Hello and welcome to today’s Transforming Primary Care podcast. My name is Liz Spice, head of primary care in the cross sector area in North East and Yorkshire. Today’s episode is titled Same Day Urgent Respiratory Care in the Community, a Breath of Fresh Air.
First things first, these services are not a new concept. Well, they’ve come into sharper focus in the past few years with the inclusion of acute respiratory infection hubs, one of the 10 high impact areas in the urgent emergency care recovery plan.
This, with the increasing need for commissioners to focus on reducing avoidable hospital attendances and improve care outside of hospital, their relevance to the future of patient care is becoming increasingly more important and without doubt leans into the integrated neighbourhood teams way of working.
In addition, the government has emphasised the importance of the hospitals to community shift in the 10-year plan and the recently published neighbourhood Health Guidance also recognises the urgent need to transform health and care systems and deliver more care at home or closer to home, building a sustainable health and social care delivery model.
Just on respiratory, one in five live with a respiratory condition in England. It is one of the three biggest killers in the UK and is estimated to cost the NHS 15.9 billion pounds. It’s worth mentioning that respiratory illness is complicated and multifaceted and not just about health. It also disproportionately impacts those from areas of high deprivation and the more vulnerable in society.
With winter on the horizon and planning well underway within our ICBs, one certainty repeated year after year is there will be surges in respiratory illness across health services during this period, adding to the winter pressures. The size and longevity of the surge can be variable year on year, but surge is predictable usually commencing when the children go back to school in September and peaking December and it will occur everywhere within the country.
In general practice, where there are significantly more increases in respiratory appointments, up to 80% in some practices. and in hospitals, patients with respiratory continues to be in the top diagnosis group for ED attendances, breaching the A and E waiting times, ambulance arrivals and admitted patients. There’s also unfortunately an increase year-on-year from last year on children and young people having asthma attacks.
In this episode, we explore ways in which services have been shifting to enable patients with same day urgent acute respiratory needs to get the care they need in a more tailored way close to home in their neighbourhood.
So with the 10 year plan now out, key shift from hospital to community on the horizon, the neighbourhood health service being the future direction, how can we learn from those who have been pioneering respiratory care closer to home?
.Joining me today to discuss these topics are Dr Cath Monaghan, Medical Director of the North East and North Cumbria Integrated Care Board, Julie Beer, Lead Nurse at the Leeds GP Confed within West Yorkshire ICB. Tarek Mustakim, Chief Operating Officer at Safe Care GP Federation in the Humber and North Yorkshire patch, and Muz Fazlee, the Senior Medicines Optimisation Pharmacist at Calderdale Cares Partnership.
Welcome. So getting back to basics, what do we mean by acute respiratory infection? Cath
Cath Monaghan
I would advise you to come in there. So this is Cath Monaghan. I’m also a respiratory consultant as well as the one of the medical directors in the ICB. So when we describe an acute respiratory infection, I’ll just talk you through, I guess what each of those words means.
Acute means of new or recent onset. Respiratory means anything to do with the airways. So that includes from your nose, your ears, down your airways and into your lungs. So it includes your nose, your ears, your throat and your chest.
An infection obviously means infection, but we could break that down a little bit further into viral or bacterial or pretty rarely, and probably not for the context of this discussion, fungal infections, which are usually in quite niche circumstances.
And I think symptoms that patients might present with would include a sore throat, stuffy nose or sinusitis, wheeze, earache, cough and bringing up sputum or phlegm as some people would describe it feeling more breathless.
Flu-like symptoms and aches and shivers. So hopefully that I guess defines what an acute respiratory infection is.
Liz Spice
Thanks, Cath. And when might someone experience one of these infections?
Cath Monaghan
So that can happen really any time of the year. We get them all year round. So I guess to give you some examples, the common cold would be considered an acute respiratory infection and then we’re thinking around flu, Covid still around unfortunately.
Other big viruses that we tend to see in winter RSV or respiratory syncytial virus and then bacterial infections as well. They are definitely more common in the winter, and the reason for that is all of these viruses and bacteria thrive in cold, damp environments.
So for every degree the temperature drops, we see a significant increase in the number of patients seeking medical attention. However, that might be through pharmacy first, through the GP, through 111, through hospitals – any route and the rate of people seeking help increases with every temperature drop, so much more common in the winter, but we would see them unfortunately all year round.
