Scheduling Unscheduled Care: Development of a Clinical Triage service  with a Primary Care GP Led MDT Urgent Care Centre

The Department Of Health, COVID-19 Urgent and Emergency Care action plan NO MORE SILOS (NMS), set out a Framework for change. A regional directive to develop Phone First & Urgent Care Centres. Transforming the delivery of Urgent Care. Urgent Care typically describes care for non-life threatening conditions requiring attention on the same day or within 24 hours. The vision was to provide a single point of access for all patients who think they have an urgent medical problem. Patients - to the right place, the first time. Scheduling unscheduled care, reducing the risk of nosocomial spread of infection, making the patient's home the waiting room. Offering patients safe alternatives to accessing urgent care other than in an Emergency Department, instead within a co-located GP Led, Multi-disciplinary Team, Urgent Care Centre This clinical telephone triage service is designed for all patients who are feeling unwell and considering travelling to an Emergency Department (ED) or Minor Injuries Unit with an injury or illness which requires urgent treatment but is not immediately life threatening. The ‘Phone First’ approach aims to help those patients access the most appropriate care as quickly as possible and avoid busy waiting rooms. When contact is made with the ‘Phone First’ service, the condition of the patient is clinically assessed. Self-care advice may be given or arrangements may be made for the patient to access the most appropriate service to fit their needs. The patient may be advised to contact their own GP, sent directly to an Emergency department, scheduled for an appointment to a Minor Injury Unit, scheduled for an appointment to an Urgent Care Centre, sent directly or scheduled for an appointment to an alternative service, or an emergency call 999 transferred to the Northern Ireland Ambulance Service (NIAS). At the proof of concept stage, GPs, nurse advisors and administration team from primary care urgent care Out of hours service, worked closely with emergency medicine colleagues , consultants, nursing staff and administration teams, community GPs, along side Patient & Public Involvement(PPI), at the design concept and at the front door of the emergency department. The service was evaluated by both staff & public by means of a survey. The Trust Communications team informed the wider public living in the Southern Trust using social media and posters strategically placed across Trust premises. Primary Care screening at the front door of the emergency department was undertaken, with re-direction of those patients who did not require access to emergency care medicine to primary care clinical triage. Significant numbers of patients walking up to EDs, were suitable for primary and secondary urgent care services. Lessons learned, the value of clinical triage while the patient is still within their home - patient directed to the right place first time. All professions value the close collaborative style of working within the Phone First /Urgent Care Centre. The Southern Trust, Primary Care GP Led MDT model with access to diagnostics, is necessary to transform patient access and delivery of urgent care across the Region