walk-in centres in barking and · pdf filewalk in centres in barking and dagenham: an audit 1...

Walk in Centres in Barking and Dagenham: an audit 1

Walk-in Centres in Barking and Dagenham A patient audit

January 2013

Dr Richard Burack Simrath Bhandal

Sarah Young

Walk in Centres in Barking and Dagenham: an audit

INDEX

Section Title Page No. 1. Introduction 1

1.1. Background to the Urgent Care Strategy 1.2. Background to Walk in Centres 1.3. Reasons for the survey and audit 1.4. Methodology: how the survey and audit were carried out 1.5. Acknowledgements

2. What the data revealed 5

2.1. The sample size 2.2. Note about the data 2.3. Demographic data: age, gender and ethnic origin 2.4. Clinical data 2.5. Attendance analysis

3. Findings 27

3.1. Findings

4. Appendices 28

A. Survey and audit questions and answers for patients B. The survey and audit questionnaire C. The telephone questionnaire D. Further audit information

Barking and Dagenham CCG Barking Community Hospital Upney Lane, Barking Essex IG11 9LX Telephone: 020 8532 6314 http://www.barkingdagenhamccg.nhs.uk/


1. Introduction

In its Commissioning Strategic Plan for 2012-15, the CCG made a commitment to developing an Urgent Care strategy as well as “a wider review of the Polyclinics and Walk in Centres across the cluster to ensure that the development of the cluster wide model for urgent care is reflected in the future provision of these services.”

This report summarises the findings of the review of walk in centres at Broad Street and Upney Lane in Barking and Dagenham conducted in November 2012, including:

• A survey to understand patients’ views • An audit to understand patients’ health needs.

1.1. Background to the Urgent Care Strategy

“Urgent care is the range of responses that health and social care services provide to people who require (or perceive the need for) urgent advice, care, treatment or diagnosis”

- Direction of Travel for Urgent Care, Department of Health” The Barking and Dagenham CCG officially becomes responsible for commissioning most local healthcare services from April 2013. The redesign of urgent care has already been identified as a key priority. We want to work in partnership with the London Borough of Barking and Dagenham and the Health and Wellbeing Board, to take on the challenge of delivering excellent health care services in our borough. Despite the progress in health and social care made over the past few years, we need to change. Our understanding of urgent care is growing and we know that we cannot simply continue providing services the way we do now. If we don’t, we are not only failing to meet the needs of our community effectively now, but we will also not be able to cope with patient demand and challenges we expect in the future. We are considering how to improve our urgent care service “to ensure patients and the public have access to convenient, high quality, timely and cost effective urgent and emergency care services and know how to access these services effectively”. A Case for Change sets out the CCG’s reasons for considering changes to the current system. It is intended as a discussion document with which to engage stakeholders in developing a local urgent care strategy which transforms the quality of services in the borough. Our principles for the urgent care service: • No confusion of what to do, who to call or where to go • A joined up and co-ordinated urgent and emergency care system • Consistent, responsive and high quality service • A consistent, standard offer throughout Barking and Dagenham. Do give us your thoughts, so we can develop services of which we can all be proud: http://www.barkingdagenhamccg.nhs.uk/


1.2. Background to Walk in Centres

There are two walk in centres located within Barking and Dagenham: Broad Street Medical Practice and Walk-in Centre and Upney Lane Walk in Centre. The walk in centres are three miles apart or 11 and 20 minutes travel by car and public transport respectively1. Both are nurse led services which are open 7 days a week. Each walk in centre sees 19% of total urgent care activity, or a combined total of 38%, including patients living in Barking and Dagenham and some who live outside the area. Broad Street Walk-in Centre2,co-located with a Medical Practice, provides a minor ailments service in Dagenham. It is a 10 minute walk from Dagenham Heathway station and 3.8 miles from Queens Hospital (13 and 28 minutes travel by car and public transport respectively). Upney Lane Walk in Centre3, located at the Barking Community Hospital, provides a minor ailments and minor injuries service in Barking. It is a 2 minute walk from Upney Station and 3.6 miles from King George’s Hospital (12 and 29 minutes travel by car and public transport respectively). A snapshot of the current walk in services is set out in Table 1 below:

1All travel times provided by googlemaps.co.uk 2http://broadstreetwalkincentre.co.uk/ 3http://www.nelft.nhs.uk/news_publications/80

Table 1: Summary of current walk in services

Broad Street Medical Practice

and Walk-in Centre Upney Lane Walk in Centre

Access Mon-Fri 7am-10pm Sat-Sun 10am-6pm

Mon-Fri 7am-10pm Sat-Sun 9am-10pm

Location

Morland Road, Dagenham, RM10 9HU

Barking Community Hospital Upney Lane, Barking IG11 9 LX

Provider Care UK NELFT

Contract An APMS contract Part of the Community Service Contract

Activity Approximately 80 patients a day or 564 patients a week

Approximately 80 patients a day or 561 patients a week

Service type

Minor ailments and minor injuries

Nurse led with health care assistants and a doctor available at co-located health centre.

Minor ailments and minor injuries

Nurse led with emergency care practioners and a doctor available

Service inter- dependencies

Co-located with a GP practice and provision of complex care to residents of Park View Care Home

Co-located at Barking Community Hospital

Diagnostic Equipment No diagnostic equipment X-ray equipment

Age Exclusions Children under 2 years None


1.3. Reasons for the survey and audit

As advised in the questions and answers at Appendix A: “We are looking at how urgent health care services work in Barking and Dagenham. This helps the CCG to plan future healthcare; it is important for the CCG to know who is using services and how happy they are with them. The survey and audit will provide some understanding as to why patients use the walk in centres, what health services they receive and if they have or will use any other services.”

1.4. Methodology: how the survey and audit were carried out

In its Commissioning Strategy Plan, the CCG made a commitment to review activity at the walk in centres. From 5-11 November 2012, the Barking and Dagenham LINk, the walk in centres and the CCG worked together to undertake a joint survey and audit of every patient that visited the walk in centres in that week: The LINk was asked to do a patient survey to understand patients’ views:

• Demographic information • People’s motivations for using the walk-in centres • If and where they seek help after using the centres • The survey was followed up with telephone calls to 10% of patients surveyed to find

out about their patient experience/how they feel about the care they receive The CCG and walk-in centres’ carried out an audit to understand patients’ health needs:

• Patterns of walk in centre use including seeking help before using the centres • The medical reasons why people use the walk in centres • The clinicians’ diagnosis, active management and referrals • Permission to use their NHS number to do further research

The survey and audits questionnaire is available in Appendix B. Patients were asked to complete the survey and pass this back to the LINk who analysed these results. 10% of surveyed patients were also interviewed by telephone at least 7 days later. The LINk’s independent report can be seen at http://www.bdlinks.org.uk/. Patients retained the cross-referenced clinical audit questionnaire and passed this to the clinician for completion during their consultation. These results are set out below. Further detailed analysis will be undertaken using a sample of patients’ NHS numbers. The results will be available in the CCG business case due for publication in early 2013. A note on consent Patient consent was sought to use the information gathered at various stages of the process:

• In the survey: we asked patients (survey questions 1-3 refer, see Appendix B): • If they were happy to take part in this survey and audit • For their consent to their NHS number being used • If they were happy to take a telephone call in a week’s time

• In the audit we asked the LINk and clinician to confirm patient consent

It was confirmed that the CCG was seeking to understand the total results and would not share or publish any information which identifies any individual patient.


