Ensuring the NHS does not slip into winter crisis is top of the priority list for the service. This guide draws upon the examples of good practice in tackling winter pressures contained in the Department of Health winter plan published in November.

The examples cover good practice in intermediate care; primary care; ambulance services; hospital services; critical care; accident and emergency modernisation, and joint working in social care.

It supplies all the relevant contact information for those trusts mentioned in the plan, so whatever your winter pressures problem, discovering a good practice solution is just a click or phonecall away.

Good practice: intermediate care

Nelson and West Merton primary care group in south London has an intermediate care service that offers a 24-hour immediate response to crises and pre-planned packages of care. The care team comprises health and social care professionals delivering care in a range of settings - the patient's home, a residential or nursing home, or in a community hospital. A computerised "alert register" accessible to GP practices, social services and accident and emergency departments identifies patients who are judged to be "at risk" and helps plan their care and treatment. The aim is to reduce or eliminate the revolving door syndrome through active management and contingency planning.
Nelson & West Merton Primary Care Trust
Organisations code: 4MQ34
Address: Hamilton Wing, Nelson Hospital, Kingston Road, London SW20 8DB
Telephone: 020-8251 1111
Fax: 020-8251 1122
Chief executive: Ian Ayres
Contact: Ian Ayres, 020-8251 1118

Good practice: primary care

East Surrey PCG is introducing primary care centres adjacent to A&E. These will act as a walk-in centre during the day, assisting local practices in meeting their access targets. In the out of hours period the centres will act as part of the primary care out of hours cover working with practices and the local deputising service. The centres will also work with A&E. The new structure will result in a much more effective use of resources and improve access. The GP home visiting service should be used more effectively.

East Surrey Health Authority
Organisations Code: QAK
Address: West Park Rd, Horton Lane, Epsom, Surrey KT19 8PH
Telephone: 01372 731111
Fax: 01372 729841
Website: www.eastsurreyhealth.nhs.uk
Chief executive: Roy Greenhalgh
Contact: Jackie Pendleton, chief officer, 01737 780209

Good practice: ambulance services

Joint working between Carlisle hospitals, Cumbria ambulance service and a recent health action zone (HAZ) bid has allowed the emergency department to place a nurse practitioner on front-line vehicles. This allows the nurse practitioner service to deliver care directly to people in more isolated rural areas. It is aimed at preventing avoidable attendance at A&E departments, particularly in the minor injury category of patients. So far, figures show one in three patients are assessed, treated and discharged at the scene by the practitioner.

Cumbria Ambulance Service NHS Trust
Organisations code: RE6
Address: Salkeld Hall, Infirmary Street, Carlisle CA2 7AN
Telephone: 01228 596909
Contact: Katherine Hughes, information manager x133
Fax: 01228520382
Chief executive: Alan Donkersley

Staff working in the West Yorkshire ambulance service patient transport service have undertaken additional training to provide an A&E support service. They will work double-handed to support the A&E service with the transport of less acute transfers between hospitals and will also handle some of the less acute admissions.

West Yorkshire Metropolitan Ambulance Service NHS Trust
Organisations code: RGH
Address: Threelands, Bradford Road, Birkenshaw, Bradford, West Yorkshire BD11 2AH
Telephone: 01274 707070
Contact: Rachel Whitehirst, public liaison officer or Sabrina Armstrong, press and public relations manager
Chief executive: Trevor Molton

Staffordshire ambulance service has trained volunteers as community first responders to respond quickly to emergencies in their local community before the ambulance arrives. Staffordshire Ambulance Service NHS Trust
Organisations code: RB7
Address: 70 Stone Road, Stafford ST16 2TQ
Telephone: 01785 253521
Contact: Bob Lee, press officer, 01785 253521

In several of the larger conurbations such as Greater Manchester and North Mersey the ambulance services play a coordinating role for all health services during the period of peak winter demand.

