Emergency Department Redirect Service
Additional GP appointments take pressure off emergency departments
Since launching in 2021, this primary care service based at North Middlesex University Hospital NHS Trust has provided much needed extra appointments for GP practices. Particularly during the busy winter months. The service, which is led by Haringey and Enfield GP Federations, works closely with the hospital to provide appointments from 12 noon to 8pm daily for patients across Haringey.
It was set up to make it easier for non-emergency patients to see a clinician, and so reduce the demand on the Accident and Emergency service and Urgent Treatment Centre at the hospital.
The service commenced in December 2021, initially providing 28 appointments per day with a GP, nurse or other clinician. This rose to 56 appointments per day once workforce capacity was fully stabilised.
The service complements the existing evening and weekend appointments that are available in Haringey and Enfield via the Extended Access Hubs Service which enables patients to see a doctor, nurse, or other member of the practice team at a convenient time for them, when their own practice may be closed. Open every evening and weekend they provide appointments for urgent primary care concerns as well as chronic conditions and things like immunisations and cervical screening if people are having difficulty getting appointments with their own practice.
Aims and ambition:
Recognising the link between good primary care and Accident & Emergency attendances over time, this pilot service sought to support the acute system by improving access to primary care.
It aimed to support safe and timely redirection of patients via a co-located primary care hub at the front door of NMUH and so reduce the number of patients who are streamed to the Urgent Treatment Centre with low acuity presentations.
The provision of a service at the front door of the Emergency Department to these patients aimed to:
- Reduce waiting times at North Middlesex University Hospital Emergency Department.
- Provide appropriate treatment for patients presenting with low acuity conditions.
- Support the system by preventing unnecessary hospital visits, investigations and admissions.
- Support awareness raising of appropriate access to healthcare services in the local community.
Patients who are registered with a GP in Haringey or Enfield are eligible for this service. In addition, patients from these north London boroughs who are not currently registered with a GP can also register as temporary or permanent patients with a local GP in order to access the redirect service.
About the service:
The service runs on site at NMUH from 11am to 8pm daily, including weekends and endeavours to offer 28-56 appointments per day.
A non-clinical care navigator and receptionist oversee the initial patient contact, ensuring signposting and referral into the service to a clinician as appropriate. Additionally existing NMUH ED staff may also identify patients suitable for redirection for the service through the standard ED triage process.
Appointments with clinicians (GP, nurse or other advanced clinical practitioner) take place between 12 noon and 8pm daily.
Benefits and impact:
More than 2,800 patients were seen between December 2021 -April 2022.
The service is providing a pilot for much-needed additional capacity, funded by Primary Care Winter Access Funds.
It demonstrates the benefits of an on-site Primary Care Hub delivering GP care aligned to Emergency Departments, ensuring patients receive the responsive primary care they need efficiently and with compassion and dignity.
In doing so, the service is relieving pressure on Emergency and Urgent Treatment teams, potentially reducing hospital admissions and therefore cost to the system by ensuring patients follow the appropriate care pathway for their needs.
What has been achieved:
- Close collaboration between Enfield GP Federation, Haringey GP Federation and NMUH NHS Trust enabled a rapid response to the unprecedented pressure on emergency services at the hospital
- 5,871 appointments were available in winter 2022/23, this was 2,939 more than in winter 2021/22
- 4,871 patients were seen in winter 2022/23, an increase of 3,210 from winter 2021/22
- 83% of appointments were used by patients in winter 2022/23, up from 60% in 2021/22
- Cost per appointment was reduced from £137 in 2021/22 to £59 in 2022/23
The service demonstrates the benefits of an on-site Primary Care Hub delivering GP care aligned to Emergency Departments, ensuring patients receive the responsive primary care they need.
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