How did you get here? Responses to those arriving at the Croydon University Hospital Accident and Emergency Department

Between July and August 2019, Healthwatch Croydon asked those who were visiting Croydon University Hospital’s Accident and Emergency department how they got there. They wanted to understand the journey they took to get to A&E and what helped inform their choices. They undertook a survey to which 364 service users responded.

Over 50% of people use A&E as a first choice because they needed to see something quickly, their illness was too serious to be seen outside A&E , attending hospital was most convenient and they found it difficult to get an appointment with their GP.  Over three in five were sure where to go when they had an illness or injury when they chose A&E.

Of those who did not choose A&E first, three in five used GP services and the majority had a positive experience.  Despite pharmacy having a role in the pathway, very few used this service, or 111 online.

Severity of injury was main reason for attending A&E following first contact, with the referrals coming from the GP and NHS 111. There was a range of issues which people felt needed to be treated at A&E, some of which could have been managed at GP surgery or GP hub

15% of people attended A&E as there were no GP appointments, or they were busy or closed. Most people agree that it is difficult to get a GP appointment apart from those between 19-25 and over 65.

For those who did not go directly to A&E, their choices are varied, but did not always follow the pathway of calling 111, GP or GP Hub and then A&E. Age and gender may have an influence on choices: 19-25 year olds are more likely to contact 111 than their own GP first, 26-40 year olds are more likely to contact their GP before attending A&E. Those looking after under 12s were the surest where to attend when they required care. More males than females prefer to go directly to hospital and strongly agreed that hospital was most or more convenient. More males strongly agreed they wanted to see someone quickly and saw their condition as too serious to be seen elsewhere.

There were five recommendations about changing the pathway to reflect real patient use of services, communicating alternatives to A&E, the need for GPs to focus improving capacity so that people only go to A&E if they need to go there; understanding more why people choose the option that they do and communicating the revised pathway with clarity.