Good reporting: Accident and Emergency-- a one stop shop for everyday healthcare needs

In January 2018, over a period of one week, Healthwatch Enfield engaged with more than 600 individuals attending the Accident and Emergency department at North Middlesex University Hospital NHS Trust. The aim of the project was to build an understanding of ‘routes’ bringing people to A&E whilst also engaging local residents in conversations about what would support their decision-making going forward.

Healthwatch Enfield also worked with the commissioning bodies for the research (North Middlesex University Hospital NHS Trust, NHS Enfield Clinical Commissioning Group and NHS Haringey Clinical Commissioning Group) to co-design the scope of the research activity.

The research found that 4% of people spoken with were not registered with a GP in Enfield or Haringey; with the majority of people not accessing primary care services presenting at Accident and Emergency on Saturday. On average, 74.9% (472) of individuals who engaged with us did not try to arrange an appointment with their GP prior to attending Accident and Emergency with individuals aged 40-69 less likely to try and get a GP appointment compared to individuals of other ages. Black British, European and Polish individuals were less likely to try and get a GP appointment compared to other ethnicities. But 20% of attendees attended A&E because they could not get an appointment with their GP.

Although 50% of people spoken with knew that they could seek medical help from their pharmacy, only 3% had done so prior to attending Accident and Emergency. Almost 50% of individuals we engaged with, knew that they could seek medical help from NHS111 but only 10% of people had phoned NHS111 before attending Accident and Emergency with the use of NHS111 was lowest during the weekend.

Awareness of pharmacy services was found to be higher among those who attended on weekends than weekdays but use of pharmacy services was lower on weekends than weekdays. Albanian and Bangladeshi individuals were least aware of pharmacy services as a source of help compared to other ethnicities.

Individuals aged 70+ were least aware of NHS111 (1 in 3) with individuals aged 18-24 and 25-39 reporting the greatest awareness. Bulgarian, Polish and Somali individuals were the least aware of NHS111 compared to other ethnicities.

The report notes that 1 in 3 people knew that they could seek medical help from GP out of hours hubs with 3% having contacted the hubs before attending A&E. Only 20% of people spoken to on the weekend visits had heard of the GP hubs; the lowest awareness of out of hours GP hubs was reported on Sunday at 5%, compared to the highest awareness on Thursday at 55%. None of the Bulgarian or Somali individuals we spoke to had heard of the GP out of hours hubs.

On average, 1 in 3 people had heard about Urgent Care Centres with less than 2% having utilised the services before attending Accident and Emergency at North Middlesex University Hospital NHS Trust. More people were aware of the Centres during the week than at the weekend; the reported use of Urgent Care Centres at the weekend was 0.00%.

Of 630 people spoken to, 30.3% (191) said they were advised to present at the Accident and Emergency Department by a range of professionals; from physiotherapists and midwives through to schools and GPs, NHS111 and 999 operators. There was no correlation found between the referral source and ethnicity of respondents or the referral source and the GP practice the individuals are registered with. However, an analysis based on age of people who presented at Accident and Emergency revealed that individuals aged 70+ are least likely to be referred to the department children with young people 18 years old or younger are most often referred to the department with GPs signposting the highest number.

23.4% (147) individuals saw a GP about their presenting health problem before attending A&E however, almost 50% of them said that they did not trust the diagnosis and/or advice and treatment provided to them by their GP.

On weekdays, more than 50% of people had chosen to attend the Accident and Emergency Department due to convenience of access; that figure rose to over 75% at the weekend. Instant access to help was the key factor for people aged 25 to 54 who identified as British, Black British, Caribbean and European, and for parents of children from African and Turkish communities. 3% of individuals aged 70+ identified convenience as the primary reason for attending the Accident and Emergency department.

The evidence gathered for this report provides an insight into how local residents negotiate primary care and health services on offer to them and reveals a mismatch between the current offer and the ‘24/7 expectations’ of residents. This shows that there is a need to meet the ‘demand’ but also a need to re-educate that ‘demand’ to utilise services effectively and appropriately.

The report concludes that to achieve this, there needs to be an improvement in engagement and communications to support individual decision-making process and recommends that the North Middlesex University Hospital NHS Trust and NHS Commissioners work with local people to manage the gap and deliver urgent and emergency care services that meet individuals’ needs.