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Agenda item

Urgent Care redesign

Minutes:

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 point of access for patients. 111 call handlers will then refer patients to either the emergency services or to the local clinical hub. The other current 111 functions – triaging and signposting patients – will be transferred to the local clinical hub, i.e., HSCC.  It is anticipated that this meet the needs of patients more appropriately.

1.9.        Pauline Butterworth assured HOSC that HSCC would be fully developed as a local clinical hub before the 111 was re-procured as a call handling service to ensure that there were no gaps in service provision.

Outreach

1.10.      Dr Mark Barnes agreed that those most deserving of care don’t always avail themselves of it. The Whole System Urgent Care programme will include the development of innovative schemes to reach out to homeless people and other vulnerable groups.

Sharing patient details across urgent care services

1.11.      Dr Adrian Bull said that Shared Care Records are increasingly used by clinicians, which contain all key information necessary to treat patients, and are often used for a patient arriving in A&E whose full medical notes may be elsewhere. A fundamental part of the STP digital transformation plan involves developing a digital clinical record for a patient where their consent has been given for its use by all clinicians across the healthcare system. This system is already used in palliative care where patients have an end of life care plan that different NHS organisations can access, in particular ambulance services, to ensure that they do not inappropriately interfere with their end of life plans.

1.12.      ESHT is about to launch the next phase of its electronic document management (EDM) programme, which involves beginning to move patients on to an electronic patient record system called EMIS. However, the process of digitising and sharing patient records is complex and takes time to reach agreement on the preferred solution, and takes time to implement. The challenge is in convincing people and in the process of migrating data, not in the limits of available technology.

Role of community pharmacies

1.13.      Dr Mark Barnes explained that a lot of calls from patients for urgent care relate to concerns they have about their prescriptions, and the Pharmacy Institute has campaigned for the greater involvement of pharmacies in urgent and emergency care. It is anticipated that one of the roles of the local clinical hub (HSCC) will be to refer patients, where appropriate, to community pharmacists to reduce the pressure on GPs. However, direct redesign of pharmacy services is not possible as commissioning pharmacy services is within the remit of NHS England, not the CCGs.

1.14.      Dr Barnes said that clinical input would be needed before prescribing further courses of antibiotics, but pharmacies could conceivably prescribe repeat prescriptions such as blood pressure medication. However, it would be important (under the new urgent care system) that a patient call 111 first and go through the correct triaging process if they wished to have medication re-prescribed.

1.15.      The Committee RESOLVED to:

1) note the report; and

2) request a future update in September 2017 once the procurement process for the urgent care service is more developed.

Supporting documents:

 

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