These standards provide a consistent urgent treatment offer to the public, to reduce attendance at emergency departments and to improve patient access, experience, and care nationally. They therefore apply across co-located and standalone urgent treatment centres (UTCs) and this content describes the minimum expectation across these services.
Drawing on the lessons learnt over the last three years, and in keeping with the NHS Long Term Plan and Delivery plan for recovering urgent and emergency care services, we have refreshed the UTC principles and standards to reflect changing ways of working, and the importance of UTCs as part of integrated urgent and emergency care systems.
This content should be read in conjunction with the frequently asked questions, which are intended to provide additional support to providers and commissioners in meeting the standards.
What change are we looking to see?
1. The Next steps on the NHS five year forward view, published in 2017, set the ambition for the rollout of standardised new ‘urgent treatment centres (UTCs)’. This was to reduce the confusing mix of urgent care services including walk-in centres, minor injury units and urgent care centres. This refresh of our 2017 UTC principles and standards sets out what we want to see integrated care boards (ICBs) implement. The Delivery plan for recovering urgent and emergency care services (2023) sets out the vision of integrated urgent and emergency care systems; UTCs can play an important role in its delivery.
2. UTCs, wherever they are located, should be able to treat patients of all ages for minor ailments and injury, with senior clinical leadership, in line with these standards. As a priority, UTCs are expected to:
- open 7 days a week, 12 hours a day as a minimum, typically increasing to 24 hours a day when co-located
- see both booked and walk-in patients
- see both minor injuries and minor ailments
- see patients of all ages, including children under 2
- have a named senior clinical leader supported by an appropriate multi-disciplinary workforce
- have a basic consistent investigative and diagnostic offering on site (with clear protocols if not on site)
- accept appropriate ambulance conveyance
- have access to patient records and the ability to send a post event message (PEM)
- report as a Type 3 daily on Emergency Care Data Set (ECDS)
- have an up-to-date directory of services (DoS) profile
- clearly communicate to the public what the service is for via consistent urgent treatment centre nomenclature, to ensure the service provision is understandable and accessible to all.
3. Increasing compliance with the UTC standards will help maximise the capacity, use and effectiveness of UTCs as part of an integrated urgent and emergency care (UEC) system. While significant progress has been made since the UTC standards and principles were first published in 2017, we know that there is not yet full compliance.
4. The purpose of these standards is to provide a consistent urgent treatment offering to the public, to reduce attendance at emergency departments (EDs), and to improve patient access, experience, and care nationally. They therefore apply across co-located and standalone UTCs and this content describes the minimum expectation across these services.
5. The Delivery plan for recovering urgent and emergency care services (2023) set out the expectation that systems increasingly move to a model where UTCs act as the front door of ED, to enable emergency medicine specialists to focus on higher acuity need within the ED. This does not replace the need for high quality standalone UTCs.
6. ICBs should determine where UTCs will be most effective; this may be co-located with the local emergency department and increasingly acting as the front door of ED, or a standalone service either on or off a hospital site. We expect that decisions about all existing type 3 and 4 services should be concluded through 2023/24.
7. Designation of services is intended to be ‘light-touch’, reliant on ICB and regional assurance that localities have met or have agreed plans in place to meet the key standards for UTCs. ICB chairs, or a representative as agreed with the relevant NHS England regional team, should provide assurance that the standards have been met.
8. NHS England is working with stakeholders to agree consistent approaches for patients who walk into hospitals, which will support patients to be seen in the most appropriate setting. Systems should ensure they have implemented streaming at the front door of ED, which will increasingly be through a co-located urgent treatment centre.
Alignment with primary care and other urgent care services
9. UTCs should operate as part of a networked model of urgent care, working closely with system partners including primary and community care to flow patients to the most appropriate service according to their need. UTCs should have referral pathways into EDs and specialist services as required. UTCs must allow for both pre-booked and ‘walk-in’ attendances; however, patients and the public should be actively encouraged to contact NHS 111 when an urgent care need arises.
10. Commissioners should make sure that all UTC services form part of ambulance services referral pathways as an alternative to conveyance to ED where appropriate. All UTCs are expected to receive ambulance conveyance where clinically appropriate. Further guidance can be found in the UTC frequently asked questions.
11. NHS England commissioned Dr Claire Fuller in November 2021 to undertake a stocktake of primary care integration, including achieving stronger alignment with UTCs and the wider urgent care system. The findings of this stocktake will inform further national guidance to ICBs on alignment, alongside the Delivery plan for recovering access to primary care (2023).
What are we asking of integrated care boards?
1. Integrated care boards (ICBs) should consider UTCs as part of their strategy for urgent care, taking into account the wider provision of emergency and primary care services for their population.
