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New ‘rapid discharge’ standard in development by NHS England

NHS England has confirmed it is developing a ‘national standard for rapid discharge’ from hospitals in its new guidance for ICBs on ‘intermediate care’.

Concerns have been raised that it does not sufficiently take into account the impact on general practice, with GPs inevitably picking up a larger share of the workload if patients are discharged sooner.

The framework recommends a number of actions for system commissioners to consider to improve short-term health and social care to adults who need support after discharge from acute settings. 

Earlier this year, in its urgent and emergency care recovery plan, NHSE committed to developing a new planning framework and national standard for rapid discharge ‘by autumn 2023’. 

The new guidance confirmed that this national standard is in development, however it emphasised that ‘improved data’ is needed to ‘inform the approach’.

It said data on discharge ‘are not standardised, consistent and are often collected at a local level in multiple formats’.

‘This limits the understanding of the timescales and processes that support optimum discharge into intermediate care,’ it added. 

The framework therefore sets out actions for ICBs to improve ‘data quality, coverage and completeness at system, regional and national-level’. 

NHS England’s guidance also aims to improve workforce mapping, increase therapist input by releasing their capacity and implementing ‘care transfer hubs’.

The hubs are intended to be a ‘focal point for coordinating discharge’, particularly complex discharges, and are made up of a multidisciplinary team of health, social care, housing and voluntary sector partners. 

Walsall Healthcare NHS Trust, one of the so-called frontrunner sites that has been trialling new approaches to step-down care, has a care transfer hub which currently includes only social care, mental health, acute and community health, but is working towards primary care inclusion.

Aside from this case study, there is no direct reference to general practice or primary care involvement in the action plan.

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said the guidance aims to ‘improve patient outcomes and reduce hospital readmissions’ which will ultimately result in a better use of resources and improved patient experience.

‘But successful implementation will require support from general practices and this is not discussed in any detail in the plans (e.g. in sharing of patient data),’ he said.

The guidance said: ‘Implementation of step-down intermediate care as outlined here is expected to result in improved outcomes, experiences and independence of people discharged, reduced avoidable hospital readmissions, and reduced avoidable/premature long-term care provision. 

‘Further expected benefits include improved flow and discharge from acute and community hospitals, freeing-up NHS hospital capacity for those who need it most.’

A recent study showed that medication errors when people go into or are discharged from hospital in England could be reduced by nearly 40% with the introduction of this standard which makes it easier to share information across hospital and GP systems.

Over the summer, NHS England announced plans to speed up patients’ discharge this winter, including additional ambulance hours, extra beds, and new ‘care traffic control centres’ to act as ‘one stop’ for staff to coordinate discharges.

This article was originally published by our sister publication Pulse.