1.1. The Committee considered a report providing an update on the progress of the NHS 111 re-procurement; the Urgent Treatment Centres (UTCs) redesign in Eastbourne and Hastings; and the progress of the roll out of Primary Care Extended Access across East Sussex.
1.2. The Committee considered reports on these areas from Ashley Scarff, Director of Commissioning Operations, HWLH CCG; Hugo Luck, Deputy Director of Primary and Community Care, HWLH CCG; Jessica Britton, Managing Director for ESBT CCGs; and Mark Angus,Urgent Care System Improvement Director for ESBT CCGs.
Revised model of service
1.3. Ashley Scarff explained that the existing NHS 111 service has huge demand on it that has in many ways outstripped the planned activity of the service. The new service will be based on increasing clinical engagement with patients over the phone via a clinical assessment service (CAS) that will help to reduce the number of onward referrals to A&E and GP practices.
1.4. Mark Angus explained that over the past year a greater understanding has developed of what an integrated urgent care system should look like. This has helped commissioners articulate to the market more clearly what is wanted from an NHS 111 service and has helped providers develop a greater understanding of what is required for delivering a successful service. There has also been improvement in the detail of key performance indicators required of the new service model. Ashley Scarff confirmed NHSE has oversight of the procurement process and approves of it.
Penalties for not hitting national deadline
1.5. Mark Angus clarified that the new NHS 111 service will be in place by April 2020 but CCGs are due to have delivered the nine mandatory NHS urgent care outcomes by March 2019. Work is ongoing to ensure that the current providers are able to deliver those outcomes to patients by March next year.
Urgent Treatment Centres (UTCs)
Viability of UTC and walk-in centre
1.6. Mark Angus explained that two main factors will be taken into consideration when designing options for the proposed UTC service:
· The majority of people who access current walk-in centres do so because they find access to GP practices both in and out of hours difficult. To assist with this, the CCGs’ primary care extended access service will provide out of hour’s access to GPs at five hubs in the Eastbourne area and four in the Hastings area from 1 October.
· The CCGs estimate that 7% of patients using the Hastings walk-in centre and 16% of people using the Eastbourne walk-in centre would benefit from the additional services of a UTC.
1.7. Mark Angus explained that feedback, including feedback around the viability of a primary care hub at Hastings Station Plaza, has been used to identify different potential options for the UTCs. The next step is to do due diligence to test the financial and clinical viability of the different options in the next few weeks before returning to HOSC in due course with final proposals.
Location of UTC at Conquest Hospital
1.8. Dr Bull confirmed that the additional area within the Conquest A&E is for the Primary Care Streaming Service – which is still in early days of development – and may be converted to a UTC at a future date.
Primary Care Extended Access
1.9. Hugo Luck confirmed that it is the responsibility of the CCGs to commission the primary care extended access service not for GP practices to agree amongst themselves how to provide it, although they could agree to do so. A GP practice’s core hours are stipulated in their General Medical Contract and primary care extended access falls outside of this agreement.
Location of hubs
1.10. Hugo Luck said that the primary care hubs in the High Weald Lewes Havens area will be either GP practices or minor injury units. One hub will be in Lewes, one is likely to be in Crowborough, and one in likely to be in Uckfield. The Uckfield hub will provide GP out of hours on a Sunday, which will only be at one location due to the difficulty in recruiting workforce on that day, and the lack of patient demand on Sundays in other pilots elsewhere in the country.
1.11. Hugo Luck explained that publicity for primary care extended access will be largely limited to within GP practices or when on the phone to NHS 111 to ensure it is clear it is an improvement or extension of the existing GP practice service and not a separate, new service.
Staffing the primary care hubs
1.12. Hugo Luck explained that the hubs will be staffed by:
· existing GPs as an extension of their service;
· the provider’s range of own bank staff; and
· paramedics overseen by GPs from the provider’s partnership with South East Coast Ambulance NHS Foundation Trust (SECAmb).
1.13. The Committee RESOLVED to:
1) resume the work of the HOSC sub-group considering UTCs proposals in the ESBT area;
2) request an update on the potential options for the UTCs in the ESBT area at the next meeting; and
3) request confirmation of the location of the extended access hubs in each CCG area.