Agenda item

(To receive a report from Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group, which provides the Committee with on update on the progress made in implementing plans to enhance primary care services and the CCG's public awareness campaign as to the alternative provisions to the Lincoln Walk-in Centre)

Pursuant to Minute Number 48 from the meeting held on 13 December 2017, the Committee gave consideration to a report from the Lincolnshire West Clinical Commissioning Group (CCG), which provided an update on the progress that had been made in implementing plans to enhance primary care services and the CCG's public awareness campaign as to alternative provisions to the Lincoln Walk-in Centre.

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group (LWCCG), Dr Sunil Hindocha, Chief Clinical Officer (LWCCG), and Wendy Martin, Executive Lead Nurse and Midwife - Quality and Governance (LWCCG).

The Chief Clinical Officer introduced the report and advised the Committee that NHS Lincolnshire West CCG's Governing Body had met on 29 November 2017 and 24 January 2018 to consider the details on the progress of the alternative provision plans.  The alternative provision plans addressed six key areas: GP appointments and access; Urgent Care Provision; Clinical Advice and GP Access for Children; University of Lincoln Practice Plans – Students; Homeless and Vulnerable Patients and Communication and Engagement Plans.  It was highlighted that at the 24 January 2018 meeting, the Governing Body had been assured and had agreed to support the recommendation to close the Walk-in Centre by the end of February 2018; but retain weekend opening only during the month of February 2018.

Attached to the report for the Committee's consideration were the following Appendices:-

Appendix 1 – Lincoln Walk-in Centre - Alternative Provisions Plan 2017;

Appendix 1A – Lincoln Walk-in Centre Consultation 2017 - Alternative Provisions Description;

Appendix 2 – Lincoln Walk-in Centre Consultation 2017 – Alternative Provisions Communications Review;

Appendix 3 – Lincoln Walk-in Centre Consultation 2017 – Alternative Provisions Engagement Plan;

Appendix 4 – Lincoln Walk-in Centre Consultation 2017 – GP Practice Case Study Summary; and

Appendix 5 – Lincoln Walk-in Centre Consultation 2017 – A & E (Lincoln) Activity Summary for Lincolnshire West CCG Patients.

In presenting the report to the Committee, the Executive Lead Nurse and Midwife - Quality and Governance, provided an update concerning the alternative provisions which made reference to the following:-

·         GP Optimisation – It was reported that GP Workflow Optimisation had been implemented across the CCG's Practices to ensure the most effective use of primary care resources;

·         The extension of clinical skills in the Primary Care team.  It was highlighted that many practices were employing community pharmacists.  It was highlighted further that four additional pharmacists had been employed, whose roles would be developed to enable them to see patients, which would release GPs to see patients who really need to see a GP;

·         Same Day Access for Urgent Need – The Committee was advised that same day access for Urgent Need was currently available at all practices.  Clarification was given that same day access for urgent need would happen when a patient was unable to get an appointment the same day, but considered that their need was urgent, then either a nurse or GP would call the patient back in these circumstances.  If following the phone conversation, it was deemed urgent, the nurse or GP would then book the appointment for that day.  It was noted that this would apply for both children and adults;

·         The University Practice – It was reported that the University Practice had seen a net increase in registrations totalling some 3,150 students.  The practice had also increased its same day capacity to provide an additional five pre-booked daily appointments.  It was highlighted that the practice had introduced a new phone system, which would avoid patients having to wait long periods of time to speak to someone to make an appointment.  The Committee also noted that the University Practice was also available to non-students;

·         GP Out of Hours Service - The Committee was advised that this service was provided by Lincolnshire Community Health Services.  The Out of Hours Service was accessed by calling 111, which was the recommended route for accessing urgent medical care.  It was noted that in Lincolnshire the Out of Hours Service was provided from bases in Lincoln, Gainsborough, Grantham, Boston, Louth, Skegness and Spalding.  The Committee noted that the capacity of Out of Hours provision at weekends would be monitored to ensure that there were facilities to support any additional demand that was assessed as requiring face to face treatment by the Clinical Assessment Service or 111;

·         Clinical Assessment Service – It was noted that the Clinical Assessment Service had been launched within the NHS 111 system.  It was noted further that 111 calls would be picked up by a trained health advisor, supported by a team of clinicians; and

·         Community Engagement – Appendix 2 and 3 to the report provided the Committee with details of the Alternative Provisions Communications Review and Engagement Plan.

The Chief Operating Officer, Lincolnshire West Clinical Commissioning Group, advised the Committee that there had not been any significant impact on A & E attendance figures.  An updated A3 spreadsheet showing A & E attendances was circulated to members at the meeting.  The Committee noted that Urgent Care streaming had been in place since October 2017, which had enabled patients to be diverted from A & E.  It was also reported that there had been a reduction in the number of patients self-presenting.

It was reported that all practices that were likely to have been affected by the closure of the Walk-in Centre, arrangements had been put in place to support patients needing same day appointments.  Appendix 4 to the report provided the Committee with a document which summarised current available capacity to accommodate need.  The Committee was advised that the Abbey Medical Practice had been busier since the Walk-in Centre had closed.  It was noted that most patients were within the catchment area of the practice and were registered, but were using the Walk-in Centre as a GP practice.  The Abbey Practice had been receiving extra support to help them meet demand but this situation had improved over the last two weeks.

