Redesign Urgent Care: paediatric pathway to flow navigation centres - review

3. Data

Data from A&A pathfinder - 3 to 23 Nov 2020

There were 87 <12s referred to the FNC in the NHS Ayrshire & Arran pathfinder November 2020. The median time for the FNC SDM to call the parent/carer was nine minutes. Of these 87, 28 were given an appointment to attend ED, 31 to MIU and 28 given self-care advice.

NB Figures in above table exclude 999 calls

NHS 24 outcomes for <12s olds across Scotland in November 2020

Comparing NHS 24 outcomes for <12s in NHS A&A pathfinder against the remainder of Scotland during November 2020, the proportions of immediate ED outcomes were 10% and 17% respectively and referrals to out of hours were 27% and 34%. Other outcomes were similar when data from NHS A&A and all other boards were compared.

NB Figures in above table exclude 999 calls

Considerations given to the collected data

• The data for November shows that 17% of <12s were managed in NHS A&A via the FNC, which is roughly the same as the % of under 12s seen in ED/MIU and urgent care centre in other boards.
• As to be expected, there is consistency between NHS A&A and other boards on % advised to dial 999, contact GP, dentist, GP telephone advice, pharmacy or self-care.
• The % <12s presenting to ED and referred to GP Out Of Hours was lower in NHS A&A compared to the rest of Scotland
• To note, NHS A&A pathfinder ran over a short period of time (3 to 23 November) and the Board was not under the same level of pressure that is currently being experienced across all Boards due to COVID-19, alongside winter pressures. This is reflected in the relatively low level of cases routed via the Flow Navigation Centre.
• Attendances to ED services in NHS Scotland saw a large drop in March 2020 due to the social distancing measures put in place to respond to COVID-19. In April attendances were at the lowest levels ever recorded.
• Based on monthly published information there was a 27.6% decrease in attendances at core Emergency Department sites in November 2020 (86,193 attendances) compared to November 2019(119,054 attendances).
• NHS 24 data suggests that under 12s account for 10-13% of all 111 demand, however, they account for 25-30% of referrals direct to ED for this pathway and that has been consistent since launch, so there are significant benefits for patients and the system by including FNC as an additional pathway.

Further data from Public Health Scotland on referral/outcome for under <12s attending ED can be found at Annex 3.

Estimate of activity across Scotland

The Chair felt it was helpful to estimate what the numerical impact of including <12s in the FNC would have on an individual board. Based on discussions and examination of the data there are two assumptions for the paediatrics pathway:

1. The current percentage of referrals to ED by NHS 24 would be the same percentage referred instead to FNC, but what would differ is the time of presentation to ED. Important to remember that the small number of NHS 24 calls (emergency or life-threatening situations) would still go direct to ED+/- ambulance

2. Extrapolating the A&A FNC outcomes shows that 32% of referrals were appointed to ED, 35% to MIU and 32% closed. The experience in 12 year olds and older in the FNC is that the proportion being directed to the different end points has changed from the November pathfinder. This means the proportions assumed in this model are also likely to change, should the FNCs include <12s.

• For the busiest month in 2019 (May) –14,110 ED presentations of which 1368 came through NHS 24 – this would mean 478 would be directed to MIU, 438 would avoid having to come to ED or MIU at all and 438 would still come to ED, but at an arranged time. For the quietest month in 2019 (Feb) – 11,103 of which 1003 came through NHS 24 – the respective numbers would be 350, 320 and 320.

• If this was translated to NHS Grampian (~10% of the population) on a pro rata basis this would be equivalent to 3-5 children a day receiving different care. If the public started to call NHS 24 more commonly then this number would obviously rise.

NB in 2019 NHS 24 only took calls during Out Of Hours and from December 2020 NHS 24 receive calls at all hours. This means that the numbers are likely to be an underestimate of any activity in the FNC, should <12s be included.