URGENT CARE STRATEGY

Data Pack

Keogh – key messagesThe number of GP consultations has risen over

recent years and, despite rapid expansion and usage of alternative urgent care services, attendances at A&E departments have not reduced. This indicates either unmet demand across the whole system or

supply induced demand: increased uptake as a result of increased provision of services.

The wide range of urgent care services available and lack of service standardisation and labelling

results in patient confusion over how to access the right healthcare quickly; this leads to duplication,

delay, increased clinical risk and poor patient experience.

Q. What will we do to make access to the right service easy?

Self-care for minor ailments and self-management of long-term conditions are effective at improving quality of life and reducing dependency on urgent and emergency care services. However there is a

lack of awareness, particularly amongst patients in lower socio-economic groups, surrounding how to

access support.Q. How are we promoting self-care locally?

GP practices in areas of high deprivation typically deal with greater volumes of patients with more complex physical and mental health conditions, which can lead to greater practitioner stress and

lack of capacity to manage some patients effectively. This may contribute to avoidable A&E

attendances and emergency admissions to hospital.

Q. What is the GP to population ratio in our deprived areas? And are A&E attendance rates

higher?

Access to urgent GP appointments across England is variable and, in urban areas where demand is high and transient populations exist, many may use an A&E department as their first point of urgent and

emergency care.Q. Is this true for us and what alternatives do we

offer in urban areas?

Growth in the number of emergency admissions to hospital has been associated with a large rise in

short or zero stay admissions. The reasons for this are multifactorial but some studies have attributed it to a lack of early senior review, risk averse triage and A&E departments trying to avoid breaching the four

hour standard.Q. Is this true for us?

NATIONAL DATA

National Demand

General practice consultation rates by professional group (1999 to 2008)

Ninety per cent of all NHS patient contacts are thought to take place within primary care. There is a lack of available, up-to-date, data on general practice consultation activity, but levels are thought to have been steadily increasing over the last 10 years, with an estimated 340 million taking place in 2012/13. - Keogh

Nurse consultations

have seen largest growth

The relationship between A&E attendances and results from the 2010/11 GP Patient Survey (GPPS)

Is this reflected locally?

Unplanned care attendances 1987/88 – 2012/13

There were 6.8 million attendances at walk in centres and minor injury units in 2012/13 and activity at these facilities has increased by around 12 per cent annually since this data was first recorded in 2002/03. Despite this, attendances at major and single specialty A&E departments have continued to increase by about 1.3 per cent per year. Accident and Emergency departments have seen a significant number of patients that could be managed in other settings, adding to those with life-threatening conditions. - Urgent and Emergency Care Review, End of Phase 1 Report

Rise in emergency calls in England 2008/09 – 2012/13

Source: Ambulance Services England

Large increase for SW in

12/13

Patients taken to A&E and those transported elsewhere or discharged at scene, October to December 2012

Source: Ambulance Services England

We already have the lowest conveyance rate

Source: HSCIC ‘Focus on A&E’

Less young people in

12/13

More 45-60yrs in 12/13

Source: HSCIC ‘Focus on A&E’

Source: HSCIC ‘Focus on A&E’

Source: HSCIC ‘Focus on A&E’

09:00 – 19:00

LOCAL DATA

Trend of A&E Attendances

Apr-08

Jun-08

Aug-08

Oct-08

Dec-08

Feb-09

Apr-09

Jun-09

Aug-09

Oct-09

Dec-09

Feb-10

Apr-10

Jun-10

Aug-10

Oct-10

Dec-10

Feb-11

Apr-11

Jun-11

Aug-11

Oct-11

Dec-11

Feb-12

Apr-12

Jun-12

Aug-12

Oct-12

Dec-12

Feb-13

Apr-13

Jun-13

Aug-13

Oct-13

Dec-13

Feb-14

4,000

4,500

5,000

5,500

6,000

6,500

7,000

A&E Attendances

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14Sum of Atts 65,955 66,042 67,983 70,504 71,659 72,956% change 0.13% 2.94% 3.71% 1.64% 1.81% Source: GPT

A&E attendances per 100,000 population

NHS Knowsley CCG NHS Northumberland CCG NHS Slough CCG NHS Brighton and Hove CCG NHS Bexley CCG NHS South Cheshire CCG NHS Oxfordshire CCG -

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

A&E attendances per 100,000 population

England

South Devon & Torbay CCG

NB: MIU record-ing may not be consistent

Source: SUS 2011/12

Trend of MIU Attendances1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

0

500

1000

1500

2000

2500

3000

3500

4000

4500

MIU visits

Is reduction related to closures?

