Community alternatives to acute hospital (CAtCH) assessment services: Design principles and implementation challenges

There is an increasing global focus on Hospital Avoidance for Older People with urgent healthcare needs. In the UK, five main service models for crisis response have been identified by the British Geriatric Society; Same Day Emergency Care (SDEC), Hospital at Home (HaH), Urgent Community Response (UCR), Acute Frailty Units (AFU) and Virtual Wards (VW).ObjectivesThis article evaluated how Community Alternatives to Acute Hospital (CAtCH) assessment services have been implemented in the UK by analysing the published literature with the aim of developing key design principles for global policy makers involved in acute community care for older adults.MethodsA critical review and narrative synthesis approach was used to develop key conceptual design principles for CAtCH services. Significant papers in the field were collated as services developed between 2016-2021 and complemented by systematic searches of OVID Medline, Embase and CINAHL in September 2024 and January 2026, and citation searches, key author searches and grey literature searches on Google Scholar and NHS websites, in 2025 and 2026. Articles were analysed using an evaluation framework based on categories developed in the BGS 2021 report. A narrative synthesis approach was used to compare the different CAtCH services.ResultsThis article provides an overview of the current provision and supporting evidence. Key principles for implementation of CAtCH Assessment services include timely access to patients with an urgent healthcare need, the ability to intervene after a rapid assessment and the need for wider public input into service design.ConclusionsThese design principles are planned to support policy makers and service providers when commissioning, implementing or evaluating CAtCH services. The article also highlights implementation challenges including rapid scale-up, regional variation, heterogeneity in service provision and limited public awareness of CAtCH services.