Liz Spice
Thanks Cath. And I guess from a healthcare perspective and care for the patient, I’m a fellow asthma sufferer, so I do have some experience in this. The importance of timeliness is really important. It’s almost a Lazarus effect from taking inhalers to having oxygen and treatment. How important and how, I guess, in this new world of neighbourhood working, how might that play out because of course urgent within a primary care is very different to urgent within an acute setting. So, I’m interested to hear your views on how that might be balanced going forwards.
Cath Monaghan
Yeah, absolutely. It can be quite difficult. So we would always advise common sense really. Common sense should always prevail. It’s absolutely fine to self-care and self-medicate if your symptoms are mild. So buy self-care and self-medicate. Drink plenty of fluid, not alcohol. That does not count, I am afraid to say.
Take paracetamol and ibuprofen, providing you’re not allergic and be very, very careful about the dosing of that. So paracetamol can sometimes be in in other preparations so that you don’t realise you’re taking it. So be very careful about dosing.
But you should seek help promptly if you’ve got severe symptoms. If you’re getting worse, not better, don’t suffer in silence – the NHS is there to help. If you notice really worrying things like much worsening shortness of breath, you can’t complete sentences because you’re so breathless, you really need to seek urgent medical attention. And if you’ve got chest pain, it’s not uncommon to get chest pain with these type of viral infections, but it’s but it’s important to seek medical attention because there can be other things going on and the sooner we know about them.
Sooner we can intervene and the more likely you are to have a better outcome.
Liz Spice
Thanks, Cath. From a paediatric perspective, is it different to how children present, how adults may present? I’m just interested in that. Julie, I don’t know if you have any views on how they are supported during particularly winter when we do see those spikes in infections.
Julie Beer
Yeah, absolutely. So children are known as super spreaders and themselves they have lots of respiratory viruses and infections and they do present very differently to adults, reasons being they’ve got narrow airways, so even mild swelling or the mucus can cause significant obstruction.
And they’re more vulnerable to infections because their immune systems are still developing, so they can present very differently – their bodies work very differently and they respond differently. Presentations for children can depend on age as well, so particularly your under ones may present with grunting or nasal flaring.
Whereas your toddlers may present with barking cough and astridor sounds. So it’s very difficult with children to differentiate a lot of the time because the symptoms can all roll into one, but then they have very different sounds as well. But we have to be aware with children how quickly they can deteriorate, they can manage very well.
compensate very well, but can deteriorate very quickly and rapidly, so more the reason for having specialist hubs that they can access.
Liz Spice
Really interesting. Thanks Julie. It mentioned it’s been mentioned a couple of times around the complexities of respiratory in that it’s not just a health issue. I recently was asked if I wanted a housing advisor at my asthma annual health check, which I thought was fantastic. I’m one of the lucky ones not to have needed that, but they’re thinking about mould and damp within houses in that regard within my GP practice. So I’m hopeful that going forwards with the onset of neighbourhoods, this will become more of a rounded discussion similar to what I had the opportunity maybe to get.
But we need to acknowledge the complexities around those wider risk factors. Just briefly, just to acknowledge that they are disproportionately impacted by people who live within an area of higher deprivation, smoking, physical activity, excess weight, air pollution. We could probably do a whole other podcast on air pollution alone and the impacts on respiratory illnesses, housing, etc. So we can only do our bit of the jigsaw – one for another time, but I think important to recognise on this podcast.
So in terms of what has been going on of late and the new initiatives in our region and what’s really making a difference in the community for patients with respiratory illnesses, can panel members please tell me what what’s making it easier for people to access care in need, In the community on what has been going on and the great stuff, really great work that you’ve been doing within your patches, Cath –
Cath Monaghan
So I think it might be helpful if I give you an overview of what we call the ARI hubs or acute respiratory infection hubs that we’ve really been working on in the last couple of years in NENC. So I don’t know if people are familiar with the geography in NENC.
We’ve got a very big patch.
