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.
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
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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.
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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
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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
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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.
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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
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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.
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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.
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Appendix 1 - Agenda
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Appendix 2 – Round table exercises
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Appendix 3 – Recent experience of urgent care
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Picker Institute Europe
Buxton Court
3 West Way
Oxford, OX2 0JB
England
Tel: 01865 208100
Fax: 01865 208101
www.picker.org
Registered Charity in England and Wales: 1081688
Registered Charity in Scotland: SC045048
Company Limited by Registered Guarantee No 3908160