A note on NHS numbers The NHS numbers being researched will be used for further analysis and modelling to inform final commissioning decisions. The NHS numbers and are proportionate to the walk in centres and localities in order to understand patterns of use and to provide a more in depth analysis of some of the attendees to gain a better (more end-to-end) understanding of the patient’s journey and reasons for choosing the WIC for their service need. The total NHS numbers available for further research are in Section 2.1. The results will be published in due course.

1.5. Acknowledgements The CCG is grateful to the following for their support of the survey and audit:

• Patients and carers who participated in the survey and audit • Care UK staff at Broad Street walk in centre • NELFT staff at Upney Lane walk in centre • Barking and Dagenham LINk


2. What the data revealed

2.1. The sample size

The survey sample was taken from 5-11 November 2012 capturing 1,025 surveys and 707 audits. The survey captured a sample of patients attending both walk in centres within those times4. The results for the survey and audit are in Tables 2 and 3 respectively:

Table2: Survey and telephone interview sample size Broad Street Upney Lane Total No. % No. % No. %

Surveys completed 470 100% 555 100% 1,025 100%

Survey telephone follow up (10% sample)

44 9.4% 61 10.2% 105 10%

Table 3: Audit sample size

Broad Street Upney Lane Total

No. % No. % No. %

Audits completed 398 100% 463 100% 861 100%

Minus blood test patients 67 17% - - 67 8%

Minus patients who did not give consent

89 22% 65 14% 154 18%

Remainder: with consent 242 61% 398 86% 640 74%

NHS numbers 87 22% 103 22% 190 22%

2.2. A note about the data

All patients attending were given the opportunity to participate. Of the 1,025 that completed the survey, 861 or 84% also completed the audit questionnaire. Of these, 67 patients were attending Broad Street for routine blood tests. These results have been omitted from the remainder of the report as these patients were receiving planned as opposed to urgent care. A further 144 patients did not give their consent for the audit and their results, even when given, have also been omitted. This report, therefore, summarises the results of 640 audits which was 78% of total audits or 62% of the total survey sample. Completion of questionnaires Not all questionnaires had responses to all questions and the analysis which follows indicates the proportion given to each question. In the case of responses to “Brief description of patient’s presenting problem” and “Clinician’s diagnosis”, the responses have been combined. Note that the LINk’s report summarises responses to the question regarding the patient’s health problem that prompted their visit to the walk in centre (survey question 7 refers).

4The survey sample was smaller (86%) of an average week’s total activity which was 1,190 patients a week in 2011-12.


�

�

��

��

��

��

��

��

��

��

�

�

��

��

��

��

��

��

��

��

�

�

��

��

��

��

��

��

��

��

� ��

2.3. Demographic information: the patients who use the walk in centres

The LINk gathered the demographic data for all 1,025 patients surveyed and the results can be seen in their report at http://www.bdlinks.org.uk/.

Given the audit sample is 62% of this, the demographic information for the audit only is below. Age and Gender of patients The trend for ages and gender attending the walk in centres is broadly similar for both, with patients 0-1 years the smallest age group of attendees, with a gradual increase through the age groups, dropping dramatically for the over 65 years, being the second smallest age group. The graph shows the services are most used by working age adults and people in their late teens and therefore patients attending are not representative of the local population in terms of age. The graphs also show more females than males attended the walk in centres, except in the younger age groups; the 0-1 age group is gender neutral but in Upney Lane there were more boys and than girls in the 1-16 age group. Within this age group, approximately 80% of attendances were for minor ailments.

Figure 1: Age and gender distribution of patients attending the walk in centres

Figure 2: Age and gender distribution of patients attending Broad Street walk in centre

Figure 3: Age and gender distribution of patients attending Upney Lane walk in centre


Ethnic origin of patients Patient ethnicity is shown in the table below, in total and for each walk in centre. Results are listed highest to lowest by total with the three highest scores for each of the WICs in bold. The proportions for these groups are shown in the Local population (right hand column)5. The results show there are representatives from all the common minority groups attending the walk in centres. Points to note are that patients who describe themselves as:

• White British were the biggest patient group at the walk in centres • Black African are slightly under represented in both settings • White other are underrepresented in both settings • A larger White population attended Upney Lane compared to Broad Street, while there

was a larger Asian population attending Broad Street compared to Upney Lane. This may merely reflect demography in relation to location of the walk in centres rather than choice of that cultural/ethnic group

• This compares with the LINk report findings, which shows that patients with White British, Black African and Asian Indian origin are the most represented.

Table 4: Ethnic origin of patients in the audit sample�Ethnic Origin Broad Street Upney Lane Total Patients JSNA

Actual % Actual % Actual % 2011 (%) White – British 188 47.2 152 62.8 340 53.1 56.4* Black (inc Brit) African 29 7.3 26 10.7 55 8.6 15.4 Does not wish to disclose 31 7.8 18 7.4 49 7.7 Asian (inc Brit) Indian 43 10.8 3 1.2 46 7.2 4.1 White – Other 21 5.3 10 4.1 31 4.8 10.7 Asian (inc Brit) Pakistani 25 6.3 1 0.4 26 4.1 5.4 Asian (inc Brit) Bangladeshi 14 3.5 4 1.7 18 2.8 3.0 Mixed – Other 8 2.0 6 2.5 14 2.2 Black (inc Brit) Other 8 2.0 5 2.1 13 2.0 0.3 Other 6 1.5 7 2.9 13 2.0 0.5 Black (inc Brit) Caribbean 10 2.5 0 0.0 10 1.6 1.9 Asian (inc Brit) Other 5 1.3 4 1.7 9 1.4 1.9 Mixed - White & Black Caribbean

4 1.0 2 0.8 6 0.9

Mixed - White & Asian 2 0.5 1 0.4 3 0.5 White – Irish 2 0.5 1 0.4 3 0.5 * Chinese 0 0.0 2 0.8 2 0.3 0.4 Mixed - White & Black 2 0.5 0 0.0 2 0.3 Total 398 100.0 242 100.0 640 100.0 100.0 * White British and White Irish combined make up a total of 56.4% in the JSNA 2011

Section 2.4 which follows, sets out the clinical analysis. Section 2.5 then sets out attendance analysis such as where patients live and which GPs they are registered with.

5JSNA 2011 athttp://www.barkinganddagenhamjsna.org.uk/Pages/jsnahome.aspx


22%5%

��

� ��

2.4. Clinical data

Clinical reasons for attending Clinicians were asked whether the problem was a minor ailment, injury or other question 10 refers). This question was not so the reason for attending sections that fell broadly into minor ailments or minor injuries

• Minor ailments, condition• Minor injuries and • ‘Other’ which was

problems were suitably categorised.

The majority of attendances were for minor ailments for both walk in centres.made up over a third of attendances at Upney Lane, where minor injuries are treated and there are facilities to x-ray limbsStreet.

Figure 4: Diagnosis category of patients attending both walk in centres

Figure 5: Diagnosis category of patients attending Broad Street walk in centre

alk in Centres in Barking and Dagenham: an audit

36%

5%

��

73%

0%� ��

64%

31%

5%

��

� ��

Clinical reasons for attending

whether the problem was a minor ailment, injury or other . This question was not fully answered (14% of cases were not specified)

the reason for attending was subsequently categorised drawing on clinical input l broadly into minor ailments or minor injuries where:

conditions normally dealt with by GPs routinely

which was minimised as much as possible in trying to ensure all attending problems were suitably categorised.

