DRAFT Urgent and Emergency
Care Facilities Specifications
August 2015
1
Introduction
This document outlines draft specifications to help the NHS in London deliver co-ordinated,
consistent and high quality urgent and emergency care (U&EC) services. It includes
specifications for the different types of facilities that function within U&EC networks (urgent care
centres (UCC), emergency centres (EC), emergency centres with specialist services (ECSS))
and the U&EC system that links these facilities together.
The primary audience of this document is commissioners and providers of health care services.
Background
The first stage of Professor Sir Bruce Keogh’s Urgent and Emergency Care review called for
clarity and transparency in the offering of U&EC services to the public. It recommended the
development of Urgent and Emergency Care Networks, and the designation of Urgent Care
Centres, Emergency Centres and Major Emergency Centres (now referred to as Emergency
Centres with specialist services). Since the publication of the review, national guidance has
been produced outlining standards for the functioning of these U&EC services. An overview of
this is provided in the table below.
It is intended that U&EC Networks will use the guidance to designate U&EC services in their
region, with recognition that the services will be tailored to meet the needs of local communities.
Urgent Care Centres
 Community-based primary care facilities providing urgent care for a local population;
 Encompass Walk-in Centres, Minor Injuries Units, GP-led Health Centres and all other
similar facilities – but now referred to as Urgent Care Centres;
 Act as an access point to the U&EC network 24/7; however, individual facilities not
necessarily open 24/7
 Recommended to be open and staffed consistently for at least 16 hours a day;
 Recommended to be co-located with emergency care centres on hospital sites.
Emergency Centres
 Hospital facilities that are able to receive, assess, treat and refer all patients with urgent
and emergency care needs;
 Include an emergency department which is under constant supervision of a team of
consultants in emergency medicine – not necessarily always present but available to attend
with 30 minutes
 Provide inpatient facilities to admit and investigate patients’ illnesses and injuries as well as
having a range outpatient and supporting services.
Emergency Centres with Specialist services
 Hospital based facilities with all the features of an EC, but also specialist facilities that
receive patients from ECs, or directly from an ambulance which has bypassed an EC;
 Provide support and coordination to the whole network for patients with specialist
emergency care needs;
 Provide consultant presence over extended hours;
 Provide immediate access to enhanced diagnostics such as CT and MRI scanning and
interventional radiology, and a wider range of facilities.
2
Developing facilities specifications for London
In London, this guidance has been supplemented and tailored to the region through the
incorporation a wide range of existing standards and guidance, including the London quality
standards for urgent and acute emergency services, specialist care standards (e.g. for stroke
and major trauma), inter-hospital transfer standards and Mental Health Crisis Care Standards. In
addition, a wide range of stakeholders have been engaged to date:





Interim London Transformation Group
U&EC Board
U&EC Clinical Leadership Group
(CLG) & Clinical Expert Group (CEG)
Trust Development Authority (TDA)
Clinical leads



Healthy London Partnership
programmes (NHS 111; Primary care;
Children and Young people;
Homelessness; Mental Health)
SPG leads
Strategic Clinical Networks and
London Clinical Senate Forum
System specification: One System, Multiple Services
The long-term vision is to create an urgent and emergency care system that is capable of
delivering the right care, first time for the majority of patients through a networked model 7 days
a week, and which is easy for patients to navigate and understand.
Past consultation has highlighted that the general public do not distinguish between urgent and
emergency healthcare. The system is therefore required to provide clarity as to which services
are provided where and robust pathways to access the appropriate service reliably 24/7.
Engagement with the multiple stakeholders in London has echoed this and highlighted the need
to provide a clear outline of a high quality, joined up system that is not confusing to the public or
staff and is financially sustainable. For urgent care services, in particular, the formulisation of a
system is required to ensure a full range of urgent care services are available to the public 24/7
without every facility open 24/7.
To achieve this, in addition to outlining specifications for individual facilities, an U&EC system
specification has been developed. The specification seeks to formalise the clinical
interdependences between community-based services (general practice, NHS111, ambulance
services and Urgent Care Centres), hospitals with Emergency Departments (Emergency
Centres) and those with specialist services. It aims to enable the development of a single system
that is greater than the sum of its parts; ensuring a joined up, seamless urgent care service.
