Making the most of urgent community response services

NHS Confederation – November 2022

Supporting community providers to maximise the potential of urgent community response services and examples of where this is being done well.

Key points

• With demand on urgent and emergency care (UEC) pathways particularly high, urgent community response services have the potential to play a key role with investment to deliver at greater scale.
• UCR services form a crucial part of the long-term vision for community care, as well as being a core part of a wider national focus on delivering more care in the community, linking in with other new and transformational service models like virtual wards.
• Despite the pressures facing the whole health and care system, community providers have made significant progress in delivering UCR services as outlined in the NHS Long Term Plan and are meeting the national target to respond to 80 per cent per cent of UCR referrals within two hours.
• With the right support and investment, there is real opportunity to maximise the potential of UCR services by driving up the volume of calls diverted to them, and therefore increasing UEC capacity across systems.
• This briefing highlights case studies of where the ambition for UCR services is being driven forward by partnership working, cross-sector collaboration and new technological solutions.
• However, government action is needed to deliver a costed and funded workforce plan for health and care. Without increasing the number of staff available, these new ambitions for how we care for people in the community rather than in hospital can only go so far.

Further information and case studies

Quality improvement using the principles of the Leading Change, Adding Value framework

NHS England | January 2019 | Quality improvement using the principles of the Leading Change, Adding Value framework 

A new case study on NHS England’s Atlas of Shared Learning looks at how the Senior Development Team  nurse undertook a programme  of quality improvement (QI).

The programme has supported the continued professional development of nursing staff to carry out a series of improvement projects, all targeting quality improvement and leadership.

The senior development team nurse collaborated with colleagues from across their organisation to identify  principles of the Leading Change, Adding Value framework (LCAV) which could be embedded in practice. They supported colleagues to be aware of and understand these principles, as well as aligning quality improvement projects with the ten aspirational commitments embedded in Leading Change, Adding Value framework (LCAV).

A nursing development conference was hosted by the Trust to launch the programme including 70 key stakeholder nursing colleagues from across the Trust.

The senior development nurse helped to create a culture shift in approach to quality improvement through empowering staff at all levels to lead change and add value (Source: NHS England).

Read the full, unabridged case study at NHS England 

Supporting young people through transition into adult care services (Sheffield Teaching Hospitals)

NHS England | November 2018 | Supporting young people through transition into adult care services 

Nurses at Sheffield Teaching Hospitals Foundation Trust (STHFT) recognised unwarranted variation in practice within the Trust where children were being transitioned between services, recognising gaps within coordination, information available to children and families and in some clinical specialist service areas, leading to delays in care.

 

This led to the creation of a new role: the Children and Young People Lead Nurse  to  transition between children’s and adult services, offering support to all clinical specialist areas within the hospital. The Children and Young People Lead Nurse engages with families, children and young people with complex needs and provides specialist advice and support to staff to ensure prompt, safe transition into adult services. This role also aimed to support the development of pathways and standardised practice to ensure high quality care at transition was available to all complex needs children within the Trust.

The Lead Nurse developed the role by working seamlessly with the transition team at Sheffield Children’s Hospital and establishing a dedicated caseload of children and young people, to give a clear overview of the transition work being carried out by each clinical specialty. They provide education and training sessions for staff and partner agencies in understanding the needs of adolescents, as well as those with complex needs.

This yielded:

• better outcomes
• better experience
• better use of resources  (Source: NHS England)

Full case study is available from NHS England’s Shared Atlas of Learning 

Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

NHS England | November 2018 | Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

The Walton Centre in Liverpool – the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services-   runs an advice line which means GPs in the Cheshire and Merseyside area can call neuro consultants for fast advice any weekday reducing extra patient appointments. 

So far the service has received 181 calls 37% were resolved by the GP saving £51,698 which over a year saves around £100k.

Programme Director Julie Riley said: “We want to deliver services closer to home and when patients do come into hospital, support them so they can recover and go home quicker. From a patient point of view, we want to work in partnership with them. We, our consultant colleagues and GPs want to support them in self-management, where appropriate – rather than taking a paternalistic approach.”

