Lancashire patients choosing urgent care services over their GP, inspectors find

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Some Lancashire residents are choosing to use under-pressure urgent care services for help that could be sought from their GP.

That was one of the conclusions of inspectors who have been assessing how the urgent and emergency care system operates across the county and neighbouring South Cumbria.

They also said that they found “significant delays” for people awaiting treatment in emergency departments. - and for help from the NHS 111 service

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The Lancashire and South Cumbria patch is amongst the first in the country to be inspected under the Care Quality Commission's (CQC) new pilot regime of assessing multiple health and social care providers within an area in order to get a picture of the entire patient journey through urgent and emergency care services.

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The regulator also wants to judge how individual operators work together to address any challenges that need to be dealt with collectively across a wider geographical area.

To that end, more than 30 services in the region - including hospitals, the North West Ambulance Service (NWAS), GP surgeries and some adult social care providers - were inspected and individual reports produced about the performance of each of them.

In an overview of its findings for the whole of Lancashire and South Cumbria, the CQC said that some people were deciding to access urgent care services instead of their GP.

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It said that feedback on such services was “mostly positive”, but that work was under way with local communities to get an idea of why people were often preferring that option over seeing their own doctor.

Meanwhile, the CQC said that ”staffing issues” and high demand were responsible for delays experienced by people seeking support from NHS 111, which serves Lanmcashire and South Cumbria as part of a wider North West-run facility.

“The…service would benefit from a wide range of clinicians to be available such as dental, GP[s] and pharmacists to negate the need for onward referral to other service providers,” the overview concluded.

It also found that people who called 999 for an ambulance experienced notable delays because of hold-ups in handing over patients at some A&E departments in the region, which “significantly impacted on the ambulance service’s ability to manage the risk in the community”. NWAS was said to focus on a “system-wide response” across the patch when services were under additional pressure.

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Delays were also identified in triage and initial treatment within emergency departments which “put people at risk of harm”.

At the opposite end of the urgent and emergency care pathway, patients who were admitted to hospital often faced delays when they were ready to be discharged - exacerbated by a lack of social care capacity in the community and the failure to plan for a patient's discharge from the moment they arrived on the wards.

Meanwhile, staff across all of the assessed services felt "tired and...under sustained pressure", the CQC said.

Ann Ford, the organisation's network director, said it was important for health and social care leaders to work together to ease that pressure on both staff and emergency services.

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She added: “More needs to be done to deliver system-wide solutions to ensure people consistently receive high-quality, timely care and treatment in the right service.

“It was concerning that people calling 999 for an ambulance experienced significant delays - and once they arrived at hospital there were delays in relation to handovers from the ambulance crews to hospital, although the length of delays varied from hospital to hospital. Delays meant that ambulance crews were experiencing difficulties in responding to other calls in a timely manner.

Inspectors found mental health services delivered from emergency departments were well run and meeting people’s needs. This has improved since the previous inspection of these services in 2019.

“However, accessing mental health inpatient services remained a significant challenge in terms of local availability. This often resulted in people being cared for outside their local area,” Ms Ford said.

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Kevin Lavery, chief executive of the newly-formed Lancashire and South Cumbria Integrated Care Board (ICB) - which is now responsible for most NHS spending in the region - welcomed that the CQC found that "many of our local services are providing good, safe care and effective treatment".

He added: The CQC’s review took place during a time of considerable and ongoing pressures within urgent and emergency care that were being experienced, both locally and nationally, resulting from seasonal pressures, the Covid-19 pandemic, and workforce challenges.

“We recognise as a system [that] we need to make improvements and are working closely with the North West Ambulance Service and across the North West to improve NHS 111 performance and have been working across Lancashire and South Cumbria to reduce long waits in our emergency departments.

“These are big challenges we need to tackle together with local authorities, primary care and wider community partners – and we will.

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“Lancashire and South Cumbria health and care partners will continue working together closely to improve the performance of our urgent and emergency care pathways. By working collaboratively as a health and care system we have a real opportunity to make improvements so that local people and communities can receive sustainable, high-quality, safe and effective urgent and emergency care services at the right time and in the right place and [ensure] every patient’s care journey is as smooth as possible.”

Meanwhile, Sarah O’Brien, chief nursing officer for the Lancashire and South Cumbria ICB said that organisation was looking to work more closely with the likes of adult social care and community services “to enable people to live healthier lives at home, which will help to improve our urgent and emergency pathways”.

She added: “We’ll continue to work with general practice and partners such as community pharmacy to look at ways we can improve access to same day appointments and ensure that people are supported to access the right service to get help.

“Our staff across NHS, adult social care, community services and the voluntary and community sector have worked incredibly hard through a very challenging time over the past two years – particularly responding to the Covid-19 pandemic and now in a phase of recovery. I would like to thank them all for their hard work and dedication, which is clear to see in the CQC inspection reports, and for their continued efforts to support our population across Lancashire and South Cumbria.”