We’re one of the the biggest I think ICB in the country with really quite a wide geography and we set up ARI hubs, I think the first time 2 or maybe even 3 winters ago now. And so we’ve really built on our learning and our knowledge and we’ve now commissioned them recurrently across NENC ICB because we really see their value. So they provide same day emergency care. So if you are a patient and you phone up, you can get access through your GP or you can get access through 111 and they’ll take you through a series of questions. And if you come out as what we call a disposition, which means your symptoms mean that you would be suitable for one of these appointments, then you’re offered a same day appointment. You can be seen promptly in in an appointment time, not necessarily of your choosing, but you will be given a same day appointment so you don’t have to go to urgent care, you don’t have to go to A & E and it’s a really good option and you’ll be seen by a very highly trained, very experienced clinician who can meet your need. Sometimes that is nothing more than giving you, I guess practical and what we would call common sense advice like we’ve discussed around self-care, all the way through to realising that you’re actually really poorly and you need to go to hospital and then they can get you in very quickly, we have quite a few pathways in from some of our hubs where you don’t have to go through A&E, but you can come straight to a medical admissions unit. So you can be seen and treated very, very quickly, which is important because if you’re at the more severe end of the spectrum with it, for example, a severe pneumonia, rare but dangerous, you need to be seen quickly and you need to be given appropriate treatment very, very promptly, but they can offer you other solutions as well. So if you need antibiotics, you can get antibiotics. Remember, antibiotics will only treat bacterial infections, so you won’t always get them, but you will get them if that’s appropriate. And they can also give out antivirals, for example, if a patient is eligible for Tamiflu.
So to give you an idea of some of the numbers we saw in the northeast and North Cumbria, 37,000 patients this winter in acute respiratory infection hubs. So that’s 37,000 patients, not all of whom would have gone to hospital, but our data suggests probably about 12% of them would have gone to hospital who were given the right care,In the right place, closer to their own home without having to, I guess, run the gauntlet of what can be a challenging A&E department in the middle of winter. So we are very, very bought in to these hubs. They are safe and effective, and we are looking really at building on the work that we’re doing – so trying to build links if a patient’s gone to Pharmacy First for example, but they feel that they need more getting allowing pharmacy to have direct pathways into them, direct links if the patient isn’t unwell enough to need a hospital admission but needs something else.
Direct links into our same day emergency assessment units, for example for chest X-rays or other things that might be needed. So, so very bought into this, a lot of work done, but still more to do to ensure this is a key part of our system moving forwards.
Liz Spice
That’s fantastic and so encouraging to hear about the recurring funding as well in in your ICB, Cath. So that’s fantastic. Julie, do you want to come in?
Julie Beer
Yeah, that’s amazing, Catherine. Well, well done. That’s really good. So in in Leeds, working with the Leeds GP Confed, we have a children’s clinic which is very similar. It’s community ambulatory paediatric service known as CAPS and it’s been running since 2023.
It was initially started as a scarlet fever outbreak centre but changed through into the ARI hub for children and we see from 12 weeks to 16 year olds for anything respiratory. We have been working with integrated and collaborated with people when we set it up, you know, through the LTHT, Leeds teaching hospitals and the ICB boards and we’ve developed this pathway that’s been running every year. Now we’re just hoping to hear about this year’s funding and each year we’ve built upon it. We did an asthma 48 project the year before last, which saw children that was admitted to hospital with asthma exacerbations that had to be followed up within 48 hours. We would see them, review them, give them the advice, the support, signpost them as needed. And last year our Yorkshire ambulance service was actually brought in and could refer direct into us.
Which we’re really, really proud of and we’re hoping to build on that this year. From the figures for 23/24, we had 3411 children and we actually had a referral rate of 0.5% to the hospitals and that was more that we didn’t have a monitoring service, we didn’t have an observation unit and these children just needed further observation. So we are building each year on it. We’re hoping to work with Pharmacy First as well this year and also the third sector. So we’ve got looking at, as somebody’s mentioned earlier, the poor indoor air quality of a lot of these people, all these children that are living. So we’re looking at working with Breathe Easy Homes as well so we can offer advice around where parents can go for suitable advice and what they don’t always need to go to A&E and try and give them that that education as well around asthma monitoring and things so each year, we’re building on what we can offer and what we can give and hopefully we can continue with that that good work with all the ARI hubs.
Liz Spice
Fantastic. Thanks, Julie. I’m really interested to hear about referrals for ambulance services because that can of course help with the conveyance rates as well. So yeah, lots, lots of exciting things going on there. Tarek, can I bring you in for Humber and North Yorkshire?
