Story Street Walk-in Service Service User Engagement www.hullccg.nhs.uk NHSHullCCG @NHSHullCCG
Page 2 Story Street Walk-in Service Service User Engagement Introduction The Walk-in Service is based in the Wilberforce Health Centre, Storey Street Hull. It is open between 8:00am and 8:00pm seven days a week. The service offers a walk-in GP service for those visiting the city, those who are not registered with a GP, or those with an urgent care need. In 2014 the walk-in service had 32,800 attendances; this was 7,800 above the baseline activity agreed in Year 2 of the contract. This equates to an additional cost of 159k and total contract value of 988k. Activity has been stable in the last 3 years at around 33,000 attendances per year. More detailed analysis of the activity has recently been attempted to understand usage. No comprehensive routine data is collected which makes analysis difficult, although the following statistics have been produced. In 2013/14 there were 21,100 patients (not attendances) in total of which 72% were registered with another Hull CCG practice (15,250). This appears high in comparison to some national benchmark data (62%). 2,900 patients (14%) were from NHS East Riding CCG practices 3,000 patients from other CCGs or unknown. Goals By undertaking this engagement exercise we hope to gain an understanding of; How people came to attend the walk-in centre Some of the decision making or referral processes Why service users attended the walk-in centre rather than their own GP How inappropriate use of the walk-in service might be addressed Methodology A questionnaire was developed and handed to every person attending the walk-in service between Monday 3 rd August and Sunday 30 th August (4 complete weeks) by the reception staff. 194 questionnaires were returned by freepost envelope, participants also had the opportunity to complete the survey online; the online version was also accessible via smartphone. The questionnaire can be seen in appendix (i) on page 9. ## people accessed the walk-in service during the survey period, assuming everyone was given a questionnaire this gives a response rate of ##%. Full demographics of respondents can be seen in appendix (ii) on page 13.
Story Street Walk-in Service Service User Engagement Page 3 Results Who is accessing the walk-in service? Chart 1 shows that the majority of people accessing the service are linked to Hull, living, working or visiting; respondents were asked to tick all statements that applied to them. Chart 1 confirms the previous intelligence; that approximately 14% (13%) of people accessing the walk-in service are linked to the East Riding. Chart 2 further confirms previous intelligence that 72% (70.3%) are already registered with a GP in Hull. Chart 1 and 2 infer a visitor population of approximately 10%; 10.5% visiting Hull and the East Riding, and 10.9% being registered with a GP elsewhere. Chart 1 Which of the following best describes you? (n=191) Chart 2 Are you registered with a GP? (n=192) Live in Hull Work in Hull Visiting Hull Live in the East Riding Work in the East Riding Visiting the East Riding Yes, a GP in Hull Yes, a GP in the East Riding Yes, a GP elsewhere No Don t know Chart 3 Diagram to show when respondents live (n=106)
Page 4 Story Street Walk-in Service Service User Engagement Chart 4 What did you visit the walk-in centre for? (n=185) A problem you had A problem a child you care for had A problem an adult you acre for had Chart 3 shows where the Hull respondents live; the highest number of people accessing the walk-in service live in the HU3 (23.8%), and HU8 (17.5%) postcodes, whereas the lowest number accessing the service live in HU2 (2.5%), HU1 (3.8%) and HU6 (5.0%). The majority of people accessing the service are attending for a problem they have (76.8%) see chart 4. 21.1% of people accessing the service were attending with a child, only 2.2% attended with an adult they care for. How are patients arriving at the walk-in service? Chart 5 Did you try and get an appointment to see your own GP? (n=182) People attending the walk-in service can be split into two groups, those who attempted to access their GP (58.2%) and those who didn t (41.2%) see chart 5. Chart 6 Reasons respondents attended the walk-in Centre rather than their own GP (n=92) Yes No Don t know The reasons why people attended the walkin service after attempting to access their own GP can be seen in chart 6, the majority (70.7%) of respondents stated that they were unable to get an appointment within 2 days, this is reinforced by the free text responses to question 6. Three representative comments are below, all of the comments can be seen appendix (iii) on page 15. There were no appointments for 2 weeks Unable to get through to the surgery A child can t wait Chart 6 also shows that 6.8% of people didn t attend their GP based on choice; there was an appointment but I couldn t make it (3.4%), the doctor I like wasn t available (1.7%), there were only nurse appointments available (1.7%).