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14Sum of atts 35178 40408 40294 39545 35815 35241% change 14.87% -0.28% -1.86% -9.43% -1.60%

Source: GPT

MIU attendances by site

2008/09 2009/10 2010/11 2011/12 2012/13 2013/140

2000

4000

6000

8000

10000

12000

14000

16000

Attendances by MIU

AshburtonBovey TraceyBrixhamDartmouthDawlishNewton AbbotPaigntonTeignmouthTotnes

Sum of attsAshburton Bovey Tracey Brixham Dartmouth Dawlish Newton Abbot Paignton Teignmouth Totnes Grand Total

2008/09 1474 714 4765 2773 2986 8876 3216 4082 6292 351782009/10 2142 218 4117 3251 3365 13386 2809 4721 6399 404082010/11 2114 4173 2757 3247 13695 3470 4543 6295 402942011/12 1949 3894 2721 4134 14805 3142 3184 5716 395452012/13 736 2966 2554 3554 15052 2696 2817 5440 358152013/14 657 2498 2497 3631 14541 3021 3045 5351 35241Grand Total 9072 932 22413 16553 20917 80355 18354 22392 35493 226481

Source: GPT

A&E attendances in weeks containing bank holidays

2008/09 2009/10 2010/11 2011/12 2012/13 2013/140

200

400

600

800

1000

1200

1400

1600

1800

Average A&E attendances in a week containing a bank holiday vs. other weeks

BHNon-BH

Source: GPT

Average of avgattsBH Non-BH

2008/09 1367 12622009/10 1138 12722010/11 1411 12902011/12 1437 13442012/13 1453 13362013/14 1548 1388

Trend of 999 calls

Source: SWAST

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1

2011/12 2012/13 2013/14 2014/15

0

200

400

600

800

1000

1200

1400

1600

1800

Ambulance calls by month - managed (999) and un-managed (from Healthcare Professional)

HCP999

HCP 999% change

(HCP)% change

(999)% change

(Total)2011/12 7255 182712012/13 7471 18523 3.0% 1.4% 1.8%2013/14 7975 18099 6.7% -2.3% 0.3%

Trend of OoH calls

05/08/2

013 - 11/0

8/2013

12/08/2

013 - 18/0

8/2013

19/08/2

013 - 25/0

8/2013

26/08/2

013 - 01/0

9/2013

02/09/2

013 - 08/0

9/2013

09/09/2

013 - 15/0

9/2013

16/09/2

013 - 22/0

9/2013

23/09/2

013 - 29/0

9/2013

30/09/2

013 - 06/1

0/2013

07/10/2

013 - 13/1

0/2013

14/10/2

013 - 20/1

0/2013

21/10/2

013 - 27/1

0/2013

28/10/2

013 - 03/1

1/2013

04/11/2

013 - 10/1

1/2013

11/11/2

013 - 17/1

1/2013

18/11/2

013 - 24/1

1/2013

25/11/2

013 - 01/1

2/2013

02/12/2

013 - 08/1

2/2013

09/12/2

013 - 15/1

2/2013

16/12/2

013 - 22/1

2/2013

23/12/2

013 - 29/1

2/2013

30/12/2

013 - 05/0

1/2014

06/01/2

014 - 12/0

1/2014

13/01/2

014 - 19/0

1/2014

20/01/2

014 - 26/0

1/2014

27/01/2

014 - 02/0

2/2014

03/02/2

014 - 09/0

2/2014

10/02/2

014 - 16/0

2/2014

17/02/2

014 - 23/0

2/2014

24/02/2

014 - 02/0

3/2014

03/03/2

014 - 09/0

3/2014

10/03/2

014 - 16/0

3/2014

17/03/2

014 - 23/0

3/2014

24/03/2

014 - 30/0

3/2014

31/03/2

014 - 01/0

4/2014

0

200

400

600

800

1000

1200

1400

1600

1800

Weekly OoH contacts

The relationship between A&E attendances and results from the 2013 GP Patient Survey (GPPS) – SD&T CCG

