Mapping Public and Private Healthcare Provision in the City. ReseaRch RepoRt City of London CorPoration

Transcription

1 Mapping Public and Private Healthcare Provision in the City ReseaRch RepoRt City of London CorPoration

2 Mapping Public and Private Healthcare Provision in the City ReseaRch RepoRt City of London CorPoration

3 Mapping Public and Private Healthcare Provision in the City is published by the City of London Corporation. The author of this report is BDRC Continental. This report is intended as a basis for discussion only. While every effort has been made to ensure the accuracy and completeness of the material in this report, the author, BDRC Continental, and the City of London Corporation, give no warranty in that regard and accept no liability for any loss or damage incurred through the use of, or reliance upon, this report or the information contained herein. February 2015 City of London Corporation PO Box 270 Guildhall London EC2P 2EJ

4 Contents Page no. 1. Executive summary Introduction Why this research was undertaken What is known about City workers and healthcare? Which services are included in the research What is covered in this report Research method Healthcare provision research City worker healthcare needs primary research Data analysis Healthcare provision and take-up in the City What healthcare services are provided in the City? What healthcare services in the City do workers use? What does appointment availability look like? What booking methods are available? What are the key future considerations for healthcare provision in the City? Appendix: sample profile...23

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6 1. Executive summary This report was commissioned by the City of London Corporation to identify and better understand current NHS and private healthcare provision in and around the Square Mile. This report provides information on the healthcare services available for City workers in the Square Mile, and about what types of healthcare providers exist and how they operate. Current healthcare provision in and surrounding the Square Mile includes 332 providers of core healthcare services. These include both single and multiple service providers. The number of services by type of services is set out in Figure 1. Figure 1: Number of public and private healthcare providers in and around the City NHS medical services 57 Private medical services 99 Travel vaccinations 70 Blood tests 43 Private mental healthcare provision NHS mental healthcare services Physiotherapy, chiropractor and osteopathy Services for smoking/alcohol and/or drug addiction Sexual health services Occupational health nurses 33 Occupational health physicians 22 Of these 332 providers, there are 57 NHS medical service providers based in and around the City. Of these, 47 are NHS providers and 10 are private providers offering NHS services. The 47 NHS providers are largely based on the periphery of the Square Mile. The 10 private providers are business retail units of a pharmaceutical company. In addition there are 17 providers of NHS mental healthcare services. Of the 57 NHS medical service providers: 47 provide GP appointments, 50 emergency appointments, 48 drop-in or same day appointments, 41 a yearly health check and 40 provide a one-off health check. There are 99 providers offering private medical services. Of these, 70 offer travel vaccinations, 43 offer blood tests, and 58 offer private mental healthcare services. A further 58 offer NHS mental healthcare services. 266 organisations provide other services, with a mix of both NHS (46) and private providers (220). 1

7 A directory of healthcare services in and around the City has been produced as part of this research and is available online 1. A map setting out the locations of all 332 healthcare service providers and types of service provided is presented later in this report. Two thirds of healthcare services are open beyond the 9.00 to working day, where demand from City workers is greatest for appointments pre- and post- office hours and during lunchtime hours (12.00 to 14.00). Two in five services can offer same day or next day appointments. Besides services offering telephone booking for appointments, online booking and is also available for around half of services. The duration of appointments is typically half an hour, with NHS services providing slightly shorter appointments and private services providing slightly longer. The current usage of services in the Square Mile shows that GP services for both regular check-ups (66%) and non-emergencies (66%) are used most widely along with travel vaccinations (27%), blood tests (39%) and emergency GP appointments (23%). Specialist services for physiotherapy (13%), addiction counselling (4%), sexual health (4%), occupational health (4%) and mental health services (2%) were used by a minority. Looking ahead, a key challenge for healthcare provision in the City is to continue to meet workers healthcare needs. Looking at where needs may potentially be unmet, this research found that the dominant reason for this, where a worker wanted to use a service but could not, was a lack of available appointments. Other potential areas to consider are GP health checks, blood tests and mental healthcare provision. Potentially, lower service levels also exist for GP appointments, private medical services, emergency NHS appointments and travel vaccinations. When considering potential gaps in healthcare service provision in the City, it is necessary to bear in mind that: Unmet demand could be borne from a perception that services are assumed not to exist or are hard to access in the City and therefore awareness-raising by service providers may be required. Accessibility is a key issue where, for example, GP services via an NHS provider can only be accessed via a home-located surgery and not via a work one (unless a worker is set up as a temporary patient). Therefore City workers using NHS facilities are largely limited to their own surgery for non-emergency appointments, therefore unmet demand may be coped with or self-medicated. In conclusion, based on the findings of this research it is suggested that key considerations for healthcare service provision in the City are to: Continue to meet City workers healthcare needs, particularly in terms of providing the types of services that they require and in offering a sufficient number of appointments at appropriate times. Raising awareness and informing City workers of the presence of healthcare providers and what types of services are available to them. This report attempts to address this challenge in part, by producing an accompanying directory of NHS and private healthcare provision in and around the Square Mile, for use by City workers and residents (available online). 1 The directory of healthcare services is available from the City of London Corporation s Research webpage. It lists all 332 healthcare service providers identified as part of this research and provides information on the types of healthcare services offered, as well as contact details. 2