Story Street Walk-in Service Service User Engagement Page 5 Chart 7 Reasons respondents attended the walk-in centre, the people or services who directed them there. (n=175) told by GP told by NHS 111 told by Friend or Relative told by A&E department Told by employer or colleague told by NHS choices The reasons why people did not attempt to access their GP can be seen in chart 7, a third of people were told to attend the walk-in service (31.1%), the majority (72.5%) of those were told by the NHS to attend; 34.9% by the GP, 30.3% by NHS 111, 5.5% by the A&E department, and 1.8% by NHS choices. The next highest reason for attending the walk-in rather than GP was informed choice (23.3%); 10.2% felt the walk-in service was the best place to get treatment, 9.6% had used the service before, and 3.5% felt ill in the city centre. 22.1% of people attending the walk-in did out of convenience; I didn t have to make an appointment (11.6%), it was easy to get to the walk-in service (10.5%). Those giving another reason (11%) fall into two main categories, those without a GP (including those visiting the city) and those unable to access primary care. The free text also reinforces the previously discussed choices. All responses can be found in appendix (iii) on page 16 Chart 8 Reasons respondents attended the walk-in centre, the people or services who directed them there. (n=175) Chart 8 shows how people attending the walkin service were made aware, this confirms the findings of chart 7, 36.2% of people finding out about the service from a health provider or agency.
Page 6 Story Street Walk-in Service Service User Engagement Is the walk-in service meeting their needs? The walk-in service is meeting the needs of people attending, 93.5% of service users stating their needs were met (chart 10). Service users are happy with the waiting time, 83.5% stating they waited about the time they expected or less (chart 12). This is further supported by; 9.6% of service users returning (chart 7), chart 8 showing that 21.1% of people found out about the service from a relative or friend i.e. a recommendation, and by the response to question 15 please use the space below to make any further comments about the walk-in centre which contains a large number of positive comments about the service see appendix (iii) on page 17. Chart 9 Graph to compare what type of healthcare professional people hoped to see, and which type they actually saw (n=190) Chart 10 Did the healthcare professional you saw meet your needs? (n=182) More than my needs Met my needs Less than my needs Don t know Actually saw Would like to see Chart 11 How long did you spend at the walk-in service? (n=180) Chart 12 How long did you wait before you got an appointment or saw a healthcare professional? (n=176) Longer than I expected About what I expected Less than I expected
Story Street Walk-in Service Service User Engagement Page 7 Conclusions It is clear that the primary factor contributing to walk-in centre attendance inability to access a GP. 58.2% of people who attend the walk-in service have already attempted to see the GP they are registered with, and a third of those who were told to attend the walk-in service were told by a GP practice. Clear referral criteria, both formal and informal, should be re-communicated to NHS partners as the majority of people who were told to attend the walk-in service were told by a healthcare provider or agency. It is important that partners are referring appropriately, and not to alleviate service pressures to ensure financial resources are appropriately utilised. A multi-agency communications campaign is required to clarify the following: Services that can be accessed for non-urgent care needs (e.g. GP, Pharmacy), including acceptable or expected waiting times, and what to do if people cannot access with an acceptable amount of time. What is an urgent care need, what services are available for urgent care needs, and how they can help, with acceptable or expected waiting times. How inappropriate access of services impacts on other services and healthcare resources. This should help relieve pressure in primary care and improve expectation, while ensuring that those with a legitimate urgent care need access the right urgent care services, at the right time. It is clear that there is a need for a walk-in GP service as there are people attending who are visiting the city, or are not registered with a GP, or have an urgent care need. Any decisions based on this information should take the visitor population into account. Although this exercise took place during the school holidays, approximately 10% of respondents fall into the visitor category, it should be noted that. The number of visitors to the city is expected to increase during 2017 as part of Hull being the city of culture. The student population; although students residing in university accommodation are encouraged to register with a GP, not all do. This is a regular variation in the population that are less likely to be registered with a GP, and therefore more likely to require a GP walk-in service. NHS East Riding of Yorkshire CCG should be made aware of the findings to ensure residents are appropriately accessing services.
