Tackling winter pressures in Primary Care and Urgent and Emergent Care
The NHS is under considerable pressure over this winter period, as demand for services has surged with the onset of cold weather, ongoing COVID-19 challenges and influenza.
At the forefront of these pressures are Primary Care and Urgent and Emergency Care (UEC). Staff have faced one of the busiest summers on record alongside another wave of COVID-19. Despite best efforts, these pressures mean there have been too many occasions when staff have not been able to provide patients with timely access to the highest quality care.
This winter’s challenges
NHS leaders in England are warning that the NHS has reached a tipping point, with nearly nine-in-ten leaders (88%) saying the demands on their organisation are unsustainable.
Almost the same number (87%) also say a lack of staffing across the NHS is putting patient safety and care at risk.
NHS England has proposed several key initiatives to help recover from the pandemic backlog and improve operational resilience into 2023. Integrated care boards (ICBs) have been asked to maximise the benefits of collaborative system working, however, there are barriers to achieving these ambitions.
Ambulance and NHS 111 services, Primary Care, community health services, and mental health services are all affected by capacity restraints due to workforce shortages, particularly where there are patients with urgent or very high-priority needs. ICBs are seeing more patients visiting emergency services and overwhelming general practice. In the past, these patients would have access to an appropriate department that reduces the strain on the whole system.
The current response
Part of the response for ICBs has included scaling up virtual wards to improve patient discharge and increase capacity. The number of NHS 111 call handlers has increased to around 4,800, and the number of NHS 999 call handlers has risen to 2,500. There is a focus on both increasing provisions for High Intensity User services and supporting good working relationships with the independent sector, building on past success to facilitate patient choice.
Community care has also seen an increase in two-hour Urgent Community Response provisions by maximising referrals from the ambulance service and other providers. They aim to maintain and improve the current standard of responding to 70% of call-outs within two hours.
ARRS, Primary Care Networks and wider support at the ICS level
There has been a massive drive across Primary Care networks to expand additional roles ahead of the Enhanced Access service that launched in October 2022. However, many PCNs still struggle to recruit and retain staff for these roles.
The flexible pool scheme enabled ICSs to procure digital staff banks that support general practice – GPs, multi-disciplinary clinicians, vaccinators and administrators – as they stand up and run PCN- and borough-wide initiatives, including integrated COVID-19 and flu vaccination clinics. ICBs have been actively supporting and engaging with PCNs to:
- Develop collaborative models for managing specific winter pressures like paediatric clinics for children with febrile illnesses
- Develop digital solutions for Primary Care, including remote monitoring of care home residents and long-term conditions management
Primary Care providers are also supporting patients with urgent care needs wherever possible, including through community-based services such as community rapid response teams. Better support for people at home includes scaling up virtual wards, especially for those with heart failure exacerbations or respiratory conditions.
Federated GP and matron-led care home response and monitoring teams are also providing additional support for anticipatory care planning to avoid unnecessary admissions to hospital.
The need to bolster the workforce
NHS staff continue to strive knowing that pressures are going to increase. The health and wellbeing of the workforce is crucial, and interventions targeting recruitment and retention will be important in managing additional demand this winter.
Recruitment and retention plans should include staff sharing and bank arrangements. Across the NHS, international recruitment has been identified as a way to help:
- Enable UEC recovery
- Identify shortages of key roles and skills
- Target recruitment and pipeline role development
The Wellbeing Practitioners’ Pack is also building on the success of the volunteer roles that surged during the COVID-19 vaccination rollout. ICBs are looking to develop more roles for volunteers that reduce pressure on services and improve patient experience, such as community first responders and discharge support.
Expanding capacity is dependent on both sufficient workforce and workforce wellbeing. It’s important that plans are built from the bottom up, with ICBs developing plans based on realistic assumptions around retention and recruitment.
System working also means a new approach to accountability. ICBs are accountable for ensuring their system providers and other partners deliver their agreed role in their local plans and work together for the populations they serve. While these plans represent substantial work to increase capacity and improve operational capacity, they should also include epidemiological modelling to aid forecasting and preparation for recurring winter pressures.
Lantum’s unique Connected SchedulingTM platform is designed to help healthcare organisations of all sizes understand their existing staffing resources, build centralised rotas quickly, and access extra locum support at a fraction of the cost of an agency.
To find out more about how Lantum can help your organisation build a stronger workforce while also saving time and money, get in touch with our team today.