Sitting on the 319 bus the other day as it trundled me home from Clapham Junction, I spied a bright orange NHS London version of the Choose Well campaign. I wonder how many other Londoners have looked at these and come away confused about what choices they should make when they or a family member aren’t well and it can’t wait?
As public involvement consultants, MAC partners are passionate about health literacy and want to do everything to encourage sound and sensible choices about accessing healthcare. We are all for consumer choice in healthcare and helping people make good choices. Making informed choices that use NHS resources effectively is part of that. But the well intentioned NHS London Choose Well campaign presents problems. Why?
Confusing and mixed messages
Basically because it conveys confusing and mixed messages. It doesn’t give diverse Londoners clear and unambiguous behaviour prompts. The result, we suspect, is that most people will continue to go to A&E because they know that they will be seen there and everything they could possibly need will be on tap. That’s basic consumer psychology and Choose Well fails to appreciate it.
Here are some examples from the consumer leaflet Feeling Unwell? How to get the right NHS treatment which supports the Choose Well campaign
We are advised to
Visit an NHS Walk-in centre, urgent care centre or minor injuries unit. You can get treatment here for minor injuries and illnesses. Experienced nurses and doctors can advise on what to do about non-urgent conditions. Centres are usually open from early morning until late in the evening and you do not have to make an appointment. To find your nearest centre, see the back page, visit www.nhs.uk or call NHS Direct on 0845 4647.
What’s wrong with this? Three things need attention:
1) the public has no understanding of what “urgent” means. It is a relative state, so what is urgent to one person with a bleeding finger is not urgent to another with a feverish toddler. Should they both go to the same place? There are no examples to make the right behaviour clear.
2) why would a person go to an urgent care centre for “advice on what to do about non-urgent conditions” as the leaflet says? This simply adds to the confusion about what is urgent in the first place and what is not – oh, and then there are emergencies. But don’t go to an urgent care centre for those we are told. What happens is people just keep trotting off to safe, reliable A&E, the best one stop healthcare shop there is.
3) there is confusing branding just where it needs to be crystal clear. How does one decide between walk in centre, urgent care or minor injuries unit? Most people can’t especially if they are frightened or anxious and so they won’t try to untangle the differences.
“Urgent” is highly subjective. To show alternative behaviours, we need to unpack “urgent” with some simple, easily remembered examples: “if x is wrong go here; if y is wrong go there” type of thing. We must not be blind to customer behaviour and understanding even if we don’t agree with it. People want one stop shops where they can get solutions to whole problems. Anything else invites users to go elsewhere because patients and clinicians won’t support an unfriendly and fragmented care pathway. If something is advertised as “urgent care” but people accessing it find they can’t have the diagnostic test they think they need, they will go somewhere else after their initial consultation. That somewhere else is likely to be A&E.
Many studies have shown that most people go to A&E because they think they need an x-ray or other investigation and, further, they know they can’t get this at a GP surgery even if they are registered with a practice and it is open and they think they could be seen quickly. Whether this perceived need for an x-ray is clinically indicated or not, it is a strong motivator underlying a large measure of consumer behaviour. We can make this work to our advantage. Users will go where they know there is a full diagnostic range even if they arrive on the wrong pretext. And referrers are more likely to recommend they do this, if only to “play safe”. The point is, once they are there, they can be appropriately handled.
What should happen
What’s missing in the Choose Well campaign literature and in the work around urgent care that PCTs have undertaken, is a description of what the preferred urgent care option will mean in terms of patient (customer) behaviour in accessing care and what the targeted messages need to be to get them to do things differently from the way they behave now.
In order to complete this missing part of the work, we need social marketing evidence identifying the segments in the population who behave in particular ways and who are likely to respond to particular messages. A leaflet with the same message for everyone will not be sufficient, no matter how many languages it appears in. Having decided to invest in commissioning new services, we must now in parallel invest in the marketing and promotion of them to their potential users and referrers. Will the new GP led commissioning consortia be any better at sorting out “urgent care” than the PCTs were? We can only hope so.
It all comes back to access
If access to primary care is poor or perceived to be poor – it amounts to the same thing from the consumer perspective – then where would you go? To A&E, of course, especially in London because they are plentiful, well known and – the essential thing – fully equipped for everything. The ideal one stop shop. That’s the psychology we cannot keep ignoring. “Millions can’t get through on GP phone lines” headlined the HSJ recently. Consumers have got that message.
Words of One Syllable
We offer the following advice in words of one syllable:
For NHS providers: “Keep one NHS brand – treat all who come – “NHS Walk In” is the right name. “
For the Public – “Go to NHS Walk In or ring 111 and they will help you find the right care. ”
Maybe if we tried something simple like that, people would get the “urgent care” message. Until we do try it, we are whistling in the wind and the traditional preference for the known quantity – A&E – will prevail.The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.