More than 200 NHS and social care leaders from across London met today to plan how urgent and emergency care services could work better to prevent patients experiencing un-coordinated or unsafe care following an accident or emergency.

The event, organised by NHS England, challenged health and social care professionals to look at how all parts of the NHS and social care system could work in a more joined-up way for patients and to prevent pressure building up in hospital A&E departments.

In response to data showing that some A&E departments struggled to deliver the 4 hour minimum A&E standard last winter, all local health economies across London are developing ‘Recovery & Improvement Plans’ showing how GPs, social care providers and community services can provide better out-of-hospital care for people with long term conditions or non-life threatening but urgent care needs.  The plans also contain details about how hospitals will ensure their A&Es provide fast and safe care and prepare them for next winter.  The plans will strengthen emergency department’s performance, improve the quality of care and improve clinical outcomes for patients. The plans also describe how local health services, as a whole, can respond better as many people attending A&E departments could receive better, more localised care, from their GP or other provider.

Anne Rainsberry, Regional Director for NHS England (London), said:

“The current system of providing emergency and urgent care in hospital A&E departments to everyone is unsustainable. We need new ways to ensure that people are seen quickly, by the professional best suited to deliver the right care.  In most cases this means that patients should receive more appropriate care in community settings rather than attending hospitals.

“Our aspiration is that all patients receive joined up care wherever they live in London. This means that acute care, including A&E and ambulance services, social care, community care and primary care work together to ensure that patients have a seamless journey from start to finish.

“We should also have very high aspirations for the timeliness in which people receive care from community professionals.   We know that some patients attend A&E departments because they know they will be seen and treated within four hours.

“We also think there is a link between satisfaction with your GP and use of A&E.  The happier people are with access to their GP, the less people use A&E (and vice versa) and in London, access to a GP is not as good as elsewhere in the country.”

The conference builds on the outcome of a meeting of the London Clinical Senate last week, which looked at the risks to the quality and safety of urgent and emergency care services and endorsed the need for greater join up between different parts of the NHS.  The Senate also highlighted the London Quality Standards for Adult Emergency Standards and agreed they were critical to drive improvements in hospitals.

The conference looked at innovative projects from across London including:

–              Chelsea and Westminster’s work to deliver joined up care across three boroughs with their CCGs, an independent company and the local community trust have started a project that will systematically align responsiveness both in the community and in hospital

–             Southwark and Lambeth Integrated Care (SLIC) is a federation between local GPs, the local NHS Foundation Trusts, both CCGs and social care in Southwark and Lambeth, funded by Guy’s and St Thomas’ Charity. This partnership, uniquely, covers social care, acute care, community and mental health provision and commissioning. SLIC helps communities and professionals to work better together so citizens enjoy healthier and happier lives. SLIC works to ensure local people spend as little time as possible in a hospital or care home with more support to stay fit and healthy, and issues detected earlier. The first phase of this work is focussing on older people.

Dr Andy Mitchell, Medical Director for NHS England (London) said:

“All the facts tell us that without reform people will continue to experience unacceptable delays that in some cases lead to preventable death. Its vital that the work the NHS has done to develop local Recovery & Improvement Plans is not just a paper exercise and that we will use them to start shaping better services in primary and community care settings.  Most clinicians acknowledge the system is unsustainable and that it’s our job to deliver better options for our patients.

“The largest group of the population visiting A&E in London are 20-29 year olds (19%) and the second largest group are 30 – 39 year olds (15%). These people, in the main, are making an active decision to go to A&E because they know they will be seen and treated by a doctor within four hours.

“They are also the biggest group to leave A&E with no investigations and no significant treatments (27%). The percentage of people leaving with no investigations and no treatment falls with age.

“This age group expects high quality services on demand and they are used to being consumers and getting what they want, when they want it.

“We have to change the NHS so that it’s much faster and more convenient to see a GP and in doing so we will decrease the pressures on emergency and urgent care.”

Merav Dover, Chief Operating Officer, Southwark and Lambeth Integrated Care, said:

“Southwark and Lambeth Integrated Care uniquely covers social care, acute care, general practice, community and mental health commissioning and provision.

“We exist to deliver radical improvement in the health and well being of our highly complex, mobile and diverse communities, and, by working with our population throughout the system of care from public health and prevention through to acute provision and recovery or rehabilitation, to ensure that they receive the highest quality care and that the impact of our collective resources is optimised.

“Our vision for integrated care will ensure that people feel more in control of their lives, and is designed to support improved health outcomes and experiences, and more resilient communities.”