Agenda item

This report updates the Committee on the review and redesign of urgent care across North Kent. The redesign of these services has previously been determined to be a substantial development of or variation in the provision of health services in Medway, triggering a statutory obligation on the relevant NHS bodies and health service providers to consult with overview and scrutiny.

The attached report from NHS Medway Clinical Commissioning Group (CCG) updates the Committee on the development of the proposals since the last update was presented to Committee in January 2017.

Discussion

The Chief Operating Officer at Medway NHS Clinical Commissioning Group introduced an update on the Medway Integrated Urgent Care Redesign. The Committee was informed that consultation in relation to some of the changes being proposed as part of the redesign was due to take place in July. There were two main parts of the redesign, face-to-face services and non face-to-face services. The non face-to-face services were being re-procured through working with colleagues at the Swale and West Kent Clinical Commissioning Groups.

It was noted that £1million was being invested in primary care and that GP services were being built around hubs and healthy living centres. Minor illness clinics were being integrated into Healthy Living Centres to improve capacity. It was anticipated that this would reduce demand for walk in centres during the hours of operation of the clinics. Minor illness clinics would be based in each of six centres in Medway. It was planned for the existing walk in centre at Balmoral Gardens, Gillingham to be relocated to Medway Maritime Hospital. This would be a 24 hour facility compared to Balmoral Gardens that was currently open 12 hours a day. Locating services in a single place was considered to make navigation of patients between services easier and would also facilitate better quality of care.

The Committee raised a number of points and questions as follows:

Service demand and capacity: A Member noted that the walk in centre located in Canterbury Street had only been relocated to Balmoral Gardens ten months previously. They were concerned that waiting times for patients could increase and questioned how there could be confidence that demand for walk in centres would be reduced. The Chief Operating Officer said that demand was expected to reduce during the operating times of the Healthy Living Centres as some patients would visit these instead. The walk in centres were also targeted at people who were not registered with a GP. It was hoped that the new system would help to meet the GP Forward View priority of patients being able to obtain same day access to a GP appointment.

Consultation: The Healthwatch representative considered that the report presented was comprehensive and said that a meeting was due to take place between NHS Medway Clinical Commissioning Group and Healthwatch Medway to discuss how Healthwatch could assist with the consultation process. Another Committee Member was concerned that there was a danger of consultation ‘burnout’ due to the number of consultations taking place during the summer. It was confirmed that list of consultation events would be provided to the Committee.

Availability of data and staffing: A Member of the Committee considered that the report was not comprehensive enough as it lacked quantitative data. She noted the current difficulty across Medway of obtaining a GP appointment, which could sometimes take up to six to eight weeks and questioned how it would be ensured that the services provided would be adequately staffed. The Committee was informed that minor illness clinics were being piloted in Rochester as it was recognised that there were particular difficulties with regards to GP appointment availability locally. The existing practices in Rochester were working together to rota staff for the clinics, which would lead to an overall increase in appointment availability.

Relationship between urgent and emergency care services: In response to a Member question it was confirmed that urgent care acted as the front door for everyone arriving at Accident and Emergency with patients being transferred to emergency care where required. Urgent care was provided where clinician intervention was needed but the patient’s life was not in danger. Work was being undertaken with partners to support patients to, where appropriate, look after themselves. This included promotion of an app and working with the Council’s Public Health function.

Consultation Questions and Risk: A Committee Member raised concerns that the proposed consultation questions could lead to a misleading response in support of centralising services. It was suggested that a question that asked whether people were prepared to travel 5,10 or 15 miles for particular services should be included. In relation to the list of identified risks, it was suggested that the risk in relation to people believing that the changes would lead to hospital closures should be more directly responded to under the mitigating actions heading to state that hospital closures were not being planned.

Patient Records: It was confirmed that patient records resulting from hospital accident and emergency visits were shared with the patient’s GP.

Decision

The Committee noted and commented on the update provided on the Integrated Urgent Care Redesign, including the Communication and Engagement Plan and draft consultation document and agreed that an update should be presented to the Committee in October 2017.