The Quiet Impact of Avoiding 11,000 ED Attendances
February 8, 2026
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March 26, 2026
When Tara Donnelly visited Gloucestershire, the headline figures highlighted a system where Cinapsis-enabled pathways are delivering measurable impact: more patients supported, reductions in A&E pressure, and increasing numbers managed safely outside hospital settings.
But the more important story is how those outcomes are being achieved, and what they reveal about the future shape of urgent care.
Across much of the NHS, urgent care still operates as a reactive system. Patients enter pathways late, often through emergency departments, with decisions made under pressure and with incomplete information.
What Gloucestershire demonstrates is a different model: one where urgent care is actively planned, not passively absorbed.
A central feature of this model is early, structured collaboration between community clinicians and hospital specialists.
Using Cinapsis, GPs, paramedics, and other healthcare professionals are able to discuss cases directly with consultants before patients are escalated into emergency care. This creates an earlier decision point in the pathway, one that fundamentally changes where and how patients are treated.
This is not simply about reducing demand. It is about ensuring patients are directed to the most appropriate setting from the outset.
As Sarah Walters, Associate Director of Urgent Care and Flow Transformation at Gloucestershire ICB, explains:
“Our teams manage incoming calls from GPs and Paramedics very efficiently. This results in the vast majority of patients being admitted directly to hospital units such as SDEC and AMU, which reduces the number of contact points and enables patients to be managed more efficiently.”
The reduction in A&E handover times reflects how Cinapsis supports structured upstream decision-making, enabling the right patient to reach the right service at the right time.
“Last year alone, 45,891 patients in the region were supported through Cinapsis across urgent and elective services. That averages almost 4,000 people a month, with 22.5% managed safely in primary care and A&E handover times reduced from 1 hour 29 minutes to 21 minutes.” Tara Donnelly said in her LinkedIn article.
One of the most important shifts highlighted during the visit came from Dr Chris Custard, who described the change as moving from “managing emergency care to planning urgent care.”
This reflects a transition from escalation-based systems to allocation-based systems.
This distinction has profound implications for flow, efficiency, and patient experience.
By enabling earlier clinical conversations through Cinapsis-supported pathways, Gloucestershire reduces unnecessary steps in the patient journey, minimising duplication, delays, and handoffs.
A consistent theme across services is the role of structured processes in enabling, rather than limiting, clinical work.
Templates, defined pathways, and consistent data capture ensure that:
In Dermatology, this has translated into tangible efficiency gains, with referral creation taking around half the time compared to eRS, as noted by Dr Alex Owen.
Through Cinapsis templates, defined pathways, and consistent data capture, referrals contain the necessary clinical detail, expectations are aligned between primary and secondary care, and decisions are fully documented and traceable.
Another notable feature of the Gloucestershire model is the way governance and learning are integrated into everyday workflows.
Structured Advice & Guidance interactions enabled by Cinapsis generate a comprehensive record of clinical decision-making, supporting audit and accountability, identification of variation, and continuous pathway improvement. This supports:
In Stroke services, this goes further. As described by Dr Kate Hellier, calls are logged and can be replayed for training purposes, turning real-world decision-making into a resource for ongoing clinical development.
This creates a system that not only delivers care, but continuously improves how care is delivered.
What makes Gloucestershire particularly instructive is the scale of adoption.
Thanks to Cinapsis, the approach now spans more than 20 services, covering both urgent and elective pathways, with further expansion across neighbouring integrated care systems.
This level of scale is not achieved through technology alone. It requires:
Without these elements, even well-designed systems struggle to move beyond pilot stages.
While performance metrics provide evidence of impact, the durability of change is often determined by less tangible factors.
Clinicians reported that Cinapsis gives them confidence in their day-to-day work:
This confidence is what enables new ways of working to become embedded.
As one clinician reflected, several years into using the system, they would not want to return to previous processes. That sentiment signals not just improvement, but transformation.
For those leading urgent care redesign, the Gloucestershire model offers several clear lessons:
Most importantly, it demonstrates that meaningful change comes from aligning clinical practice, operational processes, and Cinapsis-enabled digital infrastructure around a shared model of care.
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