The majority of attendances were for minor ailments for both walk in centres.made up over a third of attendances at Upney Lane, where minor injuries are treated and

ray limbs. Minor injuries also made up a fifth of attendances at Broad

: Diagnosis category of patients attending both walk in centres

: Diagnosis category of patients attending Figure 6: Diagnosis category of patients attending Upney Lane walk in centre

8

59%

� ��

whether the problem was a minor ailment, injury or other (audit (14% of cases were not specified)

was subsequently categorised drawing on clinical input into

possible in trying to ensure all attending

The majority of attendances were for minor ailments for both walk in centres. Minor injuries made up over a third of attendances at Upney Lane, where minor injuries are treated and

. Minor injuries also made up a fifth of attendances at Broad

: Diagnosis category of patients attending


Clinician’s diagnosis (e.g. sprained ankle, exacerbation of asthma) Clinicians were asked to give a short description of the patient’s problem (audit question 12 refers). The responses were summarised first into categories and secondly into minor injuries and minor ailments or other. Understanding patients’ clinical reasons for attending was one of the key drivers for the audit. Table 5 below summarises the clinical diagnoses indicating the most common clinical reason for attending (together with their combined percentage):

1. Injuries (including cuts, fractures and dressings) 31% 2. Respiratory conditions 22% 3. Skin related ailments (including infections) 13% 4. Reproductive and urinary 10% 5. Ear & eye related ailments 7%

For Broad Street, viral infections (categorised as respiratory conditions) were the highest ranked diagnoses at 9% while for Upney Lane, sprain, muscle and pain (classified within injuries) made up 17% of their diagnoses. A comprehensive list of clinical diagnoses can be found in Appendix D. All of the minor ailments were thought to be appropriate for General Practice and part of their core service capabilities. Certainly, respiratory conditions, skin infections and urinary tract infections would be better placed in a GP setting as there would be a proportion of patients who may require follow up and review. For minor injuries a high proportion would be suitable for General Practice management but a small proportion would not. For example, fracture care and more complex injuries may require further training in core general practice. The data suggests that there is a potential for duplication and additionality, and if follow up advice is needed, it could extend the patient journey further. On the whole, it is clear that with innovative access in primary care, these conditions could be treated in a GP practice, or in a locality.

Table 5: Clinical Diagnosis

Type Diagnosis category Upney Lane

% Broad Street

% Total %

MI Injuries 144 36 52 21 196 31 MA Respiratory conditions 81 20 61 25 142 22 MA Skin related ailments 46 12 36 15 82 13 MA Reproductive and urinary 38 10 24 10 62 10 MA Ear & eye related ailments 23 6 22 9 45 7

Other No diagnosis 17 4 13 5 30 5 MA Abdominal pain and

gastroenteritis 20 5 8 3 28 4

MA Other minor ailments 11 3 5 2 16 3 Other Other 6 2 9 4 15 2 MA Acute medical 5 1 3 1 8 1 MA Dental 1 0 6 2 7 1 MA Mental health 4 1 3 1 7 1 MA Acute surgical 2 1 0 0 2 0

Total 398 100 242 100 640 100


��

��

��

��

��

��

��

��

��

��

��

��

�� !�

!��"��# $%��&�&�"��# � ��#�&��'�� &��%��&�&��#

Patients attending by age and time of day

In order to determine if the type of patients changed according to the time of day, three different timeframes were used in the analysis:

• Core hours, i.e. GP core opening times of 08.30 – 18.30 • Extended hours, which are the additional GP opening times that vary and also include

weekends. For the purpose of this audit, extended hours are specified as 08.00 – 20.00 weekdays only

• ‘Outside core and extended hours’ is specified as 07.00 – 08.00 and 20.00 – 22.00 on weekdays and all day on the weekends

The chart immediately below shows that the proportion of age cohorts remain largely consistent at all hours, suggesting there in no correlation between the age group of patients and their time of attendance.

Figure 7: Arrival time of patients displayed by age group


Patients seeking second opinions The audit included a question on whether the patient had consulted another clinician previously about the particular health problem they visited the walk in centre for. It is important to understand if patients were seeking second opinions, if so where and if they received different advice at the walk in centres from that previously obtained (audit questions 15, 16 and 17 refer).

75% of patients did not seek previous advice, and of the 12% (74 patients) that did, the majority had sought advice from a GP. Advice was also sought from another walk in centre and A&E, coming second and third highest respectively, both overall and for each walk in centre.

Table 7: Where patients had sought previous advice

Previously Seen Upney Lane

% Broad Street

% Total %

GP 16 34.0 10 37.0 26 35.1 Walk in centre 9 19.1 7 25.9 16 21.6 Did not specify 13 27.7 3 11.1 16 21.6 A&E 5 10.6 4 14.8 9 12.2 KGH OOH 2 4.3 0 0 2 2.7 Ambulance 1 2.1 0 0 1 1.4 Queens GP 0 0 1 3.7 1 1.4 OOH 0 0 1 3.7 1 1.4 Other 1 2.1 0 0 1 1.4 Optician 0 0 1 3.7 1 1.4 Total 47 100 27 100 74 100

Clinician seen

To understand the ratios of nurse to doctor consultations and whether this might have had an impact on outcome or management, patients were asked which clinician they had seen (audit question 14 refers). Unsurprisingly, as both walk in centres are nurse led, 70% of patients saw a nurse. An additional category of Emergency Care Practitioner (ECP) was added by Upney Lane, who patients saw instead of a nurse. Broad Street patients saw a doctor instead of a nurse and only 1 patient saw both a nurse and a doctor at Broad Street:

Table 6: Patients who sought previous advice elsewhere

Previously seen Upney Lane

% Broad Street

% Total %

Yes 47 12 27 11 74 12 No 295 74 188 78 483 75 Did not specify 56 14 27 11 83 13 Total 398 100 242 100 640 100


�

��

��

��

�

��

��

��

��

(��#�

��"�� # !��$��"��$��% �

�&)�'��*�+�� (��

Clinical management and referral The audit asked clinicians whether the patientmanagement and/or was referredunderstanding of patterns within these three categories as well as the types of management and referral (audit question‘referral’ refers to a patient being signposted rather than a formal referral to another service. Approximately one third of patients that attended the walk in centres received advice only and were not actively managed or referredprofessional available and pathways for common ailments within the walk in centres. It also suggests that with no active input, a walk in centre may not be the best use of resources and alternative sites for advice coul A greater percentage of patients that attended Broad Street wereferred compared to those that attended Upney Lane. referred (including those that were actively managed),

Figure 8: Percentage of patients seen by a nurse, doctor, ECP or

Figure 9: Clinical management to of patients attending the walk in centres


$!, -�'�� (��#��. �-�'��

��"�� # !��$��"��$��% �

/0��1 ��

2�� &�3��

&&'

&&'

()'

)' *'

��

�&)�'�� '��)�� 4�� 4�� . ��+��

(��

Clinical management and referral

clinicians whether the patient was given advice only, advice with active management and/or was referred to another service. This question was asked to gain an

patterns within these three categories as well as the types of management question 13 refers). For the purpose of the audit and this report, the term

to a patient being signposted rather than a formal referral to another service.

