What is the data telling us?

There are several different definitions of what urgent care is. In the NHS North of Tyne, it has been defined as: 

"The range of responses that health and care services provide to people who require - or who perceive the need for - urgent advice, care, treatment or diagnosis. People using services and carers should expect 24/7 consistent and rigorous assessment of the urgency of their care need and an appropriate and prompt response to that need." (A New Direction of Travel for Urgent Healthcare in Newcastle, North Tyneside and Northumberland Strategy (2008))

It is considered that there is an over-reliance on acute care provision, much of which is driven by excessive emergency admissions. NHS Comparators shows that Newcastle has a considerably higher than average level of emergency admissions in England.
The rise in the number of emergency admissions can be seen in Graph 1 below. 
Graph 1 Emergency Admissions of Newcastle PCT residents 2005/06 to 2009/10
 
 Our projections indicate that the number of emergency admissions are set to rise further over the next few years. Graph 2 below demonstrates our trend analysis of emergency admissions for the North of Tyne area as a whole.

Our latest data shows that there were 56941 A&E attendances from Newcastle residents, which resulted in 31616 emergency inpatient spells into hospital. Most emergency admissions were made through General Medicine (27%) while 20% were made through A&E.

Table 1 below describes the most common reasons by condition for emergency admissions 

 

Table 1 Emergency Admissions of Newcastle PCT Residents by Condition 2009/10

  
We have further analysed the information describing the conditions for which patients are admitted. Of the emergency admissions made, almost 44% did not require an overnight or longer stay. While not all of these would be minor in nature, it does lead us to conclude that some of these A&E were for conditions which could perhaps have been more appropriately managed in settings other than Accident & Emergency.
We are also aware that there are a number of patients who attend Accident & Emergency services in Newcastle frequently. Frequently is classed as more than 3 visits per year. Table 2 provides information on attendances at Accident & Emergency in Newcastle.

We are analysing what conditions people "frequently attend" for and are implementing some initiatives, such as the Alcohol Care and Treatment Service, to help minimise unnecessary attendances and ensure that patients receive the right care in the right place.  We have, however, noticed a downward trend in the number of emergency bed days for Newcastle PCT residents, as described in Graph 3 below, although this is starting to rise again.



Graph 3 Emergency Bed Day Usage of Newcastle PCT Residents 2005/06 - 2009/10
 
We aim to reverse many of these trends to ensure that people receive the right care in the right place and at the right time.

What is the story behind the data?

A consultation process was undertaken in 2008 as an integral part of development of the NHS North of Tyne Urgent Care Strategy. Consultation focussed on: 

1. where minor injuries and illnesses should be dealt with
2. proposals around introduction of an urgent care phone number
3. What information people need about the urgent care services that are available and in what format should the information be given 

Walk-In Centres

A lot of people said they hadn't used either walk-in centres or minor injury units and it was clear from responses that there is not a high level of awareness of the centres that are available. People who had used the services were generally positive and thought they were a good idea from a convenience point of view especially when the GP surgery is closed. 

Single telephone number

Most people who responded welcomed a single, easy to remember telephone number to simplify access to all urgent care services. Direct contact with a person was considered important and the needs of people with hearing or speech difficulties need to be taken into account. Comments were received, including from Newcastle and North Tyneside LMC, about ensuring this service is not unmanageable and not confusing for patients. 

Information

Most people who responded said they were aware of which service to contact with some saying that it would depend on the time of day. Only a small number of people mentioned walk in centres or minor injury units. There were a number of suggestions about how urgent care services should be promoted and where it should be displayed. It was suggested information should be regularly updated. 

Other Issues

Urgent care services should be closely linked to local authority adult services, for example, to ensure the right support for older and vulnerable people following a visit to an A&E department or a walk-in-centre. 

Newcastle and North Tyneside Local Medical Council raised an issue about patient transport is more urgent care services are to be provided in GP practices and stressed that home visiting in an urgent situation is not always the best way to make an assessment given the need for diagnostic equipment and assistance of nursing staff.  

We are aware that the number of emergency admissions in North Tyneside are considerably higher than anywhere else in England, according to the NHS Comparator data source. 

We are also aware that people are remaining in hospital too long and that sometimes this is due to appropriate services not being available in their home to ensure they can return home safely after their hospital stay. 

We are not aware of these issues affecting any particular demographic or section of the population in North Tyneside. 

What are the gaps in the data?

