Issue - meetings

13.1.      The Committee considered a report providing an update on the procurement of a new NHS 111 service; the development of Urgent Treatment Centres in Eastbourne, Hastings and Lewes; and the future of Eastbourne and Hastings Walk-In Centres. The Committee then asked the witnesses present a number of questions.

NHS 111

13.2.      The Committee asked how many staff would need to be recruited to the new 111-Clinical Assessment Service (CAS); whether this would include new GPs; whether they would be recruited to the cost of GP practices; and whether 111 call handlers may be trained to be able to join the CAS.

13.3.      Colin Simmons explained that the winning bidders, South East Coast Ambulance Service NHS Foundation Trust (SECAmb) and Integrated Care 24 Ltd (IC24), already run between them both existing 111 services and an out of hour GP service, which includes over-the-phone clinical assessments. A gap analysis is now being undertaken to understand what workforce the two providers already have and what is needed for the new service.

13.4.      Mr Simmons said that the mobilisation plan for the new 111 service includes developing ways to recruit staff in innovative ways that are attractive to prospective staff but that do not take them from other services. This may include a contract that allows existing GPs to work for the CAS remotely in their own office, rather than physically from a CAS call-centre, whilst still continuing with their traditional GP role. He explained that this proposal will be developed as part of the mobilisation plan, might not be available on day one, and is still subject to full engagement with GPs, however, feedback to date from GPs suggests they are keen to work in different clinical environments and that the CAS could be able to fulfil this desire.

13.5.      Charles Adler added that this kind of ‘virtual working’ is already being established by SECAmb in other areas thanks to the recent availability of new technology. Midwifery calls in Surrey Heartlands for the three hospital sites in the area, for example, are taken in the SECAmb’s 999 contact centre at Crawley by midwives working there, rather than on each of the three separate wards. This allows the same number of midwifery staff to have a far greater impact on patient care and allows them to provide additional clinical capacity at the contact centre for non-maternity calls. It also brings together specialities not used to working together and helps enhance their understanding of each other’s roles.

13.6.      Colin Simmons explained that there is a nationally mandated workforce blueprint for 111 services that includes guidance on supporting the development of non-clinicians’ career paths. This is in recognition that the call handler role needed to be made more attractive due to the high turnover rate of staff nationally. SECAmb’s 111 call handlers will also be trained to do both 111 and 999 calls to increase the resilience of 999.

13.7.      The Committee asked whether the new service will have access to patient records; and how  ...  view the full minutes text for item 13

1.1.        The Committee considered a report providing an update on the redesign of the urgent care system as part of both the Connecting 4 You and East Sussex Better Together programmes, and the pause of the NHS 111 procurement process.

1.2.        Ashley Scarff,  Director of Commissioning Operations, HWLH CCG; Hugo Luck, Deputy Director of Primary and Community Care, HWLH CCG; Jessica Britton Chief Operating Officer, EHS/HR CCG; and Mark Angus, Urgent Care System Improvement Director, EHS/HR CCG; introduced the report and answered the following questions from the Committee.

Continuation of existing NHS 111 contract

1.3.        Mark Angus said that the CCGs are about to enter discussions with current NHS 111 providers to ensure continuity of service beyond the end of the current contract in April 2019. He is confident that continuity of service can be achieved.

NHS 111 procurement process

1.4.        Mark Angus said that the CCGs are intending to do further engagement with the market and see whether there are any learning opportunities from other NHS 111 system plans being developed elsewhere in the country. This will help to ensure there is a positive response from providers to the procurement process when it is reinitiated. He said it was important to reflect that the decision to pause the procurement process was not an indication of a flawed procurement process and this view is supported by NHS England.

1.5.        Jessica Britton said that the redesign of Urgent Treatment Centres (UTCs) in the East Sussex Better Together (ESBT) area of East Sussex is on pause until the impact of the pause in NHS 111 procurement can be determined. She did not anticipate that it would impact the plans significantly but it was necessary to ensure that the new specification UTCs will be deliverable within the revised timescales. Ms Britton said that further update on the effect on UTCs would be presented at the next HOSC meeting.

Lewes Victoria Hospital

1.6.        Hugo Luck confirmed that the Lewes Health Hub and Lewes Victoria Hospital (LVH) UTC would not be duplicating services as the two services will be integrated together into a single urgent care system. He explained that the three GP practices that have combined to create the Lewes Health Hub will treat patients with long term conditions at the Health Hub (or in the individual practices prior to the completion of the Hub) and patients requesting urgent care will be asked to go to the UTC at the LVH where some of the Lewes GPs will be present, along with emergency nurse practitioners (ENPs). Mr Luck illustrated this separation by explaining that a patient may ring their GP practice with an urgent care need and be directed to go to the LVH instead, or they may book an appointment at the UTC online, or via NHS 111. The triaging of patients at the UTC will be undertaken by a doctor and around 50 patients a day who would otherwise have seen their GP at a practice will see an ENP  ...  view the full minutes text for item 6

12.1     The Committee considered a report providing an update on developments in urgent care services, including redesign of the urgent care system as part of the East Sussex Better Together (ESBT) programme; and the Sussex-wide redesign and re-procurement of NHS 111.

