Agenda item

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

a.    Integrated Primary Care Access Service Update

b.    Andover Hospital Minor Injuries Unit Update

c.    Out of Area Beds and Divisional Bed Management System

Items for Monitoring

a. Integrated Primary Care Access Service Update 

Representatives from the Southern Hampshire Primary Care Alliance and Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups provided an update on Integrated Primary Care Access Service.  The hub offers GP (General Practitioner) out of office service and is part of a national pilot for evening and weekend appointments, routine and urgent, when GP surgeries are closed.  Members heard:

Seven months of running services has highlighted stresses and operational delivery issues, as set out in the paper.  Public engagement has shown how people use the service and the ease of access to full medical records.  However, the services moving from place to place have been complicated for bookings and 111 responders, in an already confusing landscape.

Geographical challenges, inadequate GP recruitment, and service challenges if GPs are absent have been significant hurdles leading to system pressures and challenges, reliability of service provision, and missed appointments.  Winter pressures are building up and changes are being considered to increase capacity to meet demand. 

In response to questions, Members heard:

While there have been accessibility and transportation issues, the provision of transportation and video consultations (especially for mental health appointments) are being considered as a long-term solution.  Manual recording of where people are coming from have been used to assess needs and challenges.  The current provision allows for home visits when patients are unable to come in (scheduling may vary depending on pressures) and one such visit has taken place in the last month.

Traditional GP practices are not commissioned to provide mandated out of hours services.  While 92 doctors have been signed up and are part of the rota capacity, they may also have other commitments and barriers to working.  There has been a shift from locum to the contract model to meet provisions, and consideration of employment model changes and necessary consultations.  There is also a missed opportunity for doctors who are wanting to shift how they work to a portfolio way.

Out of hours practice names and changes, varying locations and times can continue to cause confusion, distance challenges, appointment cancellations, difficulty filling GP shifts, etc. which can result in more 111 calls and emergency hospital visits.  The fundamental aim is to consolidate services and meet needs as best possible within current geographical restraints.

With GP availability and recruitment challenges, traditional models are not sustainable in the short or long term, but having consolidated practices are the way forwards to allow clinics to continue to run.  For indemnity purposes and transformation change, a doctor has to be on the premises for prescription checks, limiting the authority of advanced nurse practitioners and paramedics.

Communication strategies are also in place to provide support and education on self-care, services available at chemists, home remedies, when to ring 111 or A&E (Accidents and Emergency) etc. to better care for oneself.  In addition to ongoing campaigns in communities, school training for new generations are helping with both self-care and mental health concerns.  Attitudes are shifting and there is a growing trend for timely visits with all practitioners, not just doctors.

Funding is available through the national mandate but balancing operational and staffing challenges alongside public expectations is critical for the service to flourish.  Consistent direction from 111 and A&E providing up to date information about hub locations and appointment availability is key.  Managing the first contact better and providing appropriate triage and advice, can be a workforce challenge and capacity issue. 

The Hampshire geography can be more restrictive than city geography.  Tracking traveling assessments and missed appointments at surgeries can be used for making improvements and implementing new technologies to avoid unnecessary or missed appointments. 

A new service in Hampshire, e-Consult, will provide online consultation and more data will be available as time goes on.  Every GP surgery have or will have this service on their website to be accessed via a GP specific link. 

RESOLVED:

That the Committee-

1. Noted the update and current challenges as well as any recorded issues addressed and/or resolved
2. Requested a further update in July 2020.

Cllr Fairhurst arrived at this time.

b. Andover Hospital Minor Injuries Unit Update 

Representatives from Hampshire Hospitals Foundation Trust provided an update on the outcome of the co-production work undertaken to develop a viable service model for the delivery of an Urgent Treatment Centre (UTC) in Andover, including key milestones to re-design urgent care services to provide a high quality, consistent service offer to the Andover population, which delivers improved patient experience.  Members heard:

The goal remains simplifying services for patient access in the community to avoid a confusing landscape offering fragmented services.  The 5 GP practices forming the primary care network are coordinated, well sustained, and operating effectively.  Currently, all services will continue exactly as they are, extending contracts and considering medium-term offers. 

Procurement design and complexities will be addressed with a cohesive plan and core benefits and parking, and accessibility and geography are ideal for use.  The Andover Health Centre is being re-provisioned and redesigned for business care approval and will be co-located with the MIU with out of hours extended options.  An NHS exemption as urgent treatment centre will be filed while operating business as usual.  A detailed programme of engagement will determine service design to be fit for purpose based on local flavour and EIAs (Equality Impact Assessments). 

In response to questions, Members heard:

Appropriate directing will should always be provided by 111, the first point of contact, to either the UTC or A&E due to limitations in clinical skill set and patient safety issues. 

Implementing training for staff depends largely on their function and broader responsibilities.  It is fundamental to have staff who feel qualified and have access to specific training packages as needed. 

Partner organisations include agencies that are part of the NHS family, but also external institutions based on credible bids from tendering practices. 

There will be a name change and a formal note of not being a UTC (under national specification) and by April 2021 a new local service offer will be in place. 

Local stakeholders and patients, as well as staff, must understand the changes and be consulted.  Engagement will take place sequentially to keep stakeholders fully informed and with formal engagement to follow.  A communication and engagement plan will be pivotal in meeting the challenges in keeping staff, patients, and the community informed. 

Members commended the diligent operation of the Andover Health Centre.

RESOLVED:

That the Committee-

1. Noted the update and current challenges as well as any recorded issues addressed and/or resolved
2. Requested a further update in September 2020.

c. Out of Area Beds and Divisional Bed Management System

Representatives of Southern Health Foundation Trust provided an update on recent developments.  Members heard that Out of Area patients placed outside Hampshire have been decreasing and currently the number is 31.

In response to questions, Members heard:

There remains a dependence on Out of Area beds (currently there is a 17-bed block contract) at significant cost, but it has proved to be better for care and a preferable alternative to purchasing beds piecemeal from various providers.  Private bed provisions will no longer be purchased by the end of the financial year.

Population growth and demand for services, especially mental health services, remain a challenge but inpatient care is a last resort.  Investing in community services and alternative outpatient care is complex but critical, in addition to increasing bed capacity.

This is a positive direction for patients and loved ones, but cost, growing provisions, and accurate forecasts remain a challenge in service provision. 

RESOLVED:

That the Committee-

1. Noted the update and current challenges as well as any recorded issues addressed and/or resolved
2. Noted that the proposed change is in the interest of the service users affected

c.   Request a written update for March 2020 including details on current fiscal arrangements for Out of Area Beds