Trafford Urgent Care Review
Background
NHS Greater Manchester (NHS GM) worked with partners to carry out a review of urgent care services for the people of Trafford.
We wanted to ensure that access to urgent care services was simple to understand, was joined up with other parts of the health and social care system, and met people's needs.
What is urgent care?
Urgent care is the diagnosis and treatment of medical conditions which are serious but pose no immediate threat to life, limb or health but requires medical attention within 24 hours. It can be delivered by different services such as GP practices, pharmacies, NHS 111 phone line and website, urgent treatment centres or emergency departments.
How people were involved
As part of the Needs Assessment to support Trafford Urgent Care Review, NHS GM arranged a series of engagement activities that were undertaken between January and February 2023 to capture the experiences of people and communities.
This included:
- 11 x listening sessions with established community groups.
- 6 x public drop-in sessions at libraries in Trafford.
- an online survey hosted on NHS GM website.
These were promoted widely by partners across health and care services.
We spoke with 155 people. We also received 297 fully completed survey responses and 330 partially completed responses.
We commissioned Healthwatch Trafford to undertake analysis of the feedback.
Considering findings of the needs assessment and developing a draft priority work programme
During October 2023, NHS GM ran a series of focus groups for those organisations and groups who attended earlier urgent care engagement sessions in Jan/Feb 2023.
This was to provide an update about the findings from the first stages of the review and to seek views about the suggested draft priorities we may focus on next as part of a programme of work for 2024/2025. A further session took place in November 2023 with Trafford Deaf Partnership.
Feedback from these sessions was used to help inform recommendations of a draft programme of work which were received and endorsed by NHS Greater Manchester Board (see below).
Key findings from the needs assessment
Below are the key themes from feedback we received during the engagement:
- People are generally aware of the larger services around them but not those at a community or local level, such as the crisis café at Bluesci.
- Most people also knew how to access the major care providers (hospitals and GPs).
- Many people raised concerns about not being able to get a GP appointment and long waiting times to see a doctor.
- The quality of care at GP practices is generally felt to be acceptable. There was some praise for individual practices and doctors in the free comment section.
- People felt that waiting times at emergency departments were too long and often in uncomfortable and ‘chaotic’ conditions. It was felt that fewer people would attend A&E if seen to by their GP or other appropriate services more easily.
- Mental health was consistently an area of concern. People felt access was almost impossible for young people and children.
- Many people were unsure where to go to access treatment for different concerns, or where to go to find this information.
- The discussions with local groups resulted in tangible examples as to why service access is challenging for many. For example, many people cited AskmyGP as a barrier to access.
- People across the community raised the issue of needing physical information as well as digital, such as noticeboards and leaflets.
- Concerns were voiced over local pharmacies not being a wholly reliable service, with good and bad experiences tied to individual sites, and many recently closing, reducing access.
We undertook further survey analysis based on postcode:
- Concerns raised in North and Central areas of the borough in terms of access to face to face advice and treatment.
- Lower levels of knowledge to West (Partington) of services available to patients.
- Concern in West (Partington) around being able to get an appointment or speak to someone for urgent care at a practice.
- Patients particularly in North areas of Borough advised to go elsewhere by a practice.
- Where patients were advised to go elsewhere they predominantly used NHS 111, Emergency Department (ED) or a Urgent Treatment Centre (UTC).
- Patients in West (Partington) and North identified they could not get an appointment with their practice so went elsewhere.
- Lack of knowledge in West (Partington) regarding evening and weekend primary care appointments.
- Clear need in West (Partington) of patients attending a UTC as they couldn’t get an appointment with their own GP.
- Concern around access to Mental Health provision in North and West areas of the borough.
Areas:
North: Old Trafford, Gorse Hill, Stretford.
West: Carrington, Davyhulme, Flixton, Partington, Urmston.
Central: Ashton on Mersey, Sale, Sale Moor.
South: Altrincham, Bowdon, Hale Timperley.
Recommendations
Following the Trafford Urgent Care Review, a number of recommendations emerged. These are listed below.
- Improve Out of Hours Provision in Trafford: NHS GM colleagues work with the Trafford Out of Hours provider to establish a physical Out of Hours presence within or closer to Trafford.
- Improve triage and assessment of patients at Trafford General Hospital/Urgent Treatment Centre: System partners look to develop the streaming processes at the front of Trafford General Hospital and the opportunity to utilise a tablet or other electronic device to ensure patients are streamed to the most appropriate service for their needs.
- Develop consistent advice from Primary Care: The system looks to develop a pilot to explore the opportunity to refer patients directly to a GP from a pharmacy, utilising the Trafford Patient Assessment Service (provided by Mastercall) to provide a timely response and patient contact by a GP within 30 minutes. This will provide additional GP capacity through utilising existing services and improves access.
- Simplify access to services: NHS GM ICB colleagues will work with NHS 111, Directory Service Leads and Providers to ensure that patients are directed to the most appropriate service for their needs at the earliest opportunity.
- Improve streaming of patients between services: NHS Greater Manchester colleagues will work with Manchester University NHS Foundation Trust and Primary Care colleagues to ensure patient pathways for referring to specialist services rather than attending Emergency Departments is utilised effectively.
- NHS Greater Manchester Colleagues will work with GP practices and other services across Trafford to remove variation in NHS111 being able to book patients into appointments that should be available across the system.
- Undertake a controlled pilot for the Trafford Out of Hours service to directly book patients into an Emergency Department or Urgent Treatment Centre with the potential to expand to all primary care practices being able to book into these services in the future.
- Improve communication on urgent care: Amplification of the NHS GM Get to Know Where to Go (GTKWTG) campaign. Targeting GTKWTG messaging and materials to audiences in Trafford based on findings from this review. The NHS Greater Manchester Trafford commits to supports the proposal for investment in the amplification of the GTKWTG campaign within Trafford to ensure a wider reach of comms and engagement across the locality.
- Altrincham Minor Injuries Unit: Permanent closure of the Minor Injuries Unit service based at Altrincham Hospital with the continual relocation of services to the Wythenshawe Hospital site.
- NHS GM ICB (Trafford colleagues) work with Manchester University NHS Foundation Trust to ensure efficient and appropriate streaming of Minor Injury patients into the UTC at the Wythenshawe Hospital site is effective and robust.
- NHS GM ICB (Trafford colleagues) work with Manchester University NHS Foundation Trust to explore opportunities to utilise the additional space within the Altrincham Hospital site made available by the permanent closure of the Minor Injury Unit service (2 consulting rooms).
- Same Day Urgent Primary Care resilience for Partington: Additional capacity to support and improve the availability of same day urgent care offers.
- Partington: Undertake a programme of focused intervention and consideration of wider health inequalities within Partington.
Phases
Engagement reports and other useful information
Click on documents below for more information about the initial phases to support the needs assessment and the development of draft priorities and a programme of work for 2024/2025.
Thank you to everyone who provided feedback, welcomed us to their established meetings or supported us to ensure a wide reach of views.