Help shape local NHS
urgent care services
17 April - 29 May 2015
What is urgent care?
Urgent care is for health issues that:
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Arise unexpectedly
Require immediate attention
Range in severity from very serious (i.e. threaten loss of life or limb) to less serious
Urgent care services therefore need to be:
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Easy to access
Available 24 hours a day, 7 days a week
A range of services, capable of dealing with the very serious to the less serious
In common with the rest of NHS services, urgent care services also need to be safe,
effective, value for money and a good experience for patients.
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What is urgent care? cont’d
In Waltham Forest, our urgent care services are:
• Pharmacists provide advice and treatment on a range of minor ailments
Pharmacy First
Emergency GP appointments
• This varies between GP practices, but most offer some emergency
appointments that can be booked on the day
NHS 111
• A telephone advice service for people who have, or think they have, an urgent
health need
GP out-of-hours service
• If you call your GP surgery when it isn’t open, you will be redirected to an ‘outof-hours’ GP service
Oliver Road walk-in service
• Service based in Leyton, where people from across Waltham Forest and
beyond can access urgent GP and nurse appointments
urgent care needs that are less serious (i.e. don’t threaten loss of life or
Whipps Cross urgent care centre • For
limb)
Whipps Cross A&E
• For the most serious urgent and emergency care needs, i.e. issues that
threaten loss of life or limb
Most of the time you can access services outside your home borough. Accessing
GPs in this way can be tricky, but many will see people as temporary patients.
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What you might have heard about urgent care recently…
The A&E crisis deepened today as Britain’s biggest NHS trust revealed that one of its hospitals ran out of
beds and had asked ambulances to stay away … Today the Standard can reveal that Barts Health — the
country’s biggest group of hospitals — had 36 patients in Whipps Cross’ casualty department awaiting
admission to a ward at 6am on Tuesday but nowhere to put them.
(London Evening Standard, 9 January 2015)
A surge in patients sent to accident and emergency units by unqualified call handlers was blamed last
night for helping to tip hospitals into “meltdown”. Operators on the non-emergency NHS 111 helpline, who
have no medical training, were needlessly advising callers to attend A&E in what has become a “huge
problem”, experts said.
(The Times, 7 January 2015)
Whipps Cross University Hospital in east London has been rated as inadequate by the Care Quality
Commission, which noted “serious concerns” about poor leadership, culture of bullying and low staffing
levels. The majority of the hospital’s services – including urgent and emergency care, care for older
people, children and young people, and outpatients – require “significant improvements”, said the
regulator in a report published today.
(Nursing Times, 17 March 2015)
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Is there a national crisis? Is there a crisis in Waltham Forest?
Let’s look at the national and local pictures.
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The national picture
• To understand the national picture, it may help to look at this animation from the King’s Fund:
www.kingsfund.org.uk/projects/urgent-emergency-care/alternative-guide-urgent-and-emergency-caresystem-england
• King’s Fund identify some issues that are true for Waltham Forest, and some that are not true for
Waltham Forest (but are true in other areas of the country).
• Let’s explore the picture in Waltham Forest.
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The Waltham Forest picture
In common with the rest of the UK, numbers of people going to A&E in Waltham Forest are roughly stable.
But we cannot be complacent about this, because:
• The pressure on A&E creates pressure on beds in the rest of the hospital, which then in turn creates
pressure on A&E (i.e. patients need to stay longer in A&E because there are no beds on wards)
• Sometimes people go to A&E because they haven’t been able to get the right care in the community,
which is often the best place for them to access care
• Sometimes people living in care homes are taken to A&E because the homes don’t feel they have the
skills to look after some minor illnesses
• Sometimes people aren’t registered with a GP, and A&E is the only place they think they can access
care
• Often people go to A&E when they don’t need to. This is because:
• They don’t know what other urgent care services are available
• They can’t, or don’t try to, get an appointment with their GP
• They don’t feel confident about managing their health issues
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The Waltham Forest picture cont’d
In addition to these issues, in Waltham Forest:
• There are high levels of attendance from children under-5 and people aged 19-30
• Our IT systems and data-sharing processes need to be more joined up, so that staff in A&E can see
GP care plans for patients, and give care in line with those plans
• Our GPs, nurses and ambulance services need more and different support to be able to care for people
at home (this will ensure that people are only referred onto urgent care services when absolutely
necessary)
• Our population has high rates of admission for alcohol, and these rates are increasing
• Our population has high rates of admission for mental health issues
• Whipps Cross Hospital has been inspected by the Care Quality Commission recently, and as a result its
urgent and emergency services have been required to improve significantly
All these problems contribute to waiting times at Whipps A&E being a problem.
