Scrapping the national target to keep accident and emergency waits below four hours has failed to ease the pressure on trusts and commissioners in the East Midlands.

The Leicester, Leicestershire and Rutland primary care trust cluster is fretting that its 2011-12 target for 95 per cent of patients to be seen within four hours is being jeopardised by University Hospitals of Leicester Trust. Cluster board papers say the trust’s performance, which was 93.7 per cent in 2010-11, “places the whole healthcare economy target at risk”.

The acute trust’s own board documents state that for some groups of patients the figure was actually only 91.5 per cent in April this year, a finding which “remains of acute concern”.

Further north, NHS Bassetlaw’s year-end figures reveal the impact of the bitter winter on emergency admissions. The old 98 per cent target for dealing with A&E patients inside four hours was achieved just 18 per cent of the time during the “winter period” at Bassetlaw Hospital, compared with 64 per cent over the same period in 2009-10.

An NHS East Midlands review has tried to get to the bottom of what is driving demand throughout the year – specifically, why young people are persistently turning up at A&E departments instead of using walk-in centres, GPs or pharmacists.

The strategic health authority found patients in the 0-4 and 15-24 age groups were self-referring or had been referred by their parents often between the hours of 7am-11am, when alternatives were available.

It is now looking at initiatives such as training GP receptionists to provide better information; asking GPs who send too many patients to A&E to shadow hospital doctors; and educating patients through information given during discharge.