supporting bhr ccgs in researching the case for change for ......therefore, barking and dagenham,...
TRANSCRIPT
Supporting BHR CCGs in researching the
case for change for
Community Urgent Care in the borough
of Barking and Dagenham
2
Contents
Contents ........................................................................................ 2
1. Introduction ......................................................................... 3
1.1 Target audience .................................................................... 3
1.2 Methodology......................................................................... 4
1.3 Acknowledgements ................................................................. 4
1.4 Disclaimer ........................................................................... 5
2. Findings .............................................................................. 6
3. Conclusions ........................................................................ 19
3
1. Introduction
The CCG know local people find the current range of urgent care services confusing, and want it to be easier to know where to go for help if they have an urgent health need and want to get advice or treatment on the same day.
Therefore, Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups (BHR CCGs) have developed a case for change for community urgent care services, which identifies key themes that need to be addressed through a new model of care. BHR CCGs wanted to speak with local people about two priority themes in more detail. These were:
- Providing more bookable appointments for urgent health care concerns or needs
- Making urgent care more accessible through digital channels (online booking, digital apps and resources)
Feedback from local people will inform the planning of options for a new model of care.
Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups (BHR CCGs) asked Healthwatch to carry out a piece of research to inform their work to improve community urgent care services and make it easier for local people to get the right care in the right place, first time.
1.1 Target audience
Parents of young children (especially those aged 0 to 5 Years)
Older people (those aged 60+)
Young adults (aged 15 to 30)
4
1.2 Methodology
Healthwatch Barking and Dagenham held round table discussions and one to ones with the target audiences.
Participants were advised that their views were being collected and would be included in this report which would be passed to the CCG. To enable individuals to give their views without fear of their personal details being shared or any impact on the services they receive, Healthwatch explained that:
Participation is voluntary, and individuals are not required to answer the questions posed.
Participation or non-participation will not affect access to any services currently being accessed
During the discussions respondents were informed of the different urgent and emergency services available.
To ensure we could capture the views of the target audience, Healthwatch took the following steps:
The survey was sent out to all individuals and organisations currently on the Healthwatch mailing list.
Uploaded information and the survey link to the Healthwatch website.
Promoted the research through our social media channels. Attended various groups to speak to people, specifically those who
fell into our target audience.
1.3 Acknowledgements
Healthwatch Barking and Dagenham would like to thank everyone who took part in the survey and all those who shared and distributed the services. We would also like to thank the services who welcomed Healthwatch to speak to their service users.
5
1.4 Disclaimer
Please note that this report relates to findings from the responses received. Our report is not a representative portrayal of the experiences of all service users and only an account of what was observed and contributed at the time of the consultation period.
6
2. Findings
Of the 102 respondents, 52% said they understood the difference between urgent care and emergency care while 48% said they did not.
The results show that there was not a lot of variation between the responses of those who were between the ages of 15-30 and those who were 60 plus. However, the percentage of parents who said they understand the difference was on average 3.5% higher than the other two target groups.
52%
48%
Yes No
46%
47%
48%
49%
50%
51%
52%
53%
Do you understand the difference between ‘urgent care’ and ‘emergency care’?
17%
20%
16%17%
14%
18%
Between the ages of
15-30
Parent of Carer of
child under 5
Over the age of 60?
0%
5%
10%
15%
20%
25%
Yes
No
7
If yes, can you explain, in your own words, what the difference is between ‘urgent care’ and ‘emergency care’?
The following themes emerged when respondents were asked to define the difference between urgent and emergency care;
38% defined emergency care as being life or death 14% chest pain or heart attack 7% something that needed medical attention immediately
Urgent care was defined as
Something that needed attention before it progressed into an emergency
An infection such as UTI Cold, cough or flu Broken or injured limbs.
While half of the respondents said they understood the difference between urgent and emergency care, some people were unable to give examples of what health issues would require emergency care. There was a much better understanding about urgent care. Once the first two questions were completed respondents were shown the definitions. Urgent care is care needed the same day. This could include anything from cuts, minor injuries, wound infections, tonsillitis, urinary infections, or mild fevers etc.