Greater Manchester Ambulance Service NHS Trust
Organisations Code: RMA
Address: Bury Old Road, Whitefield, Manchester M45 6AQ
Telephone: 0161 796 7222
Press office: 0161 834 9836 Maggie Doyle
Contact: John Williams, director of human resources 0161 796 7222
Fax: 0161 796 0435
Chief executive: John Burnside

Good practice: hospital services

At Trafford General Hospital the A&E department has been rebuilt providing additional capacity and a larger resuscitation area. The unit includes dedicated space for a GP and there is a mental health liaison area as well as special facilities for children. The hospital has made available an additional 12 beds to cope with winter pressures as part of the trust's contribution to the Greater Manchester emergency admissions plan.

Trafford General Hospital
Address: Moorside Road, Urnston, Manchester M41 5SL
Telephone: 0161 748 4022
Chief executive: Dave Cain
Contact: Roy Harding, general manager for surgery, 0161 746 2431

The King's Mill Centre in Mansfield has developed an augmented care assessment tool (ACAT), which allows all medical and surgical patients to be monitored by the intensive care outreach scheme. All patients are monitored using a simple but objective scoring tool which acts as early warning system. If the patient's condition begins to deteriorate, they are identified quickly and senior medical staff are contacted. This helps prevent further deterioration and ultimately prevents avoidable intensive care admissions and further complications.

The Kings Mill Centre For Health Care Services NHS Trust
Organisations code: RK5
Address: Mansfield Acute Unit, Kings Mill Hospital, Mansfield Road, Sutton-in-Ashfield, Nottingham NG17 4JL
Telephone: 01623 622515, x4157
Contact: John McCulloch, community relations manager 01623 622515, x4157
Chief executive: John Watkinson

Frimley Park Hospital in Surrey has introduced a medical emergencies team (MET) which respond to medical emergencies. This ensures senior medical involvement at an early stage through the use of a medical scoring tool. This system helps prevent morbidity and mortality and shows early but promising results. This system is a good working example of a district general hospital being able to improve dramatically medical response to illness. The audit system and the way in which it is disseminated throughout the trust is a good example of how clinical audit can be used, and has the potential for use in other district general hospitals.

Frimley Park Hospital NHS Trust
Organisations code: RDU
Address: Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 5UJ
Telephone: 01276 604604
Contact: David Price 01276 604313, media and communications manager (pager 07659 129987)

The paediatric outreach nursing initiative (PONI) at the Royal Liverpool Hospital was developed to meet the needs for short stay medical admissions and provide enough nursing support to prevent a hospital admission. A common type of caseload is respiratory illness, gastroenteritis, and fever. The total number of patients who have been referred to this service to date is 196. The average length of stay during a hospital admission is approximately three days. Therefore this service alone, has resulted in a prevention of 588 inpatient bed days within the first 12 months.

Alderhay, Royal Liverpool Children's Hospital
Address: Eton Road, Liverpool L12 2AT
Chief executive: Tony Bell
Contact: Lesley Chesworth, outreach lead nurse, 0151 252 5064
Telephone: 0151 228 4811

Good practice: critical care

Leeds Teaching Hospitals NHS Trust has made an additional 12 critical care beds available this winter compared with last. In Hull, the Hull and East Yorkshire Hospitals NHS Trust, is making an additional 21 critical care beds available. These hospitals are the key units for the delivery of specialised services in developing networks for West and East Yorkshire. This will reduce the need for transfers of patients away from their home areas and ensure specialist staff and their equipment can be fully utilised over the winter.