The specification outlines the consistency in the system for equitable U&EC provision regardless
of whether initially accessed through 111, self-presentation or 999. It too has been developed
based on stakeholder feedback and cross-reviewing a number of existing service standards.
System
operating
hours
Clinical
governance
Access to
information
Clinical
assessment
and transfer
Integrated
capacity
management
111
Self-present
999
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DRAFT Urgent and Emergency Care Service Specifications
August 2015
Urgent Care Centres Specification
Domain
1. Governance
Specification
i. Have a formal written policy for providing urgent care. This policy is to adhere to the
urgent care clinical quality standards. The policy is to be ratified by the service’s
provider board and the U&EC Network annually.
i. Urgent care LQS 1 &
Draft National
guidance 2
ii. Be within an urgent and emergency care network.
ii. Urgent care LQS 2 &
Draft National
guidance 1
iii. Have integrated clinical governance structures with Emergency centres, whether colocated or standalone.
iv. All patient safety incidents are reported to the National Reporting and Learning System
and reviewed locally to identify and implement learning. Similarly all National Patient
Safety Alerts should be implemented in full and in the spirit they are intended.
2. Location
Reference
iii. Urgent care LQS 2
iv. Draft National
guidance 18
v. Have an identified clinical lead, and participate in clinical and non-clinical audit,
demonstrating effective engagement in a programme of continuous quality
improvement.
v. Draft National
guidance 3
i. Community-based primary care facilities providing urgent care for a local population.
i. Draft National
guidance principle
ii. Where possible, co-located with emergency centres.
ii. Draft National
guidance principle
3. Operating
hours
i. Open for a minimum of 16 hours per day.
ii. Consistent in staffing and service provision throughout days and weeks.
iii. During the hours that they are not open, provide immediate access to the Urgent and
Emergency Care Network for persons contacting the Urgent Care Centre by phone
(e.g. through 111, out of hours general practice, the ambulance service, or similar
arrangements) or arriving in person.
i. Draft National
guidance principle
ii. Draft National
guidance principle
iii. Draft National
guidance 5
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DRAFT Urgent and Emergency Care Service Specifications
4. Access
5. Staffing
August 2015
i. Receive patients that present themselves at the centre.
i. Addition
ii. Contain the necessary facilities to receive electronic direct bookings from NHS 111.
ii. Addition
iii. Receive patient referrals from ambulance and other urgent and emergency services
within agreed protocols and pathways of care
iii. Draft National
guidance 6
iv. Have direct access to assessment units and ambulatory care units within agreed
protocols
iv. Addition
i. During the hours that they are open, staffed by multidisciplinary teams, including: at
least one registered medical practitioner (either a registered GP or doctor with
appropriate competencies (reflected below) for primary and emergency care), and at
least one other registered healthcare practitioner.
ii. All registered healthcare practitioners working in urgent care services to have a
minimum level of competence in caring for adults, and children and young people
including: (a) Basic life support; (b) Recognition of serious illness and injury; (c) Pain
assessment; (d) Identification of vulnerable patients; (e) ability to recognise that
someone may be experiencing a mental health problem and to respond appropriately
and (f) awareness of safeguarding. At anytime the service is open at least one
registered healthcare practitioner is to be trained and competent in advanced life
support and paediatric advanced life support.
iii. Have arrangements in place for staff to access support and advice from experienced
doctors (ST4 and above or equivalent) in both adult and paediatric emergency
medicine and other specialties including mental health and paediatrics within their
network without necessarily requiring patients to be transferred to an emergency
department or other service.
i. Urgent care LQS 3 &
Draft National
Guidance 4
ii. Urgent care LQS 14
& Draft National
guidance 8 & 9 with
Mental health
addition
iii. Urgent care LQS 16,
aligns with Draft
National guidance 13
and with Mental
health addition
iv. Addition
v. Draft national
guidance 12
iv. Have arrangements in place for staff to access advice and support in relation to
medications during hours UCC is open
v. Have a medical or non-medical prescriber present throughout their hours of operation.