Emergency care is provided in a medical emergency when life or long term health is at immediate risk. This could include serious injuries or blood loss, chest pains, choking or blacking out.
8
A large proportion of respondents thought that providing more bookable appointments would help patients and carers, 11% of respondents did not feel this was the case. Tell us why?
Respondents were asked why they thought bookable appointments would be of help. People indicated various reasons and the following themes emerged:
41% of the respondents said they would be more likely to be seen on the same day.
43% felt that waiting times to be seen would be more acceptable. 16% indicated that more urgent bookable appointments would
lead to reduction in A & E waiting times. 9% said it would be more convenient. 7% thought having access to more bookable urgent appointments
would be beneficial to older, vulnerable and people with children, as they struggle not only with waiting times, but also being able to get to their practices to make appointments.
89%
11%
Yes No
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Do you think providing more bookable urgent appointments will help patients and carers?
9
The majority of the respondents indicated that they would like to be seen or speak to a GP at their own practice. When looking further into the reasons for this it came to light that patients felt this was the best option for a number of reasons including:
Patients would be able to get a blood test referral if needed. The doctor would have access to their medical history. The doctor would be able to make relevant referrals if needed. There would be no need to go back to see their own GP if further
investigation is needed.
88%
56.86%
42.16%
12.75%
45.10% 44.12%
0.98% 0.98%4.90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
If you had an urgent (not emergency) health care need, and your own GP could not see you on that
day, would you be happy with any of these alternatives. Please tick your top three choices.
See or speak to by another GP at your practice
See a GP or nurse at a GP hub in your borough
See a GP or nurse at the nearest GP hub to you, even if that is not in your borough
Get the first appointment available at a GP hub, even if this is not the closest toyour home
Speak to NHS 111 for advice, and be booked into an appointment if you need to beseen by a healthcare professional
Go to your local pharmacy if you have a minor illness that they can help with
None – I would wait to see my own GP
None of these – I would choose to wait at A&E or another walk in service
Other (please specify)
10
The next three alternatives which were chosen by respondents included attending a GP HUB within the borough (57%), calling NHS 111 (45%) and going to their pharmacy for a minor illness (44%). Furthermore 42% said they would also be happy to attend a GP HUB which may be in another borough but was the close to them.
It was evident that people would be happy to attend a GP HUB in another borough if they were sure it would be accessible to them, for example one individual said “Barking Community Hospital is easier for me to get to by bus, if there was a Redbridge [GP Hub] closer to me, but it was going to take me longer to get to because of the bus route then I would prefer to go to Barking” One thing that was highlighted in sessions was that people would like to have a choice in where they could attend.
Our findings show that 73% of the respondents had heard of NHS 111 and 27% had not. We asked respondents how they had heard about NHS 111. People said they had heard about NHS 111 in a number of ways.
27%
73%
No Yes
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Have you heard of NHS 111?
11
We asked those who had heard of NHS 111, if they had recently seen any adverts, 60% of respondents had not seen any adverts about the service but 40% had. Furthermore, our findings show that 89% were not aware of the improvements taking place to the NHS 111 service.
40.00%
60.00%
Yes No
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
If you have heard about NHS 111, have you recently seen any adverts about the service?
89%
11%
No Yes
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Have you heard about the improvements being made to NHS 111? (please only answer this
question if you have heard of NHS 111)
12
Before completing the next question, an explanation was given to the respondents about NHS 111 and the improvements being undertaken:
NHS 111 is the free 24/7 telephone advice service for people who need urgent health care advice or attention. The NHS wants more people to call NHS 111 as the first place they turn to for help with urgent health concerns. The local NHS is making improvements to NHS 111 in North East London. This means GP, nurses, paramedics and pharmacists will soon be giving urgent expert advice over the phone through NHS 111. If you need to be seen but it’s not an emergency, NHS 111 will be able to book you a convenient and timely appointment with a GP hub, the GP Out of Hours service and at the Urgent Care Centres at King George Hospital and Queen’s Hospitals.
The highest proportion of respondents at 82% agreed that improving NHS 111 would make it easier to get the health advice people need quickly.
82%
63%
49%
54%
42%
4.90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Do you think that improving NHS 111 will: (Please tick all the options you agree with.)
