The urgent community response is a nurse-led service, and the virtual ward is a geriatrician-led service with specialist consultants, advanced clinical practitioner (ACP) consultants and ACP trainees. The integrated service is co-ordinated by a single point of access (SPoA) multidisciplinary team (MDT), that was established in November 2023 and co-located with ambulance services and acute providers.

The SPoA comprises urgent community response and frailty clinicians, emergency department consultants, advanced paramedics and pre-dispatch clinicians. There are plans to involve GPs in the future.

While the virtual ward service is frailty focused due to the population need and demographic in East Kent, the urgent community response and SPoA provide care to all population cohorts. The goal of the combined service is to ensure people receive appropriate and timely care, enabled by the combined skill set of the MDT and co-location of staff. The result is an urgent community response, a virtual ward, and a SPoA MDT that work as a unified team to determine and provide the best care pathway for each individual.

Key learnings

• Integrating services required a shift from team-centric to person-centric thinking focused on delivering care based on people’s needs rather than professional roles.
• The SPoA MDT involves the East Kent Hospitals University Trust, Kent Community Health Trust, and Southeast Coast Ambulance Service, which was only possible by engaging and creating buy-in among the leadership of all organisations.
• Visibility of outcomes was crucial, as initial improved “hear and treat” and “see and treat” rates from the SPoA MDT helped gain early clinical buy-in.
• Co-locating staff from different services improved real-time coordination and decision-making and reduced the need to increase the overall workforce.
• Digital interoperability remains a challenge and area for future improvement. Currently, not everyone within the SPoA MDT has access to the same electronic patient records, nor is there universal access to primary care data via the EMIS Health software system.

Impact

Based on data from Ashford (comparing to a baseline 12 month before the intervention), the following outcomes are reported by the combined service:

• increased “hear and treat” and “see and treat” rates – “hear and treat” increased by 6.2% and “see and treat” by 7.6% over 9 months. The former meant ambulances were not sent when not required, and the impact of both resulted in “see and convey” rates decreasing by 14%
• improved ambulance response times – category 1 response time decreased from 11:20 to 8:33 minutes and category 2 from 21:24 to 15:17 minutes over 9 months
• increased referrals to urgent neighbourhood services – on average, referrals from the ambulance service via the SPoA MDT rose from 170 to 278 per month, suggesting that the SPoA effectively redirected people that required urgent care
• reduced acute admissions and bed days – over a 5-month period, on average acute admissions reduced by 27.3 and bed-days reduced by 179.2 per week

Publication reference: PRN01756_ii