Bath and North East Somerset CCG simulation of the urgent care system


Bath and North East Somerset (BANES) CCG asked OPM to design and deliver a simulation of the urgent care system as part of their planning for winter 2013/14. Senior leaders in the area were aware of the need to establish fundamental change across the whole health and social care system that would help to meet the challenge of rising demand for emergency care in a climate of limited or reducing resources.

A process for thinking creatively, holistically and collectively was needed – where current services and delivery practices would be challenged and ways of improving patient experiences and flows could be explored. To meet these requirements OPM designed a behavioural simulation exercise of the whole urgent care system from primary care, ‘blue lights’ and A&E, to discharge and social and community care services.

What we did

Following desk research, scoping work with CCG and RUH colleagues, a simulation was developed. The event held on 23 July in the centre of Bath, brought together local stakeholders from across the health and social care economy, collectively fast forwarding the local health and social care system. Simulation constructs a plausible but simplified version of reality, sufficiently developed so as to create a clear sense of what a place is like and how different events will impact, but simplified enough to be manageable in a compressed timeframe.

Fifty-one people participated in the event, drawn from across the health and social care system in BANES and Wiltshire.The simulation was designed to provide participants with the opportunity to shape and influence plans for the management of urgent care, and to ensure that the system can respond quickly and effectively to urgent care challenges when they arise.


The simulation succeeded in galvanising the entire system to take more concerted action to improve urgent care planning in Bath. It also confirmed in the minds of all parties that it is the CCG that, as system leader, has the responsibility for making this happen.

Overall there was clear evidence of a wish to move beyond any version of ‘awful is normal’. Escalation processes are of course essential to manage immediate pressures but they do not in themselves establish action plan to manage pressures in the whole system more effectively in future. However, the strong sense that all members of the health and social care community need to work together, with clear leadership, to deliver sustainable hospital occupancy levels, was increasingly evident as the simulation progressed. As a direct result of the exercises a number of tangible improvements to plans have been made.

Working with the whole health and social care system in a local area together for a day, participants are able to explore and shape their plans for the management of urgent care in a way which effectively speeds up the usual processes of arranging meetings, building better working relationships based on an understanding of each agency’s contribution and limitations, and using that time together to challenge the usual ways in which seemingly ‘stuck’ problems may be addressed. While the central focus is on urgent care provision, it is no coincidence that other aspects of integration and improved patient experience also receive valuable attention. We wrote about we learned from the simulation in the Health Service Journal: How simulations can help develop new thinking to tackle winter admissions crises.