Make it easier to get the healthadvice you need quickly
Make it easier to get an urgenthealthcare appointment at alocal service
Help people to feel confident tolook after themselves at homewith advice from NHS 111
Reduce the number of peoplewho go to A&E when they have aminor illness or minor injury
Make you more likely to use NHS111
I don't agree with any of theoptions
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63% felt it would be easier to get an urgent appointment and 54% believed the improvements would lead to reduction of people attending A&E when they could be treated elsewhere. However only 42% believed it would make them more likely to use NHS 111, and 49% thought it would help people to feel confident to look after themselves at home after advice from NHS 111.
How do you use digital or online healthcare services now?
The findings show that over half of the respondents use online healthcare services to book a GP appointment (58%), with 30% ordering repeat prescriptions and 30% browsing the internet to seek advice on how to care for themselves at home.
Furthermore 34% of respondents indicated that they did not use any digital or online healthcare services.
58%
30%
0.00%
29%
1% 0%
34%
4% 3%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Book GP appointment
Order a repeat prescription
Connect with a healthcare professional to get help with managing a long term
condition(such as diabetes, chronic pain, COPD)
Online advice on how to care for yourself at home before you book an appointment or
visit a GP or service
Video consultation with a health professional
Online help from mental health professionals when you are experiencing a mental
health crisis or need advice/ information
None of these
I don’t have access to the internet or use a smartphone
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A few people explained that their practice have provided them with login details for making a GP appointment online, but they were not shown how to use them. It was felt that a demonstration would have been helpful especially for those who were unsure. Breakdown of responses from target groups
Please note percentages are worked out from the 34 people who responded from each group.
68%
44%
0%
35%
0%
0%
26%
0%
3%
74%
35%
0%
41%
3%
0%
24%
3%
6%
35%
15%
0%
15%
0%
0%
50%
9%
3%
0% 20% 40% 60% 80%
Book GP appointment
Order a repeat prescription
Connect with a healthcare professional to get
help with managing a long term condition(such as
diabetes, chronic pain, COPD)
Online advice on how to care for yourself at home
before you book an appointment or visit a GP or
service
Video consultation with a health professional
Online help from mental health professionals
when you are experiencing a mental health crisis
or need advice/ information
None of these
I don’t have access to the internet or use a smartphone
Online health forum to talk with people with a
similar health condition, please specify which
ones
60+ 15-30 Parents/Carers of children under 5
15
How might you use digital online services in the future?
The majority of respondents indicated that they would use online services to book a GP appointment in the future, 67% said they would order their repeat prescriptions and 59% were happy to go online to seek advice on how to care for themselves at home before booking to see a health professional. In addition, our findings show that only 32% of people said they would be happy to have a video consultation with a health professional. A small number of people told Healthwatch that they would not feel comfortable with speaking to a professional online as the doctor or nurse would not be able to clearly see or feel the area of concern. People also said if
74%
67%
28%
59%
32%
23% 22%
3%
19%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Book GP appointment
Order a repeat prescription
Connect with a healthcare professional to get help with managing a long term
condition(such as diabetes, chronic pain, COPD)
Online advice on how to care for yourself at home before you book an appointment or visit
a GP or service
Video consultation with a health professional
Online help from mental health professionals when you are experiencing a mental health
crisis or need advice/ information
None of these
I don’t have access to the internet or use a smartphone
Online health forum to talk with people with a similar health condition, please specify
which ones
16
they agreed with this option then this may lead to more video consultations then face to face and they would much rather speak to someone in person than over a computer. 22% of people said they would not access any of the online/digital services, with a small percentage indicating they had no access to the internet or do not use a smart phone. There were reservations about accessing online help from a medical health professional when an individual may be experiencing a mental health crisis. Respondents felt that there would be much better outcomes if this was face to face as individuals would be in vulnerable state of mind. It was felt it would be much better if there was a meet up point for those who were suffering from mental health.
Our results also showed that people would be happy to access online groups, however at the time people could not specify if there were particular groups they would join as this would be dependent on the health issues they face in the future. 59% of the respondents said they would go online for health advice, some commented that it would be helpful to know which sites are good to look at, as there is a wealth of information available.
