Health Access Centre (GP walk-in service)

Accrington Victoria Community Hospital

November 2013

Accrington

Victoria

walk-in

centre vigil

staged

Save Our Walk In Centre

Walk in centre could face cuts

“Happy with service from current GP practice”

“You have to book an appt on the morning of that day, ringing from 8am and then when you get through there aren’t any appointments left and you are told to start all over again tomorrow”

“The walk in centre at AVH is invaluable. I have chronic asthma and heart failure. On 2 occasions I have started with chest infections on Saturdays, I was able to go the walk in centre and get antibiotics. If I had to wait until Monday I would probably have ended up in hospital.”

“My doctor is fabulous, but the

practice is not and getting an

appointment can be horrendous.”

“Having children, like most people it is important that they can be seen that day……”

“Provide clear, simple and concise information outside of the surgery…educate and empower those who are capable of helping themselves and free up valuable GP time and services for illness, disease and needs that GPs can help with…”

Listening to the Community Accrington market “meet and greet”

Questionnaires – Walk in Centre, GP practices, ELCCG website, HBC website, Hyndburn Pharmacies (906)

Receipt of petition from local residents (4566)

Visit to HAC by Di van Ruitenbeek, CCG Chair to talk to staff and patients

Meetings with Councillor Pam Barton, Rob Grigorjev and other stakeholders

Hyndburn CCG Steering Group Meeting

Hyndburn Council Meeting

Commitment to Openness and Transparency

What You SaidWhat Matters Most to Local People?

Being able to see their own GP

Being able to see a GP without making an appointment – especially same day urgent appointments

GP appointments available at wider range of times (evenings and weekends)

GP services offered at a location which is easy for them to get to by car or public transport

GP services where they are treated with empathy, dignity and respect

What You SaidWhat Concerns Local People the Most?

The difficulty of accessing GP appointments at their own practice – especially same day urgent appointments

Fears that patients might not be able to get same day urgent appointments if the HAC were to close

Concerns about where unregistered patients would need to go to access GP services if the HAC were to close

Concerns that patients might have to go to A&E or the Urgent Care Centre in Burnley instead

Concerns about the longer term future of Accrington Victoria Community Hospital as an NHS facility

Our key challenges as a CCGWhat type of service(s) do we need to commission in Hyndburn to ensure that patients are able to get GP appointments when they most need them?

Which of these offers the best value for NHS money?

How do we deliver the required CCG cost savings of £33m over the next three years?

How do we ensure fairness in GP access across all 5 CCG localities?

How can we ensure that decisions about the future of the services currently provided at Accrington Victoria Community Hospital are made in collaboration with our other NHS partners - e.g. NHS England and East Lancashire Hospital Trust?

Responsibilities for commissioning primary careBefore 01.04.13

Responsibilities for commissioning primary careAfter 01.04.13

NHS ENGLAND

Contracts for registered population (0800 – 18.30 Mon – Fri)

Essential and additional services Performance management Nationally defined enhanced

services QOF Improving the quality of primary

care

CCGs

Contract for GP Out of Hours Contract for walk-in services Local Improvement Schemes Locally commissioned services

(previously LESs) Supporting quality

improvement

Lancashire County Council

Public Health locally commissioned services

Key Facts 5 year contract November 2009 – October 2014. The current contract is with ELMS, an independently run social enterprise

2 elements:• Unregistered patients on a walk-in basis 8am to 8.30pm, 7 days a week, 365 days per

year (commissioning responsibility with NHS EL CCG)• A GP Practice with a registered patient list size of 1358 (commissioning responsibility

with the Area Team at NHS England)

High levels of patient satisfaction with GP walk-in service

Patients registered with the GP practice at the HAC

Area Team is commencing patient/stakeholder engagement process in November

Briefing was submitted to Overview and Scrutiny last week

Options currently identified include re-commissioning a GP practice through a transparent procurement process or dispersing the patient list to nearby practices.

No decision has been taken by the Area Team – this will be made following patient and public engagement process.

Whatever decision is taken, patients will be able to register with a GP practice.

Any decision taken will have regard to capacity within existing local GP practices, the possible impact on other NHS services and the NHS health economy as a whole.

NHS EL CCG has to make cost savings in the region of £33m over the next 3 years

Year Financial saving2014 – 15 £9m

2015 – 16 £15m

2016 – 17 £9m

2017 – 18 £9m

2018 – 19 £9m

The number of attendances is currently 3 times more people than originally planned & costs £1.4 million more AND there is no cap on the cost of the current service as the contract is based on a fee of £55 per attendance

Year(Nov – Oct)

Attendances at the GP walk-in centre

Over performance Over spend (£)

1 2009-10 12,729 4,845 266,475

2 2010-11 24,276 16,392 901,560

3 2011-12 33,885 26,001 1,430,055

4 2012-13 33,342 (at end month 11)

25,458 1,400,190

HAC has not reduced demand on other unplanned services

Burnley Hyndburn Pendle Ribble Valley Rossendale0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

900.0

Higher proportion of attenders than ‘expected’ based on population profile, especially females.

Lower proportion of attenders than ‘expected’ based on population profile

Greater proportion of attendances in 0-4 age group than expected based on the population profile.