8 2. Introduction 2.1 Why this research was undertaken The City of London Corporation commissioned BDRC Continental to undertake research to identify and better understand current NHS and private healthcare provision in and around the Square Mile. This report maps and provides information on healthcare services for City workers in the Square Mile, and about what types of healthcare providers exist and how they operate. Consideration is also given to City workers healthcare needs and demand for services, and where in the future potential gaps in healthcare provision might lie. The research supports the City of London Corporation s responsibility as a local authority for public health within the Square Mile, of which a priority consideration is meeting the demand for healthcare services from City workers. A key factor for the City Corporation is the relatively small resident population and much larger working population within the Square Mile. Specifically, the City has a daytime workforce population of around 392,400 employed by over 15,000 enterprises and a resident population of approximately 9, With projected economic growth, it is expected that the City working population will increase in the short to medium term 3, which in turn will mean greater numbers of workers with healthcare needs to be met. Working populations can have limited capacity to visit a healthcare provider unless they take time off work, given their working hours and limited NHS service provider options near work. This research therefore needed to understand the current behaviour of City workers and where there may potentially be gaps in meeting their healthcare needs, as well as understanding healthcare provision potentially available to City workers. Previous research published by the City Corporation in 2014 looking into employee health and wellbeing programmes among large City firms, found a number of examples of good practice across different workplace health issues, such as health promotion and wellness, back and musculoskeletal problems, and mental health and wellbeing, though it was also acknowledged there is room for improvement within private healthcare provision in the City 4. This research report presents an update for better understanding the status of current NHS and private healthcare provision within and bordering the Square Mile area, for use by City workers. It also provides some information on the healthcare needs of City workers. As part of this, the report is accompanied by a directory of healthcare services identifying the different service providers by location and types of healthcare service offered 5. 2 Total employment figures for Source: Office for National Statistics, Business Register and Employment Survey, October Employment growth projections and data for the City of London are available online at the City of London Corporation s Research webpages. See also: Economic outlook for the City of London (April 2014) by Oxford Economics for the City of London Corporation. 4 Best practice in promoting employee health and wellbeing in the City (March 2014) by Cavill Associates with the University of Salford for the City of London Corporation. Available to download from the City of London Corporation s Research webpage. 5 Available online at the City of London Corporation s Research webpage. 3

