Urgent Care and 7-Day GP services engagement overview 2013 - 2016

For the recent 2017 Seven-day GP services in Herefordshire public consultation please visit: www.herefordshireccg.nhs.uk/get-involved-seven-day-services

Introduction

From September 2013, Herefordshire Clinical Commissioning Group (CCG) asked patients, clinicians, community organisations and members of the public for their views on the typeof urgent care services they need - and whether the current network of services is meeting their needs.

This engagement exercise was part of a wider review into how future urgent care services should be provided to ensure they deliver better outcomes and value for money for everyone.

In addition Herefordshire CCG is currently working with primary care (GP) colleagues, and NHS England to take forwards the development and implementation of seven day GP services.

This means we are now reviewing all our services that provide care for urgent or unexpected primary healthcare needs. This includes the walk in centre and minor injuries units, to see whether and how we should streamline and simplify a 7 day primary care service across the county. This approach does mean that stand-alone provisions and services, such as minor injuiries services and walk in centres are being reviewed.

This work will include external scrutiny by NHS England and NHS experts, to ensure our proposals are robust and will deliver the best outcomes for patients. In addition we will be seeking external review by the Local Authority’s Health scrutiny committee.

Most importantly no decisions will be made without a comprehensive and robust consultation with the residents of Herefordshire.

What we've done so far

From September  2013, Herefordshire Clinical Commissioning Group (CCG) asked patients, community organisations and members of the public for their views on what kind of urgent care services they needed.

Following this review, HCCG decided to change how it bought urgent care services by introducing an outcomes approach to commissioning and contracting - known as Outcomes Based Commissioning.

In March 2014 Herefordshire Clinical Commissioning Group held an engagement event called 'Your Voice'. Feedback from the event and the outcomes identified as most important are available in this report.

The CCG has used outcomes and your feedback from these events alongside other sources to help shape future decision making. 

To see what we've done so far in more detail click here.

Latest updates and next steps

Frequently Asked Questions (FAQs)

Herefordshire Clinical Commissioning Group is working with the leaders of Herefordshires health and social care organisations to improve the care and support people need when they experience an urgent or unexpected healthcare need.  

Our key aim is to ensure our services are safe and effective across the whole of the county.  As part of this we are working to ensure that services both promote and support self-help, that services are simpler to access, and that we reshape services to make them more responsive to patients needs.

This work also includes the development and implementation of seven-day GP services, in line with Government policy. The Government timelines for this are currently unclear, but in Herefordshire we want to develop our 7 day GP services to make them the first point of call for unplanned or unexpected health events. This is what patients and the public have told us they want.  

Here are the answers some of the most frequently asked questions about these services.

Q. Are you closing the walk-in centre?

A. No. The walk-in centre is to remain open with no immediate changes while we develop our proposals for Urgent care and for seven-day GP services.

We are reviewing all our stand alone services, such as the walk-in centre at ASDA in Hereford, to determine whether care is being provided in the best place at the best time for patients.

The outcome of the review is not yet known and no decisions have been made. We will be undertaking a comprehensive and robust consultation with the residents of Herefordshire as part of our work. We are purposely undertaking our work in a transparent way to ensure that we are able to capture all the views of our patients and the public.

We will also be seeking external scrutiny of our work by NHS experts to ensure that our proposals are robust and deliver the best outcomes for Herefordshire patients.

Q. I’ve heard that attendance at the Walk-in-Centre has declined, is that why you’re considering closing it?

A. No. Herefordshire Clinical Commissioning Group has not issued a statement regarding any changing attendance numbers at the walk-in centre. An on-going survey of walk-in centre attendees has identified that if the walk-in centre weren’t there:

  • 75 per cent of users would go to their own GP if an appointment were available
  • 13 per cent of users would use Community Pharmacy services
  • 8 per cent would look after the condition themselves

The analysis the CCG have done shows that in 2014/2015:

  • 75 per cent of walk-in centre attendances were within current GP surgeries hours or our proposed extended hours (Mon-Friday 8-8 or Saturday/Sunday 9-1pm)
  • Only 1.6 per cent of walk-in centre attendees were sent on to A&E

In order to ensure that care is being provided in the best place at the best time for patients the future services available at the walk-in centre at ASDA in Hereford are being considered as part of the review of all the Urgent Care services across Herefordshire. It is important to remember that we are still reviewing all services. No decisions will be made without further comprehensive and robust consultation with the residents of Herefordshire. Our proposals will also be reviewed by external NHS experts, as well as by relevant stakeholders such as NHS England and the Council’s scrutiny committee before a decision is made.

Q. What is Primecare (Who is Primecare?)

A. Primecare is a leading provider of primary healthcare services across the UK. In 2009 they were commissioned by Herefordshire Clinical Commissioning Group to provide GP out of hours services (through the 111 service) and services at the GP access centre at ASDA. 
Primecare (Nestor Primecare Services Limited) is part of the Allied Healthcare Group, with 40 years’ experience working with Local Authorities, NHS Trusts and other clinical commissioning bodies.

Q. I work at the Walk-in centre, what will happen to my job?

A. Herefordshire Clinical Commissioning Group does not directly employ the staff that provides out-of- hours GP services or GP services at the ASDA centre. The service is provided by Primecare (Nestor Primecare Services Limited) and the CCG (we) cannot comment on their employment contract arrangements with their staff.

Q. What is happening whilst you perform your review? Isn’t the contract ending in March?

A. The services that Primecare provides for the residents of Herefordshire will continue. The out-of-hours GP service and the GP access centre (walk-in centre) at ASDA are to remain open with no immediate changes while the CCG develops proposals for Urgent Care and Seven-day GP services. 

All stand-alone services are being reviewed to determine whether care is being provided in the best place at the best time for patients. The outcome of the review is not yet known and no decisions have been made. We will be undertaking a comprehensive and robust consultation with the residents of Herefordshire as part of our work. We are purposely undertaking our work in a transparent way to ensure that we are able to capture all the views of our patients and the public.

The CCG is in discussion with Primecare with regard to extending the current contract to ensure that services continue to be delivered to patients while we go through this process. 

Q. What is a Taurus Hub (Who is Taurus)?

A. The Taurus Hubs extended GP access service is currently provided in Leominster, Hereford and Ross-on-Wye as a Government pilot known as the Prime Ministers Access Fund.

Taurus Healthcare Ltd, was established in 2012 as the provider arm of the GP Federation serving 185,000 patients in Herefordshire. It was founded and is owned by the GP partners of the entire Herefordshire Primary Care community.

Taurus Healthcare Ltd, and Herefordshire Clinical Commissioning Group (CCG) are currently working actively with colleagues in NHS England, to secure on-going funding for the service which was due to end on 31 March 2016. An extension has been given until the national decisions are made regarding funding of these services.

Q. Does Taurus operate the walk-in centre at ASDA in Hereford?

A. No, Taurus does not operate the walk-in centre at the ASDA centre in Belmont Road, Hereford. The walk-in centre is operated by Primecare, and the services are not connected.

Q. What is the Prime Minister’s GP Access Fund?

A. The Prime Minister's GP Access Fund – formerly known as the Prime Minister’s Challenge Fund – was announced by the Government in October 2013. This was a national £50 million fund was designed to help improve access to general practice and stimulate innovative ways of providing primary care services.

NHS England led the process of inviting practices to submit innovative bids. The first wave of twenty pilots was announced in April 2014, and Taurus healthcare Ltd was selected as one of the first pilots.

The pilots have had a positive impact in providing patients withincreased accessto primary care.  NHS England has extended the wave one pilots to enable them to work with Clinical Commissioning Groups (CCGs), to to identify how the most successful aspects of their pilot approaches can be taken forward to best meet patient needs.

Q. What is the difference between the out-of-hours GP service, extended hours GP services, and the Taurus Hubs?

A.

  • Out-of-hours means a GP service that is not your regular GP or GP practice , and who provides an emergency service to meet unexpected or unpredictable healthcare needs that can’t wait until the next day when GP practices are open. Extended hours GP services are GP practices that are opening for longer or “extended” hours, providing their usual services into the early evenings or on Saturday mornings. They are provided by 12 of our 24 practices, to provide services only to the patients registered at that practice.
  • The Taurus hubs  provide access to usual primary care services at three sites across the county for longer or “extended” hours,  providing services into the early evenings or on Saturday and Sunday mornings. They provide these services to any Herefordshire patient irrespective of which practice they are registered with.

Q. What is a minor injury unit?

A. Minor injuries units (MIUs) offer help with a range of injuries and ailments including simple breaks, minor head injuries, burns and even emergency contraception.

There are MIUs at three of Herefordshire’s   community hospitals - Ledbury Community Health & Care Centre, Leominster Community Hospital, and Alton Street, Ross-on-Wye, as well as at Kington.

Q. Are you closing minor injury units?

A. No. The MIUs are to remain open with no immediate changes while we develop our proposals for Urgent care and for seven-day GP services.

We are reviewing all our stand alone services, such as the MIUs, to determine whether care is being provided in the best place at the best time for patients.

The outcome of the review is not yet known and no decisions have been made. We will be undertaking a comprehensive and robust consultation with the residents of Herefordshire as part of our work. We are purposely undertaking our work in a transparent way to ensure that we are able to capture all the views of our patients and the public.

We will also be seeking external scrutiny of our work by NHS experts to ensure that our proposals are robust and deliver the best outcomes for Herefordshire patients.

Q. Why can’t I have a walk-in centre in my area?

A. The future of walk-in services and minor injuries units will be considered as part of the looking at all of the services to ensure that access and care is being provided in the best place at the best time for patients. The outcome of the review is not yet known.

No decisions will be made without a comprehensive and robust consultation with the residents of Herefordshire. This will also include external review by relevant stakeholders such as NHS England and scrutiny committees.

Q. What is ‘talk before you walk’?

A. ‘Talk before you walk’ is an approach within the proposed new urgent care pathway. It means that patients would be clinically assessed when they contact urgent care services and then directed to the most appropriate service that would meet their needs. This is to ensure that patients have their healthcare needs met in the most appropriate and timely manner.

This approach is currently being evaluated by Herefordshire Clinical Commissioning Group, as part of their thinking about the whole urgent care pathway. 

Q. Is the 111 service going to change too? 

A. NHS 111 is the free number to call when you have an urgent healthcare need. It directs you to the right local service, first time. 
It is available across the whole of England making it easier for you to access urgent healthcare services when you need medical help fast.
It is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. This will not change.


Q. I heard Herefordshire is getting its own 111 service?

A. In the West Midlands, NHS 111 is commissioned on behalf of 16 CCGs which includes Herefordshire. This means Herefordshire is not creating its own NHS 111 health line or stand-alone 111 service.
Each CCG in the West Midlands has an opportunity to define how the NHS 111 service works in their area. 
This ensures that 111 can be integrated with local urgent care services (A&E, GP out-of-hours, walk-in-centre, Minor Injury Units) whilst still benefiting from a 111 service that operates across the West Midlands, for example specialist clinical expertise including Mental health, dentistry, pharmacy.

Q. Have you consulted with the residents of Herefordshire about current service reviews?

A. We have engaged with the public and with patients, but our formal consultation will come a little later in the process.

In January 2013 we commenced an engagement programme on urgent care services with patients, the public and local clinicians, as part of an on-going process. We have been asking patients, community organisations and members of the public for their views on what kind of urgent care services they needed. You can read more about what we have been doing  here.

It is important to note that we are still reviewing all urgent care services across Herefordshire to ensure that access and care is being provided in the best place at the best time for patients. The outcome of the review is not yet known, and no decisions have been made. As part of our future decision making our proposals will be reviewed by external NHS “experts” and by relevant stakeholders such as NHS England and the Council’s scrutiny committee.

We will also undertake a comprehensive and robust consultation with the residents of Herefordshire before a decision is made. We anticipate that this will occur in late summer/early autumn, but the exact timing will depend upon the length of time needed for an external review of our proposals.

Q. How can I have my say?

A.

  • Currently if you are a patient at the walk-in centre or minor injury unit you will have the opportunity to answer a few questions about your visit so we can understand how these centres are being used.
  • There will be an online survey posted on these pages shortly about what people need from their GP (primary care) service.
  • Join your Patient Participation Group (local PPG) – speak to your GP practice for more information.
  • Wider engagement events will be taking place throughout the county and will be widely advertised (these are not yet scheduled, but will be part of a formal consultation in the coming months).

We will continue to update this page with answers to some of the most frequently asked questions about these services as the decision making process develops.

For the recent 2017 Seven-day GP services in Herefordshire public consultation please visit: www.herefordshireccg.nhs.uk/get-involved-seven-day-service