Many of the health centres presented as alternatives to hospital accident and emergency offer unreliable services and confuse the public, advisers to the Department of Health have warned.
Policy makers and senior managers are increasingly accepting that services are often underused, failing to reduce demand on hospitals and duplicating other urgent care services. It leads to poor patient experience, inefficiency and potential safety risks.
They have sprouted up without any cohesive view
Advisers believe many sites are underused because they have multiple and sometimes misleading names, such as walk-in centre, minor injuries unit and urgent care centre, and the public do not know what they provide.
To address this the advisers are considering specifying names to be used nationally and telling primary care trusts they must provide minimum services and standards.
One 2008 study, seen by HSJ, for PCTs in South Central, shows huge variation in the services offered at different health centres.
Of the 19 centres examined for South Central PCT Alliance, six were not open after 9pm and three had doctors “occasionally”. Eleven were staffed by nurse practitioners full time and two some of the time.
Five had full time access to X-rays and six had access to X-rays some of the time, while 14 could provide sutures full time and two some of the time.
Surveys and interviews with the public found they were most confused about “less severe” complaints.
Typical views included, “I go to A&E because I know they won’t send me somewhere else” and “I find the health service frustrating and confusing. A&E takes forever and is not great but I come here anyway”.
A DH-commissioned report by the Primary Care Foundation, unlikely to be published until after the election, is expected to add to evidence that the public are confused about the centres, contributing to inefficiency. The report is understood to have discovered little evidence of services reducing demand on A&E. Even ambulances are avoiding the centres because they do not feel they can rely on them.
Primary Care Foundation partner Rick Stern told HSJ: “People understand their GP service and understand A&E but are somewhat confused by everything else in between. We are looking at that and how we can clarify some of it.”
GP Sir John Oldham, one of the leads for the DH quality, innovation, productivity and prevention (QIPP) programme, said out-of-hospital centres would be essential for quality and productivity, but were often badly planned.
He said: “They have sprouted up - not exactly randomly - but without any cohesive view as to what is available in a geographical area. We need to encourage a much more cohesive and strategic view.
“We need to construct a system where whenever somebody has what they call an urgent problem, they are guided to whatever is most appropriate.”
Sir John said reverting to relying on A&E would be bad for quality and cost.
Urgent care in numbers
- In 2007-08, 91 PCTs declared no patients attending walk-in centres, according to Healthcare Commission urgent care review figures
- Of those remaining, walk-in centre use varied from 5 per cent of total A&E attendances for the same PCT area, to 170 per cent greater than A&E attendances
- An earlier Primary Care Foundation report found 10-30 per cent of A&E cases were “types regularly seen in general practice”
- In a legitimate emergency the role of A&E is understood
- 70 per cent of people questioned in A&E were not “particularly worried about their condition”
- 71 per cent did not believe that they needed treatment immediately
- More than two thirds did not consider their pain “very painful”
- 42 per cent say they tried to contact their GP before coming to A&E, but 30 per cent of those “never got past the GP receptionist or the voicemail”