Urgent Primary Care Centres (UPCC)

The Urgent Primary Care Centre’s (UPCC) programme is one of the four key strategic priorities of the Strategic Programme for Primary Care, and a core part of its 24/7 work stream.

The year-on-year increases in demand has resulted in growing pressure on key points in the system that can have negative consequences for patient experience and outcome and result in risk of potential harm, so our vision is for a whole system approach where seamless support, care or treatment is provided as close to home as possible. This means providing services designed around the individual and around groups of people, based on their unique needs and what matters to them, delivering quality and safety outcomes.

Urgent Primary Care Centre’s have been established because people were increasingly presenting in large numbers at GP practices, out-of-hours /111 and Emergency Departments with urgent care needs which were not all being met by existing capacity and services.

The Centres provide people with access to information and advice, assessment and care closer to home, safely avoiding the need to present elsewhere in the system.

Urgent Primary Care has been defined as:

‘Health and wellbeing issues that may result in significant or permanent harm if not clinically risk assessed and appropriately managed within the next 8 hours’.

Urgent Primary Care services include same day / out-of-hours primary care appointments, a phone consultation through the NHS111 Wales (including the 111 Clinical Support Hub), pharmacy advice, and/or referral to an Urgent Primary Care Centre (UPCC). If unsure what service is needed, NHS111 Wales can help to assess and direct to the appropriate service/s.

More information on understanding UPCC can be found here.

Background

The Welsh Government strategic aim is to provide the right care, in the right place first time for people who have a need for urgent or emergency care, through consistent delivery of ‘six goals.  You can download the policy fact sheet which shows how the model links to the Six Goals for Urgent and Emergency Care here.

The COVID-19 pandemic has had a profound effect upon the delivery of services and the behaviour of the public in the way they access healthcare, and new models of delivery across Primary Care have resulted in a more virtual and directional delivery model.

There is recognition of the need to redesign the delivery of care to meet the needs of the local population to ensure that patient pathways achieve the optimum outcome.  A co-ordinated response to care will ensure that the patient journey will be managed from initial presentation through to the completed outcome.

This programme seeks to design and deliver a new model of urgent care for the population of Wales that have an urgent primary care need providing a service for people within 8 hours of contacting their local Health Board. The aim is to provide seamless care, delivered at a local level consistently regardless of organisational boundaries.

The Urgent Primary Care Centre’s Programme is part of the 24/7 work stream and sits within the Strategic Programme for Primary Care and the Welsh Government Six Goals for Urgent and Emergency Care Programme. It is fully aligned with other existing Urgent and Emergency Care Improvement work streams including ‘Think 111 First’, the national rollout of the 111 programme and Same Day Emergency Care (SDEC).

In addition, the programme links with the Strategic Programme for Primary Care work streams, in particular the Data and Digital work stream, Accelerated Cluster Development work stream and the Community Infrastructure programme which is the second strand of the 24/7 work stream.

The case for change across Urgent and Primary Care has been made to address high levels of demand as patients are increasingly presenting in large numbers at GP practices, Out-of-Hours /111 and Emergency Departments with urgent care needs which are not always being met by existing capacity and services. Variation of services, pending time of day and location in Primary and Community care services across Wales, has also been recognised as a real issue. To address these issues, an early Pathfinder (phase 1) for National Urgent Primary Care Centre’s was funded by Welsh Government to ensure that as far as possible, the primary care offer is consistent on a 24/7 and geographic basis.

The aim is to provide seamless care, delivered at a local level consistently, regardless of organisational boundaries. The Urgent Primary Care Centres are aligned with the Six Goals for Urgent and Emergency Care.

Direction of Travel
The direction of the Urgent Primary Care Programme was set by the Strategic Programme Board for delivery in 3 distinct phases.  The first pathfinder phase allowed health boards to create local models to meet the needs of their local population with the staff they had available.  The pathfinders were quickly implemented to test the model and the learning was captured to support further design of the model during phase 2. Phase 3 is focused on embedding the model as part of the Local Health Board or Cluster core offer and is supported by robust local exit strategies. 

A plan on a page setting out the scope, key deliverables and the success criteria for each phase was provided by the Strategic Primary Care Board. You can access and download the Plans here:

Read the phase 1 plan on a page.

Read the phase 2 plan on a page.