Leeds Teaching Hospitals NHS Trust
Organisations code: RR8
Address: St James's University Hospital, Beckett Street, Leeds LS9 7TF
Telephone: 0113 243 3144
Contact: Atlas Public Relations: 01937 548000
Chief executive: David Johnson

Hull and East Yorkshire Hospitals NHS Trust
Organisations code: RWA
Address: Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ
Telephone: 01482 328541
Fax: 01482 674196
Chief executive: Chris Appleby
Contact: Alison Guy, director of performance management, 01482 674922

Birmingham Heartlands and Solihull NHS Trust is staffed to support a nine-bed intensive care unit and a four-bedded high dependency unit (HDU). Over the next six weeks the HDU bed numbers will increase to eight. Six months ago the unit employed a number of international recruits from the Philippines and Malaysia, in the knowledge that following a six-month preceptorship period they would be able to register with the UKCC and work as D/E grade staff nurses within the unit. The unit is fully staffed at present and anticipates a more productive winter period because of the strategic planning.

Birmingham Heartlands & Solihull NHS Trust (teaching)
Organisations code: RR1
Address: Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS
Telephone: 0121 424 2000
Contact: David Hallam, press officer, 0121 424 3337
Fax: 0121 424 2200
Website: www.heartsol.wmids.nhs.uk
Chief executive: Robert Naylor

East Gloucestershire NHS Trust has appointed a nurse consultant with the object of developing and implementing a critical outreach service to wards. This will encompass pre and post-critical care helping to avert admissions, enable the earlier but safe and appropriate discharge of patients from critical care units and share specialist skills with general ward practitioners. Crucially, it will free beds for extremely urgent patients with complex needs.

East Gloucestershire NHS Trust
Address: 14 Royal Crescent, Cheltenham, Gloucestershire GL50 3DA
Telephone: 01242 222222
Contact: Yvonne Ray, communications manager, 01242 274733

Good practice: A&E modernisation

Ealing NHS Trust has improved facilities including an upgrade of the acute assessment unit, provision of dedicated children's services and facilities for GP cooperatives and social services. £400,000 was invested in modernisation work which was completed in November 1999.

Ealing Hospital NHS Trust
Organisations code: RC3 Address: Uxbridge Road, Southall, Middlesex UB1 3HW
Telephone: 020-8967 5000
Contact: Dr Simon Payne, clinical director of A&E, 020-8967 5403

In St Mary's Hospital, Isle of Wight refurbishment has included the development of an eight-bedded assessment unit, improved treatment areas for A&E attendees and the installation of CCTV to improve security for both patients and staff. This will enable better management of patients and future integration with primary care and out of hours services. £300,000 has been invested with the overall aims of reducing waiting periods and inappropriate admissions, and improving communications between primary and secondary care and better security. The modernisation scheme was completed in May 2000.

Isle of Wight Healthcare NHS Trust
Organisations code: RR2
Address: St Mary's Hospital, Newport, Isle of Wight PO30 5TG
Telephone: 01983 524081
Fax: 01983 822569
Website: www.iowht.org.uk
Chief executive: Graham Elderfield
Contact: Viv Bennett, 01983 534184

Good Practice: intermediate care/social care

Manchester and North Essex have trained nursing staff to carry out care needs assessments on behalf of social service departments in order to overcome delays due to staff shortages. North Essex Health Authority
Organisations code: QAX Address: Collingwood Road, Witham, Essex CM8 2TT
Telephone: 01376 302100
Fax: 01376 302182
Website:www.ne-ha.nthames.nhs.uk
Chief executive: Nigel Beverley
Contact: Kim Wilkes, 01376 302121

Manchester Health Authority
Organisations code: QC3
Address: Gateway House, Piccadilly South, Manchester M60 7LP
Telephone: 0161 237 2000
Fax: 0161 237 2001
Website: www.manchesterhealth.co.uk
Chief executive: Neil Goodwin
Contact: Bridgit Smith, care task force manager, 0161 237 2466

Hinchingbrooke Hospital in Cambridgeshire has introduced staff rotation schemes with the local social service department to improve liaison over elderly placements and understand better what may be achieved in a community setting.

Hinchingbrooke Hospital
Address: Hinchingbrooke Park, Huntingdon, Cambridgeshire PE18 8NT
Telephone: 01480 416416
Contact: Margaret Markey, planning and development director, 01480 416342