4.3 EMERGENCY CARE PRACTITIONER (ECP) SERVICE
4.4.1 ECP Service Outline
The aim of the ECP service is to support the wider urgent care system in Doncaster and help
to avoid unnecessary admissions to/attendances at hospital by working in a community
setting and treating patients in their usual place of residence where an urgent need has
been identified. The ECP service provides a key urgent care first contact service,
accessed by a range of professionals through referral.
The ECP service will be predominantly community based and will work closely with
existing community services, with the ultimate aim being to bring patient care closer to
home and in doing so, support the reduction of hospital admissions and attendances.
The service will run 24 hours a day, 7 days a week, 365 days a year (366 in a leap year).
4.4.2 Benefit Aims
The aim of the ECP service is to provide support to the wider urgent care system in
Doncaster and help to avoid unnecessary admissions to/attendances at hospital by
working in a community setting and treating patients in their usual place of residence
where an urgent need has been identified. It is expected that the service will provide
the following where a health or social care professional has identified an urgent need:
• Reduce avoidable patient attendance at the DRI ED
• Contribute towards the avoidance of patient admissions to hospital by providing
assessment, diagnosis, treatment, referral, review or discharge as appropriate for
the patient at initial point of contact which may be in a clinical or non-clinical
environment
• Refer to the Rapid Response service, where appropriate, for health and social
care support in order to avoid conveyance to the hospital
• Contribute towards a reduction in 999 ambulance transportations
• Provide care in a variety of clinical and non-clinical settings such as residential
and nursing homes, patient’s homes, schools and other settings as necessary
• Enhance the quality of the patient/service user experience
• Work in partnership to complement existing and future urgent care services in
Doncaster
4.4.3 Service Description and Requirements
The ECP service will:
• Assess, plan, treat and evaluate urgent care at an advanced level
• Work autonomously, exercising a high degree of critical judgement to improve
outcomes and experiences for patients
• Provide expert clinical advice and expertise to patients, service users, carers
and colleagues
• Work as an expert practitioner, diagnosing, initiating treatment and referring
onwards when indicated
• Evaluate and manage a patient's response to treatment
The ECP service will be provided to any patient excluding children aged under 5 years old
(i.e. to include patients registered both locally or elsewhere, unregistered patients and
those ineligible for UK primary care services but deemed in need of immediately necessary
treatment) referred with a condition or complaint that requires an urgent response and can
be most appropriately managed by the ECP service.
In addition, the ECP service will develop close working relationships with bordering
commissioners in order to agree cross border protocols so that patients always receive
access to healthcare services and there is no undue delay due to disagreement over which
commissioner is responsible for a patient.
The ECP service must include the following as a minimum, however this list is not
exhaustive:
• Management of acute medical conditions/presentations to avoid hospital
admissions
• Recognition and treatment of acute exacerbations of the following long term
conditions and ambulatory care sensitive conditions:
o Influenza and Pneumonia
o COPD
o ENT
o Dehydration and Gastroenteritis
o Cellulitis
o Convulsions and epilepsy
o Asthma
o Heart Failure
o Angina
o Diabetes complications
o Deep Vein Thrombosis
o Stroke
• Treatment of minor injuries
• Treatment of minor and moderate illnesses
• Be able to issue prescriptions in line with Doncaster formularies, national and
local guidance
• Prescribe within NHS Doncaster CCG Patient Group Directions, ECP Clinical
Guidelines and the scope of professional practice
• Information and advice on self-care and healthy living
• Follow-up telephone contact if appropriate (but not to repeat assessment
already conducted)
• Any other urgent treatment and/or services as may be deemed appropriate and
in the best interest of the patient including determining whether to treat,
discharge, transport, organise transport or refer patients to other services
4.4.4 Staffing
The ECP service will be staffed by Emergency Care Practitioners, supported by call
handlers who will respond to the initial call into the ECP service.
4.4.5 Access
Access to the ECP service will be for health and social care professions only, as listed
below, and will be via an identified telephone number.
The ECP service will receive referrals from a number of sources in Doncaster including:
• Directly from GP Practices
• GP Out of Hours Service
• Yorkshire Ambulance Service
• NHS 111
• Community Nursing Teams
• Mental Health Services
• Senior Nurse/Officer in Charge at Residential/Nursing Homes
• Social Care Bed Based Services
• Social Care Urgent Response Services
• Schools
• Domiciliary Care providers
All consultations and external visits are to be assessed and prioritised in all cases
according to clinical need and must be delivered within 1, 2 or 6 hours depending on
clinical need.
4.4.6 Place of Residence Visits
The decision for the need for a face to face consultation at the patient’s current location
will be made by a suitably trained member of staff. Such visits will be made by a
clinician, using a suitably medically equipped vehicle, who will treat either in situ,
arrange for further site based treatment to be provided or send the patient to the
appropriate assessment unit.
4.4.7 Diagnostics
The Provider must agree direct access pathways with Doncaster and Bassetlaw
Teaching Hospitals NHS Foundation Trust for appropriate diagnostic services to avoid
unnecessary ED attendances, for example x-ray.