Read the full case study at NHS England 

Nurse leadership in providing a virtual community placement for nursing students

NHS England | August 2018 | Nurse leadership in providing a Virtual Community Placement for nursing students

A recent addition to NHS England’s Atlas of Shared Learning is a case study of a nurse leadership in providing a virtual community placement for nursing students (NHS England).

A Quality, Health and Innovation Lead in the Nurse Development Team at Bradford District Care NHS Foundation Trust (BDCFT) has developed a new placement model for  first year nursing students, to address variation in the experience and opportunities available to them.

Read the full case study at NHS England 

Of interest:

NHS England | District nursing students lead change to reduce pressure ulcers in care homes

GP Career Plus Case Study: Newham Health Collaborative Ltd

NHS England | September 2018 | GP Career Plus Case Study: Newham Health Collaborative Ltd

A new video case study from NHS England  shows the  Newham created a ‘supply and demand’ staff bank that helps retain experienced GPs, provides direct access to experienced clinicians and lowers costs for sessional staff (NHS England).

Improving asthma and COPD in primary care

NHS England | August 2018 | The Atlas of Shared Learning 

A new case study on NHS England’s Atlas of Shared Learning shows how asthma and COPD in primary care can be improved.   Following training for level 6 COPD and asthma care, the practice nurse at a Northumberland general practicerecognised the unwarranted variation between best and current practice within her GP surgery and addressed this by changing how their respiratory conditions were managed with more focus on patient empowerment and self-management, which is having a positive effect on patients ( Source: NHS England).

The case study looks at how value can be added, changes and lessons learnt

The full case study is available from NHS England 

Driving improvement: Case studies from GP practices

This publication from the Care Quality Commission looks at 10 GP practices that have achieved a significant improvement on their rating.

Key themes

Image source: http://www.cqc.org.uk

The practices in this report faced similar challenges. They all showed an impressive commitment to improve their service to patients. To achieve this they shared common experiences:

• strong leadership from a practice manager with the time and skills to lead the practice team
• addressing staffing and training issues such as poor recruitment or training practices
• making sure every member of the practice team understood their own and others roles and responsibilities
• involving the whole team in running the practice
• involving patients and the local community
• using external support to help improvement

Their experiences show that improvement in GP practices is possible. The case studies highlight some clear actions that other practices can use to help them learn and improve.

Full report: Driving improvement: Case studies from 10 GP practices

Adoption and spread of innovation in the NHS

This report, commissioned by the Academic Health Science Network, looks at opportunities to accelerate the adoption of service innovation in the NHS, drawing on findings from eight case studies of successful spread of innovation in the NHS | Kings Fund

From new communication technologies for patients with long-term conditions, to new care pathways in liver disease diagnosis, to new checklists for busy A&E departments, the report details the highs and lows of an innovator’s journey through the NHS.

While thousands of patients are now receiving new innovative treatments for arthritis, diabetes, cardiovascular disease and chronic liver disease, thanks to successful innovations, the report outlines the significant barriers that stand in innovators’ paths.

The case studies reveal common themes:

• Providers need to be able to select and tailor innovations that deliver the greatest value given local challenges and work in the local context.
• Fragmentation of NHS services remains a barrier to adoption and spread of innovation, making it harder to develop shared approaches and transmit learning across sites.
• New innovations may appear simple to introduce but can have a domino effect – triggering a series of changes to diagnosis and treatment, revealing new patient needs and resulting in big changes to staff and patient roles. That’s why staff need time and resources to implement them.
• As long as the NHS sets aside less than 0.1% of available resources for the adoption and spread of innovation, a small fraction of the funds available for innovation itself, the NHS’s operating units will struggle to adopt large numbers of innovations and rapidly improve productivity.

Full report: Adoption and spread of innovation in the NHS

 

Leeds Teaching Hospitals reducing agency spend case study

This case study shares the experience of Leeds Teaching Hospital NHS Trust on how they reduced levels of medical agency spending | NHS Employers

The Leeds Teaching Hospitals NHS Trust has reduced its medical agency spend by introducing a central deployment service and making effective use of e-rostering to deliver a consistent and professional approach to the deployment of junior doctors.

This case study details the work the trust has carried out, from the medical workforce team working with medical managers, consultants and junior doctors to standardisation of processes. Read up on the steps they took towards improvement and the successes that have been achieved.

Download the full case study here