Experiences of Urgent Primary Care Services

Optimising Patient Risk Management in Urgent Primary Care Services

The workshop was designed to inform a study being led by the Nuffield Department of Primary Care Health Services, at the University of Oxford, entitled Optimising Patient Risk Management in Urgent Primary Care Services.

The study has a particular focus on people who may be more at risk of poor health outcomes, such as people with special access requirements or facing health inequalities.

The aim of the study is to identify how to optimise the quality and safety of the care received from services such as NHS 111, out of hours GPs, Urgent Treatment Centres, Minor Injuries units.

What we heard

Key access challenges

Workshop participants shared insights around the experiences of the communities and cohorts with which they worked in accessing Urgent Primary Care Services. A number of key themes emerged, including:

• Lack of awareness and understanding – Participants told us it was hard for people to understand the complex range of primary care services available to support people out of hours.
• Communication and accessibility issues – For those with additional communication needs and those who are digitally excluded, we heard that Urgent Primary Care services were often more inaccessible than regular daytime services.

We also heard insights around some of the specific issues faced by some of the key groups of interest to the study, including gaps in support for people at end of life and challenges for people experiencing mental health issues.

Challenges in keeping patients safe

We discussed the extent to which Urgent Primary Care services were able to keep patients safe, just some of the key identified challenges for patient safety included:

• Feeling heard and building trust.
• Lack of clear information.
• Treatment of frequent callers.

We also heard insights around some specific issues faced by key groups of interest to the study, including safety issues for older adults and feat and mistrust among people from minoritised ethnic communities.

How can we improve safety?

Recommendations that emerged from the workshop included:

Improving existing services

• Implementing the Accessible Information Standard and the Reasonable Adjustments flag across all services.
• Ensuring that patients’ access to public and private transport is taken into account when making referrals.
• Training staff in active listening and person-centred support, and in supporting people who may be more vulnerable.

Recommendations around improving communication included:

• Creating communications materials in a range of formats to convey when and how services can be accessed and encouraging people to use out-of-hours services if needed.
• Ensuring advice given at the end of patient interactions is communicated appropriately in a way that reflects specific communication needs.
• Use a range of tools (leaflets, texts, voice notes) to give people ‘take away’ information.

Reconfiguring services

Recommendations around reconfiguring services included:

• Offering patients more direct routes back into services should issues escalate.
• Creating more effective pathways through support available out-of-hours in each local area by joining up the offer across the NHS, social care and VCSE support through better signposting and understanding of what is available.
• Sharing records across Urgent Primary Care Services and other primary care services so patients receive seamless care.

Acknowledgements

This workshop and report were funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship award to Dr Rebecca Barnes (NIHR302557) at Nuffield Department of Primary Care Health Services, University of Oxford. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

We would like to thank those who shared their expertise and valuable insights in our roundtable, member and non-member organisations in attendance included:

• Age UK.
• Behind the Smile.
• British Geriatrics Society.
• Caribbean and African Health Network.
• Compassion in Dying.
• Derbyshire Mind.
• Hertfordshire Mind.
• Marie Curie.
• Mind.
• National Association of Deafened People.
• Thomas Pocklington Trust.