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Would better communication solve this game of snakes and ladders?

GP Hub Purley

By Gordon Kay, Healthwatch Croydon Marketing Officer

Last month, we were contacted by a Croydon Grandmother who told us her story of what happened when her grandchild had a suspected fracture.

Being aware that the Purley GP Hub, would be the nearest and most relevant place to go, they went there. Previously, the Minor Injuries Unit was always nurse led and residents were told that this was the reason they could not access the x-ray facilities. Now the Hub was GP led, it followed that the xray facilities would now be accessible.

They waited for an hour and half before seeing a GP who suspected it may be fractured and suggested she go to Croydon University Hospital’s Urgent Care Centre as they could x-ray it. When the grandmother suggested there were x-ray facilities at Purley she was told that they were not available for this type of injury. So finally she went to East Surrey Hospitals A&E department and got the care for her granddaughter there, which meant another three- mile journey and more delay in getting treated.

Whatever people may feel about a service, nobody should have to wait over two hours in pain and have to see one specialist who then tells you to go somewhere else. Isn’t this the opposite of an integrated minor injuries service that is supposed to take the pressure of A&E?

This story raises two big issues one about buying of services that an x- ray facility exists that cannot be used and the other about poor signposting and communication of existing services.

Buying of services

We investigated further the pathway. Why is it that there are x-ray facilities at Purley GP Hub, but on this occasion they could not be used? Croydon Clinical Commissioning Group (CCG) told us that all GPs have the power to refer an x-ray at Purley but these are for injuries considered more serious, such as a chest injury.

We were advised that patients with injuries considered less serious should go to go directly to Croydon University Hospital. In short, while an x-ray facility exists it is only used in certain situations and there is no requirement to x-ray for suspected fractures at Purley.

To the public this is clearly a confusing proposition. The reason for this is that this was not an essential option in the recommissioning of urgent care services that concluded in 2016.

While the issue was discussed in the reprocurement process, the decision was taken that in order to meet the ‘right place, first time’ requirements for treatment, x-rays for minor injuries would be performed at the Urgent Care Centre at Croydon University Hospital.

The problem was that this has not been clearly or effectively communicated. Indeed Healthwatch Croydon only found this out after being sent a link by the CCG to a set of questions about the reprocurement process published deep within the CCG website.

Lack of effective signposting

As our research into GPs which is being published this week shows this is indicative of a system that is confusing the public. Indeed our research at hubs showed that whilst the majority of people we spoke to are happy with the quality of service provided, a clear majority were also unclear as to what was provided and where.

When hearing this grandmother’s account, we feel that she should at least have been informed at Purley Hospital on arrival that they did not deal with suspected fractures, and that it may be better for her and her granddaughter to go directly to Croydon University Hospital, rather than waiting for a GP assessment. A basic triage facility would have identified the potential injury and advised accordingly. It is an obvious assumption to make that a service with an x-ray unit, will conduct x-rays and if this isn’t always the case, then at a minimum the communication of this needs to be improved. This is even truer for Purley which used to have a minor injuries unit.

Croydon is not unique in these circumstances. Only last month, NHS England published guidance on what non-hospital based centres should be offering from 2019 see Urgent Treatment Centres – Principles and Standards July 2017.

On page 4 it talks about the public being confused by a mix of walk-in centres, minor injury units and urgent care centres, with a confusing variation in opening times and what diagnostics may be available. It is even refers to x-ray facilities but still refers to their use in some cases and later on page 8 at the recommendations makes only desirable plain x-ray facilities available, uses the number of people using the service as an deciding factor.

So what can be done?

Firstly, there needs to be better communication of the quickest, most effective pathway for people with different injuries and conditions to take when they arrive. This starts with effective triaging at GP hubs. By having trained professionals such as GP and nurses on the front desk, they can make swift assessments and decide whether you need to stay at the Hub or go somewhere else.

Secondly, a review of the demand for x-ray services needs to be made. The reason to make this decision was based on research by the CCG back in 2015. Well perhaps demand has changed, or maybe they need to look at cases for using the facilities when dealing with more vulnerable groups such as children.

Finally, much stronger and wider communications of which services are available where and how, which are easily accessible by phone call, mobile and print advertising, so that whatever age or background, a person genuinely gets to use to the ‘right place, first time’.

It is time to end this ‘snakes and ladders’ approach to an essential service, we should all be able to get care at the right place as swiftly as possible. After all, isn’t this what the reprocurement of urgent care services was all about?