NHS Scotland redesign of urgent care - first national staging review report: 1 December 2020 – 31 March 2021

Annex H: Phase 2 principles

Aim

Right Care, at the right place, at the right time.

Vision

Collaborate across the whole health and social care system to design and implement a safe, sustainable, patient and outcomes focused system of urgent care access, pathways and treatment in Scotland that delivers better health, care and life outcomes for our patients, staff, their families and the wider community in which we all live, grow, learn, work and play.

Principles

• Minimising the risks of moving patients around the system
• Establishing an emergency care system that benefits everyone
• Delivering a new model of care that is national, simple, effective and safe for all
• Making the best use of scarce resources
• Aligning closely with wider winter planning work
• Addressing inequalities
• Patient and staff safety is out priority across the whole system
• Supporting staff training and organisational development
• Keeping the access route as simple and as clearly defined as possible

Strategy #1 Community Pharmacy

• Providing access to the same levels of care, close to home and with an emphasis on self-care by integrating community pharmacy into urgent care
• Integrating community Pharmacy services into care and referral pathways GP (in and out of hours) and Flow Navigation Centres
• Increasing the use of the role of Community Pharmacy in urgent care
• Signposting patients with minor illnesses to Community Pharmacy where their needs would be more suitably addressed in a convenient, safe and effective manner
• Ensuring referrals methods to Community Pharmacy are effective, efficient and timely
• Enhancing and better understanding the role of community pharmacy

Strategy #2 Primary Care

• Streamlining referral pathways for patients requiring urgent care by maximising and building upon clinician to clinician communications
• Establishing a join approach to decision making between urgent and primary care to reduce unnecessary hospital attendances
• Providing secure, rapid, two-way, digital communications, advice and guidance between professionals (GPs and Emergency Departments)
• Taking a professional approach to a senior clinician seeking advice from another professional on the appropriateness of a referral for patients before or instead of making a referral (e.g whether to refer, or what alternative care pathways exist)
• Providing direct access to Flow Navigation Centres for referrals and scheduling

Strategy #3 Mental Health

• Delivering an integrated system to support mental health and wellbeing by utilising existing mental health services and enhancing their pathways for unscheduled mental health presentations
• Focusing on improving the integration of physical and mental health within the urgent care setting
• Strengthening and expanding the use of asynchronous digital consultations including Near Me for Mental Health presentations
• Exploring the use of professional to professional pathways to support rapid access to advice and support
• Continued establishment of mental health assessment services/ centres for patients presenting with urgent mental health needs
• Developing a pathway for unscheduled presentations for people with psychosocial/complex care needs
• Providing the appropriate support to people quickly, meeting their mental wellbeing needs through an evidence-based care package of care

Strategy #4 Scottish Ambulance

• Delivering care closer to home for people requiring urgent care, with equality of access to urgent, primary and community services
• Providing direct access to Flow Navigation Centres for referral, scheduling and professional to professional advice
• Enhancing the ability to refer into primary care services
• Building on the ability to refer to community pathways
• Increasing the ability to care for more patients closer to home through professional to professional advice
• Further developing the ability to access and share patient information across all health boards to improve continuity of care and patient safety

Strategy #5 Musculoskeletal

• Providing a specialist Physiotherapy resource in the assessment of acute and urgent medical needs to enhance the patient journey
• Reducing onward referrals to Flow Navigation Centres via MSK Physiotherapy resource within NHS 24
• Promoting the role of Physiotherapy in urgent care services
• Reducing the demand on urgent care services and reducing admissions to hospital through MSK Physiotherapy
• Adding to the availability of clinical decision makers within urgent care through specialist MSK Physiotherapy
• Reducing the demand to primary care and hospital based MSK services