6451 Working together to weather the storm: primary and secondary care integration to reduce winter pressures

Objectives In the winter of 2022/23, a perfect storm of high post-COVID respiratory infection and invasive Group A Streptococcus rates resulted in overwhelming levels of demand on Urgent & Emergency Care (UEC) and General Practice.¹ Worried families were waiting long periods to be seen. Leveraging existing relationships between primary and secondary care, an integrated Acute Respiratory Hub (ARH) was created at pace. The Hub aimed to deliver high-quality urgent care in the community, reducing demand on local services. Secondary aims were improved relationships and learning between professionals. Methods Revision of pre-existing plans for a community asthma clinic allowed for rapid delivery of the ARH. The design process was greatly facilitated by collaborative working between professionals from the Integrated Care Board (ICB), primary and secondary care. Referrals were accepted from primary care, 111, A&E or by re-direction from the local Urgent Treatment Centre (UTC). 15 minute appointments were given at scheduled times. Sessions were delivered by one primary care clinician and one paediatric doctor, allowing for sharing of learning and expertise between professionals. Clinicians were given access to full primary care records for each patient and clinic notes were sent back to the patient's named GP. Evaluation of the hub was continuous and mixed-method, consisting of patient and staff questionnaires; qualitative semi-structured interviews; and analysis of primary and secondary care activity data. Results The ARH saw 3377 patients over 100 days. 79% of referrals were via primary care with 15% being redirections from A&E/UTC. 46% of families questioned, 46% stated an intention to attend A&E/UTC if they had not been seen at the Hub. Although not reaching statistical significance, there was an observed reduction in paediatric attendances to A&E/UTC after the initiation of the service. 91% of parents questioned were satisfied or very satisfied with the service, with qualitative feedback indicating a high-quality experience. 86% of professionals felt the initiative helped to support both primary and secondary care and had a positive impact on relationships and knowledge base. Conclusion A willingness to work together enabled rapid mobilization of this Acute Respiratory Hub. The Hub successfully provided additional capacity to cope with demand and reduce service pressures in the winter of 2022/23. In doing so, it provided an integrated space which delivered high-quality, timely care to patients in a community setting and a highly-rated, educational experience for staff, further strengthening existing relationships between primary and secondary care. Reference Thomas R. Strep A concerns create 'carnage' and 'eyewatering demand' for the NHS. The Independent. December 2022.