Cambridgeshire & Peterborough Clinical Commissioning Group (CCG) Case Study

A Consultative Approach to Admission Avoidance Services

Hallam Medical and Cambridgeshire & Peterborough Clinical Commissioning Group


With a view to reducing the increasing number of hospital admissions, Cambridgeshire & Peterborough Clinical Commissioning Group (CCG) planned to deliver a Community based Admission Avoidance service on an initial 6 month pilot.

A Clinical Lead in a neighbouring Country recommended Hallam Medical following the success of a similar Intermediate Care Service and our ability to provide excellent staff and a consultative approach to pilot services.

The CCG had a clear vision; pilot two separate Admission Avoidance services and demonstrate the success of these services. If successful, the services would be commissioned to a healthcare provider and fully implemented.

Key measures of success included:

  • Number of patients prevented from unnecessarily attending and being admitted to hospital as a result of the pilot services
  • The financial savings calculated using local hospital tariff charges
  • Improved patient outcomes

The pilot services were:

  • A&E Front Door Discharge Team (FDDT) – to see Primary Care patients presenting to A&E
  • Intermediate Care Service – a ward based Step up/Step down service for Community patients

The Challenge

To provide a consultative approach to Cambridgeshire and Peterborough CCG regarding the design and roll out of two Admission Avoidance service pilots.

The numerous challenges included:

  • Operate in an advisory role to the FDDT Clinical Lead with no previous experience in this area
  • Supply high quality, highly skilled Nursing staff with experience in Community Admission Avoidance
  • Implement robust process to measure the outcomes of each pilot
  • Provide continuity of staff to increase efficiency and patient outcomes
  • Ability to flex the workforce at short notice due to service demand
  • Demonstrate value for money and financial viability of the services


We quickly identified and built a suitable and sustainable staffing pool over an initial 4 Week period.

Acting in an advisory role we fully specified the scope of practice of the Advanced Nurse Practitioners and their ability to undertake specific roles within the pilot services. Working closely with the CCG and Clinical Lead, this enabled new pathways and opportunities to be identified offering an enhanced service.

Regular meetings were scheduled to ensure all parties maintained good communication and ensured service alterations and feedback was shared.

The Hallam Medical team are friendly and co-operative, quickly identify how a service works and the level of skill that is required from the agency staff in order to deliver the service. They are easy to contact and liaise with and happy to resolve issues quickly and efficiently.

The agency nurses that I have worked with from Hallam Medical have always been professional, well presented and highly skilled. They are all up-to-date with training requirements and are very hard working. The skill set is high and the nurses have been very happy to be flexible with working patterns to cover the service. Because of this I have been able to set up and develop the new service with the nurses help.

Admission Avoidance Team Lead, Peterborough and Stamford Hospitals.

Alterations included:

  • New Referral Pathways
  • Expanded Patient Groups

Pilot Team feedback included:

  • Educational requirements for Multi Disciplinary Team (MDT) members unaware of the service
  • Identifying potential service improvements
  • Incorrect Patient referrals & ‘near misses’


The A&E Front Door Discharge Team (FDDT) pilot was extended and has now been fully commissioned to a new provider (Peterborough City Hospitals NHS Trust).

Key success measures recorded:

  • 770 Patients seen in 6 months pilot with 549 (71%) of these successfully avoided
  • Estimated cost savings annualised at approx. £1.5M – £2M

The Intermediate Care Service pilot has also extended, is expanding and has doubled in size.

Additionally CCG has introduced two more innovative services;

  • Care Home Educator Team
  • Community Rapid Response Team
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