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Good Practice: Primary care - Bringing down A&E attendances

Community minor emergency services work, say Drs Shyamal Mukherjee, Abhi Mantgani and Shanila Roohi.

Eastham Clinic, a new walk-in service started in February 2010
Eastham Clinic, a new walk-in service started in February 2010

Improvements in community-based urgent care services in Wirral, including an innovative pilot at two GP practices in Birkenhead, have helped to reduce A&E attendances by more than 5 per cent during the past year.

Situated on Merseyside, Wirral has a registered GP population of more than 332,000, and NHS Wirral is classed as a 'spearhead' PCT. This means the population's health and deprivation levels vary considerably - west Wirral is affluent, while east Wirral has high levels of deprivation. Between the two areas, average life expectancy varies by almost 12 years.

Our community-based minor emergencies schemes were designed to capture inappropriate A&E attendances and are overseen by the Wirral Urgent Care Network, headed by NHS Wirral locality medical director for Wallasey Dr Shyamal Mukherjee, the lead for urgent care services.

Practice-based pilot

- Minor emergencies service at two Birkenhead practices, Miriam Medical Centre and Parkfield Medical Centre.

- Managed by a nurse practitioner and staffed by a nurse practitioner/staff nurse team.

- Run on a 'drop-in' basis from 12 noon to 8pm, Monday to Thursday; 12 noon to 6pm on Fridays.

- Problems seen include bites, burns, scalds and minor head or eye injuries.

Improving access
The network looked at improving access to a range of services, and our local Choose Well campaign also focused hard on informing patients on where to go for the right treatment.

Dr Mukherjee says: 'The picture across Wirral has been very positive. A&E attendances have dropped by almost 5,000 over the past year, with patients using alternative community-based services instead.'

He adds that extended hours at GP practices and at the minor injuries unit at Victoria Central Community Hospital in Wallasey are having a significant impact, alongside the new Birkenhead minor injuries practice-based service and a walk-in centre that opened in Eastham in February 2010.

The Victoria Central minor injuries unit is now open seven days a week and has X-ray facilities. A&E attendances reduced in 2009 by 22.6 per cent from the previous year and around 37,700 patients were seen from May 2009 to April 2010.

The All Day Health Centre, a walk-in centre on the Arrowe Park Hospital site, attracted 47,000 patients during the same period, while a new primary care access unit at the hospital, has helped to reduce A&E attendances.

Through collaborative working with the Wirral Practice-Based Commissioning Consortium of 22 GP practices, a minor injuries pilot scheme was set up at Miriam and Parkfield medical centres in Birkenhead.

Referrals from GPs
Philomena Potts, nurse practitioner and a partner at Miriam Medical Centre, says: 'We are receiving many referrals through GPs and pharmacies, and the numbers of patients are steadily increasing. We are encouraging more people across Wirral to take advantage of the services now on offer.'

Ms Potts says feedback from patients has been excellent. Of those seen in the past year, 95 per cent did not require A&E treatment. The 5 per cent that did were stabilised and sent to hospital by ambulance.

Presentations included minor burns, urinary infections, 'morning after' pill requests, falls, leg ulcer dressings, chesty coughs. On average, a patient waits less than 20 minutes to be seen.

NHS Wirral locality medical director for Birkenhead Dr Abhi Mantgani says: 'A&E is for saving lives so we need to ensure hospitals are not clogged up with minor ailment presentations which could potentially delay a severely ill patient receiving treatment.'

He explains that, to date, the pilot has dealt with more than 2,500 patients with minor illness and minor injury problems who would have otherwise ended up at A&E.

'It has been very successful. We recognise that the capacity to increase the activity is there - by perhaps three or four-fold, which will bring down the (A&E) costs significantly.'

Dr Mantgani says the two GP practices have had referrals from 56 of the 62 Wirral practices. 'We believe with more publicity and more positive experience of our service, the scheme will further develop and help to provide health services closer to people's homes.'

Birkenhead mother Carla Ferns praised the service after her seven-year-old daughter Ellie-Mai fell face first off a climbing frame pole in a Birkenhead park last August, which caused swelling to her left eye.

She said: 'I really panicked after it happened but she was treated immediately at Miriam in Laird Street. If it wasn't for the nurse reducing the swelling we would have had to go to A&E. The service there was brilliant.'

Access to primary care for minor emergencies was further increased in February 2010 when a new walk-in centre opened at Eastham providing a nurse practitioner-led service for the people of south Wirral, as well as a local base for GP out-of-hours-services. By the end of April, the centre had seen 1,363 patients.

NHS Wirral locality medical director for Bebington & West Wirral, Dr Shanila Roohi, adds: 'We have exciting times ahead with the planned opening of the Warrens Health Centre in the west part of Wirral in 2012: this could help to further reduce A&E attendances.'

Chief executive of NHS Wirral Kathy Doran says the efforts of primary care health professionals across Wirral - at the Victoria Central, the walk-in centres and at the two GP practices - have helped to reduce A&E attendances.

'These savings are welcome, especially in the current financial climate and plans are underway for the community-based scheme to be expanded so that we can further help our local hospital.'

Wirral GPs Drs Mukherjee, Mantgani and Roohi are locality medical directors for NHS Wirral

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