PGDs to support the treatment of common injuries and illnesses may be used until
sufficient staff are qualified as prescribers
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DRAFT Urgent and Emergency Care Service Specifications
6. Safeguarding
i. Access to a paediatrician with child protection experience and skills (of at least Level 3
safeguarding competencies) should be available to provide immediate advice and
subsequent assessment, if necessary, for children and young people under 19 years of
age where there are safeguarding concerns. The requirement is for advice, clinical
assessment and the timely provision of an appropriate medical opinion, supported with
a written report.
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i. Paediatric
Emergency Services
LQS 22
ii. Addition
ii. Safeguarding lead in place to take ownership of safeguarding governance and linking
into system-wide arrangements.
7. Assessment & iii. Escalation protocol is to be in place to ensure that seriously ill/high risk patients
Treatment
presenting to an Urgent Care Centre are seen immediately by a registered healthcare
practitioner, and where treatment in an Emergency Centre or Emergency Centre with
specialist services is required this is facilitated by attendance from the ambulance
service within agreed timescales
iv. All patients are to be seen and receive an initial clinical assessment by a registered
healthcare practitioner within 15 minutes of the time of arrival at the urgent care
service.
iii. Urgent care LQS 4 &
Draft National
guidance 7
iv. Urgent care LQS 5
v. Urgent care LQS 6
vi. Urgent care LQS 7
v. Within 90 minutes of the time of arrival at the urgent care service 95 per cent all
patients are to have a clinical decision made that they will be treated in the urgent care
service and discharged or arrangements made to transfer them to another service.
vi. At least 95 per cent of patients who present at an urgent care service to be seen,
treated if appropriate and discharged in under 3 hours of the time of arrival at the
urgent care service (where clinically appropriate).
8. Diagnostics
i. Access to the following diagnostics during hours the urgent care centre is open, with
real time access to images and results:
-
Plain film x-ray: immediate access with formal report received by the urgent care
service within 24 hours of examination
-
Blood testing: immediate on-site access with formal report received by urgent care
service within one hour of the sample being taken
i. Urgent care LQS 10
& Draft National
guidance 11
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DRAFT Urgent and Emergency Care Service Specifications
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Clinical staff to have the competencies to assess the need for, and order, diagnostics
and imaging, and interpret the results (where this is not currently available, local
protocols should specify alternate routes of access and reporting standards).
9. Equipment
i. Appropriate equipment to be available onsite (with relevant sizes available for adults
and children where applicable):
-
a full resuscitation trolley
an automated external defibrillator
oxygen
suction and
emergency drugs
i. Urgent care LQS 11
& Draft National
guidance 10
ii. Urgent care LQS 12
All urgent care service to be equipped with a range of medications necessary for
immediate treatment.
ii. Urgent care services to have appropriate waiting rooms, treatment rooms and
equipment according to the workload and patient’s needs and the environment should
be child friendly.
10. Mental Health
Crisis Care
i. Single point of access for mental health referrals to be available during hours the
urgent care service is open, with a maximum response time of 1 hour.
i. Draft Urgent care
LQS 17
ii. Dedicated area for mental health assessments which reflects the needs of people
experiencing a mental health crisis and in accordance with RCPsych standards.
ii. - v. London Mental
Health Crisis
standards and
Mental Health Crisis
Care Concordat
iii. Arrangements in place to ensure Mental Health Act assessments take place promptly
and reflect the needs of the individual concerned.
iv. Access to all the information required to make decisions regarding crisis management
including self-referral.
v. Direct line of communication with local mental health service and knowledge of local
out of hours mental health services
vii. Paediatric
Emergency Services
LQS 21
vi. Single call access for children and adolescent mental health (CAMHS) (or adult mental
health services with paediatric competencies for children over 12 years old) referrals to
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DRAFT Urgent and Emergency Care Service Specifications
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be available 24 hours a day, seven days a week with a maximum response time of 30
minutes. Psychiatric assessment to take place within four hours of call.
