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Urgent Care Navigation

July 15, 2016 11:31

When are ‘winter pressures' not ‘winter pressures’? When they begin to occur throughout the year...

The report included in our mailer from Catherine Jones (Health Correspondent at Channel 5 News) is by no means a new topic, suggesting that A&E departments are beginning to feel the strains of winter pressures outside of colder months (although right now it’s also becoming harder to define which months are the ‘cold months’). Does this mean it will now become another new norm within the health and care services we so strenuously fight to maintain?

At this stage it’s perhaps a little too much of an assumption to make, but what we at ICE have been thinking about, and in many ways, supporting our health and care customers to deliver is - how can we tackle the big problems? How can we help stay ahead of the curve? We know it isn’t a case of one solution fixing all problems, but we have found that by being proactive in addressing the following areas together, we can make positive differences.

Why do citizens visit A&E? - The insight that leads to the change in approach

For those who are unfamiliar with the challenges Urgent Care services face, the above title may seem a little ‘state the obvious’ as an approach to take when looking to address the problems. However, if we add the following statistic into the equation, it soon becomes clear that we need to understand the ‘why?’ if we are to start making services more sustainable:

...a survey of 3,000 people in 12 A&E units conducted for the Royal College of Emergency Medicine found that 15% could have been treated in the community”…that’s 450 people.

While we can’t apportion all of that 15% to be down to inappropriate use of health services, we can suggest there is huge value in understanding why citizens choose to attend A&E. The approximate cost of an A&E visit is £135. If we can understand the behaviours, beliefs and rationale people use in making their health seeking choices, we can then form educated and measured responses to begin adjusting their future approach. ICE’s insight specialists are experienced in doing just that.

A fantastic example of such experience in leading investigations into ‘inappropriate service use’ comes from our work with Manchester Teachings Trust, supporting them with their ‘Choose Well’ campaign.

Through ‘clean language’ questioning and laddering techniques, our insight team consulted with members of the public from target groups across Greater Manchester.

The resulting insight indicated that that there were a number of repeated themes as to why these citizens were inappropriately engaging with services:

Convenience - The A&E department is closer to them and easier to get to than their GP surgery

Lack of understanding of alternative services available to them:

  • GP out-of-hours services
  • Walk-in centres
  • Consultations from pharmacies

Temporary relocation – Students that live away at university tend not to register with a local GP, and will visit A&E to have their medical needs attended to

New parents were particularly sensitive to the changes in their newborn’s health condition - This meant they would likely go straight to A&E to receive immediate medical attention for their child

Social Cognitive Behaviour - Previous experience and following the behaviour of others in their family, peer group or community who always go to A&E, regardless of their ailment, because they have previously received treatment there

Lack of confidence in self care – Members of the Bangladeshi community worried about the symptoms of diarrhoea, for example, had only experienced it as a life-threatening condition

Lack of confidence in primary care – the ‘white coat and stethoscope’ effect, which was more trusted than the ‘short sleeves and chat’ experience in primary care. “How did he know I wasn’t properly ill? He didn’t even get a stethoscope out.”  

Optimising your services & re-educating citizens

Only when insight (such as that discovered in Greater Manchester) has been gathered effectively can Urgent Care services then move away from reactive ‘fire-fighting’ of inappropriate service use towards proactive solutions. Through vast experience in working within and around the NHS, ICE is able to co-create bespoke solutions based upon our customers and their citizens’ needs.

For Manchester’s Choose Well campaign, it was a combination of our engagement, digital & creative specialisms that were required to develop a meaningful online service that would help citizens consider and choose the most appropriate health service or, where possible, how they could self-manage their health.

One of the key challenges we faced was making the digital solution universally acceptable to the diverse and multi-ethnic population of Greater Manchester. Through co-creation workshops, we defined the content for the site and tested the imagery and designs to make sure that they resonated strongly with all our target audience groups. In particular, we wanted to test the characters and animations on the site to ensure it was easy, simple and avoided any form of stereotyping.

In addition, we produced a range of marketing resources including health professional information packs and public facing leaflets and posters which were put on display across pharmacies, A&E departments and GP surgeries in Manchester. We also published the videos from the site on YouTube.

Following the website’s launch in May 2014, it has achieved well over 42,000 page views from 32,000 unique users.

Manchester is just one of the many examples of how we’ve supported organisations in improving citizen health choices. ICE has worked with NHS Coventry to co-create their own solution to help citizens choose more appropriate levels of urgent care services. In awareness raising events that were developed with ICE, we engaged with over 4,000 members of the community, understanding why people choose services and identifying levers for ‘channel shift’ - whether it is to A&E, walk-in centres, GPs or pharmacy consultations.

In a forthcoming issue of ICE-spy, we’ll share a special feature on our work in creating Gloucester CCG’s ‘ASAP’ solution. Using combinations of technology, engagement and nudging with target audiences, the organisation achieved impressive results in a short space of time.

“Within the first week of the campaign, NHS Gloucestershire Health community witnessed an 8% reduction in emergency department attendances and a corresponding 8% increase in attendances at the county’s Community Minor Injury and Illness Units.”

So in ‘summery’ (if you pardon the deliberate pun), we hear you Jon Snow, winter IS coming. We understand that it’s July and for some, the mind drifts off to summer holidays shortly before the body catches up. However, like our children, we will soon be back to school and there will be much to do. As Alan Lakein once said: “Planning is bringing the future into the present so that you can do something about it now.”

What will your approach be to ensure sustainable, proactive responses are in place?

To find out more about any of our approaches, to request a full case study or to have a discussion on how ICE can help you, please contact:

Simon Platt and Jane Cryer on 0845 5193 423 or at /