Tarek Mustakim
Sure. In terms of the consideration that we give when we set up the ARI hub, it’s really important to consider that where do we actually set it up. The accessibility is very important as we mentioned initially that the people who access those harbour mainly come from the high dense area, often it’s a deprived area and accessibility is a big challenge for people. So in terms of from what my perspective experience that when we set up the ARI hub first time and three winters ago, we consider that to be located within the central location where the most people, the people mostly who live around the most deprived area can access.
Where there is a transport link available, i.e. the bus, train and walking distance and car park facilities is very important as well. It’s mainly that we have seen the like many other guest confirmed that it -the ARI or the respiratory infection is actually does not discriminate anybody. However, it seems to be higher in a particular group where the air pollution is, you know, slightly high where number of people live in per square kilometre or per square mile is higher than the other urban extra urban area and we can see there is a demand for this, so it’s important to consider that where those people often get not enough access to medical help in the first instance or sometime they’re not aware of when to act, hence the consideration was given to set up the area hub where it’s close to those people, particularly if the geography is really big, you got to consider where the nearest facilities are. So when we did it in North Lincolnshire and we consider all of this and it was a really success from the year one actually, What we offered is to rather than confusing patient, we offered them to ring their GP as usual and we said to all the GP practices that when you are out of your normal routine appointment, those patient obviously need on the day appointment, when you realise – you start booking them onto the respiratory hub.
And it is for patient. It’s only one pathway to follow. They as usual, they ring their GP, they do their basic triage and when they know the patient is qualified for the service, they start booking them. The uptake was really good – when I say really good it’s 99.9% of the time the ARI hub will be fully booked before 12 noon or by1:00 o’ clock and people will not miss their appointment. That shows they wanted that appointment and what we added to that -we ring fenced some of the appointments for the children, particularly children 5 and under and they can come earlier on. So generally the ARI hub will start from midday, but children’s one will start a couple of hours earlier.
Particularly some of our clinical leads thought that if a child at 9:00 o’clock, parents realise that we need to see somebody and they don’t want to wait longer and that was the pure consideration that children needs to be seen within a certain time frame.
It is really good to hear, as Dr. Monaghan said, that there are pathway available to send patient directly to medical assessment unit to bypass the ED traffic. It’s really good, it’s probably the point I will take away for our clinical lead to consider as well to have that conversation.
What we have seen, how we measure the success (because our site was one of the evaluation site after we set up the ARI hub) and we consider the data, the amount of patient we have seen and the amount of patient at the same time attended to our ED. Obviously anyone can attend to the ED. That’s the one way to see.
But our data was showing at least 40 to 45% less attendance to ED and that’s because in North Lincolnshire geography is a is a quite diverse geography – one side is Hull, where we divided, you know from North Bank and South Bank by the river and the other side is Doncaster and other side is Lincoln. So we’ve got a highly dense town area where we have an urban area as well.
It was really good to know that the people prefer to come to the primary care for their primary care presentation and we also analysed the data that how many patient was then from the ARI hub to refer to the ED, the percentage was less than 5%. It’s a low number, but that also proved that that the triage was working, that people were referring to the ARI hub in either they’ve taken the advice or taken the treatment and they’ve gone home and they were happy and satisfied. The patient feedback was really phenomenal, like really positive. They said it’s easy to access the system, easy to access the ARI help centre because it was located in the middle of the town centre and a lot of positive comment compliments as well. The way we did it, most of the time we kept a specialist nurse as well as two very senior clinicians, primary care clinicians and it was really I must say that all three winter, past three winter we did it was similar outcome – very good feedback from the patient.
Liz Spice
That’s fantastic, Tarek. Lots to unpick there. Just following on from those examples, just a little bit of context behind the ARI hubs as I mentioned at the start, we received Funding across the country, each region did receive it in 22/23 and with that money we set up 41 ARI hubs across our region. We had £6 million within our region to do so and they were very well evaluated because obviously there was funding associated with them and from the word go they seem to have a real impact on both the patient outcomes and happiness levels of the staff, both within general practice and also, even though this was seen as like a UEC initiative and funding, it was impacted massively within general practice who had that kind of overflow, I guess for want for a better term into the ARI hub.