Comments from respondents “ I would use video calling if I was shown how to” “ Some of the ideas, are really not for older people, let us be and stop making us do things we don’t want to do, feels like we are going to be pushed to use online services. “ Great, I would use these services, works great for people like me who work long hours” “If someone is suffering from a mental health crisis, face to face is the best thing, I suffer from mental health and I can tell you, video calling or online support will never work” “I would use video consultations as I work in the city and would not need to take a day off to go to the doctor, especially for routine things.
17
Breakdown by target group
Please note percentages are worked out from the 34 people who responded from each group.
The findings show that older people are not keen on using online digital services options for accessing healthcare. Older people did not want to engage in a video consultation with a health professional. There was a low percentage overall across all three target audiences on the mental health crisis service. A large proportion of the 15-30 year olds and parents said they would be happy to book a GP appointment online and also order a repeat prescription. Only 35% of the older people spoken to said they would order a repeat prescription online and 44% said they would book a GP appointment online.
88%
82%
29%
79%
38%
24%
15%
18%
0%
88%
82%
41%
79%
59%
38%
6%
0%
38%
44%
35%
15%
21%
0%
9%
44%
9%
3%
0% 20% 40% 60% 80% 100%
Book GP appointment
Order a repeat prescription
Connect with a healthcare professional to get
help with managing a long term condition(such
as diabetes, chronic pain, COPD)
Online advice on how to care for yourself at
home before you book an appointment or visit
a GP or service
Video consultation with a health professional
Online help from mental health professionals
when you are experiencing a mental health
crisis or need advice/ information
None of these
I don’t have access to the internet or use a smartphone
Online health forum to talk with people with a
similar health condition, please specify which
ones
How might you use digital/online services in the future
60+ 15-30 Parents/Carers of children under 5
18
What would make you feel more confident about using the internet or digital healthcare services? Please tick your top 3 reasons.
We asked respondents what would make them feel more confident with using the internet or digital healthcare services, the three most common responses were:
More information on what is available
A guarantee that their information was safe
Free training
46%
25%
18%
12%
19%
50%
57%
20%
0% 10% 20% 30% 40% 50% 60%
I do not wish to use the internet or digital healthcare services for health advice
If I had more information on what was available
If I could guarantee that my information was safe
If my family or carers could use this service for me
If my clinician recommended this to me
If a trusted health care professional got me started
If going online was more affordable
Free training
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3. Conclusions
By analysing our findings, we have found the following:
While half of the respondents said they understood the difference between urgent and emergency care, some people were unable to give examples of what health issues would require emergency care. There was a much better understanding about urgent care.
If people are unable to see their own GP, they would prefer to see another GP at their own practice. This is so any follow on treatment can be actioned at the same time.
Mostly people use online healthcare services for booking GP appointments, ordering repeat prescriptions and finding out about health information.
Patients are ready to use online services in the future, however reservations were voiced about video calling and speaking to mental health professionals through a computer.
People would like more information on what is available online in terms of healthcare services.
47% of the respondents said free training would make them feel more confident in accessing digital and online healthcare services.
20
Demography Data
31.37%
66.67%
1.96%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Are you?
Male
Female
Other
Prefer not to say
45.54%
10.89%
24.75%
13.86%
1.98% 2.97%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
What is your ethnicity? (This is not about place of birth or citizenship. It is about the group you think you belong to in terms of culture, nationality or race)
Any white background
Any mixed ethnic background
Any Asian background
Any black background
Prefer not to say
Any other ethnic group (please
tell us what it is)
21
8.82%6.86%
36.27%
10.78%
1.96%
22.55%
6.86%4.90%
0.98%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
How old are you?
Under 18 years
18 to 24 years
25 to 34 years
35 to 44 years
45 to 54 years
55 to 64 years
65 to 74 years
75 years or older
Prefer not to say
14.00%
2.00%5.00%
78.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Do you consider yourself to have a disability?
Yes – a physical/ mobility issue
Yes – learning disability/mental health issue
Yes – a visual impairment
Yes – a hearing problems
Yes - another issue
No
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