Approximately one third of patients that attended the walk in centres received advice only and not actively managed or referred elsewhere. This may reflect the capacity of the

professional available and pathways for common ailments within the walk in centres. It also suggests that with no active input, a walk in centre may not be the best use of resources and alternative sites for advice could be sought.

A greater percentage of patients that attended Broad Street were actively managed or referred compared to those that attended Upney Lane. For the 28% of patients who were referred (including those that were actively managed),

: Percentage of patients seen by a nurse, doctor, ECP or a combination

Clinical management to of patients attending the walk in

12

��"�� # !��$��"��$��% �

/0��1 ��

2�� &�3��

was given advice only, advice with active This question was asked to gain an

patterns within these three categories as well as the types of management For the purpose of the audit and this report, the term

to a patient being signposted rather than a formal referral to another service.

Approximately one third of patients that attended the walk in centres received advice only and This may reflect the capacity of the

professional available and pathways for common ailments within the walk in centres. It also suggests that with no active input, a walk in centre may not be the best use of resources and

re actively managed or For the 28% of patients who were

a combination

Clinical management to of patients attending the walk in


+&'

&)'

&' ,'

��

�

��

��

��

�

��

��

2��&�5�#� 6

�"��- �� "��

The graphs below show what management patients received and where they were referred to. The variation between two walk in centres wasthe walk in centres combined.active management of patients, there is some degree of duplication. For example, a patient could have been given a prescription as well as had a dressing changed.

Almost two thirds of the patients managed were either given a prescription or (TTA) medication at the walk in centresa prescription at Upney Lane, 22% were diagnosedrelated/tonsillitis the second and third highest at 20% and 12% respectively. Similarly, at Broad Street walk in centre, throat related/tonsillitis was the second highest diagnosis (15%) for patients that were pain, infection or ear wax (12%). were given them for lower respiratory tract infections.

Figure 10: Clinical management of patients attending Broad Street walk in centre

Figure 12: Active management of patients attending the walk in


+&'

)('

��

(,'

+,'

)' *'

��

6�� 3�4�� '��)��

� � 4��

55��

� �&�' ��

-��##��4

�"��- �� "��

below show what management patients received and where they were referred two walk in centres was negligible, thus the graphs show results for

the walk in centres combined. It must be noted however that for figure 12, graph showiactive management of patients, there is some degree of duplication. For example, a patient could have been given a prescription as well as had a dressing changed.

Almost two thirds of the patients managed were either given a prescription or medication at the walk in centres. Of the patients that were provided with medication or

a prescription at Upney Lane, 22% were diagnosed with a UTI, with skin infection and throat related/tonsillitis the second and third highest at 20% and 12% respectively.

Similarly, at Broad Street walk in centre, throat related/tonsillitis was the second highest patients that were given medication or a prescription, followed by ear

pain, infection or ear wax (12%). 16% of patients that were given a prescription or medication were given them for lower respiratory tract infections.

: Clinical management of patients attending Broad Street walk in centre

Figure 11: Clinical management of patients attending Upney Lane walk in centre

: Active management of patients attending the walk in centres

13

))'

��

-��##��4 ,��#'��0��

�"��- �� "��

below show what management patients received and where they were referred negligible, thus the graphs show results for

It must be noted however that for figure 12, graph showing active management of patients, there is some degree of duplication. For example, a patient could have been given a prescription as well as had a dressing changed.

Almost two thirds of the patients managed were either given a prescription or To Take Away Of the patients that were provided with medication or

skin infection and throat related/tonsillitis the second and third highest at 20% and 12% respectively.

Similarly, at Broad Street walk in centre, throat related/tonsillitis was the second highest medication or a prescription, followed by ear

16% of patients that were given a prescription or medication

: Clinical management of patients attending Upney Lane walk in centre


�

��

��

��

�

��

��

*�+��

!��

*�+��

�� 7�� '�

*�+��

30�'� ��#�

*�+��

"�#0��

-�'��

� ��

*�+��

*�+��

�. $

*�+��8,

.� �� "��

178 out of the 640 patients included in this audit were referred on. Of these patients, 90 were signposted back to their GP, therefore approximately 14% of all patients that attended the walk in centres were referred back their GP. Around one quarter of the 178 attendees that were referred elsewhere, were referred to A&E or to the hospital inpatient services and so, it would appear, these patients were gaining little from their walk in centre attendance, compared with going straight to A&E. Referral to ‘other’ includes signposting to OOH, pharmacy and the urgent care centre. Best clinical management Clinicians were asked their professional opinion about the best way to manage the patient’s problem at the time they were seen so as to provide an understanding of their views on appropriate management (audit question 18 refers). As this is a key question, the results have been shown in some detail including by total; by condition type and by clinician seen. The graph overleaf shows what, in the clinician’s opinion, was the most appropriate form of management for the patient. Although the opinions seem fairly consistent across the two walk in centres, there is quite a notable difference between the two as to when patients should be self-managed.

Figure 13: Destination of referrals of patients attending both walk in centres


� � ��

-�#��'��#��)�#��9'�� '��-(

! �� +�� 7�� '�

:,� �� '��; :�'��#��

��&�� #��

5��0�� &)�'��+�� ; ��8,

!�� '��8,�� " �+��0�� &)�'�

!�� '��8,�� " �+�� 7 #��'��#��

� ��

��&��; ��8,<#�#��4��=��4��>

3��+�� 4��

-�&��#0�'�+�

��&��. $

��&�; �?��'��

��&��; ��8,<#�#��4��=��4��>

��

� �2�� &�3��

� �/0��1 ��

� � ��

! �� +�� 7�� '�

-�#��'��#��)�#��9'�� '��-(

5��0�� &)�'��+�� ; ��8,

:,� �� '��; :�'��#��

!�� '��8,�� " �+�� 7 #��'��#��

!�� '��8,�� " �+��0�� &)�'�

-�&��#0�'�+�

� ��

��&��; ��8,<#�#��4��=��4��>

��&��. $

3��+�� 4��

��&�; �?��'��

��&��; ��8,<#�#��4��=��4��>

- �� - ��

� �2�� &�3��

� �/0��1 ��

Figures 15 and 16 show results broken down by clinical diagnosis – minor ailments and minor injuries respectively.

Figure 14: Best clinical management of all patients attending the walk in centres

Figure 15: Best clinical management of all patients attending the walk in centres for minor ailments


� � ��

��&��; ��8,<#�#��4��=��4��>

-�#��'��#��)�#��9'�� '��-(

:,� �� '��; :�'��#��

!�� '��8,�� " �+��0�� &)�'�

-�&��#0�'�+�

��&�� #��

� ��

��&��. $

��&��; ��8,<#�#��4��=��4��>

3��+�� 4��

��&�; �?��'��

- �� - ��/!��

� �2�� &�3��

� �/0��1 ��

Unsurprisingly, for patients attending with minor ailments, most clinicians’ opinion was that the patient’s condition could have been managed in primary care (non-urgent) or at the walk in centre. Opinions differed between the two walk in centres when it came to patients attending with minor injuries. 29% of patients that attended Broad Street for minor injuries should have attended A&E, in the clinician’s opinion, while only 2% of Upney Lane patients should have been managed in A&E. Additionally a much larger percentage of patients attending Upney Lane could have been self-managed compared to those that attended Broad Street. The slight discrepancy between the two walk in centres, in terms of urgency, suggests a different level of support or skill mix at Broad Street as compared to Upney Lane, or that patients that attended Broad Street had more severe injuries or conditions.