9 2.2 What is known about City workers and healthcare? In 2012 the City of London Corporation published research jointly commissioned with NHS North East London and the City, exploring the healthcare needs of City workers 6. The study found that many City workers had limited capacity to visit a NHS healthcare provider without taking time off work due to long working hours, limited service availability near work, and commuting time, meaning that healthcare providers are often closed by the time they get home. This gap in provision has partly been filled by private sector services, but there was still concern about the lack of NHS provision (including the closure of the NHS walk-in centre in the City), particularly for those who did not have healthcare benefits through their work. City workers are mainly aged between 20 and 50 years and, as such, have an agerelated health advantage relative to the general population. The City of London also has a male dominant working population - 62% of City workers are male. This compares to the Great Britain average of 50%. In terms of employment type, 68% of City workers are in professional job roles, reflecting the predominance of the financial services and professional services sectors within the City 7. The 2012 report states that healthcare needs among City workers tend to relate to specific short term issues such as respiratory and/or flu-like symptoms. Absence rates from work due to sickness are lower than the national average. While the health of City workers is generally better than average 8, the 2012 report highlights a particular demand among City workers for NHS GP services and walk-in services in the City. In addition to NHS services, the research found that there was demand for other health services that address more sensitive health issues. The majority (77%) felt that at least some of these services could be provided through pharmacies in the City. A third of City workers from the 2012 survey reported having a long term health problem, with muscles, bones, joints or bad back, breathing problems, and anxiety, depression or other mental health conditions being the three most commonly mentioned areas. If it were possible to register with a GP both at home and near work, 82% of City workers surveyed in 2012 stated that they would do so. A third of City workers would have preferred to be registered with a GP near work rather than near home. A third of respondents to the 2012 healthcare survey reported that their job causes them to be very stressed for more than just occasional periods. Stress was reported as one of the major reasons for absence from work and so there was a particular need for services which would help to address stress and anxiety, substance misuse and smoking. In addition, 25% of the City workers surveyed in 2012 said that they smoke, higher than the average for London (17%), suggesting a further requirement for smoking cessation services. Levels of stress and anxiety are likely linked to the fact that City workers have longer reported working hours than in London in general. According to the 2012 report, 56% of City workers work 31 to 45 hours a week and 36% work over 45 hours, compared to 53% working 31 to 45 hours a week and 23% working over 45 hours in the rest of London. 6 The public and primary healthcare needs of City workers (May 2012) by PHAST for the City of London Corporation and NHS North East London and the City. Available to download at the City of London Corporation s Research webpage. 7 See: Economic outlook for the City of London (April 2014) by Oxford Economics for the City of London Corporation. 8 The 2012 report reported that 73.8% of City workers rate their health as good compared with a national average (from Census 2011 data) of 68.8% 4

10 The 2012 report estimated that 58% of City workers are employer-provided with private or subsidised healthcare. Interviews with stakeholders undertaken as part of the 2012 survey suggested that this does not include visiting a private GP close to work. 2.3 Which services are included in the research This report focusses on mapping the following core areas of healthcare service provision in the City. Private healthcare are the services available to those with a private healthcare policy or those who personally pay for services. NHS services are predominantly free with the exception of travel vaccinations. NHS medical services via GP appointment, health checks 9 (one-off and yearly), dropin/booked on the day appointments and emergency appointments. Private medical services via GP appointment, health checks (one-off and yearly), drop-in/booked on the day appointments and emergency appointments. Travel vaccinations. Blood tests. NHS mental healthcare services and support for illnesses such as stress, anxiety and depression via a psychiatrist, psychiatric nurse, Cognitive Behaviour Therapy and counselling, advice and therapy services. Any provider only offering hypnotherapy in any of these service areas was excluded. Also excluded were services which were exclusively provided for gym members only. Private mental healthcare services and support for illnesses such as stress, anxiety and depression via a psychiatrist, psychiatric nurse, Cognitive Behaviour Therapy and counselling, advice and therapy services. Other services which include: services for smoking, alcohol and/or drug addiction, physiotherapy and sports physiotherapy services (including chiropractic and osteopathy services), sexual health services; occupational health nurses, occupational health physicians. 2.4 What is covered in this report This report addresses the following areas: Healthcare service usage by City workers. This includes the extent to which services are used near home and work and which types of workers are using particular services to a greater or lesser extent. The services available in and around the City. An overview is provided in the main body of the report, and an accompanying directory of services is also available online. The directory is an output of a service provider mapping research exercise. The directory does not seek to be fully comprehensive and it is possible that some providers will have been unintentionally omitted. The directory is not live given information is presented for the reporting period only. 9 The NHS Health Check programme is a five yearly programme for adults aged who do not have a pre-existing condition. GPs do yearly checks for long term conditions - diabetes, heart disease and so on. Most City workers are not eligible or called in for yearly health check but private health service provider will offer these more routinely. When health checks are commented on in this report, this could either be the NHS programme, a similar private provider programme or a oneoff appointment considered by City workers to constitute a health check. 5

11 Information about appointments including the proportion of providers offering services outside working hours, how far in advance appointments need to be booked, the methods by which appointments can be booked, length of appointment times and average payment for services. Finally, the report examines what the potential future challenges are for healthcare provision in the City - where unmet demand between City workers needs and service provision lie and the associated issues concerning these gaps. 6

