Working across the interface: greater than the sum of our parts

Across the country, demand on acute care is increasing and there is insufficient capacity. Patients are waiting a long time to be seen, treatments are delayed and emergency departments (ED) are struggling to cope with rising demand.

This is not what we want for our patients. That’s why in 2023, my GP practice in Bishop's Stortford collaborated with our neighbouring practice, two community trusts, an out-of-hours provider, acute trust and integrated care board to set up an urgent treatment centre (UTC) in Harlow.

Together, we wanted to explore how community/primary assets could be used to reduce pressure on the ED by looking at alternative care settings.

Testing, modelling and creating the right infrastructure

Firstly, we worked on creating the right model for the UTC and tested ideas. One test of change was to have a GP in the ED majors unit to identify patients who could be seen in UTC instead. We soon realised we needed to capture patients before they got to the ED, but the live testing allowed us to explore the best options.

We also looked at hybrid models of employment. In primary care, we have access to a wide range of services and can provide options for alternative care that could be used to help reduce attendance at the ED.

...we identified several key components that we believe are essential for successful interface working

We also worked on creating the right infrastructure for the UTC, for example, making sure we had full shared care records and access to the same IT systems across the interface, as well as making sure the inclusion and exclusion criteria for patients was correct.

And while the right model and infrastructure are of course important, we identified several key components that we believe are essential for successful interface working, and which I’d like to share so that others might benefit from our learning. 

Developing trust and understanding 

Any kind of change can be an anxious time for people, so regular conversations and keeping connected have helped us to develop the trust that has led to the improvement being successful. The interface working might not be perfect to begin with – and it doesn’t have to be - but being honest and sharing diverse perspectives can help to find common ground. 

We also visited each other to develop an understanding of what we do. I visited the emergency department and was humbled by what I saw and likewise colleagues from the acute trust visited the primary care setting and saw the pressures we faced. This built a mutual respect and understanding of what we had in common, which helped unite our teams. 

…there cannot be an assumption one way will work over another as everyone has different perspectives

And with multiple teams involved, there cannot be an assumption one way will work over another as everyone has different perspectives. Though the change was large scale, small incremental shifts that helped prove and evidence it is working allows people to feel safe, build confidence in the change and understand how it works in practice. 

Finance, funding and finding the right people

Trust is also essential when dealing with finance and funding models. Finance is a complex matter that can often be met with suspicion because there is just not enough funding in healthcare. Being transparent on what can be invested, how it can be used and what benefit it brings to patients is essential to create trust, and it’s important to find the right people to make sure this all aligns.

Leading from the front can ensure all aspects of patient safety, risks, needs and management are at the forefront of service design.  Those who deliver the care and are experienced in managing patients need to be empowered to drive changes and be supported by operational colleagues to enable them. 

 …due to the complexities and nature of multiple settings in interface working, it can be difficult to make decisions

However, due to the complexities and nature of multiple settings in interface working, it can be difficult to make decisions. We chose to have a process to help move things forward that included a ‘go/no-go’ approach. For each decision we needed to make, we went round and asked everyone to vote ‘go’ or ‘no-go’. It was the fastest way to get pace behind the actions needed.   

Finally, we had dedicated project management support from an external company that helped with the progress, development and making sure things were in place. Without it, it can be easy to lose track, momentum or miss something critical that needs to be done.

Improving patient care, experience and outcomes

To date, the UTC has started to reduce some pressure on the ED. It has decompressed their waiting areas and contributed to a reduction in related complaints. There have been 1,000 fewer diagnostics via the ED since the UTC started and, while this cannot be completely attributed to the UTC, the significant reduction occurred when the UTC opened. This equates to a system cost saving of approximately £20,000 per month. There has been 100 per cent positive feedback on the friends and family test for the service and lots of people in the community have made donations towards it.

This improved interface working can mean patient care, experience and outcomes are better. An example is a 97-year-old lady who was very short of breath. Traditionally, she would have had a call from the GP and been sent to the ED because trying to sort out an alternative option would be difficult. With the new service, we could dispatch a community matron in a two-hour window to visit her at home. With a two-to three-day management of breathlessness at home treatment she did not need to go to hospital. If she had, it is likely she could have spent 12 hours on a trolley, been admitted, decondition and potentially been exposed to other germs.

In Harlow we’re proud of the strides we’ve made towards successful interface working. It’s great to know that the NHS Confederation’s interface programme is now available so that others can find their own way to work across the interface with the help of learning from work like ours. 

Dr Sian Stanley is a GP and clinical director of Stort Valley and Villages PCN. You can follow Sian on LinkedIn.