12.2     Mark Angus, Urgent Care System Improvement Director, East Sussex Better Together; Jessica Britton, Chief Operating Officer for the two ESBT Clinical Commissioning Groups (CCGs); Adrian Bull, Chief Executive, and Joanne Chadwick-Bell, Chief Operating Officer, of East Sussex Healthcare Trust; and Colin Simmons, Programme Director for 111 Transformation, provided answers to questions raised by HOSC Members.

Urgent Care Treatment Centres

1.1.        Mark Angus explained that the development of Urgent Care Treatment Centres (UTCs) is a national requirement that is being undertaken locally through the East Sussex Better Together (ESBT) Whole System Urgent Care transformation programme. NHS England (NHSE) requires that detailed urgent care plans are developed by March 2018 and the plans are in place by 1 December 2019.

1.2.        Mr Angus said that commissioners within ESBT were currently working out where UTCs will be located based on three potential options:

·         co-locating UTCs with the A&E Departments and the new Primary Care Streaming Services at Eastbourne District General Hospital (EDGH) and the Conquest Hospital;

·         developing existing walk-in centres to the higher UTC specifications, including diagnostic facilities like an X-ray machine; or

·         building new UTCs, although limited access to capital funds makes this option more challenging.

1.3.           Jessica Britton said that there will likely be two UTCs in the ESBT area and confirmed that there were no current plans for the development of one in Seaford. She added that in addition to UTCs the transformation programme will include the development of a range of urgent primary and community services available across the ESBT area – including extended opening hours for GP surgeries, and a re-developed Out Of Hours (OOH) GP Service.

Paediatric Urgent Care

1.4.           Mark Angus said that the ESBT Whole System Urgent Care transformation programme include provision for paediatric care, but commissioners would need to be confident that any provider would be able to provide the service safely and effectively.

1.5.           Joanne Chadwick-Bell added that A&E Departments on both hospital sites have specialist paediatric nurses that can support children with urgent or emergency care need. There are also paediatric units on both sites for children who require more specialist consultant support and there are no plans to change this configuration.

Primary Care Streaming Service

1.6.           Joanne Chadwick-Bell said that the Primary Care Streaming Service is due to commence as a pilot from October. ESHT has received a number of CVs from GPs interested in the position and one full-time GP has been appointed so far to the EDGH A&E Department. The Trust is negotiating funding for the role and will be employing GPs directly to help with their indemnity insurance. The service will be divided into shift patterns of four hours at a time to make it easier for GPs to carry out the role  ...  view the full minutes text for item 12

1.1.        The Committee considered a report informing it of the work being undertaken to redesign urgent care services in Eastbourne, Hailsham and Seaford and Hastings and Rother as part of the East Sussex Better Together (ESBT) health and social care transformation programme.

GP recruitment and GP sign up to urgent care redesign

1.2.        Dr Mark Barnes, ESBT Clinical Director, highlighted the fact that GP shortages were a national issue but the Urgent Care Programme Board is working very hard to make the role of GPs in the Eastbourne, Hailsham and Seaford and Hastings and Rother areas as attractive as possible, for example, by developing a locum bank for GPs so that newly qualified doctors can work in GP surgeries as locums in the hope that it will encourage them to take up the position long term; and offering mixed portfolio careers for young doctors where they are jointly appointed by the CCGs and East Sussex Healthcare NHS Trust (ESHT) so that they split their time between GP surgeries and other clinical areas.

1.3.        Dr Barnes explained that the urgent care workstream involves plans to encourage GPs to work together within localities and as part of GP federations in order to ensure that there is consistency within the new urgent care system. However, GP surgeries are independent business and so it can be difficult to enforce changes on their working practices.

1.4.        Amanda Philpott said that the extent to which GP practices want to become involved in ESBT wide initiatives and new contracting arrangements will vary. Some GPs will wish to continue as completely independent businesses; others may see benefits to taking up different options.

1.5.        Amanda Philpott added that one of the challenges in developing the Accountable Care Model for ESBT will be how to include independent GP services within the model.

Role of Health and Social Care Connect (HSCC) and face to face contact

1.6.        Dr Mark Barnes explained that the role of the Health and Social Care Connect (HSCC) within the new urgent care model will be as a consistent triage point for patients. Patients not in need of emergency care will be transferred by 111 to HSCC, where they will be assessed and potentially referred to the new Urgent Care Integrated Hubs located at the walk-in centres in Eastbourne and Hastings for same day urgent care access. HSCC will be upskilled to include doctors and nurses who will carry out the triage. Patients advised by HSCC to visit the Urgent Care Integrated Hubs will be able to see a clinician within thirty minutes of arriving.

1.7.        The two walk-in centres will provide face-to-face contact for patients in Hastings and Eastbourne. There may be potential to develop further face-to-face contact hubs in places such as Hailsham, Seaford and Rye to ensure that advice and assessment is spread across the county.

Role of 111

1.8.        Pauline Butterworth, Programme Director for Urgent Care, explained that 111 services will be re-procured to become a call handling service acting as a first  ...  view the full minutes text for item 26