2.5. Attendance analysis Where patients are registered / unregistered patients Patients were asked if they are registered, and the reasons for not registering to understand patterns of use (audit questions 4, 5 and 6 refers). The following density maps show the distribution of Barking and Dagenham residents attending the walk in centres. Patients are shown based on where they reside and not where they are registered; ward rather than locality boundaries are shown. For more information on patients attending by locality, see figure 19. 153 patients that attended Broad Street walk in centre provided their postcodes while 213 patients from Upney Lane provided their postcodes. The darker regions show that a higher proportion of residents living closer to Broad Street and Upney Lane walk in centres attended those walk in centres respectively. It is worth stating that due to the relatively small sample size, the slightly darker areas further away from the walk in centre could be attributed to a difference of only 9 patients.

Figure 16: Best clinical management of all patients attending the walk in centres for minor injuries

Walk in Centres in Barking and Dagenham: an

Figure 17: Patients seen at Broad Street walk in centre


Patients seen at Broad Street walk in centre Figure 18: Patients seen at

19

Patients seen at Upney Lane walk in centre


�

�

��

��

��

��

��

��

�

�

� � � � � /�?��; �

��"�� "��

2�� &�3��

/0��1 ��

GP practices in Barking and Dagenham are developing ‘locality’ based models of care for some of their health services, therefore some of the following charts show patients’ attendance based on the B&D locality / practice the patient is registered with, to give a better understanding of any patterns of use. A list of GP practices by locality can be found in table 2 of Appendix D. Table 8 below shows where patients are registered. 61% of all patients were registered in Barking and Dagenham, with 11% registered in Havering and Redbridge and 16% who did not say. Only 3% of patients disclosed themselves as unregistered, lower than the 10% advised in other samples studied. In the case for change it was estimated that approximately 10% of patients attending Upney Lane walk-in centre are not registered. A greater proportion of out of area patients attended Upney Lane compared to Broad Street. This could partly be due to the proximity of Upney Lane to Redbridge and the ease of travel by public transport (Upney Lane walk in centre is located next to Upney Lane station). Table 8: Where patients are registered Registered PCT Upney

Lane % Broad

Street % Total %

Barking and Dagenham 230 58 160 66 390 61 Havering 15 4 25 10 40 6 Redbridge 30 8 1 0 31 5 Other out of area 38 10 18 7 56 9 Unknown 73 18 29 12 104 16 Unregistered 12 3 9 4 21 3 Total 398 100 242 100 640 100

Looking at patients’ practices by the six GP localities in Barking and Dagenham, the highest number of Broad Street patients are registered in practices in Locality 4, where for Upney Lane patients it is Locality 6. Taking into consideration that Broad Street is geographically closest to Localities 2 and 4 and Upney Lane to 5 and 6, the data suggests patients prefer to be seen within the locality of their GP practice. Figure 19: Locality of registered patients attending Broad Street and Upney Lane walk in centres


Where patients live

LINk’s patient survey included questions 16 and 17 about living in Barking and Dagenham and the patient’s postcode. It is useful to analyse in more detail here for respondents to the audit. Table 9 shows that 68% of patients live in Barking and Dagenham, compared with 61% who are also registered in B&D. This can be partly explained by the number of patients who responded to this question (only 11% did not respond compared to 16% in Table 8). Table 9: Where patients live Lives in B&D Upney

Lane % Broad

Street % Total %


This compares with an indication in the case for change of approximately 10% of patients coming from outside of Barking and Dagenham. This was calculated using 4 years’ of patient information up to March 2012 Equally, Barking and Dagenham patients are also using other walk in services outside the borough, in particular, at Loxford polyclinic in Redbridge and Harold Wood and Orchard Village polyclinics in Havering.6 Attendance at these walk in centres is currently being reviewed to inform the CCG on the overall picture of unscheduled care demand by B&D patients. Why patients used the walk in centres LINk’s patient survey included question 8 about why the patient chose the walk in centre today. It is useful to analyse by time of day and B&D patients only. The graphs overleaf show the reasons for Barking and Dagenham registered patients attending both walk in centres. A total of 27% of B&D registered patients had stated their reason for attending the walk in centres was that it was local, close to home and/or convenient. This highlights the point demonstrated by the density maps; patients will often use the services that are closer or easier to access. 27% of Barking and Dagenham patients stated they attended the walk in centre because they could not access their GP or a practice nurse. Furthermore, a smaller group of patients (5%) were sent by their GPs, which would suggest that the GP either could not manage their condition, or were at capacity.

6http://www.onel.nhs.uk/health-services


��

��; ��0� ��; �'

*�+��&�7��. $

*�+��&�7��#�

*�+��&�7��; �'

�''�##��#�

8,�7 #�&� ��; �'

�&)�#�&�7��+��&9+ � ��

-�&��#0�'�+�

,��)��#��%0��'��+�; �'

(��4�#��&�; ��8,

*�+��&�7��8,

� ��&�'�#��

*�4�#��&��+� ��

(�� ''�##��8,

!��)��'�90��%��

*�+��&�7��( "3�&��'�

*�+��&�7��0� �� '�#�

@ ��?��&�� ''�##��8,�

��0�� 1 ��"��1 ��

!��# $%��&�&��# � ��#�&��'�� &��%��&�&��#

� � ��

��; ��0� ��; �'

*�+��&�7��. $

*�+��&�7��#�

*�+��&�7��; �'

*�+��&�7��0� �� '�#�

8,�7 #�&� ��@ �!

(�� ''�##��#�

�&)�#�&�7��+��&9+ � ��

,��)��#��%0��'��+�; �'

*�+��&�7��8,

-�&��#0�'�+�

@ ��?��&�� ''�##��8,

� ��&�'�#��

(�� ''�##��8,

!��)��'�90��%��

,��'�� 4��=� >��+�2. - ��4�#��&�0 ��#

��0�� "��1 ��"��

� �2�� &�3�� /0��1 ��

The following graph shows the reasons for all patients attending the walk in centres at different times during the day. For patients attending during core hours, many were sent by their own practice or by A&E, and the majority of patients that specified there were no appointments available at their practice had attended the walk in centres during core hours. The data also supports previous A&E audits performed in the borough which showed high A&E attendances during the day when practices were open.

Figure 20: B&D registered patients - reasons for choosing the walk in centre

Figure 21: Patients' reasons for choosing the walk in centre, shown by time of arrival


�

��

��

��

�

��

��#��

��&��4

��; ��

�� #

�� -�&��#0�'�+�

,��'�� 4��=�>��+�0 ��#

��A��'��+� ��& �'�

��

Patient satisfaction with booking appointments

LINk’s patient survey included question 19 about satisfaction with booking an appointment with the GP. Table 10 below shows Barking and Dagenham registered patient responses indicating that 48% are satisfied with booking an appointment compared to 25% who are not and 21% who are sometimes satisfied.

Table 10: Satisfaction with booking GP appointments

Upney Lane

% Broad Street

% Total %

Yes 111 48 77 48 188 48 No 62 27 34 21 96 25 Sometimes 40 17 33 21 73 19 Did not specify 16 7 15 9 31 8 Total 229 100 159 100 388 100

Prescriptions Patients were asked about free prescriptions to provide an understanding of patterns of prescribing (audit question 7 refers) and whether access to free medication is a factor in walk in centre activity. Table 11 below shows responses for patients aged between 16 and 65. The table shows a third of all patients between the ages of 16 and 65 receive free prescriptions with a greater percentage at Broad Street compared to Upney Lane.

