Agenda item

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 were being reached during the pandemic as before. He clarified that the consultation was not just about hearing people’s opinions but also listening to their experience of services. This helped the CCG make changes to the proposals that meant the final Decision Making Business Case better met the needs of the local population than did the Pre-Consultation Business Case. He added that there had been extensive external scrutiny of the consultation process by the Consultation Institute to ensure it met best practice.

35.10.   The Committee questioned whether there would be sufficient GP capacity in the town centre if the Eastbourne Station Health Centre were to close, given that the Victoria Medical Centre is located in the Old Town.

35.11.   Jessica Britton said that the majority of users of the Walk-in Centre are also registered patients at the Eastbourne Station Health Centre.  Around half the patients on the Eastbourne Station Health Centre registered list live in the town centre in the vicinity of the station and the rest are dispersed throughout Eastbourne and the surrounding area. Those living outside the town centre will have a range of GP practices in Eastbourne that they can join, including the Victoria Medical Centre, which will be offered in the first instance to all patients on the Eastbourne Station Health Centre list.  The CCG reviewed the needs of people who live in the town centre and concluded that they require a town centre located practice, which will be delivered via the Victoria Medical Centre branch surgery.

35.12.   Paul Deffley, Medical Director at East Sussex CCG, added that one of the advantages of Primary Care Networks (PCNs) is that GP practices within the PCN receive funding to employ physiotherapists, pharmacists and other staff who can provide a broader range of primary care to patients. Patients in the town centre will benefit from these new services that have not previously been available to the Eastbourne Station Health Centre patient list.

35.13.   The Executive Managing Director of the East Sussex CCG said that the majority of patients registered at the Eastbourne Station Health Centre are working age adults and parents with young children who use it for minor primary care issues and for repeat prescriptions. Based on the data available on the reasons why people use the Eastbourne Walk-in Centre, the CCG calculated that 80% of patients using the Eastbourne Station Health Centre could have their needs met over the phone, such as issuing an urgent prescription. The patients who have continued to the Walk-in Centre during Covid-19 – during which time patients have had to contact the Centre via phone rather than walk-in – have used it for a similar reasons to before, and the CCG has found that they have been able to largely be treated over the phone.

35.14.   Jessica Britton clarified that the Eastbourne Station Health Centre is used by vulnerable groups but no more so than other GP practices in Eastbourne, however, there is a recognition of the need for a town centre service for homeless and rough sleepers, which is why the drop-in service will be developed.

35.15.   The Medical Director added that the CCG had done significant work in identifying how the CCG can better support the healthcare needs of vulnerable groups in the town centre, including looking at how the cohort is managed in other areas such as Brighton. The CCG has also engaged with local GP practices and the Salvation Army to see whether a more holistic service can be provided to enable people in this cohort to receive medical and other services from a single location during a single visit. This should provide an enhanced service for the homeless and rough sleepers compared to what is currently available.

35.16.   The Committee asked whether a location for the Victoria Medical Centre branch surgery had been identified and what its capacity might be.

35.17.   Jessica Britton said that there tentatively has been a site identified and it was very central to the Eastbourne town centre. She clarified that the Victoria Medical Centre itself is a new-build under construction in Victoria Drive in Old Town that is due to open in the spring. This practice will establish a town centre branch for those who live in the town centre and require town centre access.

35.18.   The Committee asked about how the CCG will communicate to the people about the closure of the Eastbourne Station Health Centre and its walk-in service and the new NHS 111 service.

35.19.   Jessica Britton said that the promotion of the NHS 111 Clinical Assessment Service (CAS) will be undertaken separately and irrespective of the closure of the Eastbourne Station Health Centre. She said that since it had gone live, the CAS had proven to be successful and more people were beginning to use it.

35.20.   Jessica Britton explained the registered list of the Eastbourne Station Health Centre has been written to as part of the consultation process and will be written to again informing them of the CCG decision and next steps.  The transitional walk-in service that will be in place once the current service closes will also communicate directly with people who attend about how they can access primary and urgent care in other ways.

35.21.   Tom Gurney said that NHS services can be complicated, which makes it an ongoing challenge to communicate how they work to residents. There will be a communication plan about what is happening to the Eastbourne Station Health Centre for both regular users and the wider population. This is in addition to the NHS 111 service communication plan that will take place both nationally and locally over the coming month.

35.22.   Tom Gurney clarified that communication would be multi-faceted and include websites, radio, local press and distinct communications through community networks to inform more hard to reach groups.