2. ICBs, in their commissioning of UTCs, will need to:
- Consider local activity, demand management and patient flow and throughput.
- Establish the urgent care needs of their local population, and the capacity they require.
- Where there are high rates of referral from UTCs into local EDs, ICBs should review relevant care pathways across UEC to maximise use of UTCs where clinically appropriate. This should form part of the ongoing review of ED casemix and re-attendance.
- Ensure that UTCs meet the updated UTC principles and standards, and where there are gaps support UTCs to identify the actions required.
3. It is for ICBs to determine where UTCs will be most effective. Where type 3 or 4 A&E services have yet to determine their future function as either a UTC or alternative service (subject to local consultation and following proper procurement process where appropriate) current provision of extended GP access and plans for Enhanced Services (DES) should be considered. In this review, ICBs should also consider implications for patient transportation, to ensure appropriate transport of patients to and from UTCs.
4. ICBs, working across their integrated care system (ICS) and with other non-NHS partners, should use data to consider opportunities to reduce health inequalities through the commissioning and specification of UTCs. This is of particular importance given the disproportionately high use of Type 3 services nationally by those from the highest levels of deprivation.
Principles and standards for urgent treatment centres
Principles – all urgent treatment centres
1. UTCs provide access to urgent care for a predominantly local population. They encompass a range of services, which may have been previously named walk-in centres, minor injury units, urgent care centres, and all other similar facilities, including the majority of those currently designated as Type 3 and Type 4 A&Es.
2. UTCs can provide an alternative to EDs and provide treatment for minor injuries and illnesses that are urgent but not life or limb threatening for people of all ages.
Based on existing utilisation, a UTC patient is therefore typically:
- ambulatory or mobile
- in need of same day treatment
- not in need of constant monitoring, though may need investigative tests to be undertaken
- requiring ‘urgent primary care’ level of investigations.
3. UTCs may be co-located with acute facilities, including Type 1 EDs. There is an increasing expectation (2023 Delivery plan to recover urgent and emergency care services) that EDs will move towards a model where a UTC acts as the front door to ED.
4. UTCs may be co-located with primary care facilities (including GP enhanced access hubs or integrated urgent care clinical assessment services) or other community urgent care services, such as mental health crisis support, community pharmacy, dental, social care and the voluntary sector.
5. Some UTCs may be standalone services; it is for local systems to determine whether a UTC is co-located or standalone based on the local population and services.
Principles – urgent treatment centres that are co-located with a Type 1 emergency departments
6. Co-location with an ED can currently be either through a single front door model or via two separate entrances. The ED and UTC services should be within a short walking distance of each other so that streaming opportunities are maximised. The UTC in all cases should increasingly act as the front door to the ED.
7. Where UTCs are co-located alongside hospital EDs, this can enable the most efficient flow of patients to the service that best serves their need, but this will be determined by geographical distribution of urgent care sites and patient flows. By maximising streaming away from ED, this enables emergency medicine specialists to focus on those patients with higher acuity need. Evidence suggests that a proportion of lower acuity ED attendances could be streamed to a UTC from the ED; effective streaming and a strong urgent care offering across minor injury and illness for all ages on site can maximise these opportunities.
8. Where UTCs are co-located with EDs, this can also help increase service efficiency, provide greater flexibility around workforce capacity and skill mix, and create a ‘one stop shop’ for patients with urgent care needs who can access all diagnostics or be referred onwards for more specialist care in one location. Best practice examples for co-located UTCs can be accessed on the Urgent Treatment Centres Future NHS site (login required).
Standards for urgent treatment centres
UTCs must meet the following minimum standards throughout their opening times, and ICBs can build on these according to local requirements. In some exceptional circumstances an exemption may be made relating to a service that does not meet all the below standards. These exemptions should be agreed on a case-by-case and time-limited basis between the UTC, the ICB and the relevant NHS England regional team.
1. UTCs must be open for a minimum of 12 hours a day, 7 days a week, including bank holidays, to maximise their ability to receive streamed patients who would otherwise attend an ED. For services co-located with an ED, extended hours of access and provision should be considered as part of a capacity and demand assessment.
2. UTCs must report as a Type 3 service on ECDS, and the activity is counted against the 4-hour A&E performance standard. ICBs may set local operational measures for time in department. Such targets should be based upon patient demographics, capacity and demand reviews, and should reflect that patient acuity in a UTC is lower than that of a Type 1 emergency department. Feedback indicates that two hours from patient arrival to discharge is a typically achievable measure.
3. The UTC must ensure that two distinct standard operating procedures (SOPs), one for booked appointments and one for walk-in presentations, are in place and implemented to ensure that local respective approaches to initial assessment, treatment and investigation timescales are clearly defined.