Table 11: Free prescriptions Free Prescriptions Upney

Lane % Broad

Street % Total %


Frequency of attendances Patients were also asked about how often they or their family had visited a walk in centre. This data has provided some understanding of the patterns of health service use (audit question 8 refers).

Figure 22: Frequency of patients attending the walk in centres


�

�

��

��

��

��

��

��

�

�

��#��

��&��4

��; ��

�� #

�� -�&��#0�'�+�,��'�� 4��=�>��+�0 ��#

��A��'��+� ��& �'�

- ��

�

�

��

��

��

��

��

��

�

�

��#��

��&��4

��; ��

�� #

�� -�&��#0�'�+�,��'�� 4��=�>��+�0 ��#

��A��'��+� ��& �'�

- ��/!��

Total attendances at both walk in centres are displayed in the figure 22. Both centres have similar proportions of first attenders and a similar very small proportion of very frequent attenders. Frequency of attendance by the type of clinical reason for attending each walk in centre was also analysed. The difference in results between Broad Street and Upney Lane were minimal, thus the graphs below show the combined total for the two walk in centres. Overall the frequency for minor ailments and minor injuries were comparable.

Time of day and waiting times Patients were asked when they arrived at the walk in centre and the time of their consultation to understand their time of attendance and waiting times (questions 6 and 9 of the survey and audit refer). The LINk also asked patients their views on waiting times in the telephone follow up interviews. First results for all patients were looked at – both Barking and Dagenham and out of area patients.

Figure 24: Frequency of attendance of patients attending the walk in centres

Figure 23: Frequency of patients attending the walk in centres


11%

27%

�� "��

��"��

!��#

��"��

!��#

The charts below show that the majority of patients attendGP opening hours and 10% during extended GP hours. outside of those hours:

The charts below display results for charts show that B&D patients visited more in core hours at both walk in centres

Figure 25: Attendance times of

Figure 26: Attendance times of patients Broad Street walk in centres

Figure 28: Attendance times at walk in centres of B&D registered patients


62%

��"��

10%

30%

�� "��

*)','

(,'

��"��

!��# $%��&�&��# � ��#�&��'�� &��%��&�&��#

*+'+2'

(3'

��"��

!��# $%��&�&��# � ��#�&��'�� &��%��&�&��#

The charts below show that the majority of patients attended the walk in centres during core % during extended GP hours. Approximately

The charts below display results for Barking and Dagenham registered patients only. The that B&D patients visited more in core hours at both walk in centres

Figure 25: Attendance times of patients at both walk in centres

Figure 27: Attendance times of patients Upney Lane walk in centre

Figure 26: Attendance times of patients Broad Street walk in


25

60%

��"��

� ��#�&��'�� &��%��&�&��#

� ��#�&��'�� &��%��&�&��#

the walk in centres during core Approximately 30% of patients attend

Barking and Dagenham registered patients only. The that B&D patients visited more in core hours at both walk in centres:

Figure 27: Attendance times of patients Upney Lane walk in



�

�

��

��

��

��

��

��

�

�

��

� ��#

,��'�� 4��+�2.-��4�#��&�

0 ��#� ��&��4�=�>

�� "��

9%

29%

��"��

��

��

��

��

��

��

��

��

��

��

��

!��"��#

��

The chart below, displaying waiting times at both walk in centres, that attended Broad Street were seen within 30 minutes, while those that attended Upney Lane were seen within an hour.

�

Waiting times were also broken down by below). During extended hours, 70% of patients were seen within 30 mduring core hours 70% of patients were seen within 1 hour.

Figure 29: Attendance times at Broad Street of B&D registered patients

Figure 31: Waiting times of patients attending Broad Street and Upney Lane walk in centres

Figure 32: Waiting time of patients


��

"��

�� B��

"��#

�B��

"��#

�� B��

"��#

�B��

"��#

�� B��

"��#

@ ��4��

�� "��

62%

��"��

7%

27%

��"��

!��"��# $%��&�&�"��# � ��#�&��'�� &�

�%��&�&��#

��

�� B��"��#

�B��

�� B��"��#

�B��

�� B��"��#

below, displaying waiting times at both walk in centres, shows that eet were seen within 30 minutes, while those that attended Upney

Lane were seen within an hour.

Waiting times were also broken down by the time of day that patients attended (figure 3below). During extended hours, 70% of patients were seen within 30 muring core hours 70% of patients were seen within 1 hour.

Figure 29: Attendance times at Broad Street of B&D Figure 30: Attendance times at Upney Lane of B&D registered patients�


Figure 32: Waiting time of patients broken down by time of day

26

2�� &�

3��

66%

��"��

�B��"��#

� ��"��#

�B��"��#

� ��"��#

�B��"��#

shows that most patients eet were seen within 30 minutes, while those that attended Upney

the time of day that patients attended (figure 32 below). During extended hours, 70% of patients were seen within 30 minutes of arriving and

Figure 30: Attendance times at Upney Lane of B&D



3. Findings

Findings

Who patients are (demographics)

The services are most used by working age adults and people in their late teens and therefore patients attending are not representative of the local population in terms of age. With regard to ethnicity, there is no disproportionately represented ethnic group and patients attending approximate to the structure of the general population.

Patient registration

The proportion of unregistered people is lower than had been anticipated, at only 3%, however out of area patients equate to approximately 20%.

Where patients live

The data shows that the highest proportion of people attending Broad Street and Upney Lane are those that live the nearest to the centres.

Clinical evidence

A large proportion of the patients could be managed in standard primary care (GP and pharmacy) and a small proportion (approximately 8%) needed A&E care. As much of the usage was within core GP hours it indicates there is an issue about duplication of services and parallel provision where the patient may choose the nearest service.

Patient use

Convenience and proximity to the centres played the largest part in patients’ reasons for attending, with lack of access to their GP the second most common reason. In addition, approximately 40% of people had stated they, or a member of their family, had attended the walk in centre more than once in the 6 months prior to the audit.


Urgent care - a survey to understand patients’ views Questions and answers

Q: Why do you want this information/ what is this survey about?

A: We are looking at how urgent health care services work in Barking and Dagenham. This helps us to plan future healthcare. We want to know who is using services and how happy they are with them. The survey and audit will help us understand why patients use the walk in centres, what health services they receive and if they have or will use other services.

Q: What if I can’t complete the form?

A: Tell the LINk representative who gave you this form. They will be able to help you. They can also give you an easy read version or arrange for someone to interpret for you. If someone came with you today, they can complete the form with you.

Q: What do you mean by “your consent?”

A: We mean that you agree that we can use the information on your form. The NHS has to ask you for this. We want to understand the total results and we will not share or publish any information which identifies any individual patient. This means we will keep it safe and confidential and will only use trends or anonymous results in any reports.

Q: Why do you need my NHS number?

A: We may use your NHS number to find out about services you use. We want to learn which services people use at the walk in centres. We will keep information safe – information which identifies you will not leave your records – we will only report trends or anonymous results.

You can still complete the survey and audit even if you do not want us to use your NHS number. Just tick the “no” box. We will respect your wishes.

Q: Will my responses be shared with my GP?

A: No, we will not share or publish any information with your GP which identifies you as an individual patient.

Q: Why do you need my name and telephone number?

