2023 Engagement update

In Spring 2023 we commissioned Healthwatch York and Healthwatch North Yorkshire to conduct follow up engagement of people’s experiences of urgent care. Between May and July 2023 they talked to nearly 400 people waiting at the four Urgent Treatment Centres (UTCs) in York, Scarborough, Selby and Malton. The full report can be read here.

Urgent care engagement review 2020

Nationally, there is a focus on getting patients get the right care, in the right place and at the right time, and importantly as convenient for them as the seriousness of their condition allows. Within the Vale of York context, an opportunity has arisen to review the way that we provide urgent care in the area. 

Urgent care services are for when you need medical advice or treatment for a health condition on the same day. Urgent care covers conditions which are not life threatening but cannot wait until a routine appointment with your GP or other healthcare professional is available.  In order to provide a good service, we want to understand what our population already knows about urgent care in the Vale of York and when to use it.

As a result, we have taken the opportunity to carry out an initial scoping exercise to understand the needs of our population and how they access urgent and same day care. As part of this report we have referenced a number of surveys and engagement activities which have taken place over the last two years with a focus on accessing GP services, out-of-hours and urgent care. In addition, we carried out a specific engagement activities, in partnership with Healthwatch York and North Yorkshire to find out more about why people may attended A&E and what people do if they have an urgent care need that is not life threatening, but needs to be assessed on the same day.

Read the urgent care engagement report 2020 here.

The following documents and engagement activities were consulted as part of this report:

• April 2018: Improving access to GP practices survey for evening and weekend appointments.
  
  
• June 2019: Humber, Coast and Vale engagement about the long term plan, which included engagement around urgent care priorities across the patch
  
  
• August 2019: Healthwatch York report on key messages from the NHS Long Term Plan Engagement Project in York 
  
  
• August 2019: Survey of patients attending A&E: poke to 103 patients over a 12 hour period.
  
  
• March 2020: Healthwatch Children and Young People’s report.
  
  
• May 2020: Impact of covid-19 on health and wellbeing.
  
  
• June 2020: Urgent Care Survey - where people go if they have an urgent medical need. In June 2020 the CCG conducted a survey to find out what people do and where they go if they have an urgent health condition (that is not life threatening) and needs treating on the same day. We received 545 responses. The survey was shared with our stakeholder database and through our networks such as the maternity voices partnership, the carers centre, local businesses, patient participation groups, VCSE organisations, Healthwatch, the local authority and parish councils.  We asked questions about people would do if they need medical attention on the same day, but are not seriously injured, and how they would prefer to access services. This includes views on medical advice over the telephone and the use of digital technology (such as video consultations).
  
  
• June 2020 urgent care interviews: We commissioned Healthwatch to carry out an independent urgent care rapid assessment report, working with seldom heard and vulnerable groups to find out their experience of seeking medical help if they had an urgent health condition. Click here to read the Healthwatch report on urgent care access for seldom heard and vulnerable groups. View the full Healthwatch report on people's understanding of urgent care.
  
  
• July 2020: National GP patient survey carried out by Ipsos Mori.

What our population told us:

Reviewing the thousands of conversations and feedback submissions from the Vale of York population, there are a number of key themes that emerge around the understanding of urgent care, when to access it and people’s experience:

• The system is too confusing: People are unsure about when to use NHS 111 service, when to call a GP or when to go to A&E. Difficulties ‘navigating the system’ and ‘knowing where to go’ were raised multiple respondents.
  
  
• GP is the first choice for an urgent care need.
  
  
• There is lack of knowledge about Urgent Treatments Centres (UTC)
  
  
• People are unsure of where to go/how to access out-of-hours care
  
  
• Travel and transport was important to people
  
  
• Improved access: People commented that they would welcome better access to GP services, via the telephone and outside of working hours.
  
  
• Type of appointment: People still prefer face-to-face as a means of having an appointment. However, since March 2020 and the coivid-19 pandemic there has been more of an uptake in telephone and digital consultations.
  
  
• Range of professionals: Respondents were happy to see a range of healthcare professionals for their urgent health need.
  
  
• Using the telephone to get advice: Generally people were used to accessing services via telephone. However, experience was much more positive if this was with a health care professional rather that a call taker.
  
  
• Continuity of care and joined up care: People commented that there needs to be more joined up sharing of records, otherwise and then you have to explain to every clinician about your conditions.
  
  
• Better use of technology: For some people access to the internet and technology was not difficult and in some circumstances, especially during the Covid-19 pandemic, it was preferred. However, It is important to be mindful to not digitally exclude patients. For those who had difficulties – cost, ease of use and access to good quality broadband were some of the main concerns.
  
  
• Low awareness of online service, and appointments at the weekend and evenings through the GP surgery.
  
  
• If people had a child who was unwell, they more likely to go to A&E.
  
  
• If people had a mental health condition, they would prefer to see someone they trust.
  
  
• Better communication was a key theme. People mentioned how communication could have been better. Young people also told us that information about their own care was not always provided in an easy to understand or accessible way.
  
  
• Recognition of pharmacies was high, and according to the 2020 Urgent care survey 42% of people would chose to go to a pharmacy to try and treat and urgent medical condition.
  
  
• People who access A&E are likely to have tried another healthcare option first.
  
  
• Out of area patients, such as tourists or business people told us that they had to go to A&E because they couldn’t get appointments with local GPs, or get a prescription for medication.
  
  
• Increase awareness of carers and vulnerable patients: Awareness of their needs and providing clear information would improve the experiences when accessing health and care services.

Forums and committees:

Urgent care communications and public engagement forum

In September 2020 the CCG set up and held an engagement and communications forum with patient and voluntary sector representatives from across the patch. The forum provided the opportunity for attendees to review the CCG’s engagement process and work together to reach out to seldom heard communities. A really valuable discussion ensued, focusing on making pathways clear and simple to access, communications and involving communities. It will continue to act as a critical friend to the engagement process. 

• Presentation slides for the Urgent Care Forum - 23 September 2020

In June 2021 we conducted three workshops with clinicians, Healthwatch North Yorkshire and the voluntary sector within Selby to identify the patient need and vision for urgent care in the Selby Town PCN area. 

• Presentation slides for patient feedback from Selby residents

Updates to Health Overview and Scrutiny Committees

As part of the formal process the CCG has meetings with the Health Scrutiny Committees on 2 October (City of York Council), 6 October (East Riding) and 21 October (North Yorkshire County Council) to provide updates about the project. 

All committees were supportive of the diversity of engagement work carried out as part of the project and the efforts to seek views of a cross section of the population. They all requested to be kept informed of developments and attend future sessions. We updated the  OSCs in February 2021.