35.23.   The Committee asked how the CCG will build confidence in NHS 111 given that some people have concerns about it.

35.24.   Jessica Britton said that the new NHS 111 CAS service can deal with many issues over the phone and book patients into the Urgent Treatment Centres (UTCs), or their own GP practice, for an appointment.

35.25.   Tom Gurney said that the public had previously had low confidence in 111 as a service. Following the use of 111 as a first point of contact during the Covid-19 pandemic, however, people’s confidence and understanding appears to have changed significantly. The CCG believes that the service has continued to improve since the 111 CAS went live in October and public perception and confidence in the service should also continue to grow.

35.26.   He explained that there has long been public confusion about what health services are available to them, and one of the main purposes of 111 is to become the single point of contact in the NHS for non-emergency care that is able to either treat people over the phone or book them into the appropriate alternative service.

35.27.   The Committee asked whether 111 provided clinical assessments of patients

35.28.   Paul Deffley said 111 handles 1,000s of calls a day which are triaged and, if necessary, a caller will be given a clinical assessment over the phone. The outcome of that clinical assessment will be to ensure the patient is directed to the right place for them first time based on their clinical need. It is entirely possible, he said, that this would be A&E if the person’s condition is serious enough, for example, if they have breathing difficulties. He conceded that due to the number of cases dealt with every day, it is possible that there are some instances where they are not dealt with as they should be.

35.29.   The Committee asked about what would happen to those patients who did not want to use the Victoria Medical Centre and what effect would this have on other GP practices in the town centre that have capped lists.

35.30.   Jessica Britton explained that the plan was to move the whole Eastbourne Station Health Centre patient list to the Victoria Medical Centre, not just those people living in the town centre, but only once the town centre branch surgery was open so that those in the town centre can be accommodated. She said that patients can exercise their right of patient choice and choose another practice, provided they live within that practice’s boundary, and the CCG will work with any patients exercising their right to choose a different practice.

35.31.   Paul Deffley said that the number of patients on a GP list that has been capped, i.e., closed to new appointments other than where a CCG directs a patient to be admitted, will inevitably drift downwards as people move out of the area or pass away. The CCG can work with the small number of individuals who will dispersed from the Eastbourne Station Health Centre and prefer to be at a particular practice that has a capped list to make sure they are able to join it.

35.32.   The Committee asked why the Eastbourne Walk-in Centre could not just remain open, for example, for patients who cannot get a same day appointment with their GP.

35.33.   Jessica Britton said that the way that care is being accessed is changing and patients, especially older patients, are increasingly able to access a wider range of integrated care provided by PCNs.  The ease of attending Walk-in Centre is useful, but these other integrated services available elsewhere are not available at the Eastbourne Station Health Centre, for example, pharmaceutical assessments and community physiotherapy.

35.34.   Paul Deffley explained that the wider integrated care supported by the PCNs included nationally mandated new multi-disciplinary teams that look after the most vulnerable patients on the GP lists in their local care homes. Individual GP Practices are also taking responsibility for individual care homes and there is good data that shows this provides better care for care home residents resulting in fewer ambulance call outs and A&E admissions.

35.35.   Jessica Britton said that the Primary Care Improved Access (PCIA) hubs that provide additional evening and weekend appointments in the town centre are not fully utilised by patients. The CCG would be willing to work with individual GP practices to advise them to tell patients to use the PCIA rather than the Eastbourne Walk-in Centre when they cannot receive a same-day appointment with their GP. The UTC will also continue as a walk-in service (as well as a service with bookable appointments) for those patients who do still need a same day appointment.

35.36.   The Committee asked whether it was realistic to expect homeless or rough sleepers to keep an appointment to attend the drop-in service should it only be available once per week.

35.37.   Jessica Britton explained that the CCG is working with those who work with the homeless community to find out what service would work best for this cohort. The suggestion from the professionals is that a drop-in, wrap-around service would be the preferred model, although it is not set in stone and further work will be done before commissioning the service.

35.38.   The following motion was moved by Councillor Pragnell and seconded:

The HOSC agrees that, based on the assurance that alternative services will be in place prior to the closure of the Eastbourne Station Health Centre, the decision is in the best interest of the health service in East Sussex.

The motion was put to the vote and CARRIED by seven votes to five.

35.39.   The Committee RESOLVED to agree that, based on the assurance that alternative services will be in place prior to the closure of the Eastbourne Station Health Centre, the decision is in the best interest of the health service in East Sussex.