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Non-urgent A&E attendances

Analytics on non-urgent attendances to hospital emergency departments (A&E) for care that could have been reasonably provided elsewhere.

NHS Digital's Innovative Uses of Data service developed this data tool that looks at non-urgent attendances to hospital emergency departments. The definition of a non-urgent A&E attendance has been adopted from research conducted by the Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research, at the University of Sheffield.

According to this research a non-urgent attendance is defined as the "First attendance with some recorded treatments or investigations all of which may have been reasonably provided by a GP, followed by discharge home or to GP care."

Emergency Type-1 department data for NHS Trusts in England from April 2015 onwards has been used for this analysis. The data presented in this report is classed as "management information". For official statistics on hospital emergency care activity please refer to Hospital Episode Statistics (HES) publications and for information on data quality of the new emergency care data set refer to Emergency Care Data Set (ECDS) data quality.

Non-urgent attendances by Trust

This report shows proportion of attendances that are non-urgent by trust and benchmarks it against its closest ten peers. The methodology used to identify the closest ten peer trusts can be found in the NHS Trust Peer Finder page.

The number of investigations and treatments displayed in this report do not correspond to the number of non-urgent attendances but with the number of times they appear in these attendances. An attendance can have multiple investigations and/or treatments but duplicate entries of a code within an attendance are removed.

Non-urgent attendances by STP, CCG and MSOA

This report looks at non-urgent attendances at Sustainability and Transformation Partnership (STP) level. It also shows a breakdown by Clinical Commissioning Group (CCG) and users can also drill-down from an STP to its Middle Layer Super Output Area (MSOA) level. STPs, CCGs and MSOAs divide the country geographically and into populations of approximately similar size, with STPs having a mean population of around 1.2 million, CCGs of around 0.25 million and MSOAs of around 8,000.

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Definitions

Please note that the methodology was updated on 26 April 2019 to include only emergency department type ‘01’, previously department types ‘01’ and ‘03’ were included.

Only data for emergency department type ‘01’ is used for calculating non-urgent attendances and this is the denominator for calculating proportion of non-urgent attendances.

Below are the filters applied to the data to identify non-urgent attendances. Cases where all the treatment and investigation mentions are blank are considered non-urgent provided other inclusion criteria are met.

Department type
Description HES A&E codes ECDS codes
Type-1 Emergency departments are consultant led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients 01 01
Attendance disposal (discharge status)
Description HES A&E codes ECDS codes
Discharged - follow-up treatment to be provided by general practitioner 02 1077021000000100
Discharged - did not require any follow-up treatment 03 182992009
Left department before being treated 12 1066321000000107
Investigation
Description HES A&E codes ECDS codes
Urinalysis 06 27171005
Pregnancy test 21 167252002
67900009
Dental investigation 22 53115007
None 24 or blank

1088291000000101

or blank 

Treatment
Description HES A&E ECDS codes
Guidance/advice only - written 221 413334001
Guidance/advice only - verbal 222 Not applicable
Recording vital signs 30 Not applicable
Dental treatment 56 81733005
Prescription/medicines prepared to take away 57 266712008
None (consider guidance/advice option) 99 or blank

183964008

or blank 

Prescriptions (retired code but still present in some records) 07 Not applicable
Attendance category
Description HES A&E ECDS codes
First Accident and Emergency attendance 1 1
Arrival mode
Description HES A&E codes ECDS codes
Non-ambulance arrivals not 1 1048071000000103,
1048061000000105,
1047991000000102,
1048001000000106

Notes and data sources

  1. This analysis has been produced from the Hospital Episode Statistics (HES) A&E dataset and Emergency Care Data Set (ECDS). Published data from April 2015 onwards have been used in this analysis.
  2. From October 2017 onwards NHS Trusts have begun submitting ECDS in place of HES A&E and ECDS is expected to replace HES A&E across all NHS Trusts in 2019/20. Changes to how some Treatment codes are recorded in ECDS for corresponding A&E codes such as 30 = ‘Recording Vital Signs’, 222 = ‘Guidance and advice only - verbal’ and 99 = ‘None (consider guidance/advice option)’ could account for the sharp reduction in non-urgent attendances in some NHS Trusts since October 2017.

  3. The MSOA to STP mapping has been created using data available in the Organisation Data Service.
  4. The MSOA values and boundaries displayed in the visuals in this report are based on the 2011 Census.
  5. Where MSOA's map to more than one STP the activity is split and aggregated accordingly.
  6. GP reference data was sourced from NHS Digital's Organisation Data Service.
  7. CCG mid-2016 population estimates published by ONS have been used to calculate the non-urgent attendance rate per 1,000 population.

Disclosure control

Numbers (attendances, investigations or treatments) between 0 and 7 are rounded to 5, and all other numbers are rounded to the nearest five.

GP practices with less than fifty attendances are not displayed on the map.

Rates per head

Rates per head are calculated as the number of attendances that are non-urgent expressed as a rate per 1,000 population. CCG mid-2016 population estimates published by ONS have been used in this calculation.

How to use the reports

The reports are best used by expanding to full screen mode, using the diagonal arrows on the bottom right. To view the data behind the visual right-click on the data element in the visual such as a bar or a line or a dot and click ‘Show Data’. Alternatively use Alt+Shift+F11 on the keyboard on the selected visual or chart to view the data behind it.

This management information report is experimental and feedback is welcomed.

Last edited: 2 August 2019 2:23 pm