1. Data Pack

2. Keogh – key messages The number of GP consultations has risen over recent years and, despite rapid expansion and usage of alternative urgent care services, attendances at A&E departments have not reduced. This indicates either unmet demand across the whole system or supply induced demand: increased uptake as a result of increased provision of services. The wide range of urgent care services available and lack of service standardisation and labelling results in patient confusion over how to access the right healthcare quickly; this leads to duplication, delay, increased clinical risk and poor patient experience. Q. What will we do to make access to the right service easy? The wide range of urgent care services available and lack of service standardisation and labelling results in patient confusion over how to access the right healthcare quickly; this leads to duplication, delay, increased clinical risk and poor patient experience. Q. What will we do to make access to the right service easy? Self-care for minor ailments and self-management of long-term conditions are effective at improving quality of life and reducing dependency on urgent and emergency care services. However there is a lack of awareness, particularly amongst patients in lower socio-economic groups, surrounding how to access support. Q. How are we promoting self-care locally? Self-care for minor ailments and self-management of long-term conditions are effective at improving quality of life and reducing dependency on urgent and emergency care services. However there is a lack of awareness, particularly amongst patients in lower socio-economic groups, surrounding how to access support. Q. How are we promoting self-care locally? GP practices in areas of high deprivation typically deal with greater volumes of patients with more complex physical and mental health conditions, which can lead to greater practitioner stress and lack of capacity to manage some patients effectively. This may contribute to avoidable A&E attendances and emergency admissions to hospital. Q. What is the GP to population ratio in our deprived areas? And are A&E attendance rates higher? GP practices in areas of high deprivation typically deal with greater volumes of patients with more complex physical and mental health conditions, which can lead to greater practitioner stress and lack of capacity to manage some patients effectively. This may contribute to avoidable A&E attendances and emergency admissions to hospital. Q. What is the GP to population ratio in our deprived areas? And are A&E attendance rates higher? Access to urgent GP appointments across England is variable and, in urban areas where demand is high and transient populations exist, many may use an A&E department as their first point of urgent and emergency care. Q. Is this true for us and what alternatives do we offer in urban areas? Access to urgent GP appointments across England is variable and, in urban areas where demand is high and transient populations exist, many may use an A&E department as their first point of urgent and emergency care. Q. Is this true for us and what alternatives do we offer in urban areas? Growth in the number of emergency admissions to hospital has been associated with a large rise in short or zero stay admissions. The reasons for this are multifactorial but some studies have attributed it to a lack of early senior review, risk averse triage and A&E departments trying to avoid breaching the four hour standard. Q. Is this true for us? Growth in the number of emergency admissions to hospital has been associated with a large rise in short or zero stay admissions. The reasons for this are multifactorial but some studies have attributed it to a lack of early senior review, risk averse triage and A&E departments trying to avoid breaching the four hour standard. Q. Is this true for us?

4. National Demand

5. General practice consultation rates by professional group (1999 to 2008) Ninety per cent of all NHS patient contacts are thought to take place within primary care. There is a lack of available, up-to-date, data on general practice consultation activity, but levels are thought to have been steadily increasing over the last 10 years, with an estimated 340 million taking place in 2012/13. - Keogh Nurse consultations have seen largest growth

6. The relationship between A&E attendances and results from the 2010/11 GP Patient Survey (GPPS) Is this reflected locally?

7. Unplanned care attendances 1987/88 – 2012/13 There were 6.8 million attendances at walk in centres and minor injury units in 2012/13 and activity at these facilities has increased by around 12 per cent annually since this data was first recorded in 2002/03. Despite this, attendances at major and single specialty A&E departments have continued to increase by about 1.3 per cent per year. Accident and Emergency departments have seen a significant number of patients that could be managed in other settings, adding to those with life-threatening conditions. - Urgent and Emergency Care Review, End of Phase 1 Report

8. Rise in emergency calls in England 2008/09 – 2012/13 Source: Ambulance Services England Large increase for SW in 12/13

9. Patients taken to A&E and those transported elsewhere or discharged at scene, October to December 2012 Source: Ambulance Services England We already have the lowest conveyance rate

10. Source: HSCIC ‘Focus on A&E’ Less young people in 12/13 More 45- 60yrs in 12/13

11. Source: HSCIC ‘Focus on A&E’

13. 09:00 – 19:00

15. Trend of A&E Attendances Source: GPT

16. A&E attendances per 100,000 population Source: SUS 2011/12

17. Trend of MIU Attendances Is reduction related to closures? Source: GPT

18. MIU attendances by site Source: GPT

19. A&E attendances in weeks containing bank holidays Source: GPT Average of avgatts BHNon-BH 2008/0913671262 2009/1011381272 2010/1114111290 2011/1214371344 2012/1314531336 2013/1415481388

20. Trend of 999 calls Source: SWAST

21. Trend of OoH calls

22. The relationship between A&E attendances and results from the 2013 GP Patient Survey (GPPS) – SD&T CCG Source: GPT

23. Attendances by age Age Band2010/112013/14% Change 00 to 04524.28572.549.2% 05 to 09332.51318.50-4.2% 10 to 14459.28429.52-6.5% 15 to 19472.67440.01-6.9% 20 to 24498.84476.96-4.4% 25 to 29389.91393.250.9% 30 to 34334.52356.906.7% 35 to 39311.49310.88-0.2% 40 to 44286.65296.023.3% 45 to 49283.05289.432.3% 50 to 54281.06285.521.6% 55 to 59275.67281.802.2% 60 to 64271.25261.22-3.7% 65 to 69299.55286.64-4.3% 70 to 74361.62357.87-1.0% 75 to 79480.54437.91-8.9% 80 to 84578.17574.36-0.7% 85 to 89739.27728.05-1.5% 90+821.67825.880.5%

24. Attendances by hour of arrival

25. Attendances by day of arrival

26. Attendances per 1,000 population by practice (A&E and MIU) Source: SUS

27. Attendances per 1,000 population by practice (A&E only) Source: SUS

28. Attendances not requiring treatment Activity Not treatedTreatedGrand Total 2008/0936,58335,48272,065 2009/1025,73946,31572,054 2010/1126,03147,89673,927 2011/1214,47662,08076,556 2012/1313,71662,95976,675 2013/1417,08460,64877,732 Grand Total133,629315,380449,009 Source: GPT ‘No treatment’ defined as any attendance where the primary treatment is either ‘No treatment’ or ‘Guidance/advice only’

29. Short stay emergency admissions Source: GPT

30. 111 calls by locality

31. GP WTEs by population

32. GP WTEs by deprivation

33. Where is the demand for A&E/MIU?

34. Who attends A&E/MIU, by area

35. A&E Attendances with no treatment, by area

36. Where is the demand for ambulances, by LSOA?

37. Ambulance calls, by area

38. When do people call for an ambulance, by area?

39. Why do people call 999?