Woking and Weybridge NHS Walk-in Centres: Local Evaluation 2000-2002

1. Woking and Weybridge NHS Walk-in Centres: Local Evaluation 2000-2002 Dr Susan Turnbull On behalf of the University of Surrey

2. Acknowledgements (1) • Ross Lawrenson • John Roberts • Surrey Social and Market Research, University of Surrey: Rosemarie Simmons and Elaine Bowyer

3. Graham Browning Chris Dunstan Lou Major Sara McMullen Iain McNeil Vincent O’Neill Stephen Price Pauline Rogers Cathy Winfield WICLE Steering Group

4. Background: Local • 39 Walk-in centres were set up as a pilot project in 2000 • £31 million funding, key role in governments’ NHS Modernisation Programme • Woking WIC opened April 2000 • Weybridge WIC opened June 2000

5. Remit of WICs (1) • Offer fast and convenient access to local NHS advice, information and treatment • Complement, rather than compete with or replace local GP or hospital services • Open 7am-10pm weekdays; 9am –10pm weekends

6. Remit of WICs (2) • No appointments • Treatment provided by experienced NHS nurses • Able to deal with minor injuries and illness, and encourage self-help • Allow GPs more time to deal with patients in need of medical expertise • Potential to relieve pressure on primary care/ decrease waiting times for GP appointments

7. Policy context – access to primary care NHS Plan 2000: • “The public’s top concern about the NHS is waiting for treatment, including waiting to see a GP” • Target: by 2004 patients will be able to see a primary care professional within 24 hours and a GP within 48 hours

8. Policy context – access to primary care (2) • Practices would be “required to guarantee this level of access for their patients, either by providing the service themselves, entering into a relationship with another practice, or by the introduction of further NHS walk-in centres”

9. NHS Priorities and Planning Framework 2002/3 • 2 ‘must-do’s’ relevant to WIC aims: • Improving emergency services in terms of their availability, quality, comprehensiveness and speed • Reducing waiting throughout the system and in particular for consultations in primary care and hospital and admissions to hospital • PPF also emphasises need to address inequalities in access to services

10. 1/3 of GPs and practice nurses >50 Increasing consumer expectations Ageing population Exacting national standards / quality/ monitoring Greater scrutiny Shifting of workload from secondary to primary care More GPs part-time Increasingly complex care GPSIs – less time for ‘general’ practice Other commitments outside the practice eg PCT Primary care access: pressures (Audit Commission 2002: General Practice in England)

11. National Evaluation • Commissioned as part of the WICs pilot • University of Bristol on behalf of the Department of Health • Published 2002 • Each WIC submitted quarterly monitoring returns including activity and costings data

12. Local evaluations • DH funding to each WIC for local evaluation • Bournewood Community and Mental Health NHST managed both WICs: commissioned University of Surrey to evaluate both

13. Location

14. Study objective • To evaluate the impact of Woking and Weybridge NHS walk-in centres on improving access to health care • Combined quantitative and qualitative approach

15. Access Equity Effectiveness Appropriateness Acceptability Efficiency Framework: Maxwell’s 6 dimensions of healthcare quality

16. Quantitative analysis (1) • Database anonymised – year of birth and ward of residence only • Study period 9 October 2000 – 19 August 2001 – longest period when both WICs fully computerised + using same system (‘Interhealth’)

17. Quantitative analysis (2) • ‘Initial visits’ rather than ‘all visits’ – to avoid consideration of recurrent or review attendances for same condition • Initial visits : • 24117 Woking • 9020 Weybridge

18. Sex: WokingFemales 53.2%

19. Sex: WeybridgeFemales: 55.8%

20. Visits by age and sex

22. Time: trends in visit numbers

23. Proportion of visits by day attended

24. Time of day: weekday vs. weekend

25. Time attended, location and sex

28. Ward of residence • Most visits from residents of closest wards • Woking: Visits equivalent over a ¼ of these wards: • Kingfield & Westfield (33.7%) • Mount Hermon West (31.7%) • Mount Hermon East (28.8%) • Old Woking (28.3%) • Weybridge: • Weybridge North (27.7%) • St George’s Hill (27.1%)

35. Access and equity • Gender pattern of attendance similar to general practice F>M. Opposite re A&E M>F • 25-44 year olds most frequent attenders – but also largest age group • Older people attending in numbers appropriate to population proportion (Woking – even higher) • Most WIC visits not ‘out of hours’ • Visits gradually increased • Highest proportion of visitors live nearby and/or are registered with GP practice close to WIC

36. Proportion of visits by diagnosis (1)

37. Proportion of visits by treatment (1)

38. Proportion of visits by discharge recommendation

39. Appropriateness • Disappointing proportion of missing data • Commonest diagnoses: Soft tissue injury Woking; ENT Weybridge • Commonest treatment: advice and reassurance • Woking: 83.5% with A&R as treatment (1) had no treatment (2) recorded. Weybridge: 90.1%

40. Effectiveness • Estimates of impact based on visitors reported ‘alternative’ in the absence of a WIC • Caution about ‘desirable’ responses – ? bias against ‘self-care’ as ‘alternative’ to justify decision to seek professional advice

41. Proportion of visits by ‘alternative’ if no WIC available

42. ‘Alternative’ • Disappointing proportion of missing data • Very small proportion where alternative = self care, especially Woking • Woking males – almost equal re GP and A&E • Weybridge females: >3x as many GP as A&E ‘alternative’ • GP ‘alternative’ most frequent both WICs

43. ‘Alternative’ = GP by ‘discharge’

44. ‘Alternative’=A&E by ‘discharge’

45. ‘Alternative’= self care by ‘discharge’

46. Acceptability • Quantitative analysis did not address acceptability • Growing attendance suggests acceptability • User survey at Woking WIC July 2000: (Rogers,P. Case study of one walk-in centre pilot site. University of Surrey. Dissertation for MSc in Health Care Management)

47. Efficiency • Qualitative study did not address efficiency • Cost per visit calculated using same criteria as national evaluation: all running costs (no set up costs); all visits

48. Woking: Running costs quarter ended 31/03/01: £ 159k Estimated ‘all visits’: 8353 Estimated cost per visit £19 Weybridge: Running costs quarter ended 31/03/01: £156k Estimated ‘all visits’: 2644 Estimated cost per visit £59 Efficiency (2)

49. Efficiency (3) • Higher cost per visit Weybridge: similar running costs, visit rate much lower in study period • Recent enquiry: Weybridge activity increased by > 3-fold. Cost per visit for Oct 2001 – Aug 2002: £15.36 • Reinforces ‘moving picture’ • National evaluation – comparable cost per visit £31.11 • Average cost of visit to a GP £15; practice nurse £9

50. Qualitative study (1) • Surrey Social and Market Research (SSMR), Department of Sociology, UniS • Aim – assess impact on other local health services providers: • GPs, receptionists, practice nurses) • GPs re OOH perspective • Staff of nearest A&E • Surrey Ambulance Service personnel • WIC personnel • Total 30 interviews January 2002