Agenda item

1.1.        The Committee considered a report providing an update on the redesign of the urgent care system as part of the ESBT programme, with a focus on the development of Urgent Treatment Centres (UTCs).

1.2.        Mark Angus, Urgent Care System Improvement Director, EHS/HR CCG; Jessica Britton, Chief Operating Officer, EHS/HR CCG; and Ashley Scarff, Director of Commissioning/Deputy Chief Officer, HWLH CCG responded to questions from HOSC.

Capital requirements

1.3.        Mark Angus explained that during 2017/18 £1.7m was invested in the A&E Departments at both East Sussex Healthcare NHS Trust (ESHT) hospital sites to create the Primary Care Streaming Services. He said that he believed the capital works were completed effectively and with little disruption to the A&E Department.

1.4.        Mark Angus said that the Primary Care Streaming Services have been assessed and it has been agreed that the Conquest Hospital site can provide a UTC in its current configuration, however, the Eastbourne District General Hospital (EDGH), whilst able to support a UTC, requires some additional capital investment to optimally provide the service. Mr Angus said that the CCGs are in the process of sourcing the capital funds and are confident that the necessary works can be completed by the 1 April 2019 deadline.

Procurement process

1.5.        Mark Angus confirmed that the decision about the UTC procurement process will now be formally considered by the CCGs’ Procurement Committee in May.

Patient access to the UTC

1.6.        Mark Angus explained that the UTC will include a bookable service. In order to book an appointment to the UTC, patients will be triaged by their GP, ambulance service, or the NHS 111 Clinical Assessment Service. He said that walk-in patients will use the triaging system established for the Primary Care Streaming Service, which is led by fully trained senior nurses who can call on the support of doctors and consultants if necessary.

Reason for co-location of UTCs

1.7.        Mark Angus said that  the decision to develop co-located UTC was informed by what local people had said what was important to them when accessing urgent care services together with the outcome of engagement with local stakeholders and providers. The plans would provide 24/7 access to urgent care services, including access to a broad range of simple diagnostics where required and immediate access to co-located emergency and specialist acute assessment services for sick patients. Audit work undertaken indicates that approximately 20% of current attendees at the local A&Es would also benefit from primary care delivered services. The proposed UTC model addresses this need and should take pressure off of the A&E departments.

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Risk of staffing shortages

1.8.        Mark Angus agreed that the development of UTCs faces similar workforce challenges to the rest of the healthcare system, however, the UTCs should mitigate workforce challenges somewhat by providing existing services in a single location more efficiently and effectively. He said that feedback from staff suggests that the proposed model offers a better work-life balance.

Out of Hours GPs involvement in UTCs

1.9.        Mark Angus explained that the current Out of Hours (OOH) GP service will be changing as part of the broader Urgent Care Redesign programme. The telephony and home visit aspect of the OOH will become part of NHS 111 and the face-to-face visit aspect that is currently based at the hospital sites will become part of the UTCs.

1.10.      Mr Angus said that one of the benefits of this new service is that the current OOH GPs  have manage the challenge of answering calls, seeing patients and responding to home visits, whereas the new delivery model will separate them into different and distinct services. The new urgent care model will also use a broader range of clinical staff to provide urgent care, such as primary care trained nurses, that will mitigate GP shortages by reducing the areas within the healthcare system where those skills are required.

Equality Impact Assessment and impact on vulnerable patients

1.11.      Jessica Britton explained that, based on the CCGs’ engagement to date, the majority of people who use the current walk-in centres would be able  to use a walk-in service in a different location, or access the services they need in a different way.  However, a small but important and vulnerable cohort – including homeless people, people with chaotic lifestyles, and people with mental health issues – who tend to prefer town centre facilities are more likely to be affected by the proposed change in location.

1.12.      Ms Britton confirmed that the CCGs have and will be talking to people to understand how the changes might impact them and what the CCGs can do to ensure they are able to access the right services for them . . She said that whilst this vulnerable cohort may access current town centre services they may not be the best services for them, so the CCGs are also, for example,  working with homeless groups to consider the best services to provide for this cohort.

1.13.      Jessica Britton confirmed that the CCGs have undertaken a full Equality Impact Assessment (EqIA) that includes the impact of the relocation of walk-in centres on a range of individuals with protected characteristics and the plans to mitigate these impacts.

1.14.      Ms Britton added that the development of the proposals has been guided somewhat by the fact that UTCs have nationally set specifications, although the ESBT proposals offer a slightly better specification due to the proposed location of the UTCs on hospital sites.

Consultation plans

Jessica Britton explained that the consultation information will be available online and in leaflets available at locations such as GP practices. The CCGs will also attend specific events to discuss the proposals – either forums that they are already members of, or specific focus groups of people likely to be affected assembled for the purpose of the consultation. She said the proposal is for the formal consultation to begin in May and last for 8 weeks.

UTC at Victoria Hospital in Lewes

1.15.      Ashley Scarff explained that the proposed UTC at Victoria Hospital in Lewes will be fully compliant with the standards set out by NHS England, including that it is GP-led (by the Lewes Health Hub) and contains the prescribed facilities. 

1.16.      The Committee RESOLVED to:

1) note the report;

2) agree that the proposed relocation of the walk-in primary care service as part of the development of Urgent Treatment Centres in Eastbourne and Hastings constitutes a ‘substantial development or variation’ to services requiring consultation with the committee under health scrutiny legislation;

3) establish a Task Group comprising – Councillors Mrs Barnes, Belsey, Coles, Turner and Jennifer Twist – to consider the proposals in more detail and prepare a HOSC response for consideration by the committee in June; and

4) request a copy of the Equality Impact Assessment to be circulated by email.