Agenda item

The Committee considered a joint report of the Joint Report of the Director of Transformation and Partnerships, Durham County Council and the Director of Commissioning, DDES CCG that provided details to review the provision of Urgent Care Hubs as part of the extended and enhanced primary care service by Durham Dales, Easington and Sedgefield CCG that had commenced on 1 April 2017 (for copy see file of minutes).

The Senior Service Office, CDDFT advised of the current state of services provided within Bishop Auckland Hospital including the number of appointments and scans made (for copy of slide see file of Minutes).

The Director of Commissioning gave a detailed presentation including:-

·         Service change recap

·         Summary of findings

·         Primary care services patient engagement

·         Engagement on our current model

·         Other key issues for Dales

·         Locality specific issues – Durham Dales

o   Durham Dales preferred model

·         Outcomes locality specific – Sedgefield

o   Locality specific issues – Sedgefield

o   Sedgefield recommendation

·         Outcomes locality specific – Easington

o   Locality specific issues – Easington

o   Easington recommendations

·         Key Principles

The Director of Commissioning informed the Committee of the next steps which were to:-

·         Develop a communication and engagement strategy

·         Agree consultation messages and work with Healthwatch as independent support and gain support from PRG members

·         Focus on what else would be needed to support the recommendations – more services, better access

·         Present the findings and the consultation plans to Committee in September

·         Undertake a 6-8 week consultation focusing on the areas where the most change was proposed

The Chairman welcomed Councillor Sutherland, Barnard Castle Town Council to the meeting.

Councillor Sutherland expressed concerns about proposals for the Richardson Hospital.  These concerns had been discussed reference group meetings, led by Lesley Jeavons, Director of Integration.  One in two patients had been informed that the hospital was closing due to there being no demand for urgent care.  One in two patient wards had closed and the hospital provided thirty outpatient services however most people in Barnard Castle were not aware of what services were available.  She stated that Barnard Castle was 15 miles from Bishop Auckland and if there was no urgent care available in Barnard Castle people would have a lot of travelling to contend with.  Some areas had no or very little in terms of bus services.  She believed that the under use of services at the Richardson Hospital was due to the lack of publicity around it.  There was a lack of information in GP surgeries and pharmacies and the CDDFT website did not have the correct address for the hospital.  Only 4 of the 39 outpatient services were listed on the website and the NHS choice website had not been updated about the Richardson Hospital since 2013.  Councillor Sutherland was therefore not surprised that it was under used as no one knew about it.  She also stated that the 111 service direct callers to Bishop Auckland rather than the Richardson Hospital.

Councillor Sutherland concluded that she believed that the NHS and CDDFT were deliberately running the service down. She urged the Committee not to accept the recommendations and to give time for people to start using the services available.

Councillor Bell concurred with Councillor Sutherland’s points and added that he had knowledge of people being directed to Bishop Auckland when in need of urgent care.  He also confirmed that he could not find any reference to the Richardson Hospital providing this facility on the NHS choice website or by using Google.  He asked that the decision for Durham Dales was deferred for a period of nine months and for the CCG to take immediate action on the points raised by Councillor Sutherland regarding publicity.

With regards to the sample size of people engaged in the process, Councillor Crute asked for clarity on how many people were affected and if this was adequate.

Similar reports for people in Easington or Peterlee being directed to Sedgefield was referred to by Councillor Grant.

The Chairman reported that there was no information in his surgery about where people should go to seek urgent care.  He also referred to Councillor Crute’s point, as he was aware that there was only a 6% return in Sedgefield, 8 people in a population of 25,000.  He referred to the potential cost savings and asked what this money would be spent on.

Referring to travel, Councillor Henderson expressed his concerns about how far people would need to go from Barnard Castle to Bishop Auckland if the hub at the Richardson Hospital was removed.  He also agreed that there should be more publicity around the facility so that people were made aware.