11. Transfer
i. All patients are able to access the same integrated clinical pathways as if they had
called NHS 111 or attended an Emergency Centre
ii. All patients have an episode of care summary communicated to the patient’s GP
practice by 08.00 the next day. For children the episode of care is to be communicated
to their health visitor or school nurse, where known and appropriate, no later than
08.00 the second day.
i. Addition
ii. Urgent care LQS 13
& Draft National
guidance 16
iii. Addition
iii. All episode of care summaries, including any change in medication, to be
communicated with patient’s community pharmacist.
iv. Urgent care LQS 15
& Draft National
guidance 14
iv. All registered healthcare practitioners working in urgent care services to have direct
access to urgent referrals to specialist on-call services when necessary, and the right
to refer those patients who they see within their scope of practice.
v. London Inter hospital
transfer standards
v. Urgent care centres to be accountable for having and monitoring robust and cohesive
policies for inter-hospital transfers (IHTs) that encompass the agreed pan-London
standards. All hospitals to be linked into networks for clinically indicated IHTs http://www.londonhp.nhs.uk/wp-content/uploads/2014/12/FINAL-Adult-IHTstandards_updated.pdf
vi. Addition
vii. Addition
vi. Have access to a mobile Directory of Services and direct booking facility.
vii. Transfer to another U&EC facility to be in line with the U&EC system specification
(below)
12. Patient
information
i. All Urgent Care Centres should have arrangements in place for staff to access an upto-date electronic patient care record and Summary Care Records.
i. Draft National
guidance 13
ii. During all hours that the urgent care service is open it is to provide guidance and
support on how to register with a local GP.
ii. Urgent care LQS 8 &
Draft National
guidance 15
iii. Addition
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DRAFT Urgent and Emergency Care Service Specifications
iii. Contain the necessary facilities to receive patient information (e.g. crisis or care plan,
child/adult at risk status) as part of any electronic 111 referral directly to the clinician
via the inter-operability toolkit (ITK).
August 2015
iv. Addition
iv. Information should be provided to patients to support self-care and advise patients of
alternative sources of care – e.g. pharmacy
13. Patient
experience
i. Patient experience data to be captured, recorded and routinely analysed and acted on.
Data is to be regularly reviewed by the board of the urgent care provider and findings
are to be disseminated to all staff and patients.
i. Urgent care LQS 18
& Draft National
guidance 17
ii. All patients to be supported to understand their diagnosis, relevant treatment options,
ongoing care and support by an appropriate clinician.
ii. Urgent care LQS 19
iii. Where appropriate, patients to be provided with health and wellbeing advice and signposting to local community services where they can self-refer (for example, smoking
cessation services and sexual health, alcohol and drug services).
14. Training
i. Urgent care centre to provide appropriate supervision for training purposes including
both educational supervision and clinical supervision.
ii. All healthcare practitioners to receive training in the principles of safeguarding children,
vulnerable and older adults and identification and management of child protection
issues. All registered medical practitioners working independently to have a minimum
of safeguarding training level 3.
iii. Urgent care LQS 20
& Draft National
guidance 19
i. Urgent care LQS 21
& Draft National
guidance 20
ii. Urgent care LQS 22
& Draft National
guidance 21
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DRAFT Urgent and Emergency Care Service Specifications
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Emergency Centres Specification
Domain
1. Governance
Specification
i. Part of an identified U&EC Network, with integrated governance structures.
Reference
i. Draft National
guidance 1
ii. Have a formal written policy for providing emergency care, and clear pathways of care,
including acceptance and referral criteria, for all common emergency conditions within
ii. Draft National
the over-arching Strategic Network. This policy includes both physical and mental
guidance 2
health, and will be ratified by the service’s provider board and the U&EC Network
iii. Paediatric
annually.
Emergency Services
iii. All hospital based settings seeing paediatric emergencies including emergency
LQS 6
departments and short-stay paediatric units to have a policy to identify and manage an
acutely unwell child. Trusts are to have local policies for recognition and escalation of
the critical child and to be supported by a resuscitation team. All to be able to provide
initial stabilisation for acutely unwell children at level 2 HDU pending retrieval to an
appropriate facility.
