Agenda item

12.1     The Committee considered a report providing an update on developments in urgent care services, including redesign of the urgent care system as part of the East Sussex Better Together (ESBT) programme; and the Sussex-wide redesign and re-procurement of NHS 111.

12.2     Mark Angus, Urgent Care System Improvement Director, East Sussex Better Together; Jessica Britton, Chief Operating Officer for the two ESBT Clinical Commissioning Groups (CCGs); Adrian Bull, Chief Executive, and Joanne Chadwick-Bell, Chief Operating Officer, of East Sussex Healthcare Trust; and Colin Simmons, Programme Director for 111 Transformation, provided answers to questions raised by HOSC Members.

Urgent Care Treatment Centres

1.1.        Mark Angus explained that the development of Urgent Care Treatment Centres (UTCs) is a national requirement that is being undertaken locally through the East Sussex Better Together (ESBT) Whole System Urgent Care transformation programme. NHS England (NHSE) requires that detailed urgent care plans are developed by March 2018 and the plans are in place by 1 December 2019.

1.2.        Mr Angus said that commissioners within ESBT were currently working out where UTCs will be located based on three potential options:

·         co-locating UTCs with the A&E Departments and the new Primary Care Streaming Services at Eastbourne District General Hospital (EDGH) and the Conquest Hospital;

·         developing existing walk-in centres to the higher UTC specifications, including diagnostic facilities like an X-ray machine; or

·         building new UTCs, although limited access to capital funds makes this option more challenging.

1.3.           Jessica Britton said that there will likely be two UTCs in the ESBT area and confirmed that there were no current plans for the development of one in Seaford. She added that in addition to UTCs the transformation programme will include the development of a range of urgent primary and community services available across the ESBT area – including extended opening hours for GP surgeries, and a re-developed Out Of Hours (OOH) GP Service.

Paediatric Urgent Care

1.4.           Mark Angus said that the ESBT Whole System Urgent Care transformation programme include provision for paediatric care, but commissioners would need to be confident that any provider would be able to provide the service safely and effectively.

1.5.           Joanne Chadwick-Bell added that A&E Departments on both hospital sites have specialist paediatric nurses that can support children with urgent or emergency care need. There are also paediatric units on both sites for children who require more specialist consultant support and there are no plans to change this configuration.

Primary Care Streaming Service

1.6.           Joanne Chadwick-Bell said that the Primary Care Streaming Service is due to commence as a pilot from October. ESHT has received a number of CVs from GPs interested in the position and one full-time GP has been appointed so far to the EDGH A&E Department. The Trust is negotiating funding for the role and will be employing GPs directly to help with their indemnity insurance. The service will be divided into shift patterns of four hours at a time to make it easier for GPs to carry out the role part-time if they wish, and ESHT will employ a bank of GPs to help fill the role in a similar way to an out of hours service. The benefits of the service and the level of investment required to run it will be closely monitored over the winter period.

Extended Access Service

1.7.        Mark Angus said that there is current pre-market engagement being undertaken to understand the potential to develop extended primary care access services including the potential to establish extended access service hubs, in accordance with the national requirement to extend patients’ access to bookable appointments for primary care. He confirmed it would be unlikely that people would see their own GP at these hubs, but the results of public engagement work suggest that people’s views on the importance of seeing their own GP is mixed, whilst access to primary care expertise is of key importance.

Ambulatory Care Unit

1.8.           Dr Adrian Bull confirmed that a new consultant has been appointed to the Ambulatory Care Unit at the Conquest Hospital who starts in early-October.

Patient Care Plans

1.9.           Dr Adrian Bull said that a fully transparent care plan is an aspiration within the NHS and there are many areas where good progress is being made, for example, for people receiving palliative care in the last year of their life there has been a major effort to ensure that the details of those plans are put on the extended summary care record. He explained that all clinicians currently have access to a patient’s summary care record but the extended summary care record can only be accessed by certain clinicians mainly in acute settings. There has recently, however, been significant progress in rolling extended summary care records to primary care.

Training for palliative care

1.10.         Dr Bull agreed that working with specialised nurses trained in palliative care is important. He said ESHT is working across ESBT area to look at how the patient needs of those 20-30% of palliative care patients requiring care for conditions other than cancer can be met. The Trust has been in contact with both hospices in East Sussex about doing more to raise awareness and both have indicated that they are open to the idea. 

Communication strategy

1.11.         Jessica Britton said that under the new urgent care system, patients should be able to call NHS 111 once and be signposted to the right help that they need without needing to find out for themselves where they need to go. Once it is in place, the new 111 service will be promoted to reflect its increased importance as the first point of contact for people requiring urgent care, however, because of this there is no plan to do a major advertising of individual new urgent care services. Joanne Chadwick-Bell added that a communications plan for the winter period is about to be published asking patients to call 111 for all healthcare needs unless it is an emergency.

