Accident & Emergency Department and Alternatives

Healthwatch York examined why increasing numbers of people were attending Accident & Emergency (A&E) at York Hospital, their awareness and use of alternative services, and how the urgent care system could work more effectively for York residents. The study was prompted by public concern about pressures on A&E services and included surveys of 108 people attending A&E, interviews with service users, NHS 111 staff, mental health services, and university students. 

The report found that most people attending the A&E waiting room were seeking treatment for minor injuries or illnesses rather than serious emergencies. Many patients had not attempted to use alternative services before attending A&E. Only 29.4% had spoken to a GP or GP Out of Hours service beforehand, and only 28.6% had contacted NHS 111 before arriving. More than half of respondents had used neither NHS 111 nor a GP service before attending A&E. 

The main reasons people gave for not using GPs or NHS 111 included long waits for appointments, a belief that they would simply be referred to A&E anyway, lack of awareness of available services, and a perception that their condition required immediate attention. The report noted that many of these assumptions were inaccurate, particularly regarding NHS 111, as only around 7% of calls to Yorkshire Ambulance Service NHS 111 resulted in a recommendation to attend A&E. 

The findings also suggested that self-care and pharmacy services were underused. Over half of respondents had not attempted any self-medication before attending A&E, indicating that more people could potentially manage minor illnesses or injuries through self-care or pharmacy advice.

A strong theme throughout the report was the impact of the closure of York’s standalone Walk-in Centre at Monkgate. Seventy-two percent of respondents said they would have used a separate Walk-in Centre instead of attending A&E, and many expressed a preference for such a service because they felt uncomfortable using A&E for minor conditions and believed it would be quicker. The report concluded that the reconfiguration of the Walk-in Centre into an Urgent Care Centre within A&E had not been clearly understood by the public and may have created a gap in provision for minor injuries and illnesses. 

The survey also found that young people were overrepresented among A&E attendees. Individuals aged 0–25 accounted for 56.7% of respondents, with those aged 18–25 representing the largest single age group. The report suggested that targeted information campaigns for younger people could help raise awareness of alternative services. 

Observations of the A&E environment identified concerns about poor communication of waiting times, confusion about the difference between the Emergency Department and the Urgent Care Centre, and limited amenities in the waiting area. Patients often lacked information about why waits were lengthy and what services were available within the hospital. 

The report also highlighted the growing impact of mental health crises on A&E demand. Interviews with mental health services indicated rising numbers of people attending A&E with mental health needs, increased use of Section 136 detentions, and greater demand for mental health beds. Although concerns were raised about how some people with mental health conditions were treated by staff, the report found that partnerships between A&E and specialist mental health crisis services had improved and were helping to divert people to more appropriate support. 

Feedback about NHS 111 was generally positive among those who had used the service. The report found that NHS 111 could provide appropriate advice, support self-care, and book appointments with other services such as GP Out of Hours, helping some people avoid unnecessary attendance at A&E. 

Interviews with university students revealed that although students were required to register with a GP when they started university, they were often given little information about other health services such as NHS 111, GP Out of Hours, pharmacies, or Walk-in Centres. Students were generally reluctant to attend A&E and preferred to use other services first, but reported uncertainty about where to seek help for minor illnesses and injuries. 

The report concluded that reducing pressure on A&E would require better public awareness of alternative services, clearer information about urgent care options, improvements to self-care and pharmacy use, continued development of mental health crisis pathways, and greater support for young people and students. Key recommendations included improving communication in A&E, increasing clarity about when to use the Urgent Care Centre, promoting alternatives to A&E among younger people, enhancing the waiting-room environment, expanding mental health triage services, increasing the use of Emergency Care Practitioners, and providing students with better information about local healthcare services.