12 3. Research method The research supporting this report was conducted by BDRC Continental. Primary and secondary research was used to understand current healthcare provision in the City, and some primary research with City workers to understand their healthcare needs, to identify where potential gaps in service provision might arise in the future (next five or so years). 3.1 Healthcare provision research Healthcare providers in and adjacent to the City were identified using desk-based and online research. Services were selected based on their location within the City of London boundaries and just outside the boundary. The services outside the boundary were selected on the basis that they were a short journey from the Square Mile for City workers (a five to ten minute walk, tube or bus journey). A map setting out where healthcare service providers are based and the City boundaries is presented later in this report. Subsequent contact was made with each provider by telephone to assess: Location. Type of provision (NHS or private) and service offered. Opening hours. Appointments: number of appointments offered, proportion of appointments for different services across providers, length per appointment, proportion of appointments fully booked, how far in advance appointments needed to be booked, and how appointments can be booked. Temporary patient registrations. Type of patient by job role (professional or semi-skilled) Prices charged for different types of service. Healthcare providers were excluded from the sample if they met any one or more of the following criteria: If they did not provide one of the core services of interest for this report. If they were not open to the general public, for example, where a provider operated through a private gym which was only available to members. If a service only provided hypnotherapy and no other medical treatments. A total of 332 providers were identified as offering at least one of the core services included in the research, based in and around the City. The provider research was carried out between 28 October and 5 December City worker healthcare needs primary research A sample size of 1,042 face-to-face interviews with City workers was completed in 14 locations in the City (see appendix). Interviews were conducted between 13 October and 24 November City workers were included in the sample if they worked within the Square Mile. A boundary map was shown to respondents to assess whether they worked in the geographic area. 7

13 Both City workers with employer-provided private or subsidised healthcare and those without were included in the sample, given both groups can draw on services in the City. These are referred to as private and non-private healthcare users respectively throughout this report. It should be noted that although a non-private healthcare user may not have access to private healthcare through a privately paid for healthcare policy, they may access some private services paid for by themselves in a personal capacity - for example, travel vaccinations, which are not provided as a free service via the NHS but are widely available in pharmacies. In total, 291 interviews were conducted with private healthcare users and 751 with non-private healthcare users. Quota controls and subsequent corrective weights were imposed on the sample to ensure it reflected the actual population of City workers. The questionnaire included usage of healthcare services in the last two years, the type of services used, services they had problems with or would have liked to have accessed but were unable to access, the ideal appointment times they require and whether or not they would be prepared to pay for services Data analysis The analysis of the City workers data is robust, as all questions were answered by all respondents and the data was grossed up to an independent estimate of the number of workers. The only weakness in the City workers data is where the need for services in the City is not necessarily limited to City workers, but will also be available to: Any individuals who live in the City of London or in the surrounding area who use or might want to use services based in and around the City area. Any individuals who work elsewhere in London. Any tourists or temporary residents (British or overseas) who might use services whilst in London. The data collected also needs to take account of a respondent equating use of a service with a course of treatment or series of appointments, rather than a single appointment. This is particularly likely to be the case for services such as physiotherapy and mental health services and less likely for one-off services such as blood tests, travel vaccinations and emergency GP services. The demand for the former in terms of number of appointments may therefore have been understated. All fieldwork and project management of the research was carried out to ISO quality standards. 8

14 4. Healthcare provision and take-up in the City 4.1 What healthcare services are provided in the City? There are 332 providers of core healthcare services in or around the City of London. These include both single and multiple service providers: 57 provide NHS medical services, 99 offer private medical services, 70 offer travel vaccinations, 43 offer blood tests, 58 offer private mental healthcare services, 17 offer NHS mental healthcare services and 266 offer other services (where the majority are physiotherapy-related services). This research identified 332 healthcare providers located in the City or surrounding area which offer one or more of the core healthcare services of interest here. The number and proportion providing each healthcare service is shown in Figure 2. There are 57 providers of NHS GP-related medical services in and around the City: Of which 47 are NHS providers and 10 are private providers offering NHS services. The 47 NHS providers are largely based on the periphery of the Square Mile. There is one NHS GP practice located in the Square Mile. The 10 private providers are business retail units of a pharmaceutical service provider. Within the 47 NHS providers, there are 17 providers of NHS mental healthcare services. The dominant providers in the City and surrounding area are private providers: 99 organisations offer private GP-related medical services, travel vaccinations or blood tests. Of these 99 organisations: 52 providers offer GP appointments, 48 offer an annual health check 10, 45 a one-off health check, 41 offer drop-in or booked on the day appointments and 40 emergency appointments. There are 70 providers of travel vaccinations. There are 43 providers of blood tests. 58 organisations provide mental healthcare services. There are 266 organisations providing other services, with a mix of both NHS (46) and private providers (220): The majority of organisations offering other services provide physiotherapy, chiropractic or osteopathy services (168). Most of these providers are private (159). 27 provide occupational health nurses and 16 occupational health physicians. 65 provide services for sexual health. 76 provide services for smoking, alcohol or drug addiction. 10 Providers were asked to categorise themselves into specific categories, two of which were annual health checks and one-off health checks. The questionnaire was not designed to record if they offered NHS health checks specifically, therefore these categorisations may or may not include NHS health checks. 9

