Accident and Emergency: a place of choice for addressing everyday healthcare needs

Healthwatch Enfield undertook research on why people attend the Accident and Emergency department at North Middlesex University Hospital NHS Trust and what alternatives might better meet their healthcare needs. The research involved 630 people who attended A&E over a seven-day period in January 2018, representing more than 22% of all attendances during that time. 

The report found that convenience was the main reason people chose to attend A&E. Many participants viewed the department as a "one-stop shop" offering immediate access to healthcare professionals, tests and diagnostic services. Almost 75% of participants had not attempted to contact their GP before attending, often because they believed appointments would not be available, while awareness and use of alternatives such as NHS 111, pharmacies, out-of-hours GP hubs and urgent care centres were generally low.

Many attendees reported concerns about the accessibility and effectiveness of primary care services. One in five people who tried to obtain a GP appointment were unable to do so because no appointments were available, and almost half of those who had seen a GP before attending A&E said they did not trust the diagnosis, advice or treatment they had received. The research also found that almost a third of attendees had been directed to A&E by healthcare professionals or other services, including GPs, NHS 111, ambulance services and urgent care centres. 

The report concluded that existing urgent and emergency care pathways were not fully meeting public expectations for rapid access to assessment and diagnostics. More than half of participants said they would consider using local walk-in centres offering access to GPs, nurses, diagnostic tests and specialist advice if such services were available closer to home. Healthwatch Enfield recommended increasing awareness of alternative healthcare services, reviewing referral pathways and exploring new models of care that provide faster access to diagnostics and treatment outside of A&E.