Croydon residents' Urgent & Emergency Care journey and Experience

To support the transformation programme for Croydon, Healthwatch Croydon were invited to provide relevant patient and resident insight on the choice of pathways and their experience of using the urgent and emergency care services.  They received 1,038 responses to a survey between 26 and 31 July 2021.

First choice is GP or NHS111 for most: 52% chose their GP or NHS111 as their first choice of service, but many still used A&E/Urgent Care/No further service. Relatively few used pharmacies and the GP Hubs were not used that much as a first point of access.

Speed, difficulty to get a GP and seriousness of injury were reasons for choosing 999, GP Hub or A&E first: 40% needed to see someone quickly or felt their injury was too serious to be seen outside of hospital; 15% found it difficult to get a GP appointment. Just 7% found it most convenient.

Journeys between services are complex for some: 74% got to the Urgent and Emergency Care service within one points of contact and 88% within two points of contact, but for some there were additional contacts particularly if they took the GP Hub path with some going between GP Hub, and GP and even two Hubs.

Different age groups choose specific services first time: When you compare first choice against age of patient, those with children were more likely to pick A&E first (23%), whereas 20-60s -were around 12%, and 60-75+ around 9 to 10%. NHS111 is picked first more heavily with 10-20s (42%) 20- 30s (30%) but all the other ranged from 20-28%. GPs were more heavily chosen first by 20-30s at 36%, with 50-60s at 31%, and other others ranging between 23% and 26% except for 0-10s who used GPs less at 19%. GP Hubs were rarely used first (circa 7% and below).

Patients gave several reasons why they could not access the services they needed, as well as the experiences and advice which helped them inform their choice, as well as suggestions for improvements: Much of this concerned access to GPs, but there were several comments on NHS 111, overall access, and the GP Hub. They also gave insight into why they made the choice they did.

People understand the difference between emergency care and urgent care, but not that between a GP and GP Hub: When asked to explain the difference between emergency care and urgent, residents could quite clearly differentiate the roles. However, when GP and GP Hub was compared there was much more confusion.

Overall satisfaction of experience was high, however levels of satisfaction varied due to age, gender, ethnicity, disability and location of patients and need to be explored further: Patients over 50 reported positive score over 70%, but with 20-30s this was as little as 36% - over half of the 60 to 70’s satisfaction score of 74%. There is a satisfaction gap of 6 percentage points between men and women (67-61%),which was even lower when compared against age disabled patients were 2 percentage points less satisfied. White and Black communities both scored 66% satisfaction, but Asians only had satisfaction of 60% and those of other mixed multi-ethnic groups neither specifically Black or Asian was a low as 50%. The link between satisfaction and age, ethnicity and health condition need much more exploration, as does variance between Primary Care Networks (PCNS).

Overall satisfaction of experience was also linked to first choice of service choice: A&E has higher satisfaction at 70%, then NHS111 at 63% and GP 55% probably because of the latter of the challenges of getting through to them – see much higher numbers of difficulty in getting an appointment with GP.

When Healthwatch asked patients what could be improved: Many did say they had a good experience, but there were still issues concerning NHS111, communication, care and safety, empathy, GP access, listening, prioritisation, process and waiting times.

The report contains six recommendations.