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16 Figure 2: Healthcare provision in the City and surrounding area Proportion of All NHS Private providers out providers (no.) (no.) of total (332) (no.) % Net: NHS medical services GP appointment Emergency appointments Drop-in/booked on the day appointments Health check (yearly) Health check (one -off) Net: Private medical services GP appointment Health check (yearly) Health check (one -off) Drop-in/booked on the day appointments Emergency appointments Travel vaccinations *Blood tests Net: Private mental healthcare services and support for illnesses such as stress, anxiety and depression Counselling/advice/therapy Cognitive Behaviour Therapy Psychiatrist Psychiatric nurse Net: NHS mental healthcare services and support for illnesses such as stress, anxiety and depression Counselling advice therapy Cognitive Behaviour Therapy Psychiatrist Psychiatric nurse Net: Other services Physiotherapy (including sports), chiropractor and osteopathy services Services for smoking, alcohol and/or drug addiction Sexual health services Occupational health nurses Occupational health physicians

17 [Note: These categories were self-selected by the provider from a list of service options. These options are not broken down into further detail. For example a one-off health check was not probed for finer detail on whether the check was in response to a longterm disease annual checks or patients requesting an ad hoc annual check. Similarly one-off health checks may include other checks beside the NHS programme NHS Health Check. *Providers may have self-selected this service whether they physically take blood or analyse blood or both. This service may therefore offer a consultation or on the case of analysis only may not provide a consultation.] 13

18 4.2 What healthcare services in the City do workers use? GP services, for regular medical check-ups and non-emergencies, are used most widely along with travel vaccinations and blood tests at home or work. The bulk of service usage by City workers is currently near home. City workers were asked which types of healthcare services they had used in the last two years, either accessed near home or near work and also services that they had not accessed at all. The list of services was restricted to those shown in Figure 3 as other services were outside the scope of the research. The most prevalent services used by City workers were GP appointments for both regular check-ups and non-emergencies, where 66% of City workers had used each. Services used to a lesser extent, but by at least one quarter of workers were blood tests (39%), travel vaccinations (27%) and GP appointments for emergencies (23%). A minority had used physiotherapy-related services (13%) with very few using counselling for alcohol, drugs and smoking (4%), sexual health services (4%), occupational health (4%) and mental healthcare services and support (2%). Only a minority of City workers had used services near work, with the majority using services near home. Overall, service usage by those with and those without private healthcare were similar for some services. However there were significant differences in usage for GP emergency appointments, with non-private healthcare users accessing these to a greater extent than private healthcare users. Private healthcare users accessed travel vaccinations and physiotherapy services more than non-private healthcare users. The small proportion of City workers who used services near work in the last two years (ranging from 1% to 6% for each service) were asked whether this was an NHS service, private service or pharmacy-based service. The majority of services accessed near work were private rather than NHS services. The exception to this was treatment or counselling for drugs, alcohol addiction and smoking cessation, which were more often accessed via a pharmacy, mainly via the Stop Smoking Service delivery. Sexual health services were mainly accessed via NHS services. (Note given the low base sizes involved, this data on usage is indicative only). 14