There are several targets relating to urgent care provision which we collate and monitor in NHS North of Tyne to ensure that the services we commission are appropriate for our patients and residents. 

There is a national target aiming to reduce the wait for patients at A&E to a maximum of 4 hours. This target has generally been met by the acute hospital Trusts in our area. 

There are a number of national and local targets for ambulance services aiming to ensure that ambulances reach patients within a defined period of time, depending on the severity of the patients needs. Again, the North East Ambulance Service which provides ambulance services in Newcastle has met, and in fact exceeds, all its targets for the Newcastle area. 

There are also a number of targets for primary care practitioners to meet which focus on how quickly consultations should take place, again depending on how urgent they are and where they are to take place. Once again, these targets have met in Newcastle. 

A lot of the attendances at Accident & Emergency are for minor illnesses or injuries and it is not necessarily appropriate for A&E services to treat these conditions. Also, a considerable number of people requiring emergency admission have a long term conditions such as diabetes or chronic heart disease but who, with better facilities and access to services, could have their condition managed in the community and avoid the need to go into hospital.

The NHS and local authorities need to work together to ensure that a range of services are available in Newcastle upon Tyne, that Newcastle residents are aware of these services and how to access them, and ensure that people are not inappropriately admitted into hospital or remain in hospital for longer than necessary because alternative community or primary based services are not available.

What are the national and local drivers?

Reforming Emergency Care (2001) provided the blueprint for the major overhaul of emergency services.

Taking Healthcare to the Patient - Transforming Ambulance Services (2005) detailed the five year strategic direction for ambulance services. 

Our Health, Our Care, Our Say (2006) set out the then Government's vision of more effective health and social care services outside hospitals, itdentifying 5 key areas for change. 

Our vision, our future, our North East NHS sets out the agenda for transforming the NHS in the north east to ensure services are fair, personalised, effective and safe. Eight workstreams were identified including one specifically focusing on acute care. 

A New Direction of Travel for Urgent Healthcare in Newcastle, North Tyneside and Northumberland Strategy This strategy outlines the proposed strategic direction for the delivery of urgent care in the North of Tyne over a five year period from 2008. 

There are also a number of other drivers and influences but the ones listed above are the most influential on how services are currently provided and will be provided in the future.

What is currently working here or elsewhere?

The Urgent Care Strategy, "A New Direction of Travel for Urgent Healthcare in Newcastle, North Tyneside and Northumberland 2008-2013" outlined those areas which are perceived gaps in services. 

Awareness about which services are available, when they can be accessed and for what condition or illness is key to ensuring that the population of Newcastle receives the right urgent care in the right place at the right time. 

There is some confusion amongst parents about which services they can access for children, particularly children under 2 years old, resulting in a large number of attendances at A&E for minor injuries or illnesses. A clearer understanding of which services operate in Newcastle for children under 2 years and improved publicity of these services is required.  

A lot of the attendances at Accident & Emergency are for minor illnesses or injuries and it is not necessarily appropriate for A&E services to treat these conditions. Also, a considerable number of people requiring emergency admission have a long term conditions such as diabetes or chronic heart disease but who, with better facilities and access to services, could have their condition managed in the community and avoid the need to go into hospital. 

The NHS and local authorities need to work together to ensure that a range of services are available in Newcastle, that Newcastle residents are aware of these services and how to access them, and ensure that people are not inappropriately admitted into hospital or remain in hospital for longer than necessary because alternative community or primary based services are not available.

What should we be doing next?

The Strategic Health Authority and NHS North of Tyne QIPP list of initiatives, linked with the NHS North of Tyne Strategy document outlines our intentions in relation to urgent care services. 

We will:

• Introduce the single point of access system (including introduction of a 3 digit number)
• Improve the management of a range of ambulatory care conditions, improving primary and community services to manage patients with ambulatory care conditions
• Improve the management of a range of conditions which have high hospital admission levelsImprove the management of out of hours care and primary care extended hours service
• Negotiate local tariffs for hospital Assessment Ward usage at Acute Trusts
• Support and implement the Choose Well Campaign
• Improve the primary care management of alcohol related conditions, reducing the variation in admission levels and alcohol related conditions 

We also intend to work with the North East Ambulance Service to increase the number of patients who can be appropriately treated "on the spot" instead of unnecessarily conveyed to accident & emergency. 

We will focus attention and resources on completing implementation the QIPP Programme and North of Tyne Strategy to improve access to services whilst ensuring the delivery of high quality care in the most appropriate setting.