NHS England planning new ‘rapid discharge’ standard

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, published on Friday, recommended 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 ‘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.

Professor Majeed added: ‘General practices will need to discuss with ICBs how these changes could affect their own workload and how they will be supported in any work they need to  carry out for the new programmes.

‘I hope that NHS England and ICBs can clarify the role of general practices in the plans and what resources will be given to primary care teams for their contribution to ensure successful collaboration and delivery.’

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.’

In 2021, a new information standard was developed for sharing digital information on medication and allergies across different parts of health and social care services, and organisations were due to show compliance by March 2023. 

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 over the winter, including additional ambulance hours, extra beds, and new ‘care traffic control centres’ which act as ‘one stop’ for staff to coordinate discharges.