L83637

L83122

L83146

L83013

L83029

L83666

L83120

L83032

L83045

L83118

L83126

L83607

L83014

L83657

L83034

L83094

L83005

L83055

L83145

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

0.00

0.10

0.20

0.30

0.40

0.50

0.60

A&E attendances per head of population against patient satisfaction

SatisfactionAE Rate

Pearson correlation coefficient (where 1 = total positive correlation, -1 = total inverse correlation and 0 = no correlation)

-0.25Source: GPT

Attendances by age

Age Band 2010/11 2013/14 % Change00 to 04 524.28 572.54 9.2%05 to 09 332.51 318.50 -4.2%10 to 14 459.28 429.52 -6.5%15 to 19 472.67 440.01 -6.9%20 to 24 498.84 476.96 -4.4%25 to 29 389.91 393.25 0.9%30 to 34 334.52 356.90 6.7%35 to 39 311.49 310.88 -0.2%40 to 44 286.65 296.02 3.3%45 to 49 283.05 289.43 2.3%50 to 54 281.06 285.52 1.6%55 to 59 275.67 281.80 2.2%60 to 64 271.25 261.22 -3.7%65 to 69 299.55 286.64 -4.3%70 to 74 361.62 357.87 -1.0%75 to 79 480.54 437.91 -8.9%80 to 84 578.17 574.36 -0.7%85 to 89 739.27 728.05 -1.5%90+ 821.67 825.88 0.5% 00

to 0

4

05 to

09

10 to

14

15 to

19

20 to

24

25 to

29

30 to

34

35 to

39

40 to

44

45 to

49

50 to

54

55 to

59

60 to

64

65 to

69

70 to

74

75 to

79

80 to

84

85 to

89

90+

0.00

100.00

200.00

300.00

400.00

500.00

600.00

700.00

800.00

900.00

Attendances per 1,000 population by age

2010/112013/14

Attendances by hour of arrival2009/10 2013/14 %Change

0 1517 1693 11.6%1 1239 1282 3.5%2 1007 1119 11.1%3 814 930 14.3%4 695 828 19.1%5 574 778 35.5%6 672 808 20.2%7 1022 1352 32.3%8 3974 4290 8.0%9 8301 7364 -11.3%10 9816 9736 -0.8%11 9469 8773 -7.4%12 8071 8195 1.5%13 7804 8002 2.5%14 8126 8140 0.2%15 7730 7569 -2.1%16 7321 7100 -3.0%17 6217 6366 2.4%18 5949 5978 0.5%19 4870 5219 7.2%20 4015 4573 13.9%21 3109 3420 10.0%22 2250 2572 14.3%23 1888 2110 11.8%Grand Total 106450 108197 1.6%

0

2000

4000

6000

8000

10000

12000

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Attendances by hour of arrival

2009/10

2013/14

Attendances by day of arrival

Sum of atts2009/10 2013/14 %Change

Monday 13.61% 14.15% 4.0%Tuesday 16.05% 16.48% 2.7%Wednesday 14.12% 14.09% -0.3%Thursday 14.51% 13.81% -4.8%Friday 14.08% 13.74% -2.4%Saturday 14.43% 14.38% -0.4%Sunday 13.19% 13.36% 1.3%Grand Total 100.00% 100.00% 0.0%

Monday Tuesday Wednesday Thursday Friday Saturday Sunday8.00%

9.00%

10.00%

11.00%

12.00%

13.00%

14.00%

15.00%

16.00%

17.00%

Attendances by day of arrival

2009/102013/14

Attendances per 1,000 population by practice (A&E and MIU)Bu

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0

100

200

300

400

500

600

700Attendances per 1,000 population by practice

fy_2012_13 fy_2013_14

Source: SUS

Attendances per 1,000 population by practice (A&E only)Ab

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0

100

200

300

400

500

600

700Attendances per 1,000 population by practice

fy_2012_13 fy_2013_14

Source: SUS

Attendances not requiring treatment

2008/09 2009/10 2010/11 2011/12 2012/13 2013/140

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Cost and volume of patients requiring and not requiring treatment

