Agenda item

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 instead, which will be more suitable for their needs, and conversely 20% of current minor injury unit (MIU) patients at the LVH will see a GP instead due to their medical need. The model also makes use of the extended access to primary care currently being procured as the UTC will offer evening and weekend GP cover.

1.7.        Hugo Luck explained that the current Minor Injuries Unit (MIU) at Lewes Victoria Hospital already had a diagnostic and X ray capability and that the main difference between it and the planned UTC would be the medical oversight provided by GPs, which will enable the treatment of a much wider range of illnesses.

1.8.        Hugo Luck said that the model will require additional staffing but the current MIU that is run by Sussex Community NHS Foundation Trust (SCFT) has a low vacancy rate. Existing staff have been trained up over the past two years as part of an earlier re-procurement of community services that involved training up MIUs, which now aligns with NHS England’s urgent care requirements.

1.9.        Hugo Luck said that the LVH building has an underutilised ward that, subject to the confirmation of the business case, will be converted into three consultation wings. The building tender will go out in July and building work will begin in September. As the care model, staff and funding are in place, subject to this building work being delayed, the UTC will be in operation by December 2018. A full communications plan with patients will also be undertaken at a suitable time.

Other UTCs

1.10.      Hugo Luck said that there is a Sussex and East Surrey Sustainability and Transformation Partnership (STP) review of UTC locations that is determining where other UTCs may be required. There is a clear need for a UTC at Brighton, Eastbourne and Hastings but it is more difficult to determine in other areas, for example, a UTC at Uckfield would be only 8-9 miles from the A&E at Princess Royal in Haywards Heath and so could be duplicating the service. He said that HWLH CCG was committed to maintaining the MIU presence where possible at the sites in Crowborough and Uckfield.

1.11.      Jessica Britton confirmed that there were no plans in the ESBT area to have UTCs outside of Hastings and Eastbourne but other urgent care improvements would be put in place such as primary care extended access.

Reduction in preventative ASC services

1.12.      Ashley Scarff said that ongoing savings to Adult Social Care preventative services require more than ever closer working with the voluntary sector organisations that play a part in the urgent care system, which starts at the preventative stage. HLWH CCG will look to maximise opportunities as much as it can within the resources available to make sure that initiatives that are the bedrock of the urgent care strategy are not disrupted.

1.13.      Jessica Britton agreed and said that ESBT is predicated on how to best treat people outside of a hospital setting through investing in primary and community services and working with the voluntary and community sector. ESBT has a community resilience programme that is shared with HWLH CCG and both CCG areas are currently procuring extended primary care access, which is a preventative service in so far as it can help ensure people are treated early in a primary care setting, reducing the need for hospital admissions.

Effect of CCG savings

1.14.      Jessica Britton said that the CCGs are looking at financial recovery programmes to stabilise in-year finances and become solvent over the next three to five years. The plans – some of which have been discussed by the CCGs at Governing boards – will comprise a number of things. The ESBT CCGs are looking at a £18m saving for 2018/19 – 3% of the total allocation, which is totally achievable and the CCGs are confident that they can deliver it. Ms Britton said that there are currently no proposals for savings across services commissioned by the CCGs and that any savings that would result in service changes would be the subject of public consultation.

1.15.      The strategy for improving the primary care estate includes a number of projects and proposals from individual practices that are considered by the CCGs as part of a planning cycle. The necessity of each project will continue to be reviewed and assessed as normal. Currently there are no proposals to stop any building works, but future works will need to take account of the need for achieving sustainable financial recovery within the CCGs.

1.16.      The Committee RESOLVED to:

1) note the report;

2) agree to suspend the work of the HOSC sub-group considering Urgent Treatment Centre proposals in the East Sussex Better Together area, pending re-submission of the proposals in the autumn; and

3) request a further report on the progress of urgent care redesign in September 2018.