Would proposed urgent care centres really halve Emergency Centre attendances?

Ernst and Young’s 5 Year Strategic Plan for Calderdale & Huddersfield NHS Foundation Trust claims that 54% of patients who currently go to A&E could be treated at new Urgent Care Centres. This claim is repeated  in the Have Your Say Public consultation document on the proposed hospital cuts.(p 28)

The 54% figure is more than double the 22% of A&E patients who could be treated at such centres, that the Royal College of Emergency Medicine research identified.

After discussing this at the Threeways Centre consultation drop in, Calderdale & Kirklees 999 Call for the NHS Chair Jenny Shepherd asked the hospitals Trust medical director, David Birkenhead, for the raw data to back up this claim, and for the Trust’s analysis of this data.

The Trust Secretary Victoria Pickles replied on his behalf. The information CHFT provided is extremely cursory, in no way matches the detail of the Royal College of Emergency Medicine research and is impossible to verify.
The Question to David Birkenhead

You said that the figure of 54% of CHFT A&E patients who could appropriately be treated in urgent care centres is based on an analysis of CHFT A&E patient codes. Please will you send me the raw data and the analysis of it?

I would like to see how it can be so different from the Royal College of Emergency Medicine figure of 22% of A&E patients who could appropriately be treated in urgent care centres.

As you may remember, at the Threeways Centre consultation drop in, Dr Brook told me the RCEM data was old and didn’t refer to “wonderful new urgent care centres”.

I checked this with the Royal College of Emergency Medicine and they have told me this 22% figure is for A&E patients who could be appropriately treated at  Urgent Care Centres. Here is the link  to the research that generated this finding – although I am sure you are already familiar with it.

CHFT Response

Please find attached the information regarding the modelling for the urgent care centres which was shared with the Joint Overview and Scrutiny Committee some time ago. In essence we modelled our attendance information against the services that would be available in the urgent care centres.

UCC-EC_patient flows modellingP1
UCC_EC patients flows modellingP2
The Royal College of Emergency Medicine paper you have linked to is describing primary care provision which does not have access to appropriate diagnostics and reporting and is not open 24 hours (see para 3 under the discussion heading). The urgent care centres will have access to diagnostics and other equipment and facilities which are routinely used now by our emergency care practitioners, who will continue to provide care in our proposal in addition to the medical resource referred to the paper. They will therefore be able to care for a higher percentage of patients. The items described on slide 2 of the attachment as being minor illnesses and minor injuries are a relatively conservative list for modelling purposes.

Response to CHFT

Thank you for your prompt reply.

I’d like to make two points.

First, I disagree with your statement that

“The Royal College of Emergency Medicine paper you have linked to is describing primary care provision which does not have access to appropriate diagnostics and reporting and is not open 24 hours (see para 3 under the discussion heading).”

You will see that that section of the paper says that 15% of A&E patients could be treated by primary care provision without access to appropriate diagnostics, reporting and 24 hour services. The next sentence says:

“However, this figure rose by nearly a half to 22% of patients who it was thought could be seen immediately by a GP working on site. Such a doctor would, of course, have complete access to all the considerable facilities available in a major emergency department.”

I contacted the Royal College of Emergency Medicine (RCEM) to ask about this, because at a recent consultation drop in, Dr Brook told me what you have just told me and I wanted to check the accuracy of his statement. The RCEM replied as follows:

” The idea of a hub is that these services are co-located on the same site as an A&E department – a triage nurse could then direct the patient more appropriately to these services. As we mentioned in the statement we believe that around 20% of patients from A&E could be redirected to these on-site services and reduce the pressure on the A&E.

With regards to the 20% figure, our studies have shown that 15% of patients were thought to be suitable for delayed management (but within 24 hours) by a primary care practitioner; this figure increased to 22% for immediate care by a GP working in the emergency department.”

It seems clear that what the RCEM calls a hub is what CHFT is calling an urgent care centre. And their research shows that 22% of A&E patients can be effectively treated at a hub/ urgent care centre.

Second, the information about the modelling for patient flows to urgent care centres that CHFT provided to the JHSC is extremely cursory, in no way matches the detail of the RCEM research and is impossible to verify.

On page 1 it states that the modelling of patient flows has been based on forecast activity, rather than an analysis of actual activity. On page 2 – UCC assumptions – there is no actual data for how A&E attendance over a specific period, or at a particular point in time, broke down by treatment codes or diagnosis fields. In the absence of raw data and an explanation of how the data was analysed, it is impossible to verify these assumptions.

There must be better data than this and if there isn’t I can’t see how the 54% figure has any credibility.

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