A&E Services review in Barnet

Healthwatch Barnet carried out a review of Accident and Emergency (A&E) services at Barnet Hospital and the Royal Free Hospital during February and March 2019 on behalf of Barnet Clinical Commissioning Group. The project aimed to understand why people attend A&E and whether alternative healthcare services could have met their needs. A total of 578 patients completed surveys, and a further 135 patients completed follow-up surveys about the outcome of their A&E visit. 

The survey found that the majority of patients attended A&E because of illnesses or injuries, with illness accounting for around half of attendances at both hospitals. The most common reason given for attending A&E was that patients were in pain and did not want to delay receiving medical attention. The second most common reason was a belief that they needed diagnostic tests such as X-rays or blood tests. 

A significant finding was that approximately half of all patients had been referred to A&E by another health service rather than attending directly. Around one-third of all referrals came from GPs, making them the largest source of referrals, followed by NHS 111 and other healthcare services.

The review found that only a relatively small proportion of patients attended because they could not get a GP appointment. However, some patients incorrectly believed that GP surgeries were not available during evenings or weekends, suggesting gaps in awareness of extended access services. 

Many patients attended A&E because they thought it was the most appropriate place to access diagnostic testing. The report found that some people were unclear about what services were available at local walk-in centres and urgent care centres, particularly whether they offered X-rays, blood tests or specialist assessments. 

The review highlighted the important role of walk-in centres and urgent care centres in directing patients to A&E. However, referrals often occurred because those services lacked particular facilities, such as diagnostic imaging, blood testing or cardiology investigations. Patients frequently reported being advised to attend A&E because the alternative service could not provide the required test or treatment. 

Most people attending A&E were registered with a GP. Nevertheless, the report identified a small number of patients who were not registered, particularly among people from European and other migrant backgrounds and among those whose first language was not English. Evidence suggested that some newly arrived communities and people with limited English may be more likely to attend A&E without using other healthcare services first.

The follow-up survey found that just over half of patients received treatment during their A&E visit, while about a quarter were discharged without receiving any treatment. Patients who self-referred were more likely to be discharged without treatment than those referred by another service. Many of these patients had attended because they were worried, in pain, or thought A&E was the best place to seek help. 

The review also found that some patients who were discharged without treatment had been referred by GPs or NHS 111, suggesting that further examination of referral practices may be beneficial. At both hospitals, NHS 111 and GP referrals accounted for a substantial proportion of patients who ultimately required no treatment.

Healthwatch concluded that many A&E attendances could potentially be reduced through better public understanding of available healthcare services. The report identified ongoing confusion about where to seek urgent care, what facilities are available at walk-in centres and urgent care centres, and how to access GP services outside normal hours. 

The report recommended increasing public awareness of alternatives to A&E, including NHS 111, GP extended hours services, walk-in centres and urgent care centres. It also recommended clearer information about the diagnostic services available outside hospitals, improved communication from GPs and NHS 111 about appropriate care pathways, and targeted outreach to communities with lower awareness of NHS services or registration processes. 

Finally, Healthwatch suggested that Barnet CCG review practices with particularly high numbers of patients attending A&E, explore whether there are links to appointment access or patient management issues, and work with surgeries to reduce unnecessary attendances through improved information and support.