Royal Preston patients to be told whether they need A&E or urgent care

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Patients arriving for unplanned treatment at the Royal Preston Hospital will no longer have a choice between going to Accident and Emergency or the neighbouring urgent care centre.

The hospital has set up a new triage process which aims to ensure that the majority of people with minor illnesses or injuries are seen by urgent care centre staff – leaving A&E free for the sickest patients.

Nurses will decide whether a patient should go to A&E or the urgent care centre at the Royal Preston

Nurses will decide whether a patient should go to A&E or the urgent care centre at the Royal Preston

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It was previously up to the individual to decide which door they walked through – and if a patient picked A&E, they would usually stay there, no matter how minor their complaint.

“Patients will not be faced with two signs or any choice to make – they’ll be guided to the most appropriate place,” Faith Button, Interim Director of Performance at Lancashire Teaching Hospitals, said.

“They should also see a shorter waiting time if they’ve got a minor illness or condition, as they’re not having to wait for the sicker patients to be seen first,” she added.

Faith Button says the A&E and urgent care teams have now been told which conditions they should be treating.

Faith Button says the A&E and urgent care teams have now been told which conditions they should be treating.

The aim is for the urgent care centre – which is run by private company ‘gtd healthcare’ and commissioned by the Greater Preston Clinical Commissioning Group (CCG) – to see between 90 and 95 percent of people who arrive with less serious problems.

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The new system began earlier this month and follows the abandonment of an earlier trial in October, which actually led to a spike in A&E waiting times.

A recent board meeting heard that a joint triage experiment – which involved A&E and urgent care centre staff working together to carry out initial assessments – had seen the two teams “competing” for patients. “It got that silly,” Adrian Griffiths, Chief Operating Officer, commented.

The result was that fewer than 85 percent of patients were seen within the 4-hour waiting time standard across both A&E and urgent care last month, compared to a local target of 90 percent.

Faith Button says lessons have been learned and the problem stemmed from a lack of detail about who should be doing what.

“The whole point of pilots is to test processes out and improve things. [Sometimes] the urgent care centre thought they should be seeing a patient, whereas our A&E department thought it was more appropriate, with their clinical experience, to [treat them].

“The perception was that maybe we were competing for the same patient, [but] we just hadn’t ironed out the clinical pathways quite as robustly as we should have done,” Ms. Button added.

Now, the two departments have developed a comprehensive list of the conditions which should be dealt with by each team. However, urgent care staff will refer people into A&E if their clinical condition deteriorates after being triaged into their unit.

The trust says that early indications suggest the new system is taking the pressure off Preston’s A&E and is part of a wider winter plan to keep patients flowing through the system even as levels of sickness increase during the colder months.

“It will give our A&E department the space and time to see the sicker patients, those arriving by ambulance, the really poorly ones,” Faith Button said.

Chief executive of ‘gtd healthcare’, David Beckett, said the company has recruited additional “skilled and experienced” staff to support the new way of working.

“The aim is to improve the experience for patients while helping support performance at the emergency department as a whole. The new minor injuries pilot went live on 1 November and initial performance and progress has been positive.

“Our main priority is to always ensure patients receive the best possible care and I believe this pilot will contribute towards continuously improving their experience of when they attend the urgent care centre.

“We hope to replicate the success of the pilot at Chorley Hospital’s urgent care centre in due course,” Mr Beckett added.

A spokesperson for Greater Preston CCG said: “The new triage process at Lancashire Teaching Hospitals was designed with the aim of ensuring patients are seen by the most appropriate service.

“We are in support of the new triage process and remain hopeful that initial encouraging signs will continue to grow.”

A&E performance during the first full month of the new system will be reported to Lancashire Teaching Hospitals’ December board meeting.

VIEW FROM THE PATIENTS ASSOCIATION

Rachel Power, Chief Executive of the Patients Association, said:

“When services are reorganised, there must be strong evidence for how it will benefit patients, and thorough engagement of local patient communities to ensure the changes meet people’s needs and are supported by patients.

“With another challenging winter period for the health service approaching, patients and the public should use the health service responsibly to help ensure that care is readily available for everyone who needs it – though of course, anyone who strongly feels they need urgent attention should seek it without hesitation.”

CENTRAL LANCASHIRE'S UNDER-PRESSURE NHS

Accident and Emergency attendances across the Royal Preston and Chorley and South Ribble hospitals are up 8 percent compared to this time last year. Emergency medical admissions have increased by 11 percent.

Just last week, Chorley MP Sir Lindsay Hoyle tweeted a picture of ten ambulances doubled parked outside Preston’s A&E on Thursday.

But a board meeting at Lancashire Teaching Hospitals heard that the trust recently received a congratulatory email form the North West Ambulance Service, after going from being one of the worst in the region for ambulance handover delays to one of the best. The Royal Preston had hit an average turnaround time of 25 minutes, against at 30-minute standard.

The future shape of Central Lancashire’s A&E services will be the subject of a public consultation next year.

Residents had been due to have their say in January on how services should be delivered, but the consultation process has now been delayed until next May.

Campaigners for the reinstatement of a round-the-clock A&E at Chorley and South Ribble Hospital have regularly cited the pressure put on the Royal Preston when Chorley’s emergency facility closed for nine months in 2016. The unit has been operating on a part-time basis since January 2017.

A draft version of the document due to be put to the public in 2019 is based on the principle of a single A&E unit for Central Lancashire. Under the proposal, there would also be two urgent care centres to treat more minor complaints and a ringfenced facility for pre-planned operations.

Speaking in August, Lancashire Teaching Hospitals’ Medical Director, Dr. Geraldine Skailes, said long-talked about plans for a so-called ‘super hospital’ would not solve the region’s short-term problems.

“Our current proposals are looking at making our services safe and effective over the next few years,” Dr. Skailes said.

“We know that at the moment we are running two acute hospitals and are duplicating a number of our services across the two sites. The new model will allow a degree of consolidation so we have one workforce that is able to concentrate on providing that high quality care in one place.”