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Working together to improve urgent and emergency care in Redbridge, Barking and Dagenham and Havering

August 23, 2016

Earlier this year we worked with 3 CCGs in North East London to undertake research and engage widely with their local populations. It is a well known fact that people sometimes go to A&E when there are other more appropriate places to seek help. The findings from the research are now informing key projects and the programme as things move ahead.

Melissa Hoskins, Communications and Engagement Manager for BHR Clinical Commissioning Groups said, “By engaging with more than 3000 people across the CCG areas we were able to create a base of information on which we could begin to build our new models of care. The key has been keeping people involved and working collaboratively to test each model as we trial them and bring them on line. It is exciting to hear people talking about doing engagement first and doing it well. This helps me to demonstrate to local people that their views are really informing our work”

There is currently a redirection trial ongoing at Queen’s Hospital emergency department, which is testing a change to the triage and streaming process at the front door. A senior Emergency Department consultant and a senior GP are assessing every patient on arrival and where appropriate, redirecting them to an alternative service in the community (their own GP, a pharmacy, a walk-in-centre or out-of-hours GP service – or just to go home and rest without the need for any treatment at all).

The research found people did default to A&E due to their confusion over the different services, but that they would follow advice from healthcare professionals. This pilot is trialling a way of addressing these issues together, while also trying to reduce the pressure on the busy Emergency Department teams. Early results are that they are turning away 50-60 people a day and 1/3 of those don’t need any treatment or intervention at all. That’s 1 in 8 of everyone who is going to the hospital Emegency Department.

Patients are given lots of information and help if they do need to go elsewhere and be seen by a GP or other professional, and there has been only one complaint recorded as patients appear happy that they are seen by a clinician and given advice.

We are also looking at improvements to the NHS 111 service, so people do get better advice and reassurance at their first point of contact. There is also work on-going to scope out what might be needed to address the issues of high numbers of parents and young children attending A&E – with the research findings feeding directly into this work.

There is work starting to scope engagement work around how we address the confusion over the number of different urgent care services in the community (GP hubs, Urgent Care Centres, Walk in Centres, GP out-of-hours services, polyclinics…) It is early days but as well as getting local people to help better explain and describe the services and what they offer patients and why, it is hoped that it will help to build a case for reviewing and streamlining what is available to make it easier to navigate for local people and staff. That is real people power, as Healtwatch and others have been saying this is what’s needed.

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