Development and Delivery

Development of the Urgent Primary Care Centre’s has been a national collaborative with each of the Local Health Boards committed to funding and appointing dedicated Programme Managers to develop a local model that meets local needs and to share the learning with a wide range of stakeholders nationally.

Phase 1 saw the development of the pathfinder model which are fully aligned with existing work streams including ‘Think 111 First’, the national rollout of the 111 programme and the Welsh Government Six Goals for Urgent and Emergency Care (2022). In phase 1, Health Boards and clusters developed 2 delivery models for the pathfinders allowing for local variation to meet the changing needs of the local population.

The models were based on a mix of:
1. Urgent primary care delivered on a cluster (or pan cluster) level by local General Practice workforce with some models linked to third sector mental health support; and
2. 24/7 urgent primary care treatment centres managed by health boards, staffed by a mix of professional staff with the appropriate skills.

Key headlines for the Pathfinders (Phase 1)

1. £1.86m funding amongst 6 bids Nov 20
2. Two sites demonstrating the cost of providing care per patient
3. More than 14,000 patients assessed during the early development of the pathfinders
4. Utilisation rates increased month on month in many of the sites
5. UPCCs covered a total population of 1,535,429 people, 38 clusters, 234 practices
6. Pathfinder sites included both Health Boards and practice/cluster models
7. ‘All Wales’ Urgent Primary Care National Evaluation Framework and tools produced
8. A ground-breaking and clear definition of Urgent Primary Care was agreed

You can read the Urgent Primary Care Centres Pathfinders report here.

You can access the full set ‘Fact Sheets’ that were produced during phase 1 below:

Fact sheet 1 – policy

Fact sheet 2 – definition

Fact sheet 3 – workforce

Fact sheet 4 – impact, value, and next steps

Face sheet 5 – summary

In order to evaluate the UPCC programme through its life-cycle, the programme teamed up with the University of South Wales (USW) who were commissioned to support the development of an Urgent Primary Care Centre Evaluation Framework for Wales.

USW worked with the programme to design and deliver the following:

1. Literature review – setting the scene with international evidence enabling the programme to develop a definition for Urgent Primary Care.
2. Development matrix (developed for phase 1 as a baseline for comparing the improvements made in phases 2 and 3).
3. Concept mapping exercise (developed for phase 1 with a series of recommendations that continue to be actioned throughout phase 2 and phase 3 for measuring performance).

To complete a full National Evaluation Framework, a ‘Once for Wales’ national patient satisfaction survey was developed in phase 1 by the Local Health Boards which was used to capture the patient experience and each health board completed their own local evaluation using a national template.

The programme has been collaborating with Digital Health Care Wales to produce the standard data definitions for a National Performance Framework.  This work is expected to be completed by the end of phase 3.

The University of South Wales conducted a concept mapping exercise which highlighted the need for Local Health Boards to review datasets in their local regions. However, as there were no set national key performance indicators (KPIs) or definitions in place, there was significant variation in the information collected from each Health Board.  Digital Health Care Wales (DHCW) worked with this collaborative to address the barriers for measuring overall performance such as:

• Lack of common language including definition of urgent primary care
• Difficulty measuring and assessing impact with no common dataset
• Localisation to meet cluster population needs led to different aims with different service specifications

To find out more on how the Urgent Primary Care Centres are being evaluated and how the National Evaluation Framework continues to be developed through each of the phases you can access the documents developed and published during phase 1 here. The final report for phase 1 was published in July 21 which contains a series of recommendations for phase 2 as well as the ‘Once for Wales’ Patient Satisfaction Questionnaire included as appendix 1.

You can read the Urgent Primary Care Centres Pathfinders report here.

Read the University evaluation framework for UPCC Pathfinder and annexes.

Next steps were the approval of funding for the Urgent Primary Care Centre’s for 2021- 22 which was agreed through a series of local evaluations and a review of the impact for local people who were able to receive care closer to home.

Welsh Government provided the Scrutiny and Governance body for the programme and at the end of phase 1, the National Panel built on this knowledge and produced a plan for continuing its development and refinement.

The Plan for phase 2:

1. Agreeing data definitions based on concept mapping exercise (link to 6C Annex C Developing the core data set).
2. Standardising reporting across the different IT Systems – this entailed capturing the current state and continuing the collaboration with Digital Health Care Wales to standardise reporting for the future state and to build a National Performance dashboard.
3. Building an Urgent Primary Care Dashboard (work in progress). You can access the final report and impact assessment published by Digital Health Care Wales by visiting Urgent and Emergency Care – Digital Health and Care Wales.
4. Producing a National Workforce report with recommendations for a sustainable model. Link coming soon.