The Whipps A&E consistently does not meet the 4-hour wait target.
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The future in Waltham Forest
As well as considering the current picture in Waltham Forest, we also need to consider likely healthcare
needs in the future.
The 2011 census predicts that by 2021:
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There will be a notable population increase (12.6%)
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There will be a significant rise in the number of children (age 0-14)
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There will be a significant rise in older people (over 65), some of whom have complex needs
In addition, when the planned closure of the A&E department at King George’s Hospital in Redbridge
happens, we know we will see increased demand at Whipps A&E.
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Our response: the urgent care strategy
We have developed our urgent care strategy to respond to this current and future picture in
Waltham Forest.
This strategy has 3 main elements:
1. Responses that target particular issues
2. Responses that focus on improving the urgent care system overall, rather than
particular issues
3. Responses that focus on helping Whipps Cross improve the overall quality of
emergency care it provides
These are outlined in detail on the following slides.
Note: in the following slides we will also mention other CCG programmes (e.g. Transforming
Services Together, integrated care etc.) These programmes are not part of the urgent care
strategy, but their work overlaps and supports the work of the urgent care strategy. When an
activity is part of another programme, we have marked it with italics.
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Targeted responses
The issue
Our response
The pressure on A&E creates pressure on beds in
the rest of the hospital, which then in turn creates
pressure on A&E (i.e. patients need to stay longer
in A&E because there are no beds on wards)
• Improve patient flows around the system,
focussing on frequent attenders
• Train hospital staff to focus on improving
discharge rates
Sometimes people go to A&E because they
haven’t been able to get the right care in the
community, which is often the best place for them
to access care
• Improve rehabilitation and reablement services,
so they can support people to get up to full
strength
• Improve end of life services: so that more
people can die at home if they choose to do so
Sometimes people living in care homes are taken
to A&E because the homes don’t feel they have
the skills to look after some minor illnesses
• Train care home workers to be more confident
in managing risk
• Put more support into care homes: to help
them look after more people
Sometimes people aren’t registered with a GP,
and A&E is the only place they think they can
access care
• Primary Care strategy: as part of this strategy,
we will increase people’s awareness of the
primary care system, including how to register
with a GP
Often people go to A&E when they don’t need to,
because they don’t know what other urgent care
services are available
• Improve people’s knowledge and
understanding of the urgent care system, so
they know where to go when
• Update 111 directory of services, and link to the
community services single point of access
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Targeted responses cont’d
The issue
Our response
Often people go to A&E when they don’t need to,
because they can’t, or don’t try to, get an
appointment with their GP
• Increase availability of urgent GP appointments
• Support local GPs to establish a provider
network: GPs will work together to provide
evening and weekend appointments. We will
publicise this widely, so people know about the
change
Often people go to A&E when they don’t need to,
because they don’t feel confident about managing
their health issues
• Improve people’s knowledge of their health
• Support people to self-manage their health
conditions
There are high levels of attendance from children
under-5 and people aged 19-30
• Improve the paediatric urgent care pathway
• Link health visitors and school nurses to the
urgent care system
• Train GPs to be more confident in interacting
with parents of young children
Our IT systems and data-sharing processes need
to be more joined up, so that staff in A&E can see
GP care plans for patients, and give care in line
with those plans
• IT strategy: align IT systems and data-sharing
processes across Waltham Forest
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Targeted responses cont’d
The issue
Our response
Our GPs, nurses and ambulance services need
more and different support to be able to care for
people at home
• Train GPs to be more confident in managing
risk
• Work with ambulance colleagues to identify
opportunities for people to be cared for at home
• Integrated care: increase investment in
community services and workforce
development
Our population has high rates of admission for
alcohol and these rates are increasing
• Improve the alcohol urgent care pathway
• Work with Public Health and our local
community, to improve understanding of the
harmful effects of alcohol
