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Urgent Care: Private Vs NHS. Who Has The Answer?

London is set to see an increase in the number of private urgent care centres.

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Another private Urgent Care Centre has opened its doors in North West London. Wellington Hospital in St John’s Wood opened its centre earlier this month and will be providing care to private patients for urgent, but not life-threatening conditions. The Urgent Care Centre is the area’s second and will be competing with Casualty First, located just streets away, at the Hospital of St John and Elizabeth. Both centres allow fee-paying patients to “beat NHS queues” found at neighbouring Accident and Emergency Departments. In fact, competition for private urgent care in London is set to increase, with plans of opening additional centres in 2018.

Urgent care in the private healthcare sector is nothing new, with HCA Healthcare UK, the owners of the Wellington Hospital, already having an Urgent Care Centre at The Princess Grace Hospital. The sister hospital is located near Baker Street, London, and is part of a wider network of private hospitals across London.

The Wellington Hospital’s centre will treat adult patients with conditions that require urgent medical attention, but are not life-threatening. The centre will be staffed by doctors and nurses who are trained in urgent care, seeing patients with broken bones to abdominal pains. They will not be able to treat more serious conditions, however, such as heart attacks or major trauma.

All patients will part with a minimum of £100 for their trip to the centre, with treatments, tests and procedures subsequently being added to the bill. According to the hospital’s suggested price list, a swab of your throat will cost £50, the insertion of a tube into your bladder (catheterisation) will cost £68, and a simple blood test (FBC) will cost £38. Should a patient need to be admitted to one of HCA Healthcare UK’s hospitals, the bill’s total will rise significantly.

Urgent Care Centres are perhaps now a familiar sight to NHS patients, given that they are now located across the country and can be found within Accident and Emergency (A&E) Departments or at smaller hospitals without an A&E. They allow patients with urgent medical conditions to be seen by a doctor or a specialist nurse, freeing-up A&E Departments for patients with life-threatening conditions.

The creation of Urgent Care Centres has not always been welcomed, especially when they have been used to replace A&E Departments at smaller hospitals, requiring the most unwell patients to travel further for life-saving care. The reasoning behind this being that many A&E Departments were only seeing patients that could otherwise be seen at an Urgent Care Centre, therefore, the allocation of resources for an A&E Department could not be justified. Additionally, the creation of Major Trauma Centres and specialist heart and stroke centres, has seen a shift in the way emergency care is provided in England, with patients being directed to the most appropriate hospital for their condition, rather than the closest.

Despite efforts to make urgent and emergency care more efficient, many departments are not meeting Government targets, which state that patients should be seen, treated and either discharged home or admitted to hospital within 4 hours of them presenting to A&E. An increase in waiting times at local A&Es, may have opened up a gap in the market for fee-paying Urgent Care Centres for patients who are willing to pay to be seen quicker.

Unlike an NHS Urgent Care Centre, the Wellington Hospital is able to provide care for a wider scope of conditions. For example, breathing difficulties from an exacerbation of long-term conditions such as Asthma and COPD. People with breathing difficulties would not normally be seen in an NHS Urgent Care Centre and would instead be immediately redirected to an A&E Department. Whilst the Wellington Hospital’s Urgent Care Centre states clearly that it does not see patients with life-threatening conditions, remarking that those experiencing a heart attack should go to an NHS A&E, it also states that it is willing to treat patients presenting with conditions that have the potential to become life-threatening. A limitation of this model of urgent care being that should a patient become too unwell, they would need to be transferred to an NHS A&E, potentially delaying their treatment. Equally, the patient would be billed for their initial visit to a fee-paying unit, when their condition was more appropriate for a fully-equipped A&E Department.

In addition to a detached approach to providing urgent care, private care providers have also been working with the NHS by running certain Urgent Care Centres. St Mary’s Urgent Care Centre in London, which is run by Vocare Limited for the NHS, was put into special measures following an inspection by the Care Quality Commission (CQC). The CQC found that the centre failed to safeguard adults and children using the service, whilst concerns were also raised about staff training and X-Ray diagnosis procedures. This example demonstrating the cracks within the system that can form when an NHS service is taken over by a private healthcare provider, and the need to implement stricter regulations when this occurs.

Further consideration has also been given to the urgent care of older adults. As people are living longer, they are also developing an increasing number of medical conditions. This adds a level of complexity to their care and a traditional A&E Department is not always the most suited environment to treat these patients. The Hospitals of the University of Geneva (HUG) in Switzerland noticed that around 20% of those presenting to A&E were adults aged over 70. Doctors specialising in the care of the elderly developed the idea of having a dedicated Urgent Care Centre for patients in this age bracket with urgent and not life-threatening conditions.

Last November saw the centre opening its doors at Trois Chenes Hospital, allowing older adults to be cared for by doctors, nurses and therapists with elderly care experience, and enabling a decrease in pressure upon the other A&E Department in Geneva. Although similar ideas have also come to fruition in England, with some hospitals having a dedicated older persons team based in A&E, it is clear that a more joined-up approach to the care of older adults is needed between the NHS and social services in the community.

Perhaps the most important issue for urgent and emergency care across the NHS is the number of available beds in its hospitals. Although additional resources can be dedicated to redirecting patients towards more appropriate urgent care services, it is clear that patients will continue to wait longer in Emergency Departments if there are very few beds available in their local hospital. Given the recent overall decrease in the number of beds available to NHS patients and the winter months bringing additional pressures to an already stretch system, it is clear that the problem is far from being solved.

Private healthcare providers will continue to look for areas of the system to invest in. With plans to increase the number of private fee-paying Urgent Care Centres in London next year, evidently this is an area of interest. While these centres may reduce waits in A&E for other NHS patients, the effect will be negligible, with these Urgent Care Centres only benefiting those patients who are able to pay for their care. Moreover, many NHS services are now being provided by private healthcare providers, but recent examples have demonstrated the need for tighter regulations for these service providers. The number of beds available in NHS hospitals will continue to be the fundamental factor affecting urgent and emergency care, unless greater investment is made to increase the in-patient capacity in hospitals across the country.

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