greenwich urgent care workshop key findings report...greenwich urgent care workshop key findings...

Greenwich Urgent Care Workshop Key Findings Report

Patient and Public Forum

February 2017

Harriet Hay, Bridget Hopwood

www.picker.org

Picker Picker is an international charity dedicated to ensuring the highest quality health and social

care for all, always. We are here to:

Influence policy and practice so that health and social care systems are always centred

around people’s needs and preferences.

Inspire the delivery of the highest quality care, developing tools and services which

enable all experiences to be better understood.

Empower those working in health and social care to improve experiences by effectively

measuring, and acting upon, people’s feedback.

© Picker 2017

Published by and available from:

Picker Institute Europe

Buxton Court

3 West Way

Oxford,

OX2 0JB

England

Tel: 01865 208100

Fax: 01865 208101

Email: [email protected]

Website: www.picker.org

Registered Charity in England and Wales: 1081688

Registered Charity in Scotland: SC045048

Company Limited by Registered Guarantee No 3908160

Picker Institute Europe has UKAS accredited certification for ISO20252: 2012 (GB08/74322)

and ISO27001:2013 (GB10/80275). Picker is registered under the Data Protection Act 1998

(Z4942556). This research conforms to the Market Research Society’s Code of Practice.

mailto:[email protected]

http://www.picker.org/

Contents

Key Findings 1

Introduction 1

Workshop aims 1

Demographics 2

Workshop Findings 3

Emergency Urgent Care Settings 4

Influences in Choosing Where to Go 5

Scenarios 6

Implications of Findings 8

Workshop Feedback 8

Participants 8

Appendix 1 - Agenda 9

Appendix 2 – Round table exercises 10

Appendix 3 – Recent experience of urgent care 11

SECTION 1

Key Findings

©2017 Picker. All Rights Reserved. 1

P3138 | Greenwich CCG Patient Forum – A&E | HH_AA_BH_FINAL | 07 March 2017 | V3 [Protect]

Key Findings

Introduction

NHS Greenwich CCG are running a programme of Patient, Carer and Community Forums,

to enable the people of Greenwich to have an opportunity to provide feedback about aspects

of their healthcare.

Picker have been asked to provide independent support in facilitating these forums,

including running a number of engagement activities and round table exercises with the

group, and producing a key findings report, including learning for future events.

Some of the key areas of focus for these forums will be:

Urgent Care

Diabetes

Learning Disabilities

Cancer

Maternity/Maternal mental health

This report documents the key findings and feedback from the first workshop, focusing on

urgent care. The workshop took place on Tuesday January 31st 2017 from 6-8pm at Charlton

House and was delivered in partnership with Greenwich CCG.

Workshop aims

The aims of the workshop were to explore the following:

Experiences of Urgent care (briefly – comment cards to be provided for more in-depth

feedback)

Knowledge/familiarity with urgent care facilities in Greenwich (spontaneous recall

followed by more in-depth discussion)

Scenarios – ie what would you do? Participants to be presented with scenarios and then

discuss in groups where they would choose to go, exploring the thought processes

around this (ie how they reached this decision)

Exploring the key decision making factors in more detail – what are the most important

things to consider when deciding on an urgent care facility ie proximity to home and other

choice factors.

The workshop ran from 6-8pm in the evening to try to maximise attendance. Diane Jones,

Director of Integrated Governance at Greenwich CCG, opened the event with a welcome

and introductions, followed by a brief CCG update. Picker was then responsible for

facilitating some round table exercises to gather thoughts, opinions and feedback and then

the event closed with a Q and A session. The event was videoed, with photos, video and

discussion points shared on the CCG’s twitter page.



Demographics

In general, the event was well attended, with 33 people in total. The demographic profile of

attendees was heavily skewed towards those over the age of 51 years (see table 1), and

attendees were predominantly white British. There were a number of attendees who had

health conditions, with 7 stating they had either a physical or a sensory condition, and 3 with

a mental health condition.

Table 1

Table 2

Table 3

Age group

18-34 yrs 1

35-50 yrs 6

51-65 yrs 9

66-75 yrs 10

76+ yrs 7

Table total 33

Ethnicity

White 30

Mixed

Asian 1

Black

Other 2

Prefer not to say

Table total 33

Physical 4

Sensory 3

Learning difficulty

Mental health 3

Other 7

Prefer not to say 1

Table total 33



Table 4

Workshop Findings

Participants were first asked to define what urgent care meant to them and in what types of

situations they might use urgent care facilities.

In general, people seemed to naturally differentiate between urgent and emergency care,

citing emergency cases as more ‘life threatening’, such as cardiac and chest pain. Urgent

care was defined as something such as a broken bone or a mental health crisis. Others said

you have an innate sense of when something requires emergency attention (a ‘hunch’). One

respondent made the point that it was very important to see the right health professional, at

the right time. This could possibly negate the need for repeat visits or burdening an already

overstretched A&E.

The following were some of the responses, as recorded on the flip chart:

‘Can’t wait’ (Emergency care)

Heart attack’

‘Right person, first time’

‘GP (not immediate access)’

‘Personal decision’ - sometimes acting on a ‘hunch’

‘Mental health crisis’

‘Length of waiting time’

‘Aftercare’

‘Musculoskeletal’

‘Not life threatening’ (urgent care)

Gender

Male 10

Female 23

Table total 33



Emergency Urgent Care Settings

Participants were then asked to think about what options they had locally: each table

provided a list and then the group as a whole were asked to show which facilities they had

heard of.

Table 5

When asked to indicate which local urgent and emergency care facilities they were aware of,

we can see that all participants were aware of A&E at the Queen Elizabeth Hospital, with a

further third (citing they were also aware of the urgent care unit at the Queen Elizabeth

Hospital (see table 5). NHS 111 and Lewisham hospital both had a high level of awareness.

