NHS Incentive Scheme Misses the Mark on Urgent and Emergency Care Investment

Urgent Health UK (UHUK), the country’s leading partnership of social enterprise urgent care providers, warns that NHS England’s new incentive scheme fails to address the real pressures on A&E and urgent care services. By only rewarding the best-performing acute trusts, it overlooks the real challenge—how to reduce the demand on hospitals in the first place and create a more sustainable urgent and emergency care system.

Conor Burke, CEO of UHUK, said: "No one is going to argue that capital investment in infrastructure is not needed, but this scheme will reward just a handful of acute trusts who are already performing well. It will neglect those trusts that are struggling and completely fails to acknowledge the critical role of the wider urgent and community care system."

UHUK’s social enterprise members provide urgent and integrated care services to 70% of the UK population, playing a vital role in reducing unnecessary hospital admissions, cutting ambulance call outs and easing pressure on A & E services, while ensuring patients can access care quickly and effectively in the most appropriate setting.

UHUK’s members deliver services such as GP-led urgent treatment centres, out-of-hours primary care, NHS111, home-based diagnostics, and virtual wards. Evidence shows that investing in these community-based urgent care models can have a significant impact.

Case Study
One of UHUK’s members can demonstrate a 10% reduction in ambulance arrivals at hospital in 2024 compared to the 19/20 year, against an expected 15% increase. 17,264 calls to 999 were reviewed pre-dispatch by UHUK member IC24’s Unscheduled Care Co-ordination Hub. 10,876 (just over 60%) of these calls resulted in the patient receiving a community multi-disciplinary team care-based alternative to conveyance, with no need for the ambulance to the dispatched.  89% of the patients followed up required no further unplanned contact with the system. In addition, of the 2741 calls received from paramedics on scene, 1891 (69%) of those patients were managed safely at home with care and support.

In a recent HSJ article on virtual wards, an NHS England spokesperson said: “Virtual wards are transforming the way care is delivered by enabling patients to recover in the comfort of their own homes – and their growing evidence base shows they can improve patient outcomes while opening up additional capacity, reducing unnecessary admissions and providing cost benefits to systems.”

The latest NHS policy direction emphasises the importance of neighbourhood-based health services, ensuring care is delivered closer to home and tailored to local community needs. To achieve this vision, investment must be allocated to services that prevent crises before they escalate into hospital visits, not just those that manage demand once patients arrive in A&E. 

Conor Burke added: “We urge NHS England and the DHSC to ensure funding—both capital and revenue—is strategically deployed across the entire urgent and emergency care pathway. While capital investment can support infrastructure improvements, which may improve patient flow and bed management, what many urgent care providers require is sustained revenue funding to maintain and expand services that prevent unnecessary hospital admissions and alleviate system pressures. Investment must be directed where it can make the biggest impact—supporting the full urgent and emergency care system, not just high performing acute trusts.”