4. Locally, patients should be encouraged to use NHS 111 as the primary route to access an appointment at a UTC; patients should be able to be booked from any care setting, for example, through NHS 111 (including online), the Clinical Assessment Service, from GP practices, ambulance services etc.
- The SOP (standard 3) alongside capacity and demand assessments should over time aim to make more booked appointment capacity available as appropriate for those patients who are able to book remotely.
- UTCs can also offer patients booked appointments if they ‘walk-in’ to the service and clinically approved streaming tools are used.
5. It is important to maintain the differential between booked and ‘walk-in’ patients to encourage patients to use NHS 111 (and 111 Online) and book in future.
- Due to the general acuity of patients attending UTCs, it is unlikely that deterioration will occur within anticipated waiting times. ‘Walk-in’ patients should therefore not be routinely prioritised for treatment over pre-booked appointments. This should only occur where it is clinically necessary to avoid deterioration while waiting.
- Patients who ‘walk-in’ to a UTC must undergo initial clinical assessment within 15 minutes. Clinical assessment must be in line with Royal College of Emergency Medicine/NHS England Initial assessment – emergency department standard guidance, to ensure consistency.
- Patients who have a pre-booked appointment (and therefore have had an initial assessment via NHS 111, appropriate clinician such as GP/Paramedic, or have used an appropriately clinically governed streaming and redirection tool) should wherever possible be seen by a clinician within 30 minutes of their booked appointment time slot without undergoing a further initial clinical assessment.
- If the patient arrives early for their appointment and it commences before the booked time, then the commencement of the consultation should be the clock start.
6. All UTC services are required to receive ambulance conveyance in accordance with the clinical conditions and dispositions that are agreed locally between ambulance services, ICS/ICB leads and UTC providers. This must include, as a minimum, ‘fit to sit’ patients who may be conveyed into the UTC on a stretcher.
7. All UTCs must be able to treat minor injury and illness in adults and children of any age. This should include wound closure, removal of superficial foreign bodies and the management of minor head and eye injuries.
8. The name ‘urgent treatment centre’ must be adopted, including both road signage and onsite signage. Localities must also ensure that names are updated on relevant websites, the directory of services (DoS) and all other communications (both for internal and external stakeholders) about the service.
9. UTCs, and NHS 111, must support patients to self-care and use community pharmacy whenever it is appropriate to do so. UTCs must make every contact count and look to advise and educate patients on self-care and locally available alternative services.
10. Where appropriate, patients attending a UTC should be provided with health and wellbeing advice and signposting to local community and social care services where they can self-refer (for example, emergency and out-of-hours dental services, smoking cessation services and sexual health, alcohol, and drug services).
Health inequalities standards
11. UTCs must provide the necessary range of services to enable people with communication challenges to access British Sign Language, interpretation, and translation services. The UTC must adopt the approach of ‘making every contact count’ by signposting and directing people to appropriate NHS, ICB and charity services locally, to address the holistic needs of patients. This signposting should also include help to register with a GP if the person is unregistered.
12. UTCs should also review regularly high intensity users in collaboration with local health and social care systems to best respond to local population needs.
Clinical standards (including safeguarding and prescribing)
13. An essential requirement is that all UTCs accept all ages and both minor injury and illness. Clear protocols must therefore be in place to manage critically ill and injured adults and children who arrive at a UTC unexpectedly. These will usually rely on support from the ambulance service for transport to the correct facility. A full resuscitation trolley and drugs, to include those items that the Resuscitation Council (UK) recommends as being immediately available in its guidance Quality standards: primary care should be immediately available. At least one member of staff trained in adult and paediatric resuscitation must be present in the UTC at all times. This should all be part of an approach of ‘design for the usual, and plan for the unusual’.
14. UTCs must have access to clinical advice and guidance from a local ED (on or off-site) within their ICB. This will help ensure, where possible, that clinical care is completed within the UTC by avoiding referral to ED where support can be provided via telephone or virtual means. This should be considered in collaboration with ICBs, as part of the design of integrated referral pathways across UEC.
15. All UTCs must ensure that the Child Protection Information Sharing system is in use to identify vulnerable children on a child protection plan (CPP), looked after child (LAC) or in utero. This will ensure that information is shared with social care and other NHS colleagues to enable appropriate action to safeguard the child.
16. All UTCs must have full independent prescribing capability available through the UTC opening hours (which may include FP10, PGD and e-prescribing).
