Issue - meetings

12.1.     The Committee considered an update on a number of issues relating to urgent care in East Sussex.

12.2.     The Committee asked whether the Clinical Assessment Service has a target for its clinical call back time 

12.3.     Simon Clarke, Head of Operations Integrated Urgent Care (IUC) at South East Coast Ambulance NHS Foundation Trust (SECAmb), said that in 46% of cases where someone calls NHS 111, they will receive a call back from the Clinical Assessment Service (CAS). This call will be from a healthcare professional from the CAS multi-disciplinary team that includes dental nurses, mental health professionals, midwives, general nurses, GPs, Advanced Nurse Practitioners, paramedic practitioners and paediatric nurses. Depending on the acuity of the patient’s symptoms, NHS Pathways will drop them in to a call back queue at the CAS and an appropriate clinician will call them back depending on their skill set. The target call-back times are 20 minutes, 1 hour, 2 hours, 6 hours, 12 hours and 24 hours. The system is generally risk averse and will often set a quicker call back than may be necessary.

12.4.     Simon Clarke explained that just under 40% of patients have been receiving their call back within the set time frame, which was the result of demand far outstripping planned activity. The Trust is mitigating this issue by prioritising call backs for patients with shorter wait times, as they are perceived as higher risk. A Patient Safety team, which is not part of the CAS, will also provide patients who are close to or beyond their waiting time with a welfare call to check whether anything has changed and if their symptoms have gotten worse. Simon Clarke added that this team will not close any of these cases but may recommend to a CAS operator that they are closed. There is also a Clinical Navigator reviewing the call queue on a 24/7 basis to see if any high acuity patients have not been called, or who may need an upgraded call time based on their symptoms.

12.5.     The Committee asked what the pathway is for a patient who calls NHS 111 and is booked into a GP appointment.

12.6.     Simon Clarke explained that patients who ring 111 are triaged by a health advisor using the national NHS Pathways system.  Following a series of questions, NHS Pathways will present the health advisor with a number of services from the Directory of Services (DOS) to refer the patient to. Simon Clarke said that 27% of all patients who call 111 are now being directly booked into an appointment, either by a health advisor or a CAS clinician, to a variety of services including GP practices, Urgent Treatment Centres (UTCs), Emergency Departments (EDs), Walk-in Centres, and GP Primary Care Hubs. GP Extended Access appointments and better access to mental health support and services will also be added to the DOS soon.  

12.7.     Simon Clarke said that the DOS may include the option for a call back from the patient’s own GP practice,  ...  view the full minutes text for item 12

35.1.      The Committee considered a report asking for a decision as to whether the NHS decision on the future of the Eastbourne Station Health Centre is in the best interest of the health service in East Sussex.

35.2.      The Committee asked for confirmation that all alternative services would be in place before the Eastbourne Station Health Centre is closed.

35.3.      Jessica Britton, Executive Managing Director, East Sussex Clinical Commissioning Group (CCG), confirmed that would be the case. She said that many of the new services are already in place, such as the new NHS 111 service, however, the registered list of patients at the Eastbourne Station Health Centre would not be moved until the Victoria Medical Centre branch surgery was open in the town centre. This change would also not happen until the newly commissioned service for the homeless and rough sleeper population was up and running. In addition, once the GP list is moved, there will be a transitional period where a walk-in service is retained at the site whilst people are getting used to the new arrangements.

35.4.      The Committee asked what the potential timelines would be for implementing the decision.

35.5.      Jessica Britton said that the potential timeline would be as follows:

·         the drop-in service for rough sleepers and homeless would be in place by April 2021;

·         the GP registered list would be moved to the town centre branch surgery from June 2021; and

·         the walk-in centre would remain for three months after the GP list has been transferred.

35.6.      If any of the dates were to change, the other dates would move consequentially, i.e., they would also change.

35.7.      The Committee asked whether the CCG was correct to take the decision despite the overwhelming response from the public consultation against the closure of the Eastbourne Station Health Centre.

35.8.      Jessica Britton said that the public consultation was a really useful tool for hearing the concerns of people in the local community. The CCG made every effort to communicate as widely as possible and hear from as many residents as possible, however, the majority of people who respond to consultations tend to have a particular view on what they think is best for the local population. A major purpose of a consultation, therefore, is to identify the key concerns of local people and look to address these in the final business case.

35.9.      Tom Gurney, Executive Director of Communications, Sussex Health and Care Partnership, assured the Committee that the CCG made considerable efforts to consult with those groups identified in the Equalities and Health Impact Assessment (EHIA) as being affected by the proposals. This included reaching out through the community and voluntary sector, for example, the consultation was promoted by the Eastbourne Food Bank, which led to a spike in responses.  He said that the response rate during the final six weeks of the consultation (the period after lockdown) was the same as the first eight weeks before lockdown, which shows that a comparable number of people  ...  view the full minutes text for item 35

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29.1.      The Committee considered a report on the HOSC Review Board’s draft report on NHS proposals for the future of the Eastbourne Station Health Centre.

29.2.      The Committee asked why health provision should be changed during the pandemic and whether it was possible to conduct an effective public consultation during the pandemic, particularly in reaching vulnerable groups.

29.3.      Jessica Britton said it was appropriate for the consultation to be paused in the initial response to the pandemic, but the CCG did not want to curtail the length of it and was keen to restart when it was appropriate to do so. Jessica Britton said that the CCG gave considerable thought to whether it was appropriate to restart the public consultation over the summer and took the view that Covid-19 restrictions are likely to remain in place for the foreseeable future. This meant it was necessary to try and restart normal activities where safe to do so, rather than wait for an undetermined amount of time for things to return to normal. Ahead of restarting, the CCG considered how best it could engage with those vulnerable groups identified in the Equality and Health Impact Assessment who had not already been engaged during the initial consultation period. The CCG also asked the Consultation Institute to review the consultation proposals and identify any gaps in the plan. Jessica Britton confirmed the public consultation outcomes would be independently reviewed and provided to the HOSC (via the Review Board).

29.4.      The Committee asked whether there would be sufficient GP practice capacity in the town centre if the Eastbourne Station Health Centre closed and whether this included the capacity in the new Old Town surgery due to become available in the near future.

29.5.      Jessica Britton said that the CCG has reviewed GP provision in Eastbourne and had determined that there was a higher proportion of GPs per patient in the town than the national average. She explained that the Clinical Director of the Victoria Primary Care Network (PCN), which covers some of the town centre GP practices, had advised they had managed to recently recruit additional GPs. She added that the Eastbourne Station Health Centre had a small registered patient list and the CCG hoped to be able to provide them with access to the wider integrated primary care services offered at other GP practices.

29.6.      Hugo Luck, Deputy Director of Primary and Community Care, East Sussex CCG, added that the Primary Care Networks (PCNs) established in Eastbourne are funded to provide new roles such as pharmacists, paramedics and physiotherapists to whom patients can be referred rather than always going to the GP, where clinically appropriate. This will free up GP time to see patients who need to see them. Dr Paul Deffley, Local Medical Director, East Sussex CCG, said that this new skill mix in primary care is important to meet the growing demand in the sector. There were also national campaigns to recruit new GPs and entice retired GPs  ...  view the full minutes text for item 29