A: You may be contacted in a week or so to ask you about the service you received. It will take about 15 minutes and we can use any UK landline or mobile. If you can’t speak when we call, just say and we will agree a time with you and we will not leave a message. We will not publish information which identifies you as an individual patient.

Appendix A


Only complete this if you want to. You can still complete the rest of the survey and audit even if you do not want us to call you later. Just tick the “no” box. We will respect your wishes.

Q: Why do you need to know about the things in the “about you” section?

A: To understand and plan services for you and others who use the walk in centres – who they are, where they live and what they do. This means we can plan for the population – for example if there are lots of young mums using the centres that would be helpful for us to know.

Q: Why you need to know my age, ethnic origin etc?

A: Information about you helps us to understand who is using the services and who isn’t.

Q: What questions will the nurse or doctor ask me?

A: The questions are in the audit attached - you will take this into your consultation. The nurse or doctor will ask you the questions at the beginning and later ones s/he will complete for you, for example the action they recommend to advise or treat you.

Q: What do you mean by “registered” with a GP or “unregistered”?

A: We mean your regular doctor, family doctor or general practitioner who you see when you need health advice or treatment.

If you don’t have a GP, you are an “unregistered patient”. It is more difficult to plan and give health care when patients do not register. This is why we want to understand the reason for you attending the walk in centre.

Q: Why do you need to know about my GP?

A: We want to plan urgent care services with GPs. These questions help us do that, including which patients chose to use the walk in centres and not their GP.

Q: Why do you want to know the reason why I need to see a Nurse or Doctor?

A: This is one of the most important questions in the audit. With this information we can look at the health reasons for people using the walk in centre today. We can compare the information with the nurse or doctor’s diagnosis, advice and care results.

Q: What do you mean by clinician’s diagnosis and management? Why do you need to know this?

A: This is one of the most important questions in the audit. We will look at all of the results so we can understand what health services patients receive here. This includes advice, treatment and if you need to go anywhere else to complete your care on this occasion.


Appendix B

To be added by CCG Reference no: / /

Urgent care - a survey to understand patients’ views Barking and Dagenham Clinical Commissioning Group is reviewing the urgent health care service provided in the borough. To do this, we want to know who is using services and how happy they are with them. There is a patient survey and audit at this walk in centre today. We would like you or your carer to answer a few questions. If you are happy to, please answer the questions below. The doctor or nurse will also answer some questions about the reasons for your appointment today. We want to understand the total results and we will not share or publish any information which identifies any individual patient. If you have questions or need help, please ask the LINk representative who gave you this form.

To be completed by you (the patient) or carer (on behalf of the patient)

Your consent

1. Are you happy to take part in this survey and audit? (Please tick �one): Yes � No � If your answer is no, still please pass this form back to the LINk representative.

2. As part of the study, we may use your NHS number. Do you consent to your NHS number being used? (Please tick ��one): Yes � No �

3. We would like to telephone some patients in about a week’s time. Are you happy to take a telephone call? (Please tick �� one): Yes � No �

4. If yes, can you give your first name and the number you can best be reached on:

First name___________________________ Telephone no______________________

About today

5. Are you the patient (Please tick ��one): Yes � No �

If your answer is no, please give answers for the patient 6. What time did you arrive today? ____________________________________________

7. What is the health problem that made you visit the walk in centre today?

______________________________________________________________________

8. Why did you choose to come to the Walk in Centre today? ____________________________________________________________________


About today (continued) 9. Do you need an interpreter today (Please tick �one):

Do need an interpreter � Do not need an interpreter � An interpreter came with me � A phone interpreter will be booked for me �

About you, the patient 10. How old are you? (Please tick one):

�� 1-5 � 6-15 � 16-25 �26-40 � 41-65 � 66+ �years 11. Are you (Please tick �� one): Male � Female �

12. Are you (Please tick ��one):

�Employed �Self-employed � Unemployed � In education ��Rather not sa

13. Are you pregnant? (Please tick ��one): Yes � No �

14. Do you have a partner who is pregnant? (Please tick ��one): Yes � No �

15. Are you a carer? (Please tick ��one): Yes � No �

16. Do you live in Barking and/or Dagenham? (Please tick ��one): Yes � No �

17. What is your postcode? (where you live) __________________________________

18. What do you consider your ethnic origin to be (Please tick ��one):

Asian (incl. British) - Bangladeshi

Black (incl. British) - Other

White - British

Asian (incl. British) - Indian

Chinese White - Irish

Asian (incl. British) - Pakistani

Mixed – White & Asian

White - Other

Asian (incl. British) - Other

Mixed - White & Black African

Other [please specify]

Black (incl. British) - African

Mixed – White & Black Caribbean

I do not wish to disclose this

Black (incl. British) - Caribbean

Mixed - Other

19. Are you satisfied with booking appointments to see a GP? (Please tick � one):

Yes � No �Sometimes � Can you explain your response?

__________________________________________________________________________________ ________________________________________________________________________________

________________________________________________________________________________

THANK YOU - Please hand this completed form to the LINK representative


To be added by CCG Reference no: / /

Urgent care - an audit to understand patients’ health needs 1. LINK to confirm patient consent given to the audit (Please tick ��one): Yes � No �and

to using NHS number: (Please tick ��one): Yes � No �

PART 2 – data to be completed by clinician 2. Clinician to reconfirm consent (Please tick ��one): Yes � No �

3. Where consent given, add NHS Number: _____________________________________

About health care

4. Are you registered with a GP practice? (Please tick � one): Yes � No �

5. If you are not registered, why is that?

______________________________________________________________________

6. If registered, what is the name of your GP practice? __________________________

7. Do you get free prescriptions? (Please tick �one): Yes � No �

8. How many times in the last 6 months have you or your family visited a walk in centre? ______________________________________________________________________

9. Time of consultation: __________________________________

10. What is the presenting problem: (Please tick ��one):

A minor ailment � Minor injury � Other � 11. Brief description of patient’s presenting problem (e.g. pain on passing urine, painful twisted

ankle, dry cough and shortness of breath, ran out of medication)

__________________________________________________________________________________ _________________________________________________________________________________

PART 3 - to be completed by clinician 12. Clinician’s diagnosis (e.g. urinary tract infection, sprained ankle, exacerbation of asthma).

__________________________________________________________________________________ ________________________________________________________________________________


PART 3 - to be completed by clinician (continued) 13. Patient management (Please tick ��one or more of the following):

a. �Advice only b. � Refer to community team

c. �Advice and one of the following: d. � Refer back to own GP

e. �Prescription f. � Refer to hospital on-call doctor

g. �Dressing h. � Refer to Accident and Emergency

i. �X-ray j. � Ambulance

k. �Blood test l. � Refer to specialist

m. �Minor surgery n. � Other (Please specify): ________________________________ ________________________________

o. �Active management other (Please specify): ________________________________

14. The patient was seen by (Please tick ��one): Nurse � Doctor and nurse � Doctor �

15. Has the patient consulted another clinician previously about this presenting problem in the

last week? (Please tick ��one): Yes � No �

16. If yes, can they say where: _________________________________________________

17. Was your advice /management above different from that previously obtained? (Please tick ��one): Yes � No �

18. In your opinion, what would be the best way to manage this patient’s problem at this time? (Please tick ��one of the following:)

a. �Self-management b. � “Pharmacy now” consultation c. �Contact NHS Direct d. �District nurse visit / contact district nurse e. �Telephone advice from own GP f. �Attend own GP’s surgery (non-urgent) g. �Attend own GP’s surgery (urgently) h. �Attend walk-in centre i. �Attend minor injuries unit j. �Contact GP Out of hours for telephone advice k. �Contact GP out of hours for a base consultation l. �Attend A&E m. �Ring 999 for ambulance n. �Other [please specify]

Please use the reverse if you would like to supply additional information ~ End of audit ~

THANK YOU. Please hand this completed form to the designated lead who will retain information in line with the Data Sharing Agreement until collection by B&D CCG.


