Agenda item

(To consider a report from Lincolnshire Community Health Services NHS Trust on the integrated urgent care in Lincolnshire.  Maz Fosh, the Trust's Chief Executive and Tracy Pilcher, Director of Nursing and Deputy Chief Executive, will be in attendance for this item)

The Chairman advised that the report for this item had been circulated separately by email to all members of the Committee.

The Chairman advised further that there were two contributors for this item: Maz Fosh, (Chief Executive, Lincolnshire Community Health Services NHS Trust) and Tracy Pilcher, (Director of Nursing, Lincolnshire Community Health Services NHS Trust).

The Committee received an introduction from the Chief Executive, Lincolnshire Community Health Services NHS Trust, which provided an update on the Integrated Urgent Care Services in Lincolnshire, which was in line with the integrated urgent care commissioning standards, which sought to bring urgent care access, treatment and clinical advice into a much closer alignment through a consistent and integrated NHS 111 service model. Details of the Lincolnshire integrated urgent care delivery model was included in paragraph one of the report.

In guiding the Committee through the report, the Director of Nursing, Lincolnshire Community Health Services NHS Trust made reference to:

·               NHS England's twenty seven standards for Urgent Treatment Centres (UTCs) the Trust had to meet, to ensure that a consistent service was provided to the public.  It was noted that the standards specified that UTCs should be integrated with local urgent care services, usually led by general practitioners and should be ideally located with primary care facilities.  Details of the nationally mandated UTC standards were shown in paragraph 2 of the report;

·               How Lincolnshire Community Health Services were delivering its elements of urgent care; and how this was being achieved.  Paragraph 4 of the report provided the Committee with details relating to the significant amount of transformation that was taking place to move to the integrated model.  It was noted that the Clinical Assessment Service (CAS) was well established and was operating 24/7 365 days a year providing phone based clinical advice and guidance with timely call backs to patients to support care, closer to home. The Committee noted further that e-consultations (video conferencing) had been introduced within CAS for those patients wishing to use it.  The Committee was advised that the Louth and Skegness UTCs had gone live in October 2019; and Lincoln and Boston UTCs had gone live in December 2019.  It was also highlighted that the re-building of Boston UTC had commenced.  Further transformational changes were shown within paragraph 4 of the report;

·               The Committee noted the changes made during Covid-19.  The changes had included an increase in the daily CAS activity of 21%, increasing daily cases to 399; a reduction in attendances at Gainsborough and Spalding Minor Injuries units; a reduction in attendance at Louth and Skegness UTCs; and the designation of Grantham and District Hospital as a temporary UTC (This decision had been taken by the United Lincolnshire Hospitals NHS Trust Board of Directors on 11 June 2020), as part of plans to provide a Covid-19 free 'green' site at Grantham Hospital.

During discussion, the Committee raised the following points:

·               Some concern was expressed for Grantham & District Hospital to return to having an A&E; and not a temporary Urgent Treatment Centre.  Confirmation was given that Grantham had a 24/7 walk in UTC.  This model had allowed temporary changes to clinical pathways to support United Lincolnshire Hospital NHS Trust (ULHT) in their efforts to create Covid-19 free 'green' site at Grantham;

·               Confirmation was given that Lincolnshire Community Health Services Trust (LCHS) did not have a contract with ULHT in relation to the Grantham UTC, but that a Memorandum of Understanding was in place.  It was highlighted to the Committee that the arrangements were for a temporary period and both ULHT and LCHS were working together to ensure services were provided during Covid-19;

·               Complaints from Grantham residents contacting NHS 111.  It was reported that Grantham residents when contacting NHS 111 were being directed to either Lincoln or Pilgrim Hospital.  The Committee was advised that profile details for Grantham had now been updated to reflect the temporary changes.  The Committee was invited to pass on any further queries to LCHS;

·               Good Communication - The need to make sure that patients were aware of what was on offer and how it could be accessed;

·               Staffing – The Committee was advised that a full workforce review had taken place, which ensured that there was the correct number of staff, with the right skills in the right place to meet demand now and for the future;

·               GP Out of hours – It was highlighted that GP out of hours was still available where a UTC was integrated.  Confirmation was also given that provision was still available at Grantham Hospital;

·               Staffing of the Clinical Assessment Service – The Committee was advised that CAS was staffed with suitably qualified staff and included GPs; and that the service was agile; and that in busy times clinicians were able to log on remotely.  It was noted that the average waiting time was ten minutes; and as staff numbers had increased, patients were contacted more quickly; 

·               Reference was made to the role of Primary Care Networks in supporting urgent care, but these were not yet coterminous with Neighbourhood Teams;

·               Whether the new NHS 111 could actual cope with the demand. It was highlighted that for patients in Lincolnshire, calls made into NHS 111, which were categorised as being suitable for LCHS services were passed to the CAS.  It was highlighted further that CAS was available 24/7, 365 days a year to provide self-care advice where appropriate, provide a telephone consultation with a clinician to assess patient's needs; and when a patient was assessed as needing additional support, the CAS clinician had a range of options available to them to ensure that the best option was provided to the patient, which included: video consultation; same day direct booking into general practice; same day booked appointment into a UTC, or a home visit; or onward referral to the community nursing team;

·               Whether Care Homes had access to NHS 111.  The Committee was advised that all care homes had a special number to be able to ring to access the CAS service;

·               Reassurance was given that anyone presenting themselves at Grantham temporary UTC would be dealt with accordingly; or transferred for treatment, if necessary.  There was an appreciation that on occasions it was confusing for members of the public, and it was highlighted that patients were being encouraged to use the 'talk before you walk' concept, by calling NHS111;

·               Concern was expressed that the 'overnight walk-in' arrangements had not been reinstated at Louth and Skegness UTC'.  Reassurance was given that the situation was being monitored; and that patients had access to home visits and booked consultations.  The Committee noted that If there was an increase in numbers, the overnight provision would be re-instated;

·               A question was asked as to how many people had been referred from Grantham to A&Es elsewhere and confirmation was sought whether the figure was still at 3.88% (which represented 44 people).  The Committee was advised that the figure was closely monitored; and that  currently the figure was between 3 and 5%; and

·               The effect of the building works at Pilgrim Hospital, Boston on the UTC.  The Committee was advised that the UTC was in a different location; and that the A&E continued to meet the needs of the public.

The Chairman on behalf of the Committee extended thanks to the presenters.

RESOLVED

That the update report on Integrated Urgent Care in Lincolnshire be noted; and that a request be made for a further update to the Committee in three months.