Identifying innovative models of urgent and emergency care in rural and coastal areas in England: a mixed methods study

Background: In 2023, NHS England launched a 2-year delivery plan to recover Urgent and Emergency Care (UEC) services in England. This plan aims to roll-out demand-based initiatives, such as Same Day Emergency Care, nationally. Whilst demand on UEC services is felt throughout the NHS, rural and coastal communities face unique challenges due to: seasonal variation and unpredictable demand, workforce issues, high-levels of deprivation and large catchment areas prohibiting health care access.

The importance of funding research and developing bespoke solutions to address health and wellbeing in rural and coastal communities has been identified as a national priority for patients, providers and commissioners - notably through the Chief Medical officer’s 2021 annual report. We currently do not know how rural and coastal areas are responding to NHS England’s UEC recovery plan or how best to organise and deliver UEC care in these areas. This research addresses this evidence gap and national priority area.

Aims: To identify and evaluate innovative models of UEC in rural and/or coastal communities in England, including their impact on patient care, clinical outcomes, workforce and use of healthcare resources. Methods: The project consists of three work packages (WPs):

WP1:A desktop review of organisational and policy documents, interviews with national, regional and local leads and stakeholders, focusing on rural and/or coastal areas. The output will be a national service map outlining UEC provision in rural and coastal communities.

WP2:Using the national Emergency Care Data Set (ECDS) from NHS England, we will develop new bespoke ED performance metrics. We will use quasi-experimental and other longitudinal approaches to assess the impact of new UEC models (identified in WP1) on health and process outcomes, using standard metrics (e.g. admission rates, time to triage and discharge) and bespoke metrics (e.g. transfer avoidance, sensitivity and specificity of triage).

WP3: Up to 12 case studies of UEC models in rural and coastal communities in England. We will interview and observe patients, carers, health care professionals within case sites. Personnel from other local health and care services (e.g.

Ambulance staff, social care, primary care) will be interviewed but will vary according to the composition of each UEC model. The output will be an in-depth understanding of how and why different UEC models influence patient clinical outcomes, experience, resource use and workforce.

Anticipated impact: This study will provide an understanding of the most effective ways to organise and deliver UEC care in rural coastal areas. Short term impact will be achieved through our service map. Our expert panel will provide a continuous and direct route to impact throughout the study.

The development of a peer-network and national UEC hub for rural and coastal communities will provide additional routes to medium and sustained impact, by creating a mechanism for our findings to influence policy and organisational change that is tailored to the needs of rural and coastal communities. In addition to academic and public dissemination, structured guidelines for commissioning UEC that are tailored to rural and coastal communities will be developed.

Together, our outputs will improve workforce planning, the organisation of UEC in rural, coastal communities and the development of local, regional and national policy in this area.