The Cornwall and Isles of Scilly Sustainability and Transformation Plan (STP) is seeking to determine the best way to configure urgent care services across the county. Part of this is trying to understand where urgent care centres would be best located across the county to maximise access for patients who need it, whilst ensuring that solutions are sustainable.
The PenCHORD team was asked to undertake modelling work to understand a) what the impact would be of having fewer urgent care centres in terms of patient travel time and displacement to other services, and b) where urgent care centres should best be located, amongst the sites currently used.
The aim of the project was to provide evidence to help inform decisions about where to best locate urgent care services in Cornwall. This evidence would feed directly into the STP and ensure that decisions taken would minimise disruption for patients.
We developed a mathematical geographic model that captured urgent care activity across Cornwall. The model used three years of anonymised patient data which included when the patient accessed urgent and emergency care, the site they attended, and their home postcode sector. The data included over 360,000 patient records across 13 urgent care sites, and represented over 96% of postcode sectors in Cornwall. Isles of Scilly patients and their urgent care site were excluded from this analysis, as it was determined that urgent care provision must remain here due to the island location.
The model explored over 4,000 different combinations of urgent care sites being open, and for each combination, calculated the average and maximum patient travel time to a patient’s nearest urgent care site. The model also calculated the expected level of annual activity to each site for each scenario.
The model found that between 5 and 9 urgent care sites in Cornwall was sufficient to largely maximise benefit for patients in terms of average and maximum travel time. In other words, having more than 5 – 9 sites is predicted to only trivially reduce travel times to urgent care sites, both in terms of the average travel time, and for those patients who would have to travel furthest.
The model also found that, other than Treliske (which was fixed as permanently available in the model), Bodmin and West Cornwall hospitals frequently came up in configurations that would lower travel times for patients. In other words, the model predicts that both Bodmin Hospital and West Cornwall Hospital are key sites for urgent care activity if you are looking to minimise patient travel times to access urgent care across the county. Sites close to the border were Devon came up in fewer optimal scenarios, because fewer patients living in these areas access sites in Cornwall, and if sites close to the border were not available, sites in Devon would be closer for these patients.
The model and its predictions were presented to the Cornwall STP Urgent and Emergency Care team. The team is now using these findings to help inform decisions about urgent care provision across Cornwall. In particular, the evidence is being used to help decide where larger urgent care centres could best be located to maximise benefits for patients.