Agenda item

The Committee received a Report from the Director of Commissioning, Durham Dales, Easington and Sedgefield Clinical Commissioning Group that provided an update of a briefing paper on County Durham Urgent Treatment Centres and the Proposed Changes to Overnight Service Delivery at Peterlee Urgent Treatment Centre (for copy see file of Minutes).

The Director of Commissioning reported that there were nine hubs in the DDES area and overnight urgent care was provided from Bishop Auckland, Peterlee, University Hospital Durham and Shotley Bridge.  She highlighted the usage at Bishop Auckland and Peterlee on a weekday and weekend from midnight until 8.00 a.m. and the results showed that Peterlee had very few patients during the week with just a slight increase on a weekend.  She advised of the alternative system based model with a focus on Peterlee and Bishop Auckland and reported that the north of the County would be looked at when the review of Shotley Bridge had been determined.  Bishop Auckland would remain open as usage was high and Peterlee would lose the 8 p.m. to 8 a.m. service.  The Director of Commissioning stressed that patients could still seek an appointment with their GP and attend any other urgent care centre, and that these were for non emergency appointments. There would also be an option for home visits to be carried out so that doctors and clinicians were not static working from one centre. She added that the number of people affected were relatively small and that a full engagement and consultation exercise would be carried out on the proposed changes.

Referring to the utilisation rates in paragraph 28 of the report, and the offer of home visits, Councillor Temple asked that although the figures of patients attending urgent care in Peterlee were small would the same level of service be available in the home, for example x-ray services.  He was concerned that equipment available at the urgent care centres would not be available in the home.  He also expressed concerns about the standards of care being met and a possible reduction in the safety of the service.

Councillor Patterson believed that the 111 service was not thought out and joined up with the GP services and that this would only become worse with the problems in recruiting clinicians.  She said that these changes would put more pressure on the already stretched A&E services.

The Director of Commissioning responded that x-ray services were not open during the night at urgent care centres and she again stressed that demand was extremely low.  She advised that GP surgeries had the same equipment as the clinicians had in urgent care centres during the evening.  With the proposed changes the clinicians would be able to work across all of the urgent care centres and would be able to visit patients in their own homes, removing problems transport and travel.  She confirmed that standards would be met and that the direction of travel would move to all appointments being on a booked basis.  Referring to the recruitment of GPs members were aware of the work that had been carried out in this area.  She said that patients did not always need to see a GP and the proposed model would have a greater skills mix.

Councillor Patterson said that when ringing 111 people were directed to minor injuries or A&E and she asked how many GPs would be available and if demand would be met. She also asked if data on the highest peaks of demand were available.  The Director of Commissioning confirmed that clinicians had extensively looked at the data and demand and had built time standards into the proposed model.

Councillor Grant felt that the system for home visits was another service for people to be confused about and she said that people had already been informed that Peterlee was closed.  She asked for messages to be simplified as everyone knew to dial 999 for an emergency but below that level not everyone know who to call or what services were available where.  She added that the constant reviews of services did not help and further confused people.

Councillor Jopling stated that the weak link was the 111 service as people were directed to facilities that were not local to them.  For example she had been recently directed to Darlington when her local urgent care centre was Bishop Auckland.  Councillor Smith agreed as she had also been directed to Houghton instead of Bishop Auckland.

The Assistant Director of NEAS informed members that the 111 service used the same triage system as the 999 service and the need of the patient was determined against the directory of services available.  The operators would look to determine where a particular need was met at that particular time.  The service relied upon departments to keep directories updated.  The Assistant Director had recently invited members of the GP Services Review Group to visit the 111 centre to view how the service works.

In response to a comment made by the Chairman about attending North Tees hospital rather than using the 111 service the Director of Commissioning said that the geography of County Durham was more challenging.

Councillor Patterson commented that this was the second time that the Peterlee Centre had been reviewed and asked what the figures were then compared to now.  She believed this to be a lack of communication as people thought that Peterlee was already closed.  In response, the Director of Commissioning reported that the overnight services had never changed and that the usage had always been low between the hours of 12 midnight and 8 a.m.  As a small number of people required the service clinicians felt that they would better service patients by travelling to their homes during the night.  She assured the committee that the CCG worked closely with the 111 service and that they would book appointments for patients. 

Referring to the 111 data the Director of Commissioning advised that this was looked at to see why people had been directed out of their area, some of which was down to call handler error.  With regards to urgent care, she agreed that there was a better way to deliver the service more consistently and by engaging with the public would help gain an understanding from their perspective.

Resolved that:

1.            The Committee note the rationale for the proposed changes to service delivery in respect of the Out of Hours UTC;

2.            The results of the proposed communications and engagement process be brought back to the Committee along with the proposed skills mix of the proposed revised service model.