NHS Buckinghamshire Urgent Care Assessment Team (UCAT)

Who commissioned the service and why?

In November 2009, Buckinghamshire Urgent Care (BUC) was commissioned by NHS Buckinghamshire to provide urgent and unscheduled primary care services to patients outside normal surgery hours in Buckinghamshire.  

BUC is a Joint Venture organisation that incorporates Vale Health, Chiltern Health and Harmoni HS Ltd.

NHS Buckinghamshire was keen to learn about new, innovative approaches to ‘home visits’ in order to maximise the number of patients who could be cared for in their own home or a community facility. This would help to achieve a key objective to reduce admissions to hospital via A&E and assessment units by 5% based on 2008-2009 admission data. 

NHS Buckinghamshire was open to evidence based options including nurse led interventions, social services input and home help type assessments as well as time-of-day sensitive approaches.

Overview of UCAT

In order to provide a service to help meet NHS Buckinghamshire’s objective to reduce hospital admissions by 5%, BUC analysed short stay admission data from the two local hospitals. Analysis found that Nursing and Care Homes represented 30% of all admissions. 

BUC mapped A&E attendances and admissions per Nursing and Care Home, and assigned a Red Amber Green (RAG) status and an admission reduction target to each Home. 

BUC set up the UCAT service in March 2010 as part of the contract to provide urgent and unscheduled primary care services on behalf of NHS Buckinghamshire. UCAT’s objective is to achieve a reduction in Nursing and Care Home admissions to hospital.   

UCAT is a nurse-led team, operational Monday to Sunday, 08:00 - 24:00, which provides support to professionals caring for patients from Nursing and Residential Homes. Each Home has a named UCAT nurse, who has a reduction target for inappropriate A&E attendances per Nursing and Care Home.

Outcomes

Since UCAT’s launch in March 2010, it has developed a number of initiatives to reduce inappropriate admissions by Nursing and Care Homes to hospital. 

• The UCAT team works in collaboration with South Central Ambulance Service to reduce the number of inappropriate 999 call-outs to Nursing and Care Home patients and 999 admissions to hospital.
• The UCAT team provides telehealth equipment and training to Nursing and Care Home nurses to enable them to conduct daily Chronic Obstructive Pulmonary Disease (COPD) checks. UCAT nurses analyse the data allowing them to flag-up early signs of COPD exacerbations and provide preventative treatment.
• The UCAT team reviews daily Nursing and Care Home activity across UCAT and Out of Hours services, challenges inappropriate clinical decisions and offers advice for best practice.
• The UCAT team provides confirmation of death training to allow Nursing and Care Home nurses to confirm their own patient’s death, consequently reducing stress on the patient’s family and the need for an additional clinician.
• The UCAT team works with relatives of Nursing and Care Home patients to ensure they have an end-of-life plan in place and a family spokesperson who can represent the wishes of the patient.

In the nine months prior to UCAT’s launch, 2,019 emergency admissions were made by Nursing and Care Homes into secondary care. Nine months after UCAT’s launch, from March 2010 to November 2010, there were 1,450 emergency admissions from Nursing and Care Homes. This indicates a reduction of 569 emergency admissions.

Benefits to Commissioners

The number of emergency admissions from Nursing and Care Homes over the first nine months of UCAT's operation were substantially lower than in the prior nine month period. Enabling patients to stay in their own environment reduces demand on secondary care and ambulance services, therefore providing cost savings for the local health economy.

Benefits to Patients

UCAT offers reassurance and a proactive approach to treatment for Nursing and Care Home patients, preventing unnecessary admission to hospital. This ensures that patients receive the right treatment, by the right person, and most importantly in the right place.