19 Figure 3: Healthcare services used by City workers in the last two years % Used near % % % home or Used Used Not work near near used Base: All City workers GP appointments for regular medical check- (either) 1, home 1, work 1,042 5 ups GP appointments for non-emergencies GP appointments for an emergency Travel vaccinations Blood tests Mental healthcare services and support Counselling, advice or therapy for help with alcohol, smoking and/or drugs Physiotherapy or sports physiotherapy services Sexual health services Occupational health services , [Note: the service usage for near home or near work may not add up to the total services used/100% (either near home or work) as some City workers may use services both near home and near work.] There were some differences in usage of healthcare services by City workers (combined usage near home and work) by job role, age, gender and ethnicity: Job role. Those working in skilled roles such as administrative or secretarial, skilled trades or personal services (e.g. beautician, coaching) were significantly less likely to have accessed GP appointments for non-emergencies (60% of those in these types of roles had used healthcare services, versus 65% of professionals and 73% of those in sales roles) and travel vaccinations (22% of the sample in these skilled types of role had used healthcare services, versus 35% of those in sales roles and 27% in professional roles). Those in sales or manual roles were significantly less likely to have accessed a GP for a regular medical check-up in the last two years, either near work or near home (57% had accessed a GP compared to 69% of professionals and 65% of those in skilled roles). Gender. Females were significantly more likely to have accessed some services: a GP for a regular medical check-up (74% had done so in the past two years versus 62% of males), sexual health services (9% had used versus 1% of males) and blood tests (45% versus 35% of males). Age. Workers aged less than 24 years old were significantly more likely to have accessed sexual health services (16% had used these services versus 3% of those aged 25 or more) and those aged 25 years or more were significantly more likely to use physiotherapy-related services (13% versus 4% of under 25s). Workers aged 50 years or more were significantly more likely to access counselling for alcohol, smoking or drug addictions (8% versus 3% of those aged less than 50 years). Ethnicity. Other white (i.e. not white-british) and Asian workers were significantly less likely to have accessed GP appointments for regular medical check-ups (55% and 53% respectively had done so whereas 66% of all workers had) and blood tests (28% and 25% had whereas 39% of all workers had). Asian workers were also least likely to have accessed GP appointments in an emergency (19% had versus 23% of all workers)

20 4.3 What does appointment availability look like? What booking methods are available? Two thirds of services are open beyond the traditional working day of 9.00 to 18.00, where demand from City workers is greatest for appointments pre- and post- office hours and during lunchtime (12.00 to 14.00). Two in five services can offer same day or next day appointments. Besides services offering telephone booking for appointments, online booking and is also available for around half of services. The duration of appointments is half an hour, with NHS services providing slightly shorter appointments and private slightly longer. Healthcare providers (both private and NHS) were almost all open for five days a week, with a minority of 8% open at weekends (largely the hospitals). After work opening times for private and NHS providers were: 60% were open after 18:00. 30% were open after 19:00. 8% were open after 20:00. This is indicative that there is evening appointment provision, particularly up until In addition, pre working-day appointments are available where 65% are open prior to Given peak demand for services from City workers is around working hours, early morning (prior to 09:00), lunchtime (12:00 to 14:00) and evening (17:00 to 20:00), currently City healthcare services do largely meet demand. However, there was a proportion of City workers who expressed that they had some unmet demand. These workers identified the reason for their unmet demand as due to appointment unavailability: 10% cited inconvenient appointments as a reason for non-use of services, 13% stated that they had to wait too many days for an appointment, 12% felt that services were too busy and 7% said that in their experience, only drop-in appointments were available. Healthcare providers (both private and NHS) were largely able to offer an appointment within one week. As seen in Figure 4Figure 4, 67% of providers could offer this availability, with 42% also able to offer same day or next day appointments (or a drop-in service). 16

21 Figure 4: How far in advance appointments need to be booked (% providers) Drop-in 8% Same day 20% Next day 14% Within 5 days 25% Within 10 days 5% More than 10 days 7% Not provided 22% Besides the option to book appointments via the telephone (where 96% of services provide this method), online methods were also available from half of providers - 52% offered online booking and 50% could offer appointments via . Online bookings were marginally more available through NHS providers (60% offered this versus 50% of private providers), whereas booking methods were almost twice as likely to be provided by private providers (55%) than NHS providers (24%). Conversely, walk-in appointments were more likely to be provided by NHS (78%) than private providers (33%). City workers were found to largely book their appointments via telephone (87%) and a minority used walk-in appointments (12%) or booked online (10%). Services that did not provide information on appointment booking methods are excluded from Figure 5. 17

22 Figure 5: How appointments can be booked 96% Telephone Online booking Walk in Text message 2% 2% 2% 96% 96% 52% 60% 50% 50% 24% 55% 41% 78% 33% All providers NHS providers Private providers The average appointment length offered by providers was 30 minutes, with private providers offering a longer appointment (34 minutes on average) than NHS providers (18 minutes). This is shown in Figure 6. Figure 6: Length in minutes of typical appointment offered % All providers % NHS % Private providers providers Average 30 minutes 18 minutes 34 minutes As shown in Figure 7, appointments booked for physiotherapy-related services were the longest, with an average duration of 37 minutes. Given the dominance of the offer of physiotherapy-related services among private providers, this is largely accountable for the differences between NHS and private provider appointment lengths. All other NHS and private service categories offer appointments of between 14 and 22 minutes in length with the exception of smoking, alcohol and drug addiction support services, which were an average of 27 minutes per appointment. 18