2. Location
i. Contains an Emergency Department that operates structurally and functionally within a
supporting acute hospital.
i. Draft National
guidance 3
3. Operating
hours
i. Open 24 hours a day, 7 days a week.
i. Draft National
guidance principle
ii. Adhere to the clinical co-dependency framework to ensure all services are available.
ii. Clinical codependency
framework
4. Staffing
i. Under the continuous supervision and accountability of one or more consultants in
Emergency Medicine.
i. Draft National
guidance principle
ii. Emergency
Department LQS 1 &
10
DRAFT Urgent and Emergency Care Service Specifications
ii. A trained and experienced doctor (ST4 and above or doctor of equivalent
competencies) in emergency medicine to be present in the emergency department 24
hours a day, seven days a week.
iii. A consultant in emergency medicine to be scheduled to deliver clinical care in the
emergency department for a minimum of 16 hours a day (matched to peak activity),
seven days a week. Outside of these 16 hours, a consultant will be on-call and
available to attend the hospital for the purposes of senior clinical decision making and
patient safety within 30 minutes.
iv. A designated nursing shift leader (Band 7) to be present in the emergency department
24 hours a day, seven days a week with provision of nursing and clinical support staff
in emergency departments to be based on emergency department-specific skill mix
tool and mapped to clinical activity.
v. All emergency departments which see children to have a named paediatric consultant
with designated responsibility for paediatric care in the emergency department.
All emergency departments are to appoint a consultant with sub-specialty training in
paediatric emergency medicine. Emergency departments to have in place clear
protocols for the involvement of an on-site paediatric team.
August 2015
adapted Draft
National guidance 6
iii. Emergency
Department LQS 2 &
adapted Draft
National guidance 5
iv. Emergency
Department LQS 6 &
adapted Draft
National guidance 4
v. Paediatric
Emergency Services
LQS 2
vi. Paediatric
Emergency Services
LQS 8
vii. Addition
vi. Hospital based settings seeing paediatric emergencies, emergency departments and viii. Addition
short stay units to have a minimum of two paediatric trained nurses on duty at all times,
(at least one of whom should be band 6 or above) with appropriate skills and
competencies for the emergency area.
vii. Timely access, seven days a week to, and support from, community nursing services
including rapid response service integrated with social care provision, to support
assessment of frail elderly and discharge.
viii. Arrangements in place for staff to access advice and support in relation to medications.
Including pharmacist presence in emergency department depending on local demand.
5. Safeguarding
i. All children and young people, children’s social care, police and health teams have
access to a paediatrician with child protection experience and skills (of at least Level 3
safeguarding competencies) available to provide immediate advice and subsequent
i. Paediatric
Emergency Services
LQS 22
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DRAFT Urgent and Emergency Care Service Specifications
assessment, if necessary, for children and young people under 18 years of age where
there are safeguarding concerns. The requirement is for advice, clinical assessment
and the timely provision of an appropriate medical opinion, supported with a written
report.
August 2015
ii. Addition
ii. Safeguarding lead in place to take ownership of safeguarding governance and linking
into system-wide arrangements.
6. Access
7. Assessment/
Treatment/
Ambulatory
i. Able to receive patients that present themselves at the centre
i. Addition
ii. Able to receive patients that present via Ambulance services
ii. Addition
i. 95 per cent of patients will wait less than 4 hours from arrival to admission, discharge
or transfer.
i. Department of health
ii. Emergency
Department LQS 5
ii. A clinical decision/ observation area is to be available to the emergency department for
patients under the care of the emergency medicine consultant that require observation, iii. Emergency
active treatment or further investigation to enable a decision on safe discharge or the
Department LQS 7
need for admission under the care of an inpatient team.
iv. Addition
iii. Triage to be provided by a qualified healthcare professional and registration is not to
v. Draft National
delay triage.
guidance 7
iv. Able to receive children and have the competencies to do so
vi. Addition
v. All Emergency Centres must have 24 hour access to blood products
vi. Pharmacy – internal access or arrangements in place to safely access all medicines a
patient needs in relation to the consultation at the time they need it. If required, these
medicines to be available for a patient for at least a 24hour period
8. Diagnostics
i. 24/7 access to the following minimum key diagnostics:
-
X-ray: immediate access with formal report received by the ED within 24 hours of
examination
-
CT: immediate access with formal report received by the ED within one hour of
examination
i. Emergency
Department LQS 3 &
Draft National
guidance 8
12
DRAFT Urgent and Emergency Care Service Specifications
-
Ultrasound: immediate access within agreed indications/ 12 hours with definitive
report received by the ED within one hour of examination
-
Lab sciences: immediate access with formal report received by the ED within one
hour of the sample being taken
-
Microscopy: immediate access with formal result received by the ED within one
hour of the sample being taken
August 2015
When hot reporting of imaging is not available, all abnormal reports are to be reviewed
within 24 hours by an appropriate clinician and acted upon within 48 hours.