It was reported that the LWCCG had been working with the Lincolnshire Community Health Service who provided the Walk-in Centre Service.  It was confirmed that all staff had secured alternative employment with the majority of the team taking up posts within essential urgent care services.  Thanks were extended by the Chief Clinical Officer to all staff who handled the extra pressures over the Christmas and New Year period.

The Committee was advised that LWCCG Governing Body were actively monitoring data and performance relating to A & E.  Appendix 5 to the report provided the Committee with such data.  It was highlighted that the average monthly A & E attendances in October 2017 to December 2017 (Q3) had dropped compared to the average monthly A & E attendances January 2017 to September 2017 (Q1 to Q3), and that 2017 attendances were less than those recorded in 2016.

The Committee was advised further that the LWCCG would be continuing to roll-out the alternative provisions as identified in the Appendices to the report.  The Committee was advised further that the CCG would support, post closure of the Walk-in Centre, for a period of additional General Practice Out of Hours provision at weekends (from 1 March 2018 to 8 April 2018).  This was to ensure that an effective and safe transition to the alternative services had been achieved.

During debate, the Committee raised the following issues:-

·         Some members of the Committee extended their congratulations to the LWCCG for the progress that had been made with regard to alternative provisions;

·         Reference was made to the confusion experienced by members of the public on the different types of services available; for example although not relevant to this item, the signage at Louth Hospital still identified the hospital as having an A & E rather than Urgent Care provision;

·         Abbey Road Practice – Confirmation was given that arrangements were still in place with the practice.  Confirmation was given that same day access was a standard requirement for all practices.  In cases where this was not happening, patients needed to voice their concerns through their practice Patient Participation Groups.  It was highlighted that Healthwatch had recently undertaken a targeted survey;

·         Praise was extended by one member of the Committee to the Primary Care Streaming at Lincoln Hospital, who had found the service to be quick and efficient.  The Committee was reminded that the purpose of an A & E was to deal with serious life threatening injuries; and the streaming of patients who attended A & E had enabled the more minor injuries to be dealt with in urgent care;

·         Some concern was expressed relating to the number of patients who had open access to the Walk-in Centre would be let down by the system.  The Committee was advised that the Abbey Road Practice had taken on additional staff to deal with the increase.  Members noted that currently the facilities at Abbey Road Practice had some constraints as they were currently operating from two sites.  Going forward, it was hoped to extend the facilities onto one site;

·         A further concern was expressed as to whether enough had been carried out to contact the difficult to reach people to make them aware of the changes to service provision.  It was reported that work with this particular group was ongoing and that this particular group of individuals did not use the Walk-in Centre.  It was also reported that a range of media releases had been used to target hard to reach groups.  Engagement activities had also been undertaken by using facebook, twitter, engagement events at Children's Centres; and the use of information leaflets;

·         A further concern was raised as to whether the Lincoln GP practices would reach a point of saturation due to an increase in the number of patients.  It was highlighted to the Committee that the patients were not new patients, as they were already on GPs list.  It was highlighted further that patients that were registered with a GP had access to routine appointments and urgent care;

·         Some concern was expressed to the fact that urgent same day appointments were not available in the Sleaford area.  The Chief Clinical Officer of Lincolnshire West CCG indicated that he would pass this observation to South West Lincolnshire CCG, in whose area Sleaford was located; 

·         One member highlighted that the definition of urgent care varied from GP to GP.  It was further highlighted that Healthwatch tended only to receive complaints when patients had failed to receive a good service.  The Committee was advised that sometimes the reasons for not providing a good service were as a result of staff shortages/or a lack of understanding by staff.  There was agreement that there was a lack of understanding by the public on the definitions of emergency care and urgent care; and what services were provided by A & E.  It was felt that more publicity and education would help in this matter.  The Committee noted that there needed to be a more consistent approach to urgent care and that some reception staff needed to receive further training in relation to this matter. Some members felt that this training needed to be done sooner rather than later.  Officers advised that receptionists had received care navigation training in the last six months; and that training was an ongoing to ensure the enhancement of all staff.  It was highlighted that if a patient was unable to get an appointment with a GP, they could always ring 111.  Officers agreed that more publicity needed to be undertaken in relation to the arrangements relating to the proposed grouping of practices; and for late night and Saturday opening times.  Confirmation was given that where provision was required out of hours, the route would be through the 111 service;

·         One member enquired as to whether lessons had been learnt as a result of the process.  The Committee was advised that some workshops sessions had been planned to look at lessons learnt;

·         Some members expressed concern that the Committee had not received all the relevant information to make an informed judgment, particular reference was made to the usage of the Walk-in Centre during the January 2018 period compared to the alternative provision usage i.e. increase in the number of GP appointments; increase in the number of 111 requests.  It was also felt further information relating to the number of bookable GP appointments in Lincoln would also be useful; and

·         One member enquired as to whether there was anything members of the Committee could do to help with patient registration.  The Chief Clinical Officer agreed to send the Health Scrutiny Officer information which could be circulated to all members of the Committee.

The Committee agreed that some progress had been made, and that more information need to be provided to evidence the said progress.

RESOLVED

1.    That the Health Scrutiny Committee for Lincolnshire acknowledged that whilst some progress had been made, the decision for the phased closure the Walk-in Centre had been made by the Lincolnshire West Clinical Commissioning Governing Body on 24 January 2018. 

2.    That the Committee was still not clear from the evidence provided that sufficient progress had been made relating to improved access to General Practice and to the development of alternative provisions.

3.    That as a result of (2) above, further information be requested relating to these areas being presented to the Committee for review in three months' time.