Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper

Abstract

Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function—from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.

Is streaming patients in emergency departments to primary care services effective and safe?

“…Effectiveness will be evaluated by waiting times, admission rates and (re)attendances, patient satisfaction, and cost-consequence analysis, with patient safety incident reports analysed for patient safety outcomes. The teams have collaborated to update the taxonomy to ensure consistency of terminology and classification of models, and to include the wider primary care workforce 13Figure 2. shows the form these service models take, inside and outside emergency departments 13.…”

“…The teams have collaborated to update the taxonomy to ensure consistency of terminology and classification of models, and to include the wider primary care workforce 13Figure 2. shows the form these service models take, inside and outside emergency departments 13. The studies, due to be completed in 2021, will attempt to identify service models that may be better suited depending on local demographics and contexts.…”

“…Clinicians, service directors, managers, and commissioners should acknowledge the current evidence gap for effectiveness and safety in this area. The function of these service models is complex and influenced by many variables at multiple levels including: wider system determinants (eg patient demand, staffing); department level (eg access to investigations, governance); and individual level (eg, experience, skill set and interest) 13…”

“…A “co-located” primary care service may deliver patient care in a separate unit to the emergency department, without access to acute diagnostics, thus similar to normal general practice settings. Alternatively, general practitioners may work within the emergency department, with responsibilities beyond usual primary care 13. It is uncertain if national implementation of streaming, considering the heterogenous nature of emergency medicine case mix and practice, improves patient care and safety.…”

David Oliver: Why force GP streaming on NHS emergency departments?

“…A 2019 review found inconsistent terminology around primary care services in emergency departments, as numerous different models were put under the same umbrella. Any meaningful evaluation must be much clearer about defining the delivery model and not comparing apples and oranges 8…”