9. Equipment
10. Mental Health
Crisis care
i. The Emergency Department must include a resuscitation area with appropriate
equipment to provide advanced paediatric, adult and trauma life support prior to
transfer to definitive care.
i. Addition
i. Adhere to the Mental health crisis standards –
http://www.crisiscareconcordat.org.uk/inspiration/nhs-london-strategic-clinicalnetworks-london-mental-health-crisis-commissioning-standards/
i. London Mental
Health Crisis
standards and
Mental Health Crisis
Care Concordat
-
Dedicated area for mental health assessments which reflects the needs of people
experiencing a mental health crisis and in accordance with RCPsych standards.
-
Have access to on-site liaison psychiatry services 24 hours a day, 7 days a week.
-
Liaison Psychiatry services to see service users within 1 hour of ED referral
-
Arrangements in place to ensure Mental Health Act assessments take place
promptly and reflect the needs of the individual concerned.
-
Access to all the information required to make decisions regarding crisis
management including self-referral.
ii. Paediatric
Emergency Services
LQS 21
ii. Single call access for children and adolescent mental health (CAMHS) (or adult mental
health services with paediatric competencies for children over 12 years old) referrals to
be available 24 hours a day, seven days a week with a maximum response time of 30
minutes. Patient ED episode to be completed including psychiatric assessment within
four hours of call.
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DRAFT Urgent and Emergency Care Service Specifications
11. Transfer
i. Following initial stabilisation some patients who require specialist care will be
transferred to another Emergency Centre or a Specialist Emergency Centre; this
transfer capability is integral to the functioning of an Emergency Centre and the
network in which it operates.
August 2015
i. Draft National
guidance principle
ii. Emergency
Department LQS 4
ii. Emergency department patients who have undergone an initial assessment and
iii. Emergency
management by a clinician in the emergency department and who are referred to
Department LQS 9
another team, to have a management plan (including the decision to admit or
iv. Inter hospital transfer
discharge) within one hour from referral to that team. When the decision is taken to
standards & National
admit a patient to a ward/ unit, actual admission to a ward/ unit to take place within one
guidance 11 & 12
hour of the decision to admit. If admission is to an alternative facility the decision
maker is to ensure the transfer takes place within timeframes specified by the London
v. Addition
inter-hospital transfer standards (See below link).
vi. Addition
iii. Timely access, seven days a week to, and support from, onward referral clinics and
vii. Addition
efficient procedures for discharge from hospital.
iv. Trusts to be accountable for having and monitoring robust and cohesive policies for
inter-hospital transfers (IHTs) - including repatriations – that encompass the agreed
pan-London standards – adult and paediatric. All hospitals to be linked into networks
for clinically indicated IHTs - http://www.londonhp.nhs.uk/wpcontent/uploads/2014/12/FINAL-Adult-IHT-standards_updated.pdf
v. Transfer to another U&EC facility to be in line with the U&EC system specification
(below)
vi. Formal arrangement in place linking to community service teams
vii. Have access to a mobile Directory of Services and direct booking facility.
12. Clinical
support
services
i. All Emergency Centres must have 24 hour access to care or advice from all
specialties, including mental health, directly or through the Network (in some cases this
may be provided remotely, for example using telemedicine)
ii. Emergency departments to have a policy in place to access support services seven
days a week including: - Alcohol liaison - Mental health - Older people’s care Safeguarding - Social services.
i. Draft National
guidance 9
ii. Emergency
Department LQS 8
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DRAFT Urgent and Emergency Care Service Specifications
iii. Timely access, seven days a week to, and support from, community nursing services
including rapid response services integrated with social care provision, physiotherapy
and occupational therapy teams to support discharge.