Key Facts

GP practices everywhere are under pressure

None of the other 4 CCG localities have a similar walk-in service

The numbers of patients with long-term conditions managed in primary care continues to increase

Minimal growth in funding of primary care since 2005 - 06

Data source/s: http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130305_anatomy-health-spending_0.pdf

Estimated cost for the HAC in 2013-14 is £2.2m compared with a cost of £8.5m for all other GP services in Hyndburn

(Does not include APMS which is the contract mechanism for the HAC)

(Excl. Slaidburn)

Burnley Hyndburn Pendle Rossendale Ribble Valley

Total Payment £11,055,487 £8,590,081 £8,324,911 £7,194,000 £4,594,260

Cost per Patient Raw list £114.60 £113.58 £116.53 £109.14 £127.38

Cost per Patient weighted list £107.30 £107.57 £111.17 £101.60 £129.37

Activity – Consultation Rate – Locality level

Locality Burnley Hyndburn Pendle Ribble Valley Rossendale CCG Total

Practices Completing Activity Section 16 16 12 4 7 55

Population Represented in Survey 96,716 75,666 71,448 37,086 43,606 324,522

Number of Consultations in Week 9,385 6,775 7,826 3,644 4,073 31,703

Extrapolate Number of Consultations in Year 488,020 352,300 406,952 189,488 211,796 1,648,556

Estimate Consultations per Person per Year 5.0 4.7 5.7 5.1 4.9 5.1

. Burnley Hyndburn Pendle Ribble Valley Rossendale .0.0000

1.0000

2.0000

3.0000

4.0000

5.0000

6.0000

Locality Consul-tations per Person per Year

CCG Total Con-sultations per Person per Year

National Con-sultations per Person per Year

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

P811

34P8

1620

Y026

05P8

1069

P816

77P8

1711

P817

32P8

1008

P817

79P8

1634

P810

17P8

1738

P811

46P8

1726

P810

35P8

1749

P816

41P8

1104

P810

27P8

1755

Y026

06P8

1100

P817

78P8

1137

P811

65P8

1065

P816

59P8

1070

P817

30P8

1047

P810

78P8

1053

P810

95P8

1699

P811

97P8

1166

P810

28P8

1757

P810

88P8

1130

P812

12P8

1123

P811

32P8

1215

P817

97P8

1780

P816

86P8

1032

P817

31P8

1147

P810

20P8

1160

P810

36P8

1118

P817

36P8

1099

P810

25P8

1170

P811

82P8

1003

P812

18P8

1756

2012-13 Patient SurveyQ18 - Overall experience of making an appointment is 'Very Good' or 'Fairly Good'

BURNLEY HYNDBURN PENDLE RIBBLE VALLEY ROSSENDALE EL CCG

74.4%

Patient satisfaction with appointment systems in Hyndburn is similar to the rest of East Lancashire

Options1 Keep the status quo and tender a service in its current format

2 Tender the current service as a fixed price contract rather than a fee per attendance

3 Let the current contract expire without a replacement service

4 A walk-in service to remain, with opening times and access limited to hours outside GP core contract hours. This would be funded at a fixed price. Options include:a) Evenings 6.30pm – 8.00pmb) Weekends 8.00am – 8.00pm

5 Commission individual practices or groups of practices working together to provide extended hours to offer guaranteed extra access. This would be funded at a fixed price and apply across East Lancashire. Options include:a) Evenings 6.30pm – 8.00pmb) Weekends 8.00am – 8.00pm

6 Decommission the GP walk-in service and extend the contract for the Minor Injuries Unit (MIU) to include minor illness (walk-in, nurse led, fixed price contract)

Things we will take into account when making our final decision

The needs of local people to access GP appointments when they most need them - especially same day urgent appointments

The views of patients and stakeholder groups in Hyndburn about the types of GP services they would prefer

The conclusions of the recent Monitor Report on NHS Walk in Centres

The cost, value for money and affordability of future GP service provision

The need for the CCG to make cost savings of £33m over the next three years

Fairness of primary care access and provision across East Lancashire

NB. Any GP members on our Governing Body who may have a conflict of interest in relation to this issue, will be required to declare this interest in keeping with the rules of the CCG Constitution. The final decision on any recommendation made by the CCG Governing Body, will be the responsibility of the CCG Remuneration Committee which does not have any GP members.

Involvement and consultationNHS Act 2006 (Section 242) - Duty to involve and consult:

• The user of those services • Planning of services• Development and consideration of proposals for changes to those services ** • Decisions to be made by that Body affecting the operation of those services.

**Current position

Guidance says:

• Carry out pre-consultation **• Involve users **

** i.e. Engagement exercise up to end October 2013.

Formal ConsultationLocal Authority (Overview and Scrutiny Committees, Health Scrutiny Functions) Regulations 2002 require:

• Consultation with OSCs when they are considering ‘substantial’ development of health services in the area of the Local Authority, or for a ‘substantial variation’ in the provision of services.

Accrington

Victoria

walk-in

centre vigil

staged

Save Our Walk In Centre

Walk in centre could face cuts

“Happy with service from current GP practice”

“You have to book an appt on the morning of that day, ringing from 8am and then when you get through there aren’t any appointments left and you are told to start all over again tomorrow”

“The walk in centre at AVH is invaluable. I have chronic asthma and heart failure. On 2 occasions I have started with chest infections on Saturdays, I was able to go the walk in centre and get antibiotics. If I had to wait until Monday I would probably have ended up in hospital.”

“My doctor is fabulous, but the

practice is not and getting an

appointment can be horrendous.”

“Having children, like most people it is important that they can be seen that day……”

“Provide clear, simple and concise information outside of the surgery…educate and empower those who are capable of helping themselves and free up valuable GP time and services for illness, disease and needs that GPs can help with…”