20180331_Enfield_ A&E good reporting Accident-and-Emergency-a-one-stop-shop-for-everyday-healthcare-needs.pdf

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Summary of report content

In January 2018, over a period of one week, Healthwatch Enfield engaged with more than 600 individuals attending the Accident and Emergency department at North Middlesex University Hospital NHS Trust. The aim of the project was to build an understanding of ‘routes’ bringing people to A&E whilst also engaging local residents in conversations about what would support their decision-making going forward. Healthwatch Enfield also worked with the commissioning bodies for the research (North Middlesex University Hospital NHS Trust, NHS Enfield Clinical Commissioning Group and NHS Haringey Clinical Commissioning Group) to co-design the scope of the research activity. The research found that 4% of people spoken with were not registered with a GP in Enfield or Haringey; with the majority of people not accessing primary care services presenting at Accident and Emergency on Saturday. On average, 74.9% (472) of individuals who engaged with us did not try to arrange an appointment with their GP prior to attending Accident and Emergency with individuals aged 40-69 less likely to try and get a GP appointment compared to individuals of other ages. Black British, European and Polish individuals were less likely to try and get a GP appointment compared to other ethnicities. But 20% of attendees attended A&E because they could not get an appointment with their GP. Although 50% of people spoken with knew that they could seek medical help from their pharmacy, only 3% had done so prior to attending Accident and Emergency. Almost 50% of individuals we engaged with, knew that they could seek medical help from NHS111 but only 10% of people had phoned NHS111 before attending Accident and Emergency with the use of NHS111 was lowest during the weekend. Awareness of pharmacy services was found to be higher among those who attended on weekends than weekdays but use of pharmacy services was lower on weekends than weekdays. Albanian and Bangladeshi individuals were least aware of pharmacy services as a source of help compared to other ethnicities. Individuals aged 70+ were least aware of NHS111 (1 in 3) with individuals aged 18-24 and 25-39 reporting the greatest awareness. Bulgarian, Polish and Somali individuals were the least aware of NHS111 compared to other ethnicities. The report notes that 1 in 3 people knew that they could seek medical help from GP out of hours hubs with 3% having contacted the hubs before attending A&E. Only 20% of people spoken to on the weekend visits had heard of the GP hubs; the lowest awareness of out of hours GP hubs was reported on Sunday at 5%, compared to the highest awareness on Thursday at 55%. None of the Bulgarian or Somali individuals we spoke to had heard of the GP out of hours hubs. On average, 1 in 3 people had heard about Urgent Care Centres with less than 2% having utilised the services before attending Accident and Emergency at North Middlesex University Hospital NHS Trust. More people were aware of the Centres during the week than at the weekend; the reported use of Urgent Care Centres at the weekend was 0.00%. Of 630 people spoken to, 30.3% (191) said they were advised to present at the Accident and Emergency Department by a range of professionals; from physiotherapists and midwives through to schools and GPs, NHS111 and 999 operators. There was no correlation found between the referral source and ethnicity of respondents or the referral source and the GP practice the individuals are registered with. However, an analysis based on age of people who presented at Accident and Emergency revealed that individuals aged 70+ are least likely to be referred to the department children with young people 18 years old or younger are most often referred to the department with GPs signposting the highest number. 23.4% (147) individuals saw a GP about their presenting health problem before attending A&E however, almost 50% of them said that they did not trust the diagnosis and/or advice and treatment provided to them by their GP. On weekdays, more than 50% of people had chosen to attend the Accident and Emergency Department due to convenience of access; that figure rose to over 75% at the weekend. Instant access to help was the key factor for people aged 25 to 54 who identified as British, Black British, Caribbean and European, and for parents of children from African and Turkish communities. 3% of individuals aged 70+ identified convenience as the primary reason for attending the Accident and Emergency department. The evidence gathered for this report provides an insight into how local residents negotiate primary care and health services on offer to them and reveals a mismatch between the current offer and the ‘24/7 expectations’ of residents. This shows that there is a need to meet the ‘demand’ but also a need to re-educate that ‘demand’ to utilise services effectively and appropriately. The report concludes that to achieve this, there needs to be an improvement in engagement and communications to support individual decision-making process and recommends that the North Middlesex University Hospital NHS Trust and NHS Commissioners work with local people to manage the gap and deliver urgent and emergency care services that meet individuals’ needs.

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General details

Report title 
20180331_Enfield_ A&E good reporting Accident-and-Emergency-a-one-stop-shop-for-everyday-healthcare-needs.pdf
Local Healthwatch 
Healthwatch Enfield
Date of publication 
Saturday, 31 March, 2018
Date evidence capture began 
Wednesday, 24 January, 2018
Date evidence capture finished 
Tuesday, 30 January, 2018
Type of report 
Key themes 
Booking appointments
Communication between staff and patients
Health inequalities
Health promotion
Health protection
Information providing
Public involvement
Service delivery organisation and staffing
Healthwatch reference number 

Methodology and approach

Was the work undertaken at the request of another organisation? 
What type of organisation requested the work 
Service Provider
Primary research method used 
How was the information collected? 
Visit to provider
If an Enter and View methodology was applied, was the visit announced or unannounced? 

Details of health and care services included in the report

Primary care services 
Diagnostic and/or screening service - single handed sessional providers
GP practice
Out of hours
NHS 111
Urgent care services
Secondary care services 
Acute services with overnight beds
Accident & emergency
Urgent and emergency care services 
Accident & emergency
NHS 111
Urgent care services

Details about conditions and diseases

Conditions or diseases 
Injuries, accidents and wounds
Types of disabilities 
Types of long term conditions 
What type of pregnancy or maternity themes are included in the report 

Details of people who shared their views

Number of people who shared their views 
Age group 
Specific ethnicity if known 
Does the information include carer's, friend's or relative's views? 
Does the information include staff's views? 
Types of health and care professionals engaged 
Does the information include other people's views? 
What was the main sentiment of the people who shared their views? 

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Not applicable
Does the information contain a response from a provider? 
Not applicable
Is there evidence of impact in the report? 
Not applicable
Is there evidence of impact external to the report? 
Not known
What type of impact was determined? 
Implied Impact

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.