23 Figure 7: Average length in minutes of typical appointment offered by type of service (NHS and private) NHS medical services via a GP appointment NHS medical services for yearly type health checks NHS medical services for one-off health checks 15 NHS medical services for emergency appointments (walk in/ booked on the day) Private medical services 22.3 Travel vaccinations 20.8 Blood test NHS mental healthcare provision Services for smoking, alcohol and/or drug addiction services Physiotherapy, chiropractic or osteopathy Sexual health services Occupational health services The average number of appointments provided per day is provided in Figure 8, which shows that per provider, 37 appointments are offered on average on a daily basis. Where services did not provide information, they are excluded from the calculations. Figure 8: Average number of appointments offered per day % All providers % NHS providers % Private providers Average number There was some propensity found among City workers to pay for services near to a workplace, no doubt because of the perceived convenience in doing so. However this was not found to be a widespread practice as a number of services can largely be accessed for free via NHS services or by way of private healthcare. Typically 25 to 34 was found to be an average amount willing to be paid per appointment among City workers. However there are varying degrees of interest in usage, relative to the proportion that are using each service. GP check-ups and non-emergency appointments were most likely to be paid for (amongst private or non-private healthcare users this ranged from 22% to 25% willing to pay for services), as well as travel vaccinations (32% of private healthcare users and 18% of non-private healthcare users). Data on the amount charged by each healthcare provider was collected as a general price point. Where several services were offered by a healthcare provider, a single price was provided as an indicative average. Price points were often provided as a range, likely to reflect differing prices depending on the type of treatment required or potentially for a course of treatment required as opposed to a one-off charge per appointment. Where price points were provided, a qualitative examination of costs showed that most treatment was charged at around 60 to 80 for GP appointments, travel vaccinations and blood tests. Mental health services commanded a higher cost 19

24 for treatment and more variance where ranges between 65 and 90 were typically provided as minimums and upper limits were 300 to What are the key future considerations for healthcare provision in the City? Looking ahead to future healthcare provision in the City, a key consideration is to continue to meet workers healthcare needs, and also address where they may be some potential unmet demand. This research finds that the dominant reason given by workers for their healthcare needs not being fully met (i.e. where a worker has wanted to use a service but could not) was due to a lack of available appointments. In terms of services, City workers identified some unmet needs in the areas of GP health checks, blood tests and mental healthcare provision. Potentially lower service provision levels were also identified for GP appointments, private medical services, emergency NHS appointments and travel vaccinations. Given the City of London hosts a large working population, but a relatively small residential one, service provision in the City, linked with City workers limited capacity to visit healthcare providers, can result in unmet healthcare needs in some areas of service provision. The research shows there may have been occasions over the last two years where City workers have wanted to use a healthcare service but were unable to do so. There is indicative evidence that this is mostly the case for those without private healthcare (59% would have liked to have accessed services but could not) compared with those with private healthcare (31%). Looking at where there may be scope for further healthcare provision, the research shows this is greatest among City workers without healthcare provision and lies mostly with GP appointments, where one third would have liked to access GPs for nonemergencies (37%) and one quarter for regular medical check-ups (26%). GP appointments (16%), blood tests (12%) and travel vaccinations (8%) were also within the top five services where there was found to be some scope for further provision. By looking at current demand for healthcare services from workers and where needs may potentially be unmet, and cross-checking this against current supply, the services where supply is more limited is for: NHS medical services for health checks and blood tests. Although demand is relatively low, provision for NHS mental healthcare is also limited in meeting demand and unmet demand. Services which are on the periphery of meeting supply are NHS GP services via an appointment (taking account of services both in and on the boundary of the Square Mile), private medical services, NHS medical services for emergency appointments and travel vaccinations. For non-private healthcare users, service provision for potential demand for physiotherapy related services and occupational health services is also limited. This suggests that if additional services of this nature were available in the City, this would enable City workers to access the full spectrum of healthcare services they need at a more convenient location and time to fit around their working lives. It is worth noting however that current limited supply does not suggest that healthcare needs are not being met, nor does it necessarily indicate current under-supply. It simply highlights that there may be scope for further provision in these areas, particularly 20

