Staffing vital to high hear and treat rates, say trusts

The proportion of emergency calls dealt with through hear and treat ranges from more than 20 per cent at the best-performing trusts to less than half that in other areas.

Typically, this involves patients being given advice such as self-care, seeing a GP or pharmacist, or being directed to an alternative pathway for urgent care.

Based on February’s figures, released by NHS England, an additional 30,000 patients could have been seen if every trust matched the performance of West Midlands Ambulance Service University Foundation Trust and London Ambulance Service Trust, both of which dealt with 20.6 per cent of patients in this way.

The average was 16.3 per cent — which is higher than most months — and the lowest performer, excluding the Isle of Wight service, was North East Ambulance Service FT at 9.4 per cent.

Improving phone advice rates was one of the 10 action points in NHSE’s leaked draft urgent and emergency care report from earlier this year, aimed at reducing avoidable conveyances to hospital. “See and treat” — where ambulance staff deal with an issue onsite without taking the patient to hospital — is also an aim, but there is less variation between ambulance trusts.

NHSE said it is supporting regions and systems to reduce these differences as part of the planning round process – but no targets would be set centrally.

Usage of “hear and treat” has been increasing during recent years, up from an average of just 11 per cent in February 2023.

Some trusts have prioritised increasing rates as a way of coping with the increasing demand on services.

London Ambulance Service Trust has managed more than one in five patients through hear and treat while seeing an additional 500 to 520 calls each day this winter.

Michael Ward, deputy director of clinical safety and compliance at LAS, told HSJ the initiative had helped lessen demand on hospitals.

He said the trust had boosted recruitment of both band 6 clinical advisers and band 7 clinical support managers, to support control room staff. Advice to control room staff on the most clinically appropriate pathway is readily available, including a 24/7 clinical safety officer.

The trust has also worked to make these roles attractive for staff, with the provision of training and development plus timely feedback on decisions, he said, adding that the roles were attractive to paramedics who no longer want the physical strain of frontline work.

“I think there is scope for more hear and treat,” Mr Ward said. “There is a natural ceiling but I don’t think we have reached it yet.”

Top performer WMAS has around 30 paramedics and nurses — including some prescribing paramedics — working in its clinical validation team 24/7, with the aim of streaming 400 to 500 calls a day to urgent care services across the region.

A spokesman said: “We have an electronic system that allows us to pass the call details to the relevant service, be that primary care, local authority or whatever.

“The team at the opposite end also have the ability to send it back to us if they don’t have the required team available at that point in time – not all services work 24/7. In those cases, we would try and provide the necessary care and support over the phone but will send an ambulance if that is the best option.”