South west London’s urgent community response service is among the busiest in the country, recent figures show. The service is ninth highest of England’s 42 NHS areas for referrals per head of population. A total of 1,745 referrals were made to the service in April, the most recent month where data is available.
More than eight out of ten (87%) people contacting the service received a response within two hours in April, against a target of 70% and a national average of 75%.
The service brings community responders direct to people’s doors for a range of urgent medical issues. Where possible, the aim is to manage their condition at home, without a hospital visit. Many of the people helped are elderly, frail or with long-term health conditions.
According to the data, most calls (28%) came from GPs. However, residents can contact the service direct, and an increasing number are doing so (19%).
The April figures show that the highest number of call outs were for catheter problems at 15%. Respiratory conditions, including chest infections, asthma and worsening COPD, were at 10%. End-of-life support followed at 9%. Responders were also called for falls, urinary tract infections and confusion.
It’s about trying to keep patients at home as much as possible, to help maintain their independence and prevent a hospital admission”
All calls are triaged to ensure they are appropriate for the service – rather than needing a 999 response or NHS 111. Each borough team is managed by a lead nurse, experienced in this area of care. They make rapid decisions and allocate the right person to the call, which could be a district nurse, paramedic or other healthcare professional.
Caralyn Miller, advanced nurse practitioner working in Croydon’s urgent community response team (pictured above), explained: “It’s about trying to keep patients at home as much as possible, to help maintain their independence and prevent a hospital admission. We endeavour to get to patients within two hours of a referral and complete a full clinical assessment in their own homes including blood tests.”
The swift response often enables people receiving palliative care to remain comfortable at home rather than be admitted to hospital. This was seen when responders attended a call from the ambulance service about an 86-year-old end-of-life care patient in Croydon, who was experiencing vomiting and abdominal pain.
Sepsis and gastric bleeding were suspected, however, the patient was clear about her wishes to remain at home. This was supported by her family. The urgent response team updated her GP, collected medication to ease her symptoms and kept her comfortable. She died peacefully at home that day, in line with her preference.
Visits by the responders are also a chance to connect people with services that can help them manage at home and maintain independence. This could mean a referral to social care for extra support or input from occupational therapists – with equipment to prevent falls, for example.
While often a lifeline for older and frail people, responders help adults of any age who need urgent care. Croydon responders were called to a patient in her 40s with severe leg ulcers and infection. She lived alone with a young child and little support. Anxious about her situation and lacking trust in local services, she had delayed seeking treatment.
This is such a valuable service, both for the patients who receive speedy treatment in the comfort of home and the way it keeps people out of busy emergency departments.”
The responders worked with the patient over several days, building trust and helping her manager her pain. They organised treatment and care in the community, including visits by district nurses to dress her wounds and a referral to a complex care team. They also contacted children’s services to put her mind at rest about her child’s care, should she need a hospital admission.
Dr Nicola Jones, GP and south west London Medical Director welcomed the data: “This is a valuable service. Patients receive speedy treatment in the comfort and safety of home and avoid a visit to a busy emergency department if they don’t need to be there.
“We’ve worked hard to connect with GPs, care homes and other health professionals to communicate the benefits of the service. This is reflected in our high referral rates. We’re now encouraging more residents and family members to refer to the service direct.”
The service operates seven days a week – 24/7 in Sutton, 8am to 7am in Richmond and 8am to 8pm in other boroughs.
Contact the urgent community response service
Croydon – 8am to 8pm, last referral 6pm, call 020 8274 6445 or 07768 376 832
Kingston – 8am to 8pm, last referral 6pm call 020 8274 7088 (option 3)
Merton – 8am to 8pm, last referral 6pm call 0333 004 7555 (option 2)
Richmond – 8am to 8pm, last referral 6pm – call 020 8714 4060, 8pm to 7am, last referral 5am – call 020 8973 3450
Sutton – 24 hours – 7am to 8pm, call 020 8296 4011, 8pm to 7am call 020 8296 4120
Wandsworth – 8am to 8pm, last referral 6pm, call 0333 300 2350 (option 2)