Overview

Key messages:

Urgent and emergency care is for patients that need prompt attention – with emergency care treating more serious cases. It is provided in a range of settings from the community to hospitals.

• Getting urgent and emergency care right is important in achieving quality outcomes, maintaining public confidence in the health system and reducing the overuse of hospital services.
• Primary care should be the first point of contact for urgent care but is often bypassed because:
  • there is insufficient capacity in the system to provide same-day appointments and out-of-hours care
  • family medicine is struggling to recruit and retain enough staff to adequately meet demand
  • patients may lack confidence in the quality of primary care
  • systems can create perverse incentives that encourage overuse of hospital services (for example, co-payments for primary but not for emergency care).
• Minor injury treatment models can offer an extra layer between primary care and hospitals, catering for walk-in patients including out-of-hours services to relieve pressure on emergency departments, but they may sideline primary care and create demand.
• Ambulance services are important in emergency provision and require:
  • the capability to treat patients at the scene and to make decisions – including when not to take patients to hospital
  • clear arrangements for the safe handover of patients
  • integration with the whole system, access to records and remote advice from specialists
  • appropriate staffing including by paramedics.
• Hospital emergency departments may be an effective way of focusing resources but are difficult to establish from scratch. Key to this are:
  • a dedicated group of specialist medical and nursing staff with the right training; and
  • physical facilities, appropriate internal organization and links to the wider hospital.
• System-wide planning and coordination can improve patient flows, integration and oversight. Policy-makers will want to consider:
  • evidence-based design principles and behavioural insights into how people use emergency care
  • the wider health care system context, local factors and public expectations
  • how resource allocation can incentivize optimal delivery
  • improvements in data, monitoring and performance measurement.
• Developing the right workforce mix requires creating suitable incentives and training for staff in primary care, particularly in remote settings, paramedics and, potentially, emergency medicine specialists.
• Coordinated working helps reduce barriers to effective operation and entails using digital tools and aligning objectives, payment and performance measures across providers.
• Improving public trust in the health system, and particularly in primary care, improves utilization patterns as does explaining how the system works and how best to use it.