Agenda item

(To receive a report from Simon Evans (Health Scrutiny Officer), which asks the Committee to consider the outcomes of the Working Group held on 14 July 2017; and to finalise the Committee's response to the Lincoln Walk In Centre Consultation. Dr Sunil Hindocha (Chief Clinical Officer from Lincolnshire West CCG) and Wendy Martin (Executive Lead Nurse and Midwife – Quality and Governance) will be in attendance for this item)

The Chairman on behalf of the Committee welcome to the meeting Dr Sunil Hindocha, Chief Clinical Officer, Lincolnshire West Clinical Commissioning (LWCCG) Group and Wendy Martin, Executive Lead Nurse and Midwife Quality and Governance, LWCCG.

The Committee received a short joint presentation from the Chief Clinical Officer LWCCG and the Executive Lead Nurse and Midwife Quality and Governance LWCCG, which provided some background information to the Walk-in-Centre; the alternative services available for urgent and routine primary care requirements; provided information of user groups of the Walk-in-Centre; and provided confirmation concerning the communications campaign.

During discussion, the Committee raised the following comments:-

·         Contract expiry date – The Committee was advised that the contract had already been extended several times previously.  The current contract was due to expire on 30 September 2017.  From the feedback received so far, it had become apparent that very few people were aware of the alternative provision available.  The Committee was advised that urgent access to health services was already available through GP surgeries and NHS 111.  For less urgent health issues, these could be addressed by a routine appointment with a GP, or health advice from a Pharmacy.  If assistance was needed 'Out of Hours' patients would be able to access urgent GP services through calling 111; it was also highlighted that many GP surgeries also ran minor illness clinics which were run by Advanced Nurse Practitioners.  For parents with children, GPs would be providing a separate phone line for them to use. 

It was also reported that 25 GPs had been recruited to Lincolnshire from GP International Recruitment Scheme; seven of whom were now based in practices in the Lincoln area;

·         The financial viability of the proposal and the impact on A & E – Some concern was expressed as to the financial viability of the proposal, as it was suggested that the financial appraisal would follow the consultation.  The Committee was advised if the Walk-in-Centre were to close, national survey data indicated that 20% - 30% of patients stated that in such circumstances they would present themselves to A & E; however evidence from elsewhere, where walk-in-centres had closed, suggested that the actual number presenting to A & E was much lower.  It was highlighted that the LWCCG had realised that there was more to do to educate people not to attend to A & E unless it was an emergency.  The Committee was advised further that actual figures of patients diverting to A & E were estimated as being between 2% – 3%.  It was confirmed that a modelling exercise had been conducted;

·         What happened following the consultation – It was reported that the consultation would now conclude on 18 August 2017.  All comments received would be reviewed and taken in to account for a final recommendation to the Governing Body.  A final decision would be made in September 2017;

·        What alternative provisions would be made if a decision was made to close the Walk-in-Centre – It was highlighted that promotional work of alternative provisions had already been included on BBC Radio Lincolnshire.  Irrespective of the outcome of the Walk-in-Centre consultation, a campaign had already started to advise the public of the different routes to routine primary care, urgent primary care, emergency care and self-care.  Also, educational information was being provided at GP practices and public places.

Some concern was expressed to patients seeking advice from          pharmacists for minor ailments, as some pharmacists were under threat.  Reassurance was given that the CCG worked very closely with             the pharmacists, and confirmation was given that clinical pharmacists       were expected to support general practice in the future.

Further concern was expressed with regard to encouraging more self-care.  Some members felt this was satisfactory for minor ailments, but for those patients with more serious conditions, patients should be given the time and care needed.  The Committee was advised that self-care was available through a support network; in conjunction with information on the website.  Some members felt that the use of any website offering health advice in some instances could cause patients more anguish.

Reassurance was sought from members of the Committee that if the Walk-in-Centre was to close, that alternative services would be able to cope with the extra workload, some of the points raised included:-

Ø  That there needed to be improved access for patients having to explain their personal information to receptionists face to face.  The Committee noted that all practices had a confidential area that patients could request to use to discuss matters of a personal nature;

Ø  That a period of transition should be maintained to allow patients to become fully aware of the alternative options available;

Ø  The Committee welcomed the installation of a children's line;

Ø  Transferring patient's records.  The Committee noted that most were now done electronically;

Ø  Clarification was sought as to the arrangements for patient registration.  It was reported that a patient would register once at their main GP practice; and that registration elsewhere would only be temporary;

Ø  More awareness for service users of the alternative services available.  Reassurance was given that support would be given to support people to meet their needs;

Ø  Clarification was sought as to who the main user group was.  The Committee was advised that students comprised the main user group of the Walk-in-Centre;

Ø  The potential increased use of A & E;

Ø  The lack of confidence in the NHS 111 option due to some members of the Committee's personal experiences; and

·         Some concern was also expressed relating to the inadequacy of the consultation, due to the lack of information relating to models of alternatives; that no firm costs had been made available relating to the proposed changes.  The Committee felt that it was very hard to make a measured decision on the information provided.  It also felt that the whole process had not been planned sufficiently.

In conclusion, the Committee was not satisfied firstly with the inadequacy of the consultation, in terms of the overall information provided and its availability; secondly that that there would not be suitable alternative arrangements in place, if the Walk-in-Centre were to close, as what was proposed currently would not create a back to back replacement of the service currently provided, or provide an enhanced service.  The Committee also felt that the closure of the Walk-in-Centre would in all probability add pressure on to the A & E Department at Lincoln County Hospital.

At the conclusion of this item, two documents were circulated: Lincoln Walk-in-Centre Data Summary for 2015-2017; and a revised version of the Frequently Asked Questions.

RESOLVED

1.    That the Committee's concern be recorded that the alternative arrangements suggested in the event of the Lincoln Walk-in-Centre's closure would not be acceptable as suitable alternative arrangements, as they would not provide a seamless replacement or alternative service; or an enhancement of the service currently provided.

2.    That the Committee's concern with the adequacy of the Lincoln Walk-in-Centre Consultation be recorded; and that the Committee record the view that the matter might need to be referred to the Secretary of State for Health.

3.    That a further meeting of the Working Group be arranged to formulate a response on behalf of the Committee to the Lincoln Walk-in-Centre Consultation.