Overall there appears a lower awareness of the urgent care providers - we can also see that

there is a degree of confusion over use of the terms hospital, A&E, urgent care and the ED

and what they may mean to individuals. Many people were not aware of GPs/ out of hours

Doctors as a route for urgent care.



Influences in Choosing Where to Go

Participants were asked what factors contributed to their decision-making, when seeking

urgent and/or emergency care. This produced a vibrant discussion, provoking interesting

comments and feedback.

On the whole, the group were agreed that the decision would vary depending on who the

visit was for: they may make different decisions if, for example, it was an elderly relative,

their child, or someone who had, underlying long term condition, compared to if it was

themselves who needed care. In addition, it would depend on location and time of day.

Access was a big issue – some mentioned that they would probably go to their nearest

facility and it would depend on whether they had transport options. For some, particularly

those with long term conditions, pre-existing relationships and rapport with healthcare

professionals was important – they may choose the facility that has staff they are familiar

with or that they know understand their condition.

For some, hospitals were considered to be a potential hazard (‘dangerous’), particularly for

populations whose health might be more fragile (such as those with pre-existing conditions,

the elderly, the young etc), possibly because of the risk of being exposed to new infections

and there was a discussion around choosing not to go to A&E if it could be helped. Others

mentioned that sometimes people presented to A&E on the advice of their GP (whether this

was then deemed necessary by A&E staff or not).

There was a further observation that potentially people had just moved to the area and had

not yet registered with a GP - therefore A&E was felt to be the best and only option. People

also mentioned that if they had a condition which was worsening, but then were unable to

get a GP appointment, they would resort to A&E. Others just automatically ‘default’ to A&E,

possibly due to lack of understanding between urgent care and A&E and also the feeling that

perhaps in A&E they will be taken more seriously.

Several participants drew attention to the fact, that sometimes aftercare provision and

discharge was not well-informed or thought through, and this therefore potentially increased

repeat A&E admissions.

The feedback as recorded on the flipchart is listed below:

Access/ Transport

Reverse Psychology/ Advice (Negative)

Horror Stories/ Fear Of Hospitals

Elderly man avoids [hospital] – ‘dangerous’

Underlying social factors (eg location, LTC)

GP sending you to A+E



Waiting times in A+E (better)

Condition worsening + no appointment availability

Repeat visits/ readmissions (Care Home eg) because of poor advice / Aftercare

Lack of awareness about what is Urgent/Emergency

Young people (eg) not registered/ or unable to just to register, arrived in country)

People Moving

Having a relationship with a Centre + confidence

Possible limitation of Locum GPs

Scenarios

During the round table exercises, participants were presented with four different scenarios

and asked to discuss what they would do in each of them.

The results were then written down and documented in the table below.

As before, people indicated that their decision would vary depending on what their

relationship with the patient was – and also depending on age and whether any underlying

conditions. However, on the whole, when it was felt that life was in danger, the majority were

clear that dialling 999 and getting to A&E was the most appropriate thing to do. How they

should arrive at A&E differed when faced with it being a child with all saying that they should

call 999, unless you lived close enough to the hospital to get them there quicker than an

ambulance.

Self-care appeared to be the favoured option if somebody were to cut themselves whilst

cooking, although this was dependent on the severity of the cut, and whether a lot of blood

had been lost. The participants’ views differed greatly when asked what they do if a runner

had tripped and injured his ankle, and again, circumstances such as location would dictate

the most appropriate course of action.



Implications of Findings

It is clear from the findings that whilst the majority of respondents understand which

emergency care provider should be called upon when life is in danger it is less clear for

minor injuries or those needing ‘urgent’ care. There are many factors that come into play

when deciding which service to use and this isn’t helped by the clear misunderstandings

between going to ‘hospital’, going to the ‘urgent care centre’ or going to the ‘Emergency

Department’ or ‘A&E’. More clarity is needed.

More publicity around the findings would be welcomed including defining what constitutes an

emergency and where people should go for different types of injuries and scenarios. Some

publicity around the different urgent care choices that people have in the local area would be

sensible, to raise awareness of some of the lesser known services that might help to

alleviate the burden on A&E. There should also be more publicity around the Health Help

Now app as there was no spontaneous mention of this as somewhere they would look to for

urgent care choices.

Workshop Feedback

Participants

Participants were asked to describe what they found enjoyable about the event- many cited

the table discussion. They also cited being able to voice their opinions, networking, hearing

other people’s views and finding out what other services were available in Greenwich.

When asked what the least useful aspects of the event were, a number of people said that

the microphones (which affected the Q&A session and impacted facilitation), acoustics and

sound system was poor, that the event seemed a little ‘unstructured’ and that there was too

much information. They were also on occasion, unsure of facilitators’ and staff roles.

Some participants appear to have gained important messages from the session, including

what the difference between emergency and urgent care is and that people have many

different views and can often be confused by their choices and where to get information.

Some people discovered more information about hospitals and facilities that they didn’t

previously know about. Participants also felt that their views were important.

However a number of areas for improvement were also cited: participants wanted to see

action on feedback, along with what would happen as a result of these meetings. More

education of the public is needed for future events.



Appendix 1 - Agenda



Appendix 2 – Round table exercises



Appendix 3 – Recent experience of urgent care

Picker Institute Europe

Buxton Court

3 West Way

Oxford, OX2 0JB

England

Tel: 01865 208100

Fax: 01865 208101

[email protected]

www.picker.org

Registered Charity in England and Wales: 1081688

Registered Charity in Scotland: SC045048

Company Limited by Registered Guarantee No 3908160

mailto:[email protected]

http://www.picker.org/

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