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

4. Key messages

The first phase of the Redesign of Urgent Care Programme (RUC) was adopted by all territorial Health Boards, NHS 24 and the Scottish Ambulance (SAS), and reports strong collaborative working. There are a number of key messages to be considered and shared:

1. NHS 24 111 have established a 24/7 service, with evidence of an increase in activity week-day (Monday-Friday) contacts, particularly in daytime hours (In-Hours).

2. All Boards have established Flow Navigation Centres (FNC's) since Dec 2020, with NHS Highland covering Orkney, Shetland and the Western Isles NHS Boards.

3. Weekly implementation meetings with all Board RUC Implementation Leads are now well-established, to support joint working and to help embed the new and evolving RUC programme.

4. Regular meetings between NHS 24 and local Board Clinicians were established to discuss clinical referral pathways and optimal joint working. Good engagement has been reported to date.

5. Activity Data:

a) Apart from NHS 24 111, other urgent care services involved have seen relatively stable or experienced reduced activity. This excludes FNC activity, as these are new developments with no historical controls to allow comparisons.

b) GP OOH activity appears stable since Go-Live. There was a perceived risk that GP OOH activity would be increased, however this is not evident in the data to date. It is recognised that COVID-19 Hub and CAC activity overlaps, particularly in relation to specific dependencies on GP workforce resources. Other experiential outcomes are considered later in this report.

c) COVID-19 Hub and CAC activity was stable until a peak in January 2021, followed by monthly decreases since, as at end March 2021. (COVID-19 Hubs and CACs have contributed approximately one third of total COVID-19 and GP OOH mid-week activity, and one sixth of all weekend activity).

d) Scottish Ambulance Service (SAS) activity (non-attended attended, conveyed) has remained relatively stable with minor fluctuations.

e) For both total ED attendances and for patients who self-present, activity was reducing prior to Go-Live (December 1 2020) and has continued to show decreases until late February/early March 2021. More recent data show a new upturn, although activity remains below 20% of September/October 2020 baselines.

6. It remains difficult to assess the relative impact of changing public help seeking behaviour and overall NHS system response to the COVID-19 second wave. On the basis of available FNC and ED data, the new RUC pathway may be contributing about 5% of the reduction of total ED attendances.

7. Patient Journey Times (for the NHS 24 111/FNC/ED pathway):

a) The median total journey time from NHS 24 111 contact to completion of ED attendance is approximately 217 mins.

b) NHS 24 111: Time to answer calls (TTA) and call abandonment rates have increased, particularly over weekends, compared to historic data. It would appear there is an association between call abandonment rates and TTAs, which requires further elucidation. Note: NHS 24 collects data patient experience data on ongoing basis. Despite longer call answering TTA times NHS24 complaints have not increased and patient satisfaction remains high.

c) FNC: From initial FNC contact the median call back time to contact patients is approximately 10 mins, across Scotland.

8. Paediatric (Children's) Urgent Care: Following consideration of the views of the Scottish Association of Medical Directors (SAMD), the Scottish Executive Nurse Directors Group (SEND), a majority consensus view of Board Chief Executives and as endorsed by the NHS A&A Pathfinder Report children <12 years were not included in the national RUC roll-out on 1 December 2020. Paediatric activity is more complex to interpret as patterns of activity are more variable. Changes in demand reflect also COVID-19 vagaries and associated distancing measures.

9. Mental Health Urgent Care: Some patient pathway re-design (Mental Health Hubs) was already in place (not RUC related) pre-Go-Live. Since Go-Live, demand has been relatively stable for all services with minor decreases. Note: ED attendances for mental health urgent care are again increasing but have not (yet) reached September/October 2020 baselines.