgery, we need to see a patient within 48-72 hours, so it is busy, which is why Consultant Connect helps us ensure we utilise our resources effectively. It’s all about planning for attendances, carrying out diagnostics quickly so that we can decide where a patient needs to go next.
‘There will inevitably be initial anxiety around increased phone calls. Every specialty has its resources; some are small, with insufficient consultants to man a rota. But it doesn’t have to be consultants – we’ve trialled registrars and found that consultants need to be the senior decision-makers, but they didn’t have the capacity to take calls. So, we expanded our healthcare professional workforce specifically to deal with that. But it is possible, and it’s about finding the right balance to make it work.’
– Chris Morris, Consultant Colorectal Surgeon and Lead for Surgical SDEC in Cardiff and Vale.
Hear more from Chris Morris in this short audio clip from our recent panel discussion:
SDEC in South East London ICB
‘As our ICB covers a large area of around two million patients, the key for us was starting small to prove the concept, building trust between clinicians and the system.
‘Post Covid, a South East London SDEC working group was set up with the idea to include 111 and ambulance crews to ensure patients were directed to the most appropriate service. This pilot was initially launched only for chest pain, but its success allowed us to peer review the process so other specialties could see what we did, what we’d learnt, that our service wasn’t overwhelmed, and that it fostered excellent relationships between the healthcare professionals. It also facilitated a mechanism for feedback, allowing users to identify if a patient could have been directed to a more appropriate place, so it helped build community learning.
‘Our overall ambition was to use Consultant Connect technology to direct patients to the most appropriate place, and that’s a clear achievement. We initially started with four planned care specialties, but this success enabled us to move into the urgent care space. We developed the provision with SDEC and ambulatory units, setting them up with dedicated Consultant Connect lines, streamlining the service and removing the need for bleeps and switchboards. We could see the activity data in real-time, whereas, before, we could not know how many calls were being made and answered. Consultant Connect has also become an educational tool that allows us to follow trends in activity and identify surgeries where additional GP learning could be beneficial.
‘In the last year, we’ve received more than 12,000 calls into SDEC services, with 78% answered the first time. This is now a job-planned service compared to the unplanned answer rates in the 50s when we first launched. The first person on the rota is a consultant. If this line isn’t available, the call re-routes to the nurse-led line, allowing us to backstop and improve the answer rate. The nurses expect the calls, so the onus doesn’t need to always be on the consultants.
‘Making the benefits to all involved clear from the outset helped massively: for the referrers, how it will save them time and prevent hospitals from being overwhelmed. It’s also helpful to onboard an enthusiastic person willing to try something new on a small scale. Dr Roshan Navin, who launched the chest pain pilot at Guy’s and St Thomas’ NHS Foundation Trust, helped us develop our initial pathway. It grew from that: other hospital sites saw how it benefited clinicians and patients alike. The biggest step is getting one innovator to initiate the journey.
‘It’s been a positive experience, and Consultant Connect has given us the platform to do this.’
– Clive Moss, Senior Commissioning Manager for Urgent and Emergency Care in South East London ICB.
How do the UEC pathways fit in with NHSE’s latest SPoA guidance?
‘SPoA can be a confusing term as it means something different to everyone. In essence, it’s simply getting patients to the right place. For acute clinicians providing advice to help colleagues make the right decisions and grow their confidence, it’s about how we can make this as easy as possible. When NHS systems share knowledge and look less at policy and more at doing the right thing, the outcomes show a reduction in people needlessly attending A&E and fewer hurdles for patient journeys. We must use digital technology to make providing the right care for patients easier at an SPoA level.’
– Chris Morrow-Frost.
If you would like to discuss setting up a UEC pathway via Consultant Connect in your NHS area, please email hello@consultantconnect.org.uk or call 01865 261467.
Related materials:
- Prof-to-Prof Advice in NHS Tayside
- Same Day Emergency Care (SDEC) in South East London
- SWFT and Consultant Connect win Health Tech Case Study of the Year! HTN Now Awards 2023/24
- Medical SDEC advice line expedites patient’s diagnosis for rare disorder in Cardiff and Vale
