This report updates the Committee on improving the outpatient services across Medway and Swale. This is in line with the Medway Model and community service redesign which will enable care to be delivered closer to people’s homes. The improvement programme will be bringing services together, this will enable health and care staff to work more closely together and develop services that focus on the needs of the patients.
This report from NHS Medway Clinical Commissioning Group (CCG) updates the Committee on the progress of the programme since the previous paper on the Community Service Redesign and the Medway model that was sent to the Committee in January 2019 and the paper related to Improving Outpatient Services sent to the Committee in March 2019. At this meeting, the Committee deemed that the proposal to reconfigure the delivery of outpatient services does represent a substantial development of, or variation to, the health service in Medway. The Committee requested that a further update report be provided.
The plans were part of a long term plan across the NHS to improve outpatient facilities and provide appointments closer to the patient home. Consideration was being given to what services could be delivered through healthy living centres and various community networks. Engagement sessions had started across the health sector. Services under initial consideration included neurology, cardiology, respiratory, clinical haematology and rheumatology. Cardiology, neurology and respiratory patient engagement workshops had been held with a variety of feedback provided to suggest how services could be improved and moved away from an acute hospital.
In relation to neurology, there had previously been some unnecessary referrals as patients had not always been referred in accordance with National
Institute for Health and Care Excellence (NICE) guidance. Consideration would be given to the referral pathway and the education of GPs in relation to referrals. In some cases, patients were initially referred by their GP but were then referred back to their GP by a consultant without an appropriate care plan being put in place. This could result in the GP needing to refer the patient back to the consultant. Ensuring that appropriate care plans were developed would help to ensure that patients could be treated in the community. Previously, GPs had been able to obtain advice from consultants without making a referral. This tended to no longer be the case. Consideration was being given as to how this consultant access could be reintroduced, with a view to reducing referrals. The possibility of making increasing use of phone consultations and tele health was also being looked at, with it suggested that the provision of blood test results and minor changes to treatment could be undertaken via telephone rather than the patient having to visit hospital.
Questions asked by Committee Members were responded to as follows:
Risk management – In response to a Member question about the risks in relation to stakeholder engagement set out in the report, it was confirmed that while the report stated that there was a risk of poor stakeholder management and engagement, it was currently considered that these had been good. There had been strong, positive engagement across the health sector with task and finish groups having been established in four areas, in line with the engagement plan.
Appropriateness of telephone consultations – A Member expressed concern that some patients would be provided a telephone consultation when they were not in a fit condition to undertake a meaningful discussion. The CCG representative said that telephone consultations would only be used for specific groups of patients and would not be used to assess pain. Patients with more complex needs would not meet the criteria for telephone assessment. Services would be provided by a multi-disciplinary team comprising consultants, physiotherapists, pharmacists and nurses. The changes under consideration did not involve service reduction, rather they were about providing services that were better able to meet the needs of the patient. There would be a move away from disease pathway management to creating treatment pathways based upon individual patient needs, ensuring that patients had an appropriate care plan and that these were monitored effectively.
Substantial Variation and health infrastructure – A Member noted that the Committee had previously determined the proposed changes to be a substantial variation to the health service and said that there was strong evidence that they were. She asked why Medway CCG had assessed the changes to not be substantial. It was accepted that changes would happen in the context of a desire to provide more services in the community. However, the Member was concerned that the local health infrastructure was not sufficient to support such changes. Healthy Living Centres were not yet fully established and Medway had recently been ranked as the fourth worst area in the country for getting a GP appointment.
The Committee was advised that there were not yet plans to physically move services and that further engagement work was required. It was recognised that changes were needed to ensure that outpatient services were fit for purpose and that consultant time was not taken up unnecessarily. The Task and Finish groups already established were looking at referral pathways but the relocation of services was not yet under consideration. This would require capacity demand modelling to have first been completed.
Public engagement and service provision – A Member asked whether plans developed would go to full public consultation and whether the number of staff available or service provision would be reduced. The Committee was advised that the CCG considered that consultation would be too prescriptive and that engagement would better enable a full range of feedback, including patient stories, to be taken into account. Funding and staffing levels for services had not yet been discussed.
i) Considered and commented on the report and proposed development or variation to the health service, as set out in the report and Appendices 1 and 2.
ii) Noted and supported the proposed patient engagement activity as part of the programme for improving the outpatient service in Medway and Swale.
iii) Agreed that a further update on outpatient services be added to the Work Programme for the October 2019 meeting.