13. Inpatient
i. Adhere to the following London Quality Standards
August 2015
iii. Emergency
Department LQS 10
i. Range of LQSs
-
Acute medicine and emergency general surgery http://www.londonhp.nhs.uk/services/quality-and-safety-programme/acutemedicine-and-emergency-general-surgery/
ii. London clinical
dependency
framework
-
Paediatric Emergency Services - http://www.londonhp.nhs.uk/wpcontent/uploads/2013/03/PES-standards_FINAL-Feb2013.pdf
iii. Draft National
guidance 20
-
Critical care - http://www.londonhp.nhs.uk/services/quality-and-safetyprogramme/critical-care/
-
Fractured neck of femur pathway - http://www.londonhp.nhs.uk/services/qualityand-safety-programme/fractured-neck-of-femur-pathway/
-
Maternity services - http://www.londonhp.nhs.uk/services/quality-and-safetyprogramme/maternity-services/
ii. Adhere to the London clinical dependency framework http://www.londonhp.nhs.uk/services/quality-and-safety-programme/clinicaldependencies-framework/
iii. All Emergency Centres must include facilities for ambulatory care, admission
avoidance, early supported discharge and a frailty pathway
14. Patient
information
i. IT system for tracking patients, integrated with order communications. A reception
facility with trained administrative capability to accurately record patients into the
emergency department to be available 24 hours a day, seven days a week.
Attendance and admission record and discharge summaries to be immediately
available in case of re-attendance and monitored for data quality.
ii. Ability to receive information via the inter-operability toolkit
i. (Based on)
Emergency
Department LQS 11
ii. Addition
iii. Addition
iv. Addition
v. Addition
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DRAFT Urgent and Emergency Care Service Specifications
August 2015
iii. Have access to Summary Care Records and care plans including crisis care and end
of life.
iv. Contain the necessary facilities to receive patient information from NHS 111
v. Information should be provided to patients to support self-care and advise patients of
alternative sources of care – e.g. pharmacy
15. Patient
experience
i. Consultant-led communication and information to be provided to patients and to
include the provision of patient information leaflets.
i. Emergency
Department LQS 13
ii. Patient experience data to be captured recorded and routinely analysed and acted on.
Review of data is a permanent item on the trust board agenda and findings are
disseminated.
ii. Emergency
Department LQS 14
iii. Consistent and clear information should be readily available to children and their
families and carers regarding treatment and ongoing care and support.
16. Training
iii. Paediatric
Emergency Services
LQS 25
i. The emergency centre to provide a supportive training environment and all staff to
undertake relevant ongoing training.
i. Emergency
Department LQS 12
ii. Organisations have the responsibility to ensure that staff involved in the care of
children and young people are appropriately trained in a supportive environment and
undertake ongoing training.
ii. Paediatric
Emergency Services
LQS 23
iii. All nurses looking after children to be trained in acute assessment of the unwell child,
pain management and communication, and have appropriate skills for resuscitation
and safeguarding. Training to be updated on an annual basis.
iii. Paediatric
Emergency Services
LQS 24
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DRAFT Urgent and Emergency Care Service Specifications
August 2015
Emergency Centres with Specialist Services Specification
Emergency Centres with Specialist services will provide all the features of an EC, but also specialist facilities. These additions are outlined below.
Domain
1. Governance
Specification
Reference
i. Provide support and coordination to the whole Network for patients with specialist
emergency care needs, and work in partnership with the other system components to
ensure that patients are able to access specialist care in a timely way.
i. Draft National
guidance principle
ii. Addition
ii. Protocols across networks should be in place with London Ambulance Service in
regards to who should be conveyed to a Specialist Emergency Centre.
2. Staffing
i. Provide consultant presence over extended hours.
ii. Provide staffing in line with agreed specialist specifications.
i. Draft National
guidance principle
ii. See below
3. Assessment/
Treatment
i. Receive patients identified with specialist needs, either from ambulances that have
bypassed an Emergency Centre or patients transferred from Emergency Centre in line
with agreed protocols.
i. Draft National
guidance principle
4. Diagnostics
i. Provide24/ 7 immediate access to enhanced diagnostics such as CT and MRI scanning
and interventional radiology, and a wider range of facilities.
i. Draft National
guidance principle
5. Transfer
i. Transfer from a Specialist Emergency Centre will be rare, other than for recovering
patients being returned to community based settings of care, closer to patients’ homes
or based on agreed protocols for specialist services.
i. Draft National
guidance principle
ii. Inter-hospital transfer
ii. As per the Inter-hospital Transfer standards – adult and paediatric:
-
If a specialist centre is unable to accept an IHT on clinical grounds clear
reasons for the decision and targeted advice on further care must be provided
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DRAFT Urgent and Emergency Care Service Specifications
August 2015
to the sending hospital. The name of the specialist giving advice should be
recorded in the patient’s medical notes at the sending hospital.
