Proposed changes to Urgent Primary Care in Oldham

Proposed changes to Urgent Primary Care in Oldham Dr Shelley Dr Bal Nurse Irene RIGHT CARE RIGHT TIME RIGHT PLACE www.oldhamccg.nhs.uk/consult

This prospectus sets out proposals for changes to urgent primary care in Oldham and explains how you can get involved through a public consultation exercise. This consultation is run by NHS Oldham Clinical Commissioning Group (Oldham CCG), whose members are all of Oldham s GPs. Oldham CCG, Oldham Council and others are working together to join up health and social care under the Oldham Cares banner, and these proposals form a key part of that work. Doctor Bal What is urgent primary care? Urgent primary care is when you feel you need to be seen urgently and your problem can t wait for the next routine appointment at you GP s but it isn t a serious accident or emergency. Since November 2016, we have been working with GPs A&E staff and local people to better manage patients who attend the A&E departments, who have urgent primary care needs and who would be better seen in the community by primary or community care staff. Our three guides, Doctor Shelley, Nurse Irene and Doctor Bal will explain: What is urgent primary care? What does really good urgent primary care look like? What are the alternatives? What do we need to change? How you can take part in the consultation The proposals at a glance What are our proposals? A new Urgent Care Treatment Service delivered by locally tailored Urgent Care Hubs in each local cluster area, offering bookable urgent GP appointments. A single point of entry via patients own GP practices, a single care plan and medical records shared between GPs, hospital clinicians and other health and social care professionals. A&E to triage patients on arrival into either emergency or GP-led primary care streams, based on their medical needs. Oldham currently has access to a range of urgent primary care services, including: Same day contact with your GP practice (urgent appointments or triage / telephone appointments) with additional access at practices for children under five with acute and urgent problems NHS 111 - the NHS non-emergency number who can assess your symptoms and direct you to the best medical care The Walk in Service at the Integrated Care Centre The Out of Hours service based at the Royal Oldham Hospital, accessed and booked via NHS 111 7 day access - additional evening and weekend GP appointments offered at selected GP practices; and The Alternative to Transfer pilot scheme for patients who have called an ambulance, but who could be cared for safely in the community rