Redesign Urgent Care: paediatric pathway to flow navigation centres - review

2. Background

The Redesign of Urgent Care (RUC) programme seeks to promote significant transformational change in how optimal urgent care can be delivered for the people of Scotland. The RUC included establishing flow navigation centres (FNCs) in each board. Callers to NHS 24 who require emergency department (ED) attendance receive a call back from a Senior Decision Maker (SDM) based in the FNC within four hours, except for life threatening or major trauma presentations where (as currently) an ambulance will be called or the caller directed immediately to ED.

All emergency, life threatening or trauma presentations should continue to proceed directly to ED without calling NHS 24.

The FNC was tested in a "pathfinder" carried out in NHS Ayrshire & Arran between 3 and 23 November 2020 helping inform national rollout on 1 December 2020.

The NHS A&A pathfinder included all ages and in this period - 87 under 12 year olds were referred to the FNC, accounting for 17% all FNC referrals. Feedback from staff and from parents was very positive, with parents appreciating the opportunity to speak to a clinician as early as possible. An additional benefit was that the appointment system allowed families to make arrangements for other siblings rather than expose them to a hospital setting unnecessarily.

At the time of the rollout concerns were expressed around the inclusion in the system of infants and children. The majority view at that time was that it was not safe to include unwell <12 year olds (<12s) in the new system at the very outset.

Therefore patients <12 years were not included in the rollout to the FNC pathway. Currently NHS 24's outcome is to direct to ED all calls for <12s that could have been eligible for the RUC stream. As pre 1st December, NHS 24 continue to refer <12s to non-ED points of care, e.g. the GP Out of Hours service.

This Short Life Working Group (SLWG) was established to support a pathway review and develop an optimal pathway of care for <12s. The Group reports to the Scottish Government and Strategic Advisory Group on findings and recommendations on when and how to include <12s in referrals to the Flow Navigation Centres. The SLWG is multidisciplinary (see Annexe 1 for group membership) and met four times between 15th December 2020 and 14th January 2021. The SLWG considered

relevant data, the benefits and risks of including <12s in the FNC, discussed issues arising and made recommendations.