An innovative care model for urgent and emergency care: a qualitative evaluation of community unscheduled care co-ordination hubs

Background

High demand for emergency care continues to place strain on ambulance services and emergency departments. Many patients present with acute problems that, while requiring an urgent response, do not require hospital care. Providing safe alternatives to hospital conveyance for these patients is a priority. Community unscheduled care co-ordination hubs (UCCH) support clinicians (e.g., paramedics) to identify and refer patients with acute care needs into community services, allowing patient care close to or in their own home and reducing ambulance callouts or conveyance to hospital. Our study identified the barriers and enablers to the operation and impact of UCCHs in three locations across England.

Methods

Twenty-one semi-structured interviews were conducted with clinical and non-clinical staff working in UCCHs, and clinical staff working in services which refer patients into UCCHs (e.g., paramedics). Transcripts were analysed thematically.

Results

Four themes were identified: (1) UCCHs promote integrated community working by improving clinicians’ access to rapid community-based support for patients; (2) there was a tension between maintaining easy access for referring clinicians and ensuring consistent referral decision-making, with unclear eligibility criteria creating uncertainty about the remit of UCCHs (3) UCCH staff perceived limited ambulance service engagement as a key barrier to maximising the service’s impact on avoiding unnecessary hospital admissions; (4) Recruiting and retaining individuals with the right skills mix was a significant challenge, limiting the pace at which the UCCH could expand.

Discussion

UCCHs have the potential to simplify access to community services and support avoidance of unnecessary ED conveyance. However, their impact may be limited by inconsistent referral processes, variable engagement from ambulance services, and workforce challenges. Addressing these factors may enhance the effectiveness, sustainability, and scalability of UCCHs as part of wider efforts to deliver urgent care closer to home.