17. All UTCs must be able to provide emergency contraception, where requested.
18. All UTCs must have direct access to local mental health advice and services along with local substance misuse advice and support services. This may be via on-site provision of psychiatric liaison mental health services where services are co-located with acute trusts and/or links to community-based crisis services where services are not co-located. ICBs should ensure adequate service provision for the local population to enable UTCs to directly access all required services.
19. An appropriately trained multidisciplinary clinical workforce must be deployed whenever the UTC is open. The staff profile and skill set must enable a consistent service throughout the UTC’s opening hours and must be able to treat patients of all ages for both minor injuries and illnesses.
20. The UTC must be led and governed by an appropriate named senior clinical lead who will take responsibility for general oversight, governance, audit, staff training and the strategic development of the service. This leadership and governance may be on site, remote or a mixed model. While GPs have often been the default, this leadership can be provided by a GP, ED consultant or other appropriate senior clinical lead.
21. All UTCs must, wherever possible, provide support to educational programmes for a range of professions and specialties, including GPs, doctors, and paramedics. UTCs should consider training opportunities such as rotational roles, as part of workforce development in urgent care, and where appropriate participate in clinical research opportunities. This should be considered in collaboration with local ICBs.
22. All healthcare practitioners working in UTCs must complete all statutory training and must receive training in the principles of safeguarding children, vulnerable and older adults, and identification and management of child protection issues.
Investigation and diagnostic standards
23. All UTCs must have access to investigations including swabs, pregnancy tests and urine dipstick and culture. Timely blood testing (near patient testing when appropriate), such as glucose, haemoglobin, and electrolytes, must be available. Electrocardiograms (ECG) must be available, and in some UTCs D-dimer, troponin and CRP testing should also be considered. If D-dimer, troponin, and CRP testing are unavailable within the UTC, where this has been agreed as part of exemption status with ICBs, clear referral pathways into same day emergency care (SDEC) and alternative clinics should be in place, with ICBs reviewing referral rates into these alternatives and into EDs to address any high referral rates. An appropriately skilled clinician must be available to analyse and interpret the results through the UTC opening hours.
24. Access to bedside diagnostics and plain X-ray facilities must be available throughout the UTC opening hours. Plain X-ray facilities, particularly of the chest and limbs, will increase the assessment capability of a UTC. Where facilities are not available on site, clear access protocols should be in place for post X-ray review to avoid duplication. The DoS should reflect service availability. UTCs and ICBs should consider within future planning that, as a minimum, plain film X-ray facilities are available on site where it is not currently available, in accordance with capacity and demand planning. An appropriately skilled clinician must be available to analyse and interpret the results through the UTC opening hours.
IT and digital standards
25. All UTCs must have arrangements in place for staff to access an up-to-date electronic patient care record, including access to view relevant flags and crisis data; this may be a summary care record or local equivalent. This access will be based on prior patient consent, confirmed where possible at the time of access, or in the patient’s best interests in an emergency situation where the patient lacks capacity to consent.
26. A patient’s registered GP must be notified about the clinical outcome of a patient’s encounter with a UTC via a post event message (PEM), accompanied by a timely update of the electronic patient care record locally. Where clinically appropriate, for children, the episode of care should also be communicated to their health visitor or school nurse, where known, within 2 working days.
27. UTCs must make capacity and waiting time data available to ICS partners for the purposes of system-wide capacity management across local integrated UEC systems.
28. The UTC must be clearly identified within an updated and maintained DoS in line with standards and principles, to enable effective referral from NHS 111 and 999 services. The DoS profile for the service must clearly and accurately outline provision of service for the local area and highlight any exception to provisions, and an annual review must be held between UTC, NHS 111 and commissioning colleagues to maintain DoS accuracy and improve pathway dispositions. Ongoing updates to the DoS are crucial to maintain clear pathways. For more information, please contact email@example.com.
- Those providers currently using an interim solution should ensure that they are working towards adoption, by March 2024 at the latest, of the national booking and referral standard to ensure digital booking functionality within an agreed timeframe (to be agreed via ICBs and regional teams).
30. Where available, systems must use the nationally defined interoperability data standards; clinical information recorded within local patient care records should make use of clinical terminology (SNOMED-CT) and nationally defined record structures.
31. While the national booking and referral standard is being fully adopted, UTCs must refer to and align with the integrated urgent care technical standards to ensure effective service and technical interoperability.
32. All UTCs must collect contemporaneous quantitative and qualitative data, including on patient experience. All UTCs, including those co-located with a Type 1 ED, must return the data items specified in the Emergency Care Data Set (ECDS) and report via UTC-specific ODS codes as a Type 3 service daily. Locally collected data should be used in a process of continuous quality improvement and ongoing refinement of the service. More information can be found on the ECDS pages.
Publication reference: PR2003