1.12.         Joanne Chadwick-Bell explained that the Primary Care Steaming Service in A&E departments involves the extension of skill sets available at an existing service and are not new services in themselves, and as a result there is no plan to advertise it as a new service.

Capacity, recruitment and retention of urgent care staff

1.13.         Mark Angus and Joanne Chadwick-Bell said that GP recruitment it is a significant challenge and area of concern both locally and nationally and explained how the Whole System Urgent Care transformation programme is looking to alleviate the issue: 

·         a single, better co-ordinated OOH contract rather than the current arrangement of a separate walk-in centre and OOH contract that can lead to both services vying for the same GP workforce;

·         exploring the use of technology such as Skype that could allow GPs to provide OOH services remotely;

·         using a wider skill set within the workforce, e.g., advanced nurse practitioners with the right training can deal with a number of primary care presentations instead of GPs; and

·         incentives to work in a primary care setting, for example, offering joint acute and primary care roles for GPs who want more of a ‘portfolio career’.

1.14.         Colin Simmons said that ensuring the OOH workforce has sufficient capacity will require other healthcare workers to be involved in urgent care. He said that many OOH contacts are around requests for repeat prescriptions, so capacity for OOH can be enhanced by developing the 111 service so that when a patient calls 111 they can be asked whether their query is a pharmaceutical one and transferred to their local pharmacist, who can provide the repeat prescription for them.

1.15.          Dr Adrian Bull said that workforce recruitment and retention is one of the biggest challenges across ESHT and effects all departments. He agreed that there is merit in exploring the idea of recruiting a senior Associate Consultant to draw in other junior doctors and consultants. He explained that ESHT has had ongoing discussions with Brighton & Sussex Medical School to see how the Trust can better link up with their training programme and improve the academic attraction of ESHT for all clinicians.

NHS 111

Scope of NHS 111 procurement

1.16.      Dr Bull explained that the scope of the NHS 111 procurement is for a service that will respond to calls from the public, assess the medical need of the caller, and pass the caller on to the relevant service. Colin Simmons added that under the new procurement model, NHS 111 service will include clinical assessment carried out by clinicians via a Clinical Assessment Service (CAS).

1.17.         Dr Bull explained that under the new urgent care system NHS 111 will remain the number to call for urgent medical assessment and will have clinical expertise on site to provide this assessment. On the other hand, Health and Social Care Connect (HSCC) will be there for more complex patients – or a GP on behalf of a patient – to call when they require a mix of clinical and social need, for example, physiotherapy, reablement, district nursing or social care assistance.

Indemnity insurance

1.18.         Dr Bull clarified that GPs who are employed by private OOH companies, such as IC24, have different indemnity requirements than if they are employed directly by the NHS. This issue has been recognised and is being rectified through the 111 procurement for those individual who will work within 111 and the CAS. It is also being resolved for GPs due to begin working in the Primary Care Streaming Service by ESHT employing the GPs who work in A&E.

Indemnity insurance

1.19.         Dr Bull clarified that GPs who are employed by private OOH companies, such as IC24, have different indemnity requirements than if they are employed directly by the NHS. This issue has been recognised and is being rectified through the 111 procurement for those individual who will work within the new 111 service. It is also being resolved for GPs due to begin working in the Primary Care Streaming Service by ESHT employing the GPs who work in A&E.

Privacy and electronic patient records

1.20.         Jessica Britton said that over the past 4 years the CCGs have been mindful of people’s concerns about information sharing and it has been discussed extensively at patient engagement events. The consistent message is that patients want their information to be appropriately shared where it is helpful to meet their treatment needs. This feeds into the development of how to use technology within the boundary of good information governance.

1.21.          Dr Adrian Bull said that the 111 re-procurement work has included a survey on patients’ attitudes towards the sharing of records. Colin Simmons added that any provider of the NHS 111 service will have to follow the information governance guidelines around data protection, security and audits. Any procurement specification will also make clear who should have access to that data, i.e., clinicians having access to summary care records, rather than all employees being able to access them.

Access to 111

1.22.         Joanne Chadwick-Bell said that the 111 call handler will quickly pick up whether the caller does not speak English and will transfer them to a language line. This is a national standard and already available. Access for the deaf community is recognised as a major challenge nationally and NHS England is working with providers on solutions. There are schemes such as signing over Skype that are being trialled by some OOH services.

Call handler career progression 

1.23.         Colin Simmons confirmed that NHS England’s national career blueprints for call handlers will be known before the new 111 provider is appointed. The outline of the national career blueprints – setting out what career progression will look like for a call handler becoming an advanced call handler – will be published early in 2018.

1.24.         The Committee RESOLVED to:

1) note the report;

2) consider a further update on urgent care at the June 2018 committee meeting;

3) provide a written update on 111 in January 2018 and a further update in 2 October meeting;

4) request a report on GP access in March 2018; and

5) request confirmation as to the number of GPs to be employed as bank staff for the A&E Primary Care Streaming Service.