Councillor Patterson had been positive about the proposed changes but did not feel that concerns had been addressed and said that a wider group of people should be consulted with due to the low number of returns.  She asked how many appointments made in a hub were a direct result of not being able to get an appointment with their own GP surgery.  She was also aware of people being directed further away when using the 111 service.

The Chairman summarised the concerns raised as the 111 service referrals, travelling, the accuracy of the survey and public awareness of the services available and the cost savings.

The Director of Commissioning explained that the publicity campaign had been the same across the whole of DDES and was about people knowing that services were available and rather than people turning up they would be expected to ring the NHS 111 service. They would be booked into a hub with an appointment.  Where a patient was booked in would also depend on the condition as not all hubs dealt with minor injuries.  It was a direct service based on need.  She added that staff were not available for all 9 hubs but that the changes would ensure that GPs and staff nurse practitioners would be available in each area.  If the service was to remain the same further staff would be required in the Bishop Auckland, Easington and Sedgefield areas.  She advised that talks had taken place with councillors in the Dales area very early on in the process and this formed part of the engagement plan.  The hubs had seen more people being able to access urgent same day appointments with a GP that could access medical records.  With regards to the survey sample size, the Director of Commissioning confirmed that questionnaires had been sent out and discussions had taken place with people who used the services.  Surveys were carried out in every hub and people were encouraged to complete them.  She concluded that the CCG had to look at the budget and how to make best use of the funding available.  The service was not quite right and did require a variation in each area. 

The Chairman asked that GPs and the role they played was considered.  Following on from Councillors Bell’s earlier point, he reiterated that the changes should not go out to consultation at this time as the figures and survey numbers were flawed.

Councillor Patterson pointed out that it had only been 18 months since the urgent care review had been set up and she felt that the CCG should undertake an investigation as to why the hubs had failed and the reasons behind that.  She said that the small numbers involved in the survey responses did not justify the recommendations for change.

Referring to the fall in numbers at the urgent care centres, Councillor Temple was not convinced that removing centralised services would be the best option especially since it had only been a short period since this preferred system was introduced.

The Director of Commissioning confirmed that there had been the same level of publicity carried out in every area.  The analysis of the data results varied across the geography and she could not see that changing.  The public had been informed of talk before you walk, which was a clear and key message delivered as part of the process.  A lot of hard work had been put in to try to get people to complete the surveys however as low numbers are often seen across the County they did expect the low return.  She did understand the concerns expressed about the website.

Councillor Grant reiterated the point that the 111 service were not highlighting some of the hubs as having urgent care available.

The Director of Commissioning responded that publicity had not been carried out in the way in which the committee were now asking for but in a way that was previously agreed.  The message was to talk before you walk and this had been circulated to every household in DDES and the surrounding areas.  This had been in line with the regional and national approach taken to talk before you walk.  She advised that there had been leaflet drops and a radio campaign and that they would carry out far reaching engagement on the proposed changes.  She added that she could not see how the result would be different.

Councillor Bell asked that the proposals be put on hold until the publicity of these services was addressed and that a greater emphasis be put on collecting data.

With reference to the website, the Acting Associate Director of Marketing and Communications, CDDFT responded that there was a reference group at the Richardson Hospital and they looked at all of the information available.  A separate Task & Finish Group was also set up to look at the recommendations.  She confirmed that the website had been updated, that there had been pro-active communication for the Richardson Hospital and that any concerns were being addressed by the Task & Finish Group.

The Chairman confirmed that the Committee were asking for the changes to be put on hold until all of the issues raised had been addressed, and for a report to come back to Committee.

Resolved:

That the report and presentation be noted and that the Committee recommend to DDES CCG that the proposed review of Primary Care Support Services and the associated communications and engagement activity be paused for a period of 9 months to allow for more robust patient/stakeholder engagement activity to be undertaken along with a review of the referral practices being adopted by NHS 111 service to ensure that local residents are able to access urgent appointments in primary care services within their locality and that these services are being actively promoted by the CCG.