Our population has high rates of admission for
mental health issues
• Continue to improve the mental health urgent
care pathway
There will be a notable population increase
(12.6%)
• Increase availability of urgent GP appointments
• Increase availability of other urgent care
services at A&E
• Transforming Services Together: one of the
main drivers for this programme is the
projected population growth in East London,
and the need to find solutions within available
resources. (This programme covers a range of
hospital services, as well as primary care,
mental health services and integrated care)
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Targeted responses cont’d
The issue
Our response
There will be a significant rise in children (age 014)
• Improve the paediatric urgent care pathway
• Link health visitors and school nurses to the
urgent care system
• Train GPs to be more confident in interacting
with parents of young children
There will be a significant rise in older people
(over 65), some of whom have complex needs
• Integrated care: development of specific
integrated care initiatives, e.g. the Rapid
Response service
• Increase availability of other urgent care
services at A&E
When the planned closure of the A&E department
at King George’s Hospital in Redbridge happens,
we know we will see increased demand at Whipps
A&E
• Increase availability of other urgent care
services at A&E
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Improving urgent care: overall and Whipps-focussed responses
Overall responses
These responses focus on improving the urgent care system overall, rather than addressing particular
issues. They are:
• Transforming Services Together urgent and emergency care workstream. This will work towards
aligning urgent care services across the boroughs of Waltham Forest, Newham and Tower Hamlets, to
ensure a high-quality, consistent and whole-system approach across east London.
• Overall integrated care programme, including Better Care Fund. The integrated care programme aims
to link health and social care services, and so improve experiences for patients. The Better Care Fund
is a specific integrated care initiative, which involves health and social care services sharing some of
their budget. The Better Care Fund aims to reduce unplanned admissions to hospital by 2.5%, and so
will support the urgent care strategy in reducing pressure on Whipps A&E.
• Reviewing urgent care services to ensure they meet the current and future needs of the population.
• Supporting local GPs to establish a provider network. GPs will work together to provide a wider range
of services.
Responses to help Whipps Cross improve quality
Whipps Cross has been inspected by the Care Quality Commission recently, and as a result its urgent
and emergency services have been required to improve significantly. We will respond to this by working
with Barts Health, CQC, NTDA and other CCGs to drive up quality at the hospital.
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Vision
These targeted, overall, and Whipps-focussed responses come together to
form our vision for urgent care services in Waltham Forest:
“We will work with partners to develop a sustainable urgent care system,
so that the people of Waltham Forest can access the most appropriate
health and social care, advice and support, in the right place and at the
right time.”
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Outcomes and challenges
Outcomes: how will we measure success?
Over the next 3 years we will see:
• A marked improvement in achievement of 4-hour wait target at Whipps Cross A&E
• 30% decrease in attendances at A&E
Challenges
• All of this change needs to be delivered within the current budget. (The current cost of urgent care in
Waltham Forest is £25 million per year.)
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Next steps
Please tell us your views by 29 May
2015. If you would like us to update you
on the progress of our strategy, please
include your email and/or postal
address.
Our urgent care strategy has been developed by:
• Reviewing audits and performance data;
• Researching local and national best practice;
• Listening to stakeholder views at workshops;
• Analysing results from a survey conducted by Healthwatch Waltham Forest;
• Undertaking a snapshot of patients attending A&E and the urgent care centre at Whipps Cross, to
understand their reasons for attending and their knowledge of other urgent care services; and
• Reviewing feedback from the CCG’s Annual General Meeting in September 2014.
Now we want to hear your views!
The questions we would particularly like feedback on are:
1. Do you think our strategy addresses the main problems facing urgent care services in Waltham
Forest? If not, please explain why.
2. Do you agree we need all of the targeted, overall and Whipps-focussed responses?
3. If you don’t agree we need all of the responses, which ones do you think we should we remove? And
why?
4. Do you think we have missed anything in our strategy?
5. Can you think of any ways that you, or your organisation, could help us deliver this strategy?
6. Do you have any other comments?
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