Expert teams of emergency medics are taking the Emergency Department to the patient in rapid response cars across North East London, forming a vital part of the capital’s Covid19 response.

The Physician Response Unit (PRU) is a collaboration between London’s Air Ambulance, the London Ambulance Service and Barts Health NHS Trust. It is staffed by a senior emergency medicine doctor and an ambulance clinician, and carries advanced medication, equipment and treatments usually only found in hospital. The service responds to 999 calls, treating patients in their homes who would otherwise have often required an ambulance transfer to hospital.

Since Monday 6 April, the PRU service is now operating with two cars and its operational hours have been extended to run from 8.30am to 11pm seven days a week.

The Covid-19 pandemic means that the NHS across the capital is responding to the biggest global health threat in a century while also ensuring that people who don’t have the virus can still access the other services they need in as safe a way as possible. In response to this, the PRU has also established new ways of working to provide care for more patients in their own homes.

These include:

• Enabling early discharge from Emergency Departments – ED clinicians in the Royal London, Whipps Cross and Newham hospitals may discharge a patient in order that they are visited at home by the PRU rather than referred for inpatient care
• Saving vulnerable/ at risk patients a trip to hospital – PRU teams can be tasked to visit patients that are ‘high risk’ for instance cancer patients on chemotherapy that would otherwise need to come to hospital for assessment. They are able to perform an advanced assessment, do blood tests and other investigations, and administer treatments, all in the patient’s home.
• Taking referrals from inpatient wards – the PRU has created a consultant rota so that ward teams can discharge patients that they would normally have to keep in hospital, but can now be discharged with the safety net of a review by the PRU in the community
• Supporting palliative care services – palliative care teams at St Joseph’s Hospice and The Margaret Centre can liaise with PRU for them to visit and provide community review or clinical consultation, when otherwise patients would need to be taken to hospital by ambulance.

These measures will free up hospital beds and reduce risks for vulnerable patients by helping them avoid a trip to hospital.

In addition, the PRU is offering assistance to the London Ambulance Service to help with transfers of unwell Covid-19 patients to the Nightingale Hospital. This undertaking will support the large-scale Nightingale project being orchestrated by NHS services across London and will offer the ambulance service additional support at a time when it is facing huge pressure from 999 and 111 calls across London.

Consultant in Emergency Medicine at Barts Health NHS Trust & Clinical Lead for the Physician Response Unit Dr Tony Joy said:

“The Physician Response Unit is proud to be expanding our service and stepping up at this critical time. By taking the Emergency Department to the patient in their home we can ensure they get the right care fast, while also reducing risk and keeping hospital beds free for those who really need them.

“The launch of a second car is a huge step forward for the PRU, allowing us to cover more hours of the day, delivering safe and effective emergency care in the community at this extremely challenging time.

“This is another way in which the NHS is ensuring it is still open for business and there for everyone during this pandemic, and while Londoners are responding to advice on staying at home, they should still seek NHS medical help when they need it.” 

London Ambulance Service Chief Operating Officer, Khadir Meer said:

“The expansion of the Physician Response Unit will ensure we continue to provide the best possible care for Londoners and help to reduce the unprecedented pressure on the wider healthcare system at this extremely challenging time. 

“The PRU, a collaboration between both the hospital team and ambulance clinicians – and dispatched from our 999 control rooms – helps bring clinical expertise into a person’s home, potentially saving a patient an avoidable, unnecessary trip to hospital.

“Introducing an extra vehicle means more of our other ambulance resources will be available for critically injured patients in London.

“This is one of a number of advances the Service has made to offer more people the right care for them closer to home, in their community, without an unnecessary trip to hospital.”

Jonathan Jenkins, Chief Executive of London’s Air Ambulance Charity said:

“At a time when NHS staff are working round the clock it is humbling to see blue light services pulling together, and the expanded Physician Response Unit is vital in terms of bringing the Emergency Department to the patient and helping the wider system respond to the Covid-19 challenge.”

“It is down to the unwavering hard work and determination of Tony Joy, Bill Leaning, and everyone at the PRU that we are able to expand the service in this crucial way, and at this crucial time, and they should be incredibly proud.”

As well as carrying state-of-the-art equipment, the PRU vehicle also has a computer with access to patients’ electronic records, allowing the team to review hospital and GP notes.

The PRU is also using an innovative new mobile app, Pando, to manage referrals and disseminate information within its clinical team. Pando allows users to track tasks using the information-sharing platform, and the duty team can receive and communicate clinical information about patients wherever they are, enabling timely care and efficient decision-making.

In addition, mobile network operator EE have donated iPhones and an iPad to the PRU and its expanded service, covering all associated running costs, in order to ensure a smooth communications operation.

Barts Health, London’s Air Ambulance and the London Ambulance Service were the first in the UK to set up a PRU, launched in 2001. The innovative model has since been implemented across the UK, including Wales, Oxford, Lincoln and Leicester, with other parts of the country also looking to develop similar services.