Now in our region in the second year following that there wasn’t any funding. So year on year we’ve had a presence of ARI hubs within our region from the first year where there’s 41 to this last winter, we have 78 ARI hubs within our region, which is phenomenal and they continue to expand and evolve and do different things, an incredible amount of appointments that I’ve seen which would have, which would have in many cases I’m sure have gone to ED. But not just that the patient experience as well, which is brought about by some of the ARI hubs. It’s the same day urgent appointment, it’s a booked appointment and there’s minimal waits.
Many of our ARI hubs you know undertake assessments as diagnostics as a point of care testing and there’s also inhaler techniques and some have seized the opportunity to do also flu and covid vaccinations. In comparison if a patient was to present within ED it would be classed as same day lower acuity priority, unless they were of course blue in the face and needed the care. But there is a phenomenal amount of what we would class as low acuity ARI attendances that could easily have been seen within ARI hubs. So, there’s that missed opportunity and we, winter on winter, have been doing analysis on this and a good 25% of the cases could have been seen within an ARI hub, which is quite staggering. But think about the experience of the patient as well waiting if they had a low acuity respiratory infection, they would be low priority. They’d be seen the same day, but they’d have to sit and wait, because they’re still ill and what our findings are, they do not contribute towards the four-hour wait. The average time is over 5 hours for those patients as well.
Yes, they’d get triage, yes they’d get seen, but the likelihood is that they’d be sent on their way and maybe with follow on care, self-care going forwards. So the differences between the two and how it might play out are quite stark.
Just in terms of the evolution side of things to some of our ARI hubs in particular last winter and Muz, I’d like to bring you in because you’ve been doing some fantastic work, particularly the point of care testing, which we know there is a strong appetite to move forward on this, certainly within the ARI hubs that are being planned on, not just the ARI hubs because it isn’t just about ARI hubs. This is at the cutting edge of some of the technology, isn’t it? So Muz, if you care to share, that would be fantastic.
Muz Fazlee
Thanks, Liz. Yeah, I’m Muz from Calderdale Cares Partnership, West Yorkshire ICB. I’m really pleased to introduce the Calderdale Point of Care testing project, which we’ve used within our ARI hubs. This initiative actually came about through a business case that we developed in the ICB, so using winter capacity funding, and it was a partnership bid with Calderdale-based Pennine GP Alliance and we purchased a test called February X with the ARI hub bid and our aim was to demonstrate how Point of Care testing could reduce unnecessary any attendance and hospital admissions. A key strand for me as a pharmacist was how can I help to tackle inappropriate antibiotic prescribing? So this came became our Calderdale transformation priority plan in 24/25 and we’ve really embraced the innovation of using point of care testing to tackle antimicrobial resistance really head on and this initiative was actually shortlisted for an award. We introduced it in our ARI hubs, general practice and our community teams – which were the care homes teams, the paramedics in our acute home visiting service, UCR urgent community response service and the respiratory nurses who worked for the Calderdale Trust. And so using our February DX, it allowed our clinicians to make better evidence-based decisions, It has two biomarkers. It’s got CRP and MXA and that helps to distinguish between viral and bacterial infections. It also improved our prescribing accuracy and data showed with reduced antibiotic prescribing, given patient confidence and reassurance of when antibiotics are needed. These ARI hubs have been a great example for us in Calderwell, how innovation in diagnostic support with medicines optimisation help to tackle antimicrobial resistance.
Liz Spice
Fantastic. Thanks, Muz. And I do feel like you’ve started a bit of a movement as a result of the work that’s been going on in Calderdale, which is fantastic. So I think more to come on this certainly within our patch for the winter to come.
So, big question. We’ve you’ve already touched on some of these points already. Do ARI hubs relieve pressure on the system?
And that can come in different guises. And I know you’ve already mentioned a few bits and pieces, but how does it feel for the staff? Do we see it? Can we measure it? And I know that certainly in the past three years there’s been a number of academic evaluations that’ve been picked up within our patch and nationally as well, but through universities who have demonstrated, and we can now quote, that they do have a statistically significant impact on particularly ED attendance when there’s an ARI hub within the vicinity.