25 when considering projected growth in the City working population over the short to medium term. There are also other considerations which may present a challenge for healthcare providers and the way in which their healthcare service provision is arranged: Awareness of services - is there sufficient awareness around services available in the City? It could be that services are not accessed or there is a perception of unmet demand as services are assumed not to exist or are considered hard to access. For example, if a service has limited signposting to its services (e.g. insufficient internet presence). Just under half (46%) of City workers with unmet demand stated they were unable to find a service near work. Accessibility of services. For example, GP services via an NHS provider can only be accessed via a home-located surgery and not via a work one (unless a worker is set-up as a temporary patient). Therefore, City workers using NHS facilities are largely limited to their own surgery for non-emergency appointments, therefore unmet demand may be coped with or self-medicated. The research identifies some different types of City worker where unmet demand for healthcare services is more prevalent and if further services were to be developed, it is suggested that these groups be borne in mind: Mental healthcare support for professionals, administrative workers, 40 to 49 year olds, males. GP check-ups for professionals. GP non-emergencies for professionals and Asian workers. GP appointments for professionals. GP emergency appointments for Asian workers. Travel vaccinations for professionals, administrative workers and white British workers. Blood tests for professionals and males. Physiotherapy related services for professionals, 50 to 59 year olds and black ethnic groups. Addiction services for administrative workers, 20 to 24 year olds and other white (not white British) workers. Sexual healthcare for administrative workers, 20 to 24 year olds, females and Asian workers. Occupational health for 20 to 24 year olds, males and white British workers. This research asked City workers to identify the key reasons why they could not use a service that they wanted to over the last two years for each service that they could not use. The main cause of unmet demand identified was because of service unavailability as opposed to personal reasons. This indicates a lack of supply in some cases, where nearly half of City workers were unable to find a service near work (46%). Additionally, one in ten or more of City workers, felt that they either had to wait for too long a period to get an appointment (13%), the service near their work was too busy (12%) or the service near work offered inconvenient appointments (10%). Less than one in ten City workers mentioned the services were too expensive (7%) or that only drop-in appointments were available (7%). For some services, City workers felt that they had experienced some inconvenience for services that they had wanted to use but were unable to do so. This ranged from 19% of City workers who felt inconvenienced a lot by not being able to access a GP regular medical check-up to 35% who felt that they were inconvenienced a lot by not being able to access a GP emergency appointment (see Figure 9). 21

26 Figure 9: The extent to which non-private healthcare users were inconvenienced when they had unmet demand GP appointments - regular medical check-ups 19% 57% 23% GP appointments - non-emergency 22% 60% 16% GP appointments - emergency 35% 49% 10% Travel vaccinations 20% 58% 13% Blood tests 37% 42% 16% Inconvenienced a lot Inconvenienced a little Did not inconvenience at all In conclusion, based on the findings of this research it is suggested that key considerations for healthcare service provision in the City are to: Continue to meet City workers healthcare needs, particularly in terms of providing the types of services that they require and in offering a sufficient number of appointments at appropriate times Raising awareness and informing City workers of the presence of healthcare providers and what types of services are available to them. This report attempts to address this challenge in part, by producing an accompanying directory of NHS and private healthcare provision in and around the Square Mile, for use by City workers and residents (available online). 22

27 5. Appendix: sample profile Proportion (%) of sample by location of interview Liverpool St 5.0 Bank 8.0 Monument/Gracechurch St/Eastcheap bus stops 1.0 Moorgate 3.0 Blackfriars 6.0 Fenchurch St/Tower Hill 15.0 Mansion House 5.0 London Bridge 14.0 City Thameslink/Ludgate hill bus stops 15.0 St Paul s/newgate bus stops 3.0 Aldgate 3.0 Barbican 6.0 Cannon Street 6.0 Farringdon 7.0 Proportion of sample by profession (%) Director, manager or senior official 15.4 Professional (e.g. doctor, lawyer, chartered accountant) 30.0 Associate professional (e.g. technician, nurse, broker) 22.5 Administrative or secretarial 10.6 Skilled trade (e.g. telecoms, engineer, mechanic, chef, electrician) 5.2 Personal services (e.g. carer, coaching, beautician) 2.1 Sales or customer service (e.g. shop floor retail, restaurant/bar, call 4.3 centre) Process, plant, machine or vehicle operator 3.5 Other (e.g. construction, cleaning, security) 6.4 Proportion of sample by age (%) Up to 24 years old to 49 years old years old 15.9 Proportion of sample by gender (%) Male 66.0 Female

28 Mapping Public and Private Healthcare Provision in the City ReseaRch RepoRt City of London CorPoration FebRuaRy