Primary and urgent care survey - use of A&E

We are particularly interested in the reasons for attending A&E, especially as a recent audit suggests that approximately a quarter of attendance at A&E could be treated in primary care.

Over half of the people attending A&E were either recommended by a health professional or were taken by ambulance.

For those who chose independently, the main reason was that they thought it was the best place for the problem. After that, a proportion went due to locality/convenience, not knowing where to go.

However, a small proportion did attend as they thought it would be quicker than a GP appointment, or because they didn’t have confidence in their GP, implying that they could have been treated in primary care.

Owing to the way the questions were asked, we can only identify the reasons for the choices for each individual service from the 443 responses in the telephone interviews. Of these, 230 went to A&E.

Table 17: Reasons for use of A&E (both sites)

People could give more than one reason

Total 230 Percentage
Best place for this particular problem 91 40%
Was recommended by a health professional e.g. GP or 111 75 33%
Did not choose - was taken by ambulance 59 26%
Nearest place to home or work 48 21%
Did not know where else to go 41 18%
Wanted a second opinion 24 10%
Thought it would be the shortest wait 18 8%
Quicker than GP appointment 15 7%
Recommended by friends, family or colleagues 8 3%
More confidence in advice there than own GP 6 3%

The section above describes the problems people have been encountering in trying to get GP appointments, both urgent on the day and routine pre-booked appointments. Some comments related directly to this link:

I think it's extremely poor that my local GP Practice could not even offer me a routine appointment - nearly a two week wait. I was very worried about the episode I had and could not wait two weeks, so I contacted 111 who said that I should visit A&E within 1 hour. I was seen in A&E and my episode was diagnosed as a minor problem which would clear up on its own, and I felt much less anxious. I can't praise A&E enough, very good service, and would go to them again. Obviously do not want to put unnecessary pressure on A&E for minor issues, but when you get a GP Practice which was completely unhelpful, and you are in a state of worry and discomfort, then using A&E becomes a practical option.

People were generally positive about their experiences of A&E:

I have had to go to A&E at Worthing hospital a couple of times this years - their service and care is excellent but do feel need more staff .

Exceptional service by ambulance and A & E at Worthing hospital when I suffered a stroke.

Thirty-eight comments were about delays/waits in A&E, and people felt there needed to be more staff (11).

A&E waiting times are so ridiculous. I had to wait 6 and a half hours. I appreciate they are busy but at Worthing Hospital they spend more time seeing to drunks in A&E than the genuine patients in need and pain.

I attended A&E with minor injury to 2 years old daughter waiting 4 hours to be seen but for the first 2hrs no one in the waiting area was called in this was frustrating as no information or communication from staff.

Whilst sitting in the waiting room in A&E it would be nice for a nurse to check on you now and again to see if you are OK and give some idea when you’re likely to be seen. Instead of sitting for hours not knowing a thing.

Table 18: Most important factors when choosing urgent care services

Which three things are most important to you when you are deciding which urgent care services to use? (Number) ranked 1-3 first second third
Confidence that staff can treat my condition 4,697 79% 41% 26% 12%
Know it will be open 2,920 49% 14% 20% 16%
Closest to home 2,884 48% 20% 16% 12%
Shortest waiting time 2,820 47% 9% 21% 17%
How easy it is to get to by car 2,188 37% 6% 16% 15%
Have used it before 1,144 19% 3% 8% 8%
How easy it is to get to by public transport 669 11% 3% 5% 3%
Recommended by friends, family or colleague 357 6% 1% 2% 3%

Including people who had, and had not used urgent care services in the last year, we asked what were the three most important things when choosing which urgent care service to use.

Table 18 and Figure 15 show that the most important factor is the confidence that staff can treat the condition appropriately with nearly 80% ranking it in the top three and 41% saying it is the most important.  Knowing it is open, how close it is to home and the shortest waiting time were equal after that with nearly half ranking them in the top three.

Ease of access by car or public transport and having used it before were not prioritised highly.

Figure 15: Most important factors when choosing urgent care services ranked in top three and first