Providing effective and timely ‘in hours’ urgent primary care response and support

5 March 2015

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“Significant potential to build upon the demonstrated expertise of the AVS in the community management of people with frailty.”

Fusion48 were commissioned to evaluate an Acute Visiting Service that had been operational for around 14 months to inform future commissioning decisions.  The requirements of the evaluation were:

  • Identify patient needs;
  • Understand whether AVS Doctors are able to meet needs once identified;
  • Assess the impact/outcomes achieved by the service e.g. are admissions appropriately avoided, or are they just delayed.

Key findings with wider applicability included:

  • The demand for home visits requested both via Ambulance Service and from GP practices is driven by the needs of older people with frailty and complex needs with the majority of presenting symptoms being characteristic ‘points of crisis’ for this cohort, such as falls, dizziness and breathlessness. 
  • The particular features of ‘added value’ offered by the AVS in the admission avoidance cases included:
    • Prompt and comprehensive assessment, enabling diagnosis at the point of crisis;
    • Urgent diagnostics, specifically the ability of the AVS to take urgent blood tests at the time of the visit, which were then used to inform patient management plan; 
    • Senior clinical decision making, combined with willingness to support patient choice and independence, not just to ‘manage risk’.
  • The scale of the service meant it was very vulnerable to peaks in referral rates, particularly in the late afternoon.

A summary of the review is available here