Page 8 Story Street Walk-in Service Service User Engagement Appendices i. Walk-in Service Questionnaire ii. Demographics of Participants iii. Free Text Responses
Story Street Walk-in Service Service User Engagement Page 9 Appendix (i) Walk in Service Questionnaire
Page 10 Story Street Walk-in Service Service User Engagement
Story Street Walk-in Service Service User Engagement Page 11
Page 12 Story Street Walk-in Service Service User Engagement
Story Street Walk-in Service Service User Engagement Page 13 Appendix (ii) Demographics of Respondents Distribution of Service Access Chart 13 What day of the week did you attend the Walk-in centre (n=192) Chart 14 What time of day did you attend the Walk-in centre (n=189) Monday Tuesday Wednesday Thursday Friday Saturday Sunday 8:00am 12:00pm 12:00pm 4:00pm 4:00pm 8:00pm Distribution of Service User Characteristics Chart 15 Age of Respondents (n=37) Chart 16 Ethnicity of Respondents (n=104) White English / Welsh / Scottish / Northern Irish / British White other Asian / Asian British Black / Black British Mixed / Multiple Ethnic group Prefer not to say
Page 14 Story Street Walk-in Service Service User Engagement Chart 17 Religion of Respondents (n=98) Chart 18 Gender of respondents (n=102) No Religion Buddhism Christianity Hinduism Islam Judaism Sikhism Prefer not to say Male Female Prefer not to say Chart 19 Respondent Sexuality (n=99) Chart 20 Are your day to day activities limited because of a health problem or impairment which has lasted, or is expected to last at least 12 months (n=94) Heterosexual (Straight) Bi-sexual Gay / Lesbian Prefer not to say Yes, limited al little Yes, limited a lot No Prefer not to say Chart 21 Do you identify with any of the following impairment groups? (n=26)
Story Street Walk-in Service Service User Engagement Page 15 Appendix (iii) Free Text Responses Question 4 How did you find out about the walk-in centre? Respondents identified the following additional places / ways they found out about the service: PCSO Just knew employer A&E Always know about it cannot remember Aware since opening Partner works for the NHS Through work Work for the NHS Newspaper Local knowledge Question 6 To help us understand the reasons why you attended the Walk-in centre rather than your own GP, please tick any of the following reasons that apply? The responses specified for another reason were: Away from home No appointments I could only attend on a weekend It was to urgent to wait for my doctor very poorly! No Doc No appts for a week 2 week wait No appts Couldn't be bothered to wait for an appt Receptionist told me to go to story street There were no appointments for 2 weeks Always off! My GP couldn't see me for 3 weeks There were no appts available in the next two weeks No practice nurse A child can t wait a week Crap Doc! No appointment for 10 days Next appointment was Monday (5 days) Unable to get through to the surgery
Page 16 Story Street Walk-in Service Service User Engagement Question 7 To help us understand the reasons why you attended the Walk-in centre, please tick any of the following reasons that apply? The responses specified for another reason were: Away Someone else I forgot to register with a Dr when I moved to Hull this is the first time I have need a Dr I work in the same area No appts at my GP Can never get an appt at my own surgery MIU told me to go there Can never get an appointment on the day at my surgery PCSO Prescription had ran out can t get to my own Drs because of my working hours I m here on holiday and forgot my tablets Working in the area for 3 months live 80 miles away Child I live in Scotland A&E had a lot of patients and a 7 hour waiting time they recommended the walk-in-centre for minor ailments I moved to another address Once again a child can t wait a week Was emergency A&E Crap!! Self I can never get a timely appointment. They are always days ahead. My own idea because it was urgent though I have an appointment for wed (7 days) We always have to wait days for appointments Don't know anywhere else Needed to see a doctor now Between GPs because of moving house Have to wait about a week for an appointment, easier to come here and you don't need an appointment Infection occurred overnight, I work in town No appointment available at GP Never able to get a GP appointment No appointment at the doctor I needed an appointment straight away I am looking for somewhere to live in hull and just staying for now. Not yet registered with a GP in Hull Urgent infection