Continue to define a national model for Urgent Primary Care Centres based upon the experience of phase 1 continuing to gather intelligence for

1. Capturing the model maturity, local processes and development which will provide the key model components and principles for embedding the National Model in phase 3.
2. Funding a 3-month programme of innovation projects that would:

•  Support the interface across urgent primary care, between daytime and ‘out of hours’ focusing on seamless care.
•  Encouraging joint working across the urgent care interface.

The Urgent Primary Care Innovation Fund was awarded to Local Health Boards in December 21 when each Health Board was invited to bid for funding to develop a model that would support the Urgent Primary Care Centres.

The Innovation Fund was a rapid three-month programme, set up at pace and ‘Expressions of Interest’ were invited for clinician led initiatives around the urgent primary care interface that encouraged pilots to test proof of concept.

Given the rapid timescales and known recruitment constraints, it was recommended that pilots considered the use of their existing workforce and could demonstrate:

1. The added value for the winter (2021 – 2022)
2. Adequate financial governance
3. Measures to quantify impact

The majority of bids focussed on providing acute home visiting services with some aspiring to an urgent response time of one hour, others included increased triage, first contact mental health practitioner and targeted frailty services.

Read the final national programme report describes the pilots work, benefits, and impact as well as lesson learned.

Innovation fund report – Coming soon

The National Evaluation Framework for phase 2 is still under development – Coming soon

Read the phase 3 plan on a page.

Read the National Framework for Urgent Primary Care Centres.

View the National Framework for Urgent Primary Care Centres infographic.

Read the Urgent Primary Care Centre Final Report. This is a summary of the Urgent Primary Care Centre Programme Final Report Sept 2020- March 2023. This paper reviews impact and lessons learned during the All-Wales National Urgent Primary Care Centre Programme (UPCC).

Communicating and engaging with stakeholders to co-produce new or changing services is an important task and we have chosen to share our experience through a number of videos and Factsheets.  These videos have been at the forefront of our approach to explain how Urgent Primary Care Centres developed and contain a plethora of interviews with key staff sharing their learning, including, how they overcame some of the barriers and constraints. We hope that the following videos which were launched at our learning event on 21st October 21 will be appreciated and enjoyed by a wide audience who will find them engaging as well as providing informative content for everyone.

The videos align with the 6 Goals for Urgent and Emergency Care policy framework which aims to support the delivery of co-produced, comprehensive, integrated 24/7 Urgent Primary Care same day care model which enables patients to be directed to the most appropriate health care professional at the time they need to access urgent health and social care, delivered on a cluster, or multi-cluster footprint.

A set of videos and conversations are available which captures our journey ‘telling the story’ of how we moved from phase 1 and the learning that was captured to take into phases 2 and 3. (videos for phases 2 and 3 are still in development and will be made available here as soon as they are available).

Links and descriptions of each video are visible in this downloadable document. 

While this section has been populated with the learning from developing our Urgent Primary Care Centres in mind, there is a wealth of information in these videos that can support you and your teams in communicating with other stakeholders.

Communicating and engaging with stakeholders to co-produce new or changing services is an important task for all teams. Communication is the successful conveying or sharing of ideas and feelings, therefore any information imparted or interactions with other are forms of communication.

The Engagement section of the Accelerated Cluster Development toolkit is being shared as it is an adaptable resource that provides a wealth of information for managing communications and engagement.  This toolkit has been divided into sections and covers the following areas:

• Why communication and engagement is important
• Cluster communication and engagement principles
• Cluster communication and engagement strategy
• Communication and engagement goals
• Stakeholders and audiences
• Communication and engagement channels and approaches
• Why engage with service users, carers, and the public
• Communication and engagement with cluster staff
• Channels and approaches for health and care system engagement
• Channels and approaches for wider stakeholder communication and engagement
• Communication and engagement action plan and audit tool
• Dependencies and risks
• Continuous improvement in communication and engagement
• Cluster communication and engagement delivery plans – OASIS

While the language here is focused on clusters the information is broad and applicable to all teams and is an incredibly useful resource.