Agenda item

The Chairman introduced those in attendance for this item and asked the Director of Commissioning, DDES CCG Sarah Burns to give a presentation in relation to the review of Urgent Care Hubs across DDES CCG (for copy see file of minutes).

The Director of Commissioning began by explaining the difference of Extended and Enhanced Primary Care Access (EPCA) and Urgent Care, with changes that had been made in April 2017 in terms of retaining minor injuries units at Bishop Auckland and Peterlee, expanded same day appointments during the day across DDES for illness, and evening and weekend hubs in 9 areas across the geography.  It was noted this was to get the right care for individuals, with “right care, right place, right person, right time”, and to “talk before you walk”, access services via the NHS 111 telephone number.

Members were referred to a comparison in relation to services in DDES with those in North Durham, in terms of minor injuries units, GP out-of-hours services, and extended access hubs.  It was explained that there were other services in place, including: additional same day appointments in General Practices; day time “overflow services”; out-of-hours service; Vulnerable Adults Wrap Around Services (VAWAS) extension 8am-8pm weekdays and weekends, with proactive visiting if GP has concerns; day-time visiting services, from October 2018; and seven day palliative care services, from October 2018.

In relation to how the NHS 111 service directs patients, it was noted that a Directory of Service (DoS) sets out the conditions seen by a particular service, and that they did not differ between each EPCA hub.  It was added that patients presenting injury would go to a minor injuries unit, either Peterlee or Bishop Auckland, or an out of area service if that was closer.  Figures from an audit in the Durham Dales for the period 1 April – 18 August were given, noting one instance where there had been a missed opportunity.

The Director of Commissioning introduced Dr David Robertson, a GP from Barnard Castle to speak in relation to how a General Practice worked.

Dr D Robertson thanked Members for the opportunity to speak and noted one of the main points to note was the burgeoning quantity of patients seen at General Practices, and there was an ageing population combined with a greater complexity with some patients having 3, 4 or 5 issues.  He added that in these cases managing multiple medicines and dealing with longer term conditions were becoming more commonplace. 

Dr D Robertson noted that it was important to understand that General Practices worked as a team, with a significant percentage of care being given by Nurses, Healthcare Assistants and Receptionists where appropriate, as well as outside of the practice for example via VAWAS or District Nurses.  Members noted that while EPCA focused on same day appointments it was noted some chronic and day-to-day issues were being managed via EPCA.  Dr D Robertson noted that there was a particular geography and cohort of people in the Dales area, and there was need to ensure that the needs of patients in this area was met. 

Members were introduced to Craig Hay, Emergency Care Practitioner (ECP) who was in attendance to speak as regards the role of an ECP or Advanced Nurse Practitioner (ANP) in comparison to a GP.  C Hay explained how ECPs and ANPs usually came from another discipline, for example from an A&E background, from the ambulance service or Practice Nurse and this gave them a broad range of experience in many types of patient from acute cases through to issues associated with elderly.  Members noted that ECPs and ANPs worked with autonomy and had the ability to spot serious illness, with many also being able to proscribe.  It was added that their decision making ability was an excellent asset to the GP provision and out in communities too.  It was explained that not all issues could be addressed via ECPs or ANPs for example pregnancy issues or mental health issues, though there were other clinicians within the practice team that could assist with those areas.  C Hay explained that NHS 111 were the gatekeepers in terms of service adding that they were very accurate and safe with the appropriate patients being directed to the ECPs and ANPs.  He noted that while ECPAs were not A&Es and sometime patients felt they were at the wrong site, they were seeing the correct clinician.

The Director of Commissioning noted the work since attending Committee including: a consultation, communication and engagement strategy having been developed; meeting with the Chair and Vice-Chair of the Committee in terms of an evidence log; Healthwatch having agreed to provide independent advice; a “myth-buster” having been developed with information supporting the review; there has been substantial support from Patient Reference Groups (PRGs); and there had been meetings with key Councillors across DDES; work with NHS England on the “5 tests” and NHS England Assurance have support for our approach; there was further patient engagement undertaken. 

The Director of Commissioning asked Angela Seward, Chair of the Durham Dales Patient Reference Group (DDPRG) and Chair of Barnard Castle GP Surgery Group to speak in relation to her experience.  A Seward noted that it had been clear that the DDPRG had consulted at every turn and there had been a lot of data presented, including that during the April to July period the Stanhope/Barnard Castle hub saw no patients.  She added that there had been some misunderstanding in terms of the Richardson Hospital, noting it was not a “walk-in”, rather appointments were made via NHS 111.  A Seward noted that there had been consultation and the information that had been provided was clear, and the DDPRG supported the CCG in the proposed changes to help our rural population.  The Director of Commissioning noted there had been similar PRGs within the Peterlee, Easington and Sedgefield areas.

Members were referred to slides highlighting the engagement and publicity undertaken, including on social media, regional publicity and via DDES Health Federations and displays within surgeries and via websites such as NHS Choices.

The Director of Commissioning noted in summary of the review: services are valued, but utilisation is very low in some areas; 111 received very positive feedback; current capacity was double the national recommended requirement; there were concerns as regards retaining staff in hubs where usage was low; value for money of current services was an issue given the health needs of the DDES population; and Practices are supportive of the proposed changes and think we could meet patients’ needs in a different way.  Members noted how the proposed services could look and were asked as regards what would enhance the proposals, and also noted how consultation would take place and what questions that would be put to patients.

The Chairman thanked the Director of Commissioning and the other speakers and asked Members for their questions and comments.

Councillor J Grant thanked the speakers for the clarity of their presentation and noted she felt there needed to be more publicity of the 111 and the hubs as another option other than a GP appointment, she noted that she had been asked to ring back to the GP surgery rather than the option of 111.  Councillor S Quinn noted the opposite experience, with her GP surgery advising of the option to call 111.

Councillor R Bell noted promotion of the Richardson Community Hospital and felt it could be clearer as regards appointment only via 111 and that it did not treat injury, even via 111.  The Director of Commissioning noted each hub had received the same publicity, with the regional message, and added that depending upon the clinical issue then each type of service would be appropriate, for example chest pains would perhaps warrant a 999 response.  The Chief Clinical Officer, DDES CCG added that the entire region worked similarly, to go to the nearest service, with the DoS setting out where.

The Chairman noted that consultation, communication and engagement plan was set out from page 45 of the report and the Director of Commissioning noted the timescales in terms of consultation.  Councillor R Bell noted that where 111 did not direct to a local centre, then the public should be made aware of what was available, to allow the public to challenge.  The Chief Clinical Officer, DDES CCG noted that the DoS would set out suitable centres and Dr D Robertson noted his staff would look to see where a patient is directed to Bishop Auckland, whether it would be possible to direct to Barnard Castle.

The Principal Overview and Scrutiny Officer noted that given the concerns in terms of the missed opportunity and the proposed 6-8 week consultation, the Committee could take assurance and have further information over that period to monitor the situation.

R Hassoon asked as regards mental health provision at GP surgeries and noted she believed NHS Choices had been disbanded.  Dr D Robertson noted that typically, though not always, ECPs and ANPs did not have mental health training and patients would be directed to a GP, for example if in the Dales area to Bishop Auckland.  The Director of Commissioning noted that she would check as regards NHS Choices.

A Seward added that the Barnard Castle GP Surgery Group cared very much as regards the Richardson Community Hospital and wanted to understand the difference in services between EPCA and the Richardson.

Resolved:

(i)        That the Committee receive the report and comment of the presentation and information contained therein.

(ii)        That during the 6-8 consultation, information in terms of missed opportunities be recorded and monitored, and reported back to Committee at a future meeting.