Community services team up with paramedics to provide urgent care more quickly in patients’ own homes


Community rapid response teams from Central London Community NHS Trust (CLCH) in Merton, Wandsworth and Barnet are working with the London Ambulance Service (LAS) to respond to patients who need urgent treatment at home.

The pilot sees paramedics and community teams work together in Urgent Community Response (UCR) cars to provide swift and holistic care to adult patients, helping them to avoid unnecessary trips to hospital and stay living independently in the place they call home.

Since launching one year ago in October 2022, Merton and Wandsworth’s rapid response team has worked with paramedics to respond to 2,791 patients.

Meanwhile, as part of the Barnet and Enfield Urgent Community Response car pilot, UCR teams in Barnet saw 926 patients between February and June 2023.

Both services supported around 70% of the patients they saw to receive treatment at home and avoid an unnecessary trip to hospital.

Through the partnership, patients, who often have reduced mobility or are living with frailty, are treated at home rather than having to wait for an ambulance, go to busy emergency departments or be admitted to a ward.

At the visits, community clinicians are also able to assess and respond to any other needs of patients, such as ordering them equipment to prevent falls or referring them to further services for longer term support, whether that’s other community services, their GP, a voluntary organisation or social care support.

This is better for patients, who often don’t want to go to hospital and can receive more tailored, longer-term treatment in the community, and it’s helping to relieve pressure on busy hospitals too.

In Merton and Wandsworth, the car is staffed by LAS paramedics and enhanced nurse practitioners, whilst in Barnet the paramedics are joined in the car by a physiotherapist, occupational therapist or nurse.

Expanding urgent community response teams was one of the key priorities highlighted in NHS England’s Urgent and Emergency Care Recovery Plan published earlier this year to improve urgent and emergency care ahead of winter.

Margaret Green, 82 years old, lives in Sutton and was seen by the Urgent Community Response car recently. She said: “I’ve been suffering with a trapped nerve in my back, and I was in a lot of pain. I had tried to get through to my GP but the queue was very long, so I rang 111. It took 15 minutes for the paramedic and nurse to arrive. They came and examined me and did some tests. They got me some medicine for my pain and contacted the hospital about my MRI scan results and future appointments. They were really brilliant, lovely people and such a big help to me. They really put me at ease.”

Charlie Sheldon, Chief Nursing Officer at Central London Community Healthcare NHS Trust, said: “Our community rapid response teams have the expertise to provide tailored care to patients who have fallen or have minor injuries at home, and working with paramedics means they’re able to combine skills to respond quickly and help patients regain or maintain their independence. These pilots across two different areas of the Trust are fantastic examples of partnership working in action to better support patients to stay living at home for longer, closer to their families and friends.”

Melissa Geron, Highly Specialist Occupational Therapist at Central London Community Healthcare NHS Trust, staffs the car in Barnet. She said: “This service creates a great learning opportunity for both the paramedics and our clinical staff in a way that facilitates a sense of camaraderie and empathy for each other’s roles in urgent patient intervention. The service is innovative and is designed to reduce the number of patients coming into hospital unnecessarily, enabling them to receive more immediate care and stay at home.”

Alison Blakely, Director of Clinical Pathways and Transformation at London Ambulance Service, said: “Until now, many of these patients would have been taken to hospital. But we know with treatment and support at home or in a community setting, most of those don’t need to go to a busy Emergency Department or be admitted to a ward – and most don’t want to go.

“This is a great start to our new pilot project, and I hope will reassure older people across the capital, as well as those with elderly relatives and loved ones.

“This is making a real difference to patient experience – not to mention relieving the pressure on hospitals.”