Story Street Walk-in Service Service User Engagement Page 17 Work in town centre Near to where I am staying Question 15 Please use the space below to make any other comments about the Walk-in centre? The additional comments were: Excellent!!! Good Thank you I arrived a t 8am when it opened, but the GP did not arrive until 8.10am he didn t see patient told he was doing paperwork Very good but should be able to book an appointment The nurse who saw me was very helpful Thank you all very much More needed Needed emergency inhaler for hols. No fuss Brilliant service for the NHS seen promptly and treated with dignity and respect Pleasant experience Quick and staff were nice Fast, efficient, friendly, service. Better than my GP Handy for students that are registered elsewhere Better service then my own GP, staff are pleasant and helpful, great when it s urgent - like I was! There are too few Drs for the amount of people attending, the time I was waiting I only saw 1 Dr Brilliant Service!!! As I have been before I know the best number to ring to find out the waiting times as they can vary also very helpful very good service although needs more clinical staff when busy Quick and convenient Really nice staff at the surgery I was really upset when I arrived but the staff made me feel better. The Dr saw me quickly and was nicer then my Dr! i might even register here!!! Great service, godsend, very nice friendly folk, will use again Wasn't urgent enough for A&E but i couldn't wait over a week. I was in great discomfort and getting worse. Thank heavens for this service. Easy, convenient, great Very convenient My son suffers with his tonsils all the time. Always go to storey st. Might have a wait sometimes but he will get seen. Fantastic service Very friendly and helpful staff Got told the wait would be 15 mins and I was waiting nearly 1 hour. Noisy waiting room. Smelly. Good staff
Page 18 Story Street Walk-in Service Service User Engagement Shame this service has to be because I can t get to see my own GP I was seen very promptly and as a result straight to A&E. This service saved my life last year. I have been using this service ever since as it is more efficient than my GP. Couldn't praise the service highly enough. Thank you. My surgery told me i could get a repeat prescription but this wasn t the case, the staff were very polite explained why so my surgery obviously gave me the wrong information, I will go again as it was very helpful Staff were very good Very polite and caring staff, professional Better than my GP surgery Very helpful and gave an emergency supply Happy staff and helpful at reception Hospital told me to go, but they didn t do stitching so they sent me to Bransholme Seen in my lunch break treated and back to work very good and convenient I rang first and was told the waiting time approx. very helpful and my child was treated very well Fantastic! Takes the piss Very handy and good value service I was very grateful to be seen my own GP surgery was closed. The waiting time was acceptable, friendly staff Fantastic place and staff! More Drs and nurses to deal the demand Good Helpful and useful service for my child whilst visiting relatives It seems a lot of people from the local area use the walk in centre instead of going to their own GP, thus increasing the waiting times Good to get seen and treated, nice friendly place Very good service and convenient Brilliant service, needs to be 24/7, my children and family are safe with this service, available everyday unlike my surgery!! Sometimes very busy but today was good It is lovely as I don t have to suffer till i get to see my doctors Ok Left medication at home Good and quick I prefer to see my own GP but can never get an appointment!! I always end up coming here as it is easier and you always get seen. Very helpful and friendly The Reception staff deserve a medal! Excellent service better than my own GP A credit to Hull The surgery is much better than my own GP's
Story Street Walk-in Service Service User Engagement Page 19 Brill!! Helpful useful service Thank you, excellent :-) 10/10/2015 I was already told by the reception staff that i'd have an hour wait before i could be seen so i was prepared for the wait as it was still shorter that having to wait 2 weeks to see my GP!, saved me a long wait in pain. An invaluable service to the public. The staff are always helpful and go the extra mile to make sure you are seen promptly, i am elderly and without this service i would have had to wait in uncomfortable surroundings for much longer at the A&E Lovely service pleasant staff would recommend. Don t shut it! Good and quick Fantastic recommended a week off work Didn t realise what a great place it was and so easy to find the Receptionists so helpful too! The Dr was very good and helpful other options was A&E Brilliant my own GP wouldn t give me a prescription Sent me back to A&E Long wait! More Drs! Luckily not busy enough staff for amount of people, 1 nurse My client was disabled and wasn t very well but the staff made sure he was seen and was very friendly fantastic service. Would highly recommend Need more staff Very busy only 2 clinicians Excellent and necessary service. Thank you. Very friendly and helpful Need more doctors on The doctor needs to shout louder for their next patient