Acute GP service

A 2-hour urgent response team as part of the NHSE Aging Well initiative designed to mitigate the need for acute admission. This is not an alternative service for GP home visiting but rather to pick up acutely declining patients in the community.

 

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Inclusion criteria:

•Individuals requiring a 2 hour urgent care response, will receive an assessment, treatment and support in their usual place of residence to prevent an acute admission to hospital.

•Individual is aged 18+.

Typical presentations which may necessitate a need for rapid 2 hour response include:

•Acute confusional state with unknown cause

•Acute on chronic frailty symptoms

•Acute breathlessness alongside pre-existing COPD or heart failure, 

•New or deteriorating mobility problems which will result in hospital admission if not addressed within 2 hours. 

•Inadequate support at home which could lead to acute hospital admission or immediate risk to the individual

•Patient requiring palliative care who has a new or deteriorating  issue which may result in acute admission if not assessed and treated within 2 hours.

•Urgent catheter care

•Clinical judgement will support triage and decisions regarding necessity  for 2 hour urgent crisis response.

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Exclusion criteria:

•Patient requires immediate emergency response e.g. life threatening sepsis.

•Where a person needs a specialist clinical condition pathway e.g. acute stroke.

•Crisis mental health scenarios requiring functional diagnosis or dual diagnosis

•Sole GP home visit for the purposes of diagnosis/treatment with no further intervention from an MDT.

•Pregnancy

•If clinical judgement at triage determines that patients clinical needs do not require 2 hour urgent crisis response

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Referral for 2h UCR is appropriate if the person is experiencing a crisis which can be defined as a sudden deterioration in a person’s health and wellbeing. This may have been caused by a stressor event which has led to an exacerbation of an existing condition or the onset of a new condition. This health or health and social care need requires urgent treatment or support within two hours. 

 

In addition to the UCR inclusion/exclusion criteria, clinical judgement also needs to determine which individuals would benefit from 2-hour response. In conjunction with available history and social situation, this would be judged on key risk factors such as:

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High Risk Factors:

•Age >65; 

•Rockwood Clinical Frailty score of 6 or above;

•Previous acute admissions;

•Previous falls;

•Care home residents;

•Multi-morbidities (2 or more long term conditions) with or without dementia;

•Polypharmacy;

•And urgent care sensitive conditions - COPD, falls (aged 65 and over), non-specific abdominal pain, deep vein thrombosis, cellulitis, blocked catheters and feeding tubes, hypoglycaemia, urinary tract infection, angina, epileptic fit, minor head injuries.

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