What needs to be done and why?
Strategic Issue 1
What needs to be done
Improve access to GP appointments to reduce the consequential burden on emergency services.
There needs to be consultation with GP patients in the Borough to determine the barriers faced when attempting to access and arrange GP appointments.
There needs to be consultation with GP practices in the Borough to determine barriers faced in providing sufficient numbers of GP appointments.
Within this GPs should be supported to expand the use of the NHS App for easier patient access and streamlining of processes within surgeries. GPs should be encouraged to utilise pharmacy services and promote community services, navigating care appropriately.
Why
Hartlepool’s population includes highly deprived communities, with individuals 1.7 times more likely to attend A&E than those in affluent areas, therefore signifying a need for improved access to primary care and advertisement of non-emergency services.
Residents have expressed a need for improved access to services through the Big Conversation.
The NHS Delivery Plan suggests:
- Empowering patients through expanded use of the NHS App for booking, messaging, and prescriptions.
- Expanding pharmacy services to reduce GP demand.
- Increasing GP training places and reducing administrative burdens.
- Implementing digital triage and telephony systems to streamline appointment booking.
NICE Guideline NG94 explores the impact of extended GP hours (evenings and weekends) on patient outcomes.
Key findings:
- Extended access may improve patient satisfaction and reduce emergency department use.
- Evidence on cost-effectiveness is mixed, and implementation should be tailored to local needs.
Hartlepool consistently ranks in the worst 25% of local authorities for multiple emergency admission metrics, including all-cause admissions, COPD, heart disease, stroke, and childhood infections. This signifies that conditions are not being managed in primary care and in community settings.
Strategic Issue 2
What needs to be done
Targeted outreach with strategic focus in areas of high deprivation are needed to provide inclusive health services with the aim to reduce disparities in health literacy and emergency hospital admissions.
Integrated care models that link primary care, community outreach and hospital services are needed to support this group in accessing services.
Interventions should include health coaching to improve health literacy and self-management, apps and digital tools for self-monitoring and education and provision of community support from other residents and professionals.
Residents should be informed of services through advertisement of alternative services such as community pharmacies for non-emergency cases. Residents should be provided advice, education and behavioural support to encourage uptake through community-hubs and through signposting by GPs and NHS 111.
Throughout the process there should be data-driven monitoring and evaluation of interventions with health equity in mind.
Why
Hartlepool’s population includes highly deprived communities, with individuals 1.7 times more likely to attend A&E than those in affluent areas. Deprivation and health literacy go hand-in-hand, therefore addressing health literacy in the Borough is key.
Emergency admission rates increase significantly with age, especially 65+, with highest hospital activity in the 70–74 age group. Hartlepool’s older population is particularly vulnerable to falls, hip fractures, and chronic conditions.
Hartlepool has consistently high emergency admission rates for children, especially 0–4 years, for conditions like gastroenteritis, respiratory infections, and injuries.
The Health Foundation found that over 60% of emergency admissions involve patients with long-term conditions (e.g., asthma, diabetes, mental illness) and patients spend less than 1% of their time with health professionals; most care is self-managed.
Supporting less activated patients (i.e. patients' ability to manage their health) could prevent up to 436,000 emergency admissions and up to 690,000 A&E attendances annually. The Health Foundation recommend interventions including health coaching (goal-setting and motivational support); online communities (peer support and shared experiences); apps and digital tools (self-monitoring and education); and tailored services which are adjusted based on health literacy levels.
NICE Guideline NG102 outlines how community pharmacies can promote health and wellbeing. Key recommendations include:
- Raising public awareness through consistent messaging and integration into health pathways.
- Using referrals and signposting from other services like GPs and NHS 111.
- Providing advice, education, and behavioural support to encourage uptake.
Collaborating with local authorities and commissioners to embed pharmacies in public health strategies.
Strategic Issue 3
What needs to be done
Investment in mental health and social care to reduce avoidable admissions. Investment should be directed to services that prevent mental health crises and support those with mental health conditions with management.
Services should be community-based and placed in areas of highest need (areas of high deprivation, which is linked to mental health need). Services should include community mental health teams, community-based crisis teams and crisis alternatives such as crisis cafes and safe havens.
This would provide a mental health equity initiative which aims to tackle disparities and should use data-driven planning to monitor trends and need and evaluate interventions.
Why
There are rising emergency admissions for intentional self-harm suggesting mental health crises. The rate in 2023/24 was 233.9 per 100,000 which was higher than the regional and national rate for that year. Hartlepool is in the worst 25% of local authorities for this metric.
Mental health affects all population groups and has systemic consequences.
NHS England advise investment in community-based crisis teams and crisis alternatives (e.g., crisis cafés, safe havens, crisis houses) aims to reduce reliance on A&E and inpatient care. Services are expected to include peer support workers and address local inequalities in access and outcomes.