-
Where a specialist centre within a network lacks capacity to take an IHT
within appropriate timescale, the specialist centre is responsible for finding an
alternative destination for the patient
-
The specialist centre receiving a patient is to inform the sending hospital with
the estimated date of discharge/repatriation as soon as possible, and no later
than 48 hours from admission.
i. Contains one of more specialist facilities and expertise – likely to fall within the remit of
specialised commissioning (outlined below).
i. Draft National
guidance principle
a. Major
Trauma
i. Adhere to standards for Major Trauma Centres.
http://www.londonhp.nh
s.uk/services/majortrauma/
b. HyperAcute
Stroke
Units
i. Adhere to standards for Hyper-Acute Stroke Units.
http://www.londonhp.nh
s.uk/services/stroke/
c. Heart
Attack
Centres
i. Adhere to standards for Heart Attack Centres.
http://www.england.nhs.
uk/wpcontent/uploads/2013/0
6/a09-cardi-primpercutaneous.pdf
d. Vascular
Centres
i. Adhere to standards for specialised vascular services.
http://www.england.nhs.
uk/wpcontent/uploads/2013/0
6/a04-spec-vascuadult.pdf
6. Specialist
care
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DRAFT Urgent and Emergency Care Service Specifications
August 2015
Urgent and Emergency Care System Specification
This specification applies to all urgent and emergency care services.
Domain
Specification
1. System
operating hours
i. Telephone and in-person urgent and emergency care services are available 24 hours a day, 7 days a week at a
System Resilience Group (SRG) level.
2. Clinical
governance
framework
i. Nested integrated clinical governance arrangements joining all urgent care services are in place to assure the
clinical quality of the patient pathway when accessing urgent care services and so issues can be identified and
service improvements made.
ii. Patient experience of moving within the urgent care system is captured and routinely analysed and acted on.
This data is regularly communicated and reviewed by all urgent care services.
iii. Safeguarding governance arrangements in place including regular system meetings. IT system flags and
process to share additional information.
3. Access to
information
i. All services have access to patient’s Summary Care Records (SCR). This is a copy of key information held in
GP records and includes knowledge about patients’ contact history and medical problems.
ii. All services have access to care plans including crisis care and end of life. Patients with a specific care plan are
treated according to that plan and, where patients have specific needs are transferred to the appropriate
professional or specialist service.
iii. All services have access to a mobile Directory of services and are responsible for informing NHS 111 of
updates to the DoS when appropriate.
iv. At every access point within the system information should be provided to patients to support self-care and
advise of alternative sources of care – e.g. pharmacy
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DRAFT Urgent and Emergency Care Service Specifications
August 2015
4. Clinical
i. Regardless of initial urgent care service access, patients are able to access the same integrated clinical
assessment and
pathways across the health and social care system.
transfer
ii. All urgent care services are able to make direct bookings to other services, as close to their location as possible
for:
a. Patients that require escalated clinical assessment and treatment
b. Access to diagnostics that are not available within the current setting.
c. Access to a community service/ social care
iii. All services to have access to OOH clinical hubs for Dental and pharmacy services.
iv. Where a referral is not made through a direct appointment, a robust referral process must be put in place and
agreed by all services involved.
v. A minimum data set of information on initial assessment should be agreed and accompany a referral and direct
booking.
vi. Patients that are transferred to an alternative urgent care service are not required to present at that service as a
new patient.
vii. At every facility all patients to have an episode of care summary communicated to the patient’s GP practice by
08.00 the next day. For children the episode of care is to be communicated to their health visitor or school
nurse, where known and appropriate, no later than 08.00 the second day.
5. Integrated
Capacity
Management
i. Integrated capacity management protocols are in place across the system, including access to real-time
capacity information.
6. Training
ii. Staff rotations should be in place across the U&EC system
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