Appendix C

To be added by LINk Reference no: / /

Urgent care - a survey to understand patients’ views

Telephone follow up calls v0.7 final

Source documents: Questionnaire on page 38 of the following: http://www.bcu.ac.uk/_media/docs/emergency-department-and-urgent-care.pdf Adapted by the Urgent and Emergency Care PREM surveys for walk in centres - combined version – final link on: http://www.rcpch.ac.uk/final-urgent-and-emergency-care-prem-tools

LINK to complete before the call: Add telephone no _________________________ Add name of patient or carer to call _______________________ They are (Please tick ��one): The patient � The carer �

Hello [x]. You kindly took part in a patient survey and audit at this walk in centre at the beginning of November. My name is [ x ] and I am calling from Barking and Dagenham LINk to ask you some follow up questions. This will take about 10 minutes. We will not share or publish any information which identifies you as an individual patient.

Your consent

20. Are you happy to take part in this telephone survey now? (Please tick �one): Yes � No � If your answer is no, would you be happy for us to call you at another time? (Please tick �one): Yes � No �

21. Provide preference re times _________________________________________________

[Caller: I am now going to read out some statements and then asked you for your response]

See overleaf:


1. Why did you go to the walk in centre?

a) It was my decision to go �

b) My family said I should go �

c) A friend said I should go �

d) My GP said I should go �

e) My GP practice reception said I should go �

f) A nurse said I should go �

2. Did you expect to be treated: [choose a, b or c]

a) by a Doctor �

b) by a Nurse �

c) It didn’t matter who treated me �

[Caller: now we have a few questions for you to answer yes or no]

3. Were you happy with the way you were treated?

a) Yes �

b) No �

4. Did you feel your condition was diagnosed properly?

a) Yes �

b) No �

5. Were you given all the information you needed about your condition?

a) Yes �

b) No �

6. During your visit do you think you were given all the treatment you needed for your

condition?

a) Yes �

b) No �

7. Are you happy now about the health condition you went to the walk in centre about?

a) Yes �

7> No ��


To be added by LINk Reference no: / /

8. Have you gone or do you intend to go somewhere else to get another opinion?

a) Yes �

b) No �

If yes, please tell us which from the options below:

p. � Pharmacy q. � NHS Direct r. � Own GP s. � Out of hours service t. � Another WIC u. � Accident and Emergency v. � Ambulance w. � Other (Please specify):

________________________________

9. Do you think you will need to go back to the Walk in Centre about this condition again?

a) Yes �

b) No �

10. If you have another health problem would you go to the same Walk in Centre?

a) Yes �

b) No �

11. Would you go to another Walk in Centre?

a) Yes �

b) No �

[Caller: One final question about your recent visit]

12. In your opinion [choose one from the following]:

a) I didn’t have to wait too long to be seen �

b) I waited too long to be seen �

Do either of these statements apply? [choose none or one]

c) I realise that there were others who waited longer than me �

d) I think I could have been seen sooner �

[Caller: That’s the end of the survey – thank you for your time.]


Further Audit Information Appendix D

Table 1: Clinical Diagnosis

Type Diagnosis category Upney Lane

% Broad Street

% Total %

MI Sprain, muscle or pain 68 17 12 5 80 13 MA Viral infection 32 8 22 9 54 8 MA Skin infection 30 8 20 8 50 8 MA Urinary tract infection 26 7 13 5 39 6 MA Throat / tonsillitis 21 5 16 7 37 6 MA Skin other 16 4 16 7 32 5

Other No diagnosis 17 4 13 5 30 5 MA Ear pain, infection or wax 14 4 15 6 29 5 MA Lower respiratory tract infection 10 3 16 7 26 4 MI Injury 20 5 5 2 25 4 MI Dressings and wounds 10 3 13 5 23 4 MI Injury - soft tissue 21 5 2 1 23 4 MA Abdominal pain 14 4 6 2 20 3 MA Eye - medical minor problem 9 2 7 3 16 3

Other Other 6 2 9 4 15 2 MA Upper respiratory tract infection 12 3 3 1 15 2 MI Skin - cut 14 4 1 0 15 2 MI Injury - fracture 5 1 7 3 12 2 MA Contraception and pregnancy test 5 1 6 2 11 2 MA Respiratory problem 6 2 4 2 10 2 MI ROS 2 1 6 2 8 1 MA Acute medical 5 1 3 1 8 1 MA Gastroenteritis 6 2 2 1 8 1 MA Gynaecological problems 4 1 3 1 7 1 MA Mental health 4 1 3 1 7 1 MA Other - dental 1 0 5 2 6 1 MA STD and thrush 3 1 2 1 5 1 MA Other - fever 3 1 1 0 4 1 MI Injury - foreign body 1 0 2 1 3 0 MA Other - headache 1 0 2 1 3 0 MA Other - foot 3 1 0 0 3 0 MI Skin - burn 3 1 0 0 3 0 MI Eye - traumatic and foreign body 0 0 2 1 2 0 MI Injury - cut 0 0 2 1 2 0 MA Other - rectal bleeding 1 0 1 0 2 0 MA Acute surgical 2 1 0 0 2 0 MA Other - limb (not traumatic) 2 1 0 0 2 0 MA Dental - infection 0 0 1 0 1 0 MA Other - neurological 0 0 1 0 1 0 MA Other - medical chest pain 1 0 0 0 1 0

Total 398 100 242 100 640 100


Table 2: GP practices and IDs relating to density maps GP Practice ID

Locality 1 The Lawns 1 Marks Gate Health Centre 2 Dr Teotia 3 Valence Medical Centre 4 Highgrove Surgery 5 Dr Afser 6 Tulasi Medical Centre 7

Locality 2 Becontree Medical Centre 8 Laburnum Health Centre 9 Dr Ola 10 Heathway Medical Centre 11 Oval Road Medical Centre 12 Parkview Medical Centre 13 Church Elm Lane Medical Centre 14

Locality 3 Five Elms Medical Practice 15 Markyate Surgery 16 The Gables Surgery 17 Julia Engwell Health Centre 18 Dr I A Moghal 19

Locality 4 Broad Street Practice 20 Dr Pervez 21 Dr Fateh 22 Dr Ahmed & Monterio 23 Urswick Medical Centre - Dr Alkaisy & Dr Islam 24 Urswick Medical Centre - Dr Mohan & Partners 25 Dr Quansah 26

Locality 5 King Edwards Medical Centre 27 Porters Avenue 28 John Smith House 29 Dr Ansari 30 Thames View Medical Centre 31 Faircross Health Centre 32 Abbey Medical Centre 33

Locality 6 Dr Chawla 34 Barking Group Practice 35 Dr Chibber & Dr Gupta 36 Victoria Medical Centre 37 Child & Family Centre 38 Shifa Medical Centre 39 White House Surgery 40

walk-in centres in barking and · pdf filewalk in centres in barking and dagenham: an audit 1...

Documents