TreatedNot treated

ActivityNot treated Treated Grand Total

2008/09 36,583 35,482 72,0652009/10 25,739 46,315 72,0542010/11 26,031 47,896 73,9272011/12 14,476 62,080 76,5562012/13 13,716 62,959 76,6752013/14 17,084 60,648 77,732

Grand Total 133,629 315,380 449,009

Source: GPT

‘No treatment’ defined as any attendance where the primary treatment is either ‘No treatment’ or ‘Guidance/advice only’

Short stay emergency admissions

Source: GPT

Length of Stay2010/11 2011/12 2012/13 2013/14

0 5828 5493 5271 54941 6814 7313 7034 6936Grand Total 12642 12806 12305 12430

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1

2010/11 2011/12 2012/13 2013/14 2014/15 YTD

0100200300400500600700800

EmAdms with LoS <=1

01

111 calls by locality

Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014North 611 2032 2313 2844 2545 2385 2939East 1473 1676 1805 2280 2804 3135 4892West 1754 2039 2044 2541 2616 2696 5609Other 1299 1462 1414 1639 1197 1099 1596

Total 5137 7209 7576 9304 9162 9315 15036Population 901176 901176 901176 901176 901176 901176 901176

Rate per 1,000 population 5.70 8.00 8.41 10.32 10.17 10.34 16.68

SD&T 1153 1450 1544 1840 1984 2059 4230Population 287395 287395 287395 287395 287395 287395 287395

Rate per 1,000 population 4.01 5.05 5.37 6.40 6.90 7.16 14.72

NE

W D

evo

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D&

T C

CG

GP WTEs by population

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,0000

2

4

6

8

10

12

R² = 0.843597749768735

GP Working Time Equivalent vs Practice Population

Practice Population

WTE

GP WTEs by deprivation

10.0 15.0 20.0 25.0 30.0 35.0 40.00

2

4

6

8

10

12

R² = 0.0508517618248652

GP Working Time Equivalent vs Average IMD

Average IMD

WTE

Where is the demand for A&E/MIU?

Who attends A&E/MIU, by area

Coastal Moor To Sea Newton Abbot Torquay Paignton and Brixham0

5000

10000

15000

20000

25000

30000

28014005 4935 5725 5304

6913

9135

10223

1402912809

5046

6062

5542

59638048

A&E / MIU Attendances All Providers 2013/14 By Age Group & Locality

over_65adultchild

A&E Attendances with no treatment, by area

Coastal Moor to Sea Newton Abbot Paignton and Brixham Torquay0

5

10

15

20

25

30

35

40

45

Patients Receiving No A&E / MIU Treatment All Providers 2013/14, per 1,000 weighted pop.

Locality CCG

Patie

nts /

100

0 W

eigh

ted

Popu

latio

n

Coastal Moor to Sea Newton Abbot Paignton and Brixham Torquay0%

2%

4%

6%

8%

10%

12%

14%

Percentage Of Attendances Receiving No A&E / MIU Treatment All Providers 2013/14

Locality CCG

Perc

enta

ge O

f All

2013

/14

Atten

danc

es

Where is the demand for ambulances, by LSOA?

Ambulance calls, by area

Coastal Moor to Sea Newton Abbot Paignton and Brixham Torquay0

2000

4000

6000

8000

10000

12000

346 471 549 818 10131405

1892 1957

3172

46982699

3203 3125

5628

4438

Managed SWAST Calls 2013/14 by Age Group & Locality Of Pickup Location

65+20 to 640 to 19

When do people call for an ambulance, by area?

Coastal Moor to Sea Newton Abbot Paignton and Brixham Torquay CCG0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2361 3137 3048 5035 5096 18677

2387 2861 3001 5224 5879 19352

Managed SWAST Calls 2013/14 By Time & Locality Of Pickup Location

Out Of HoursIn Hours

Why do people call 999?19%

8%

7%

5%

5%

4%4%

3%3%

2%

2%

2%

2%

2%

2%

29% Immediate threats to lifeChest, Upper Back Pain or PalpitatGP Urgent and Bed BureauFalls or FaintsHead, Facial or Neck InjuryNon-trauma Emergency(blank)CONCERN FOR WELFAREBreathing Problems, BreathlessnessProbable StrokeUnconscious or Fitting / Fits in lst 24hrsTrauma EmergencyMEDICALLeg Injury, BluntTRAUMAOthers