So we can say that now and we’re now involved in the final bit of the jigsaw in terms of research with the National Institute for Health Research doing a final piece this year and because of the higher prevalence of ARI hubs within our patch, it’s obviously a light shone on us, but the final piece around patient outcomes and economic benefits, so good that they’re involved and will obviously help support them on that piece. Muz?
Muz Fazlee
I could say a little bit about in Calderdale we see Point of Care testing is a support tool to help clinicians with diagnosis. It’s not a replacement of clinical judgment, but it adds a layer to diagnostic confidence. It’s a really simple, finger prick blood test on a device that looks a bit like a Covid test. It just takes 2 minutes to do the test, but takes 10 minutes to get the result. And what we found is using point of care testing really reduced re-consultations in ARI hubs and GP practice unnecessary antibiotic prescriptions and avoiding out of hours and hospital attendance and some of the clinicians using them, including the junior doctors, they felt more confident as well as the patient.
And they were satisfied with the result, so they’re not looking for second opinions from other clinicians in other settings. So I would say point of care testing with ARI hubs is really relieving the pressure on the whole system
Liz Spice
Thanks, Muz. Cath, can I bring you in?
Cath Monaghan
Yeah, of course. So I think there’s definitely qualitative and quantitative evidence that they really relieve pressure on the system. So as we’ve already discussed, there are hard things that you can measure, reduced tendencies to any and absolute reductions in that from that lower acuity respiratory infections. So you can actively measure that, you can measure attendances and pressure really I think on GP practices if you site them right, that these are a system benefit, I firmly believe that, but I think one of the real benefits is felt certainly around primary care because if there’s no primary care capacity, then that spills off, doesn’t it, into UTC and A&E. So there’s hard things that you can measure there. And then in terms of the qualitative data, certainly the experience in NENC was extremely high levels of patient satisfaction – patients like this, you can get the care that you need.
need closer to your own home from an experienced professional who can give you the appropriate treatment for your needs. It’s fairly difficult to argue with that, I think, without having to, I think, as I’ve said, run the gauntlet of an undifferentiated.
A&E department. There’s benefits for other patients if you site them right. So there’s good evidence that if you put these type of patients in a community hub, they’re not sitting in an undifferentiated GP waiting room or A&E waiting room spreading their acute respiratory infection amongst people who are immunocompromised, who you know immunosuppressed for whatever reason. So you’re not sharing acute respiratory infections around so that, you’ve got benefits to the system as well. And I think as I’ve said patients love them but staff, the staff really enjoy them. We’ve not had problems really in filling these shifts, they’re popular places to work because for staff, again, what’s not to love? You’re given the care that you need in a controlled, safe, not overwhelmed environment. And I think that’s something that’s really helpful and beneficial for frontline healthcare workers’, mental health really In the very pressured winter months.
Liz Spice
And can I just as a follow on to that, Cath, can I just ask, is there something about the tailored nature of these acute respiratory infection hubs with a focus on respiratory where you think you know that the staff have might have more of a, dare I say, integrated neighbourhood team, but it does have that sense of that, doesn’t it and that common goal – I don’t know, just interested in your thoughts on that?
Cath Monaghan
Yeah, absolutely. I mean this is very much the direction of travel and if you get this right, this shouldn’t sit isolated and this should sit as an integral part of the system with links to everywhere else. So, I’ve already mentioned direct links into same day emergency care if some of those diagnostics like chest X-rays that you couldn’t necessarily get in an ARI hub. You can access that through same day emergency care. You should have direct pathways into medical admissions units for the more unwell patients – you should have direct pathways and we’re mandating this in NENC this year into Hospital Home services. So, for those patients that you’re a little bit worried about, but you think they need something more, but you don’t necessarily want to admit them, then you can get that hospital home expertise and step them up directly into that. And then you’re really starting to become dangerously close to a system that’s actually completely meshed in where you’ve got if they’re in Hospital at Home, you’ve got that secondary care oversight of patients who have been seen and assessed in primary care, all in the community with the care being wrapped around the patient instead of I think of them fitting into our system and I think to me that that’s what the heart of neighbourhood health is all about really, isn’t it?
Liz Spice
Yeah, fantastic. Thanks, Cath. Tarek.
Tarek Mustakim
Very beautifully explained by Doctor Monaghan from clinical perspective, but I’m just going to touch on the operational perspective to having a hub within the community is very useful, is very cost effective and then like Doctor Monaghan said that is giving the expert professional in ED front door to focus their expertise to the right source of patients. So then you know they got ambulance conveyancing time and things can be improved so the primary care patients are dealt with in the primary care.
I think it’s very important and patient satisfaction is telling us everything. Thank you.
Liz Spice
Thanks, Tarek. Great points. So I think we discussed that a bit potentially around what the future might hold and I think we are absolutely in agreement around, you know, this does complement the hospital to community shift and neighbourhood ways of working. I guess as a closing question, what would your advice be for any commissioners listening who might be considering funding acute respiratory infection hubs this winter? Cath.
Cath Monaghan
Sorry, I feel like my hand’s always up first!
Liz Spice
That’s fine – eager!
Cath Monaghan
Obviously I’m not a commissioner, but I’m probably in a little bit of an unusual position that I’m a secondary care clinician sitting in an in a commissioning organisation. So I think they’re an absolutely vital part of future proofing the NHS for the winter, as clearly there is real financial benefit to this. If you do a cost benefit analysis, this is cheaper than providing a secondary care A&E type appointment. It absolutely definitely is cheaper – it’s clearly not the only lens to look at it, but it makes financial sense as well as clinical sense. That does sometimes get tangled up, doesn’t it, because of the way the trusts are on block contract. But actually if you’re looking at it in terms of the public money, the NHS money, this is a cheaper, better, safer and more patient-focused way of delivering care. So I would challenge people is to say why aren’t you doing this? Then why should you? I think it makes absolute clinical sense, it makes financial sense, it makes sense for our patients and for our staff and as long as you site it right as part of your system, as I’ve already said, not something that’s completely separate, but something that’s properly integrated with other things wrapped around it and other links, then I absolutely think it is the way forward. And you know, guess what? Winter comes every year. I sound like the Starks from the Game of Thrones. We know this and we know when it starts to hit, it starts to hit in for adults, and apologies Julie for not being so clear on the children, but it starts to hit round about October and it starts to drop off round about every March.
And the vast majority of winter surge is respiratory. The data tells us that. It tells us that absolutely beautifully. So sitting back and just thinking, oh, well, it might be all right this winter or doing more of the same is probably not going to work. In fact, we know it’s not going to work because that’s what we’ve done. This is something different and it’s proving effective. So I would really urge anybody in the commissioning framework to look seriously at the data around this and I know there’s not a lot of money in the system, but this is a way of getting it out where it where it needs to be really.
Liz Spice
Thanks, Cath, Tarek?
Tarek Mustakim
Very quickly, Dr Monaghan again said everything. I, you know, I couldn’t add much, but just a short survey was done locally in the Humberside area where it was showing to run an appointment in acute care in ED basis, it cost more or less £198 on average, where in the primary care is less than £60 and when it comes to the ARI hub is about less than £30.
So you know, financially it makes sense and it gives so much value to the community now. Absolutely agree with you. It is working and we should continue with this.
Liz Spice
Fantastic. Thanks, Tarek. Julie?
Julie Beer
Hi, yeah, thanks. Agree completely with what you both said. But one piece of advice, if I can give it that I would give to commissioners is for us is to have them conversations earlier so we can start planning earlier. We know winter’s going to hit for children, particularly the minute they go back to school. That’s when we start with the spikes, and so we can secure the workforce, we can build on what’s already there and have the conversations with the system partners earlier. So when it does hit, we’re ready for it rather than building day by day when we’re already in the winter crisis.
Liz Spice
That’s great. Thanks, Julie. So well, thank you for your contributions today, panel members. I hope listeners have found the discussions of value and are maybe inspired to follow their lead. I think what’s clear from the discussion says there’s a great deal of passion for these services.
They are positioned in the right place within the system and the model of working is aligned to both the recommendations in the 10-year plan and the neighbourhood Health Service which are on the horizon. But doing something different for respiratory this winter is key. We can’t continue to do the same things and expect different results. I think in times of big change, it’s important to focus on the incremental improvements and movements towards the bigger goal that can feel overwhelming otherwise and I believe this is a fantastic example of how urgent care in the community can be undertaken with some clearly fantastic outcomes for patients and for staff satisfaction and that it helps relieve the inevitable increase in demand in respiratory over winter. So thank you for listening.