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Sandwell and West Birmingham CCG

Reducing A&E attendance and improving relationships with primary care

December 2013 - June 2014

The Challenge

Sandwell and West Birmingham Clinical Commissioning Group (SWBCCG) have higher than national average A&E attendance rates and A&E was increasingly becoming the default first point of contact for health services. On average 3000 people attend A&E each week, most leaving without treatment or with very minor treatment. The CCG wanted to understand who was attending A&E and why in order to ensure people were accessing services appropriate to their needs.

"The knowledge and insights have been very useful. IMPOWER provided practical options for dealing with the issues raised by the insights."

Debra Howls, Senior Commissioning Manager, SWBCCG

What we did

The aim of the project was to analyse, define and segment population groups to apply behavioural insight about A&E attenders and offer recommendations for reducing A&E demand.

The IMPOWER team worked with Sandwell and West Birmingham CCG to carry out an in-depth data analysis of over 80,000 data points and a population segmentation exercise to identify target groups for other interventions.

Focusing on demand-side behaviour, IMPOWER conducted an on-site study within A&E departments across Sandwell and West Birmingham, incorporating behavioural insights alongside the data analysis and the research.

Insights highlighted the relationship with primary care as a key factor in A&E attendances and our recommended design gave equal weight to three strands:

  • a shift in the primary care offer
  • messaging in A&E departments
  • targeted population strategies.

The strategy was presented at various stakeholder groups across the CCG, acute trust, GP groups and voluntary sector groups. As a result of the insights, the CCG commissioned a second phase which resulted in a detailed design phase of primarily four interventions to reduce A&E demand and improve the primary care offer.

  • Urgent appointment brokerage and online request booking system – engaging primary care services in the development of a system targeting registered lists of two locality groups and a population size of 150,000 initially during the proposed trail.
  • Flash reporting – developing a performance dashboard to enable individual surgeries to monitor and proactively respond to their urgent care attenders as well as compare against other surgeries in the local area.
  • A&E messaging redesign – using behavioural economics, we redesigned messages in A&E that were encouraging reattendance to direct patients to the right urgent care option.
  • Targeted marketing – collaboratively designing a targeted campaign and mobilisation strategy for 17-39s across the SWBCCG population. All interventions are designed to launch in September 2014 with a six month trial and evaluation.

Delivering benefits

The strategy developed for Sandwell and West Birmingham CCG will not only reduce A&E attendance but will improve relationships with primary care and pathways between acute and GP services.

SWBCCG have embraced the insight both as validation and evidence of what they thought were the reasons for increased A&E attendance, but also as a redefining of their focus and strategy.

The work linked the analysis and recommendations with their urgent care and preventative strategy, giving them deliverable interventions and the opportunity for IMPOWER to develop these in more detail over the next couple of months.


The IMPOWER team have worked collaboratively across the urgent care system in Sandwell and West Birmingham. We have delivered GP locality insight sessions as well as voluntary sector events and focus groups. The insight produced by the team has been shared at executive level across the CCG and acute trust with positive feedback leading to the detailed design phase which has been produced collaboratively with the CCG.

Flexibility and responsiveness to change

From early on there were difficulties in obtaining sufficient data to enable to the analysis component. The IMPOWER team worked flexibly with the CCG to come up with solutions and refocus some of the tasks as a result. Debra Howls (Senior Commissioning Manger) commented that the team “adapted well and found different ways of doing things”.

Effective stakeholder engagement

Through regular steering group meetings and day-to-day engagement the team built effective relationships with stakeholders. To raise the profile and validity of the insight the team took the insight to executive levels across the organisations and gained momentum and buy-in to the strategy.

Innovation & insight

The analysis provided evidence and insight from three different perspectives:

  • a data perspective
  • a patient perspective from people attending A&E
  • a behavioural environment perspective.

Reframing the insights from these areas has given the CCG clarity and a work programme to reduce A&E attendance and improve service delivery. This innovative approach considers the behavioural component as an equal factor in demand-side management.

Overall the piece of work has provided focus in the CCG’s overarching urgent care strategy and opened their debate on what their urgent care system landscape needs to be in the future to manage the critical risk of overuse of urgent care.

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