Agenda item

This paper has been produced by North West Surrey Clinical Commissioning Group (CCG) and Guildford and Waverly CCG to outline their progress to date and future plans for developing proposals on Urgent Care.

Witnesses:

Karen Thorburn, Integrated Care System - Director of Performance (Leads on urgent care across Surrey Heartlands)

Jack Wagstaff, Director North West Surrey Integrated Care Partnership

Giles Mahoney, Director Guildford & Waverley Integrated Care Partnership

Dr Asha Pillai, GP, North West Surrey

Dr Seun Akande, GP, Guildford & Waverley

Simon Angelides, Programme Director

Liz Patroe, Head of Engagement, Diversity & Inclusion, Surrey Heartlands CCGs

Nick Markwick, Surrey Coalition of Disabled People 

Matthew Parris, Healthwatch Surrey

Key points raised during the discussion:

1. Officers introduced the item and presented Members with a presentation which outlined the key aspects of the report. It was noted that the report was produced by North West Surrey Clinical Commissioning Group (CCG) and Guildford and Waverley CCG to outline their progress to date and future plans for developing proposals on Urgent Care (and where appropriate Out-of-Hospital Care) in their respective geographies. The presentation delivered to Members is attached as appendix 2 to these minutes.
2. Witnesses were asked to provide any initial feedback on the newly procured NHS 111 service. It was explained that the NHS 111 service had recently been procured to a new specification which included a number of additional functions. NHS 111 now contained a full clinical assessment service which allowed 50% of service users direct access to a clinician for assessment. It was highlighted that feedback was so far encouraging and that the number of users accessing NHS 111 as the first point of contact were increasing year on year. Witnesses confirmed that the NHS 111 service was meeting the national standard for calls answered in a specified time and that the rate of abandoned called had fallen compared to previous data.
3. Members requested further information on the projected timeline for the proposals outlined in the report. Witnesses confirmed that The Big Picture programme was expected to identify a preferred option or options in the next couple of months. Following this, a number of factors affected its timeline which included whether or not a public consultation was required. In regards to the Better Care Together programme in Guildford & Waverley, witnesses confirmed that there would be a significant number of events in the summer which would allow for the identification of the programmes next steps by autumn 2019.
4. Members noted that the service’s standardised specifications for urgent care should promote a better understanding of where service users can visit to access various types of treatment. It was further noted that the use of the 111 service as a central point of contact would particularly help with understanding and navigation.
5. Members requested further information on the risks related to resourcing the various services outlined in the report. Witnesses from North West Surrey CCG stated that resourcing was a major concern for the programme due to the shortage in clinicians, nurses and GPs. It was noted that there was an ongoing workforce development team who were considering a number of proposals to encourage, recruit and retain those who were already in the health system. Witnesses from Guildford and Waverley CCG reiterated the same issues and stated that the rural nature of the southern portion of their population also caused issues with resourcing services.
6. Members raised concerns related to Urgent Care service location changes and the impact it could have on a vulnerable patient’s transport arrangements. Witnesses explained that officers would consider various transports needs as well as identify other similar programmes nationally which could be used to integrate similar thinking around clinical standards to inform the proposals. Members further noted that a vast majority of service users used private cars to access Urgent Care services. Witnesses agreed to provide further detailed information on the process of formulating travel plans to any Members interested outside the meeting.
7. Members requested more information on the ‘Livi’ service and what feedback it had received from service users. Witnesses explained that the ‘Livi’ app was an opportunity to test a new infrastructure on how people access medical opinion and that it had accounted for eight thousand additional appointments since September 2018. It was noted that there had been very positive feedback from service users and that it was significantly popular with young people and those whose employment hours were during the day.
8. The representative from Healthwatch Surrey asked for confirmation on what changes would be made to services from a service user perspective, and if this included the closure of walk-in centres in north-west Surrey. Witnesses confirmed that the specification was available but no decisions had yet been made.
9. The representative from Healthwatch Surrey informed Members that, when engaged, a number of service users were unaware of the services available through the NHS 111 service. It was noted that unfamiliarity was especially prominent in those who were in disadvantaged groups. Witnesses explained that Care UK, the provider of the NHS 111 service, would be holding a large scale public relations programme to increase public knowledge of the services available. Witnesses confirmed that Care UK would be informed of the feedback received and would work toward targeting those in disadvantaged groups.
10. Members stated that a simple one page document which outlined the various Urgent Care services available being placed in GPs surgeries, health centres and borough officers would be a beneficial way of spreading service information to residents.
11. Members requested information on the future of the Weybridge Hospital which burned down in 2017. Witnesses confirmed that it was the intention to rebuild a health and care facility and that there was an ongoing working group to discuss what types of services would be made available onsite. When discussing the timeline for this, witnesses stated that discussions related to access to capital funding for the project could take up to two years.
12. Members highlighted that they had received some very positive feedback from residents on the performance of the NHS 111 service.
13. Witnesses informed the Committee that they would be happy to provide Members with an opportunity to visit the various locations where the Urgent Care services were provided to enable a better understanding.

Recommendations:

The Committee:

1.  Supports the proposal outlined at this stage and recognises the need to undertake development of the proposals at a local level based upon:

1. Local, current and future patient need taking into account additional population and housing in all boroughs and districts as a result of local plans, also changes in demographics.
2. Patient activity and flows
3. Development of Integrated Care Partnerships
4. Urgency of developing proposals for the configuration of a health facility on the site of the Weybridge Community Hospital/primary care Centre in North West Surrey CCG which was destroyed in July 2017.

2. Requests that a further report be presented to the Select Committee following the agreement of a preferred option or options for each of the programmes which outlines development proposals and a timeline of delivery.

3. Requests that due consideration be given to the following matters:

1. Information is made available to service users to ensure there is an understanding of the services available.
2. That appropriate consultation is undertaken early with residents and all relevant groups including those hard to reach.
3. A transport assessment takes into account variables related to population density and an aging population, as well as distance.
4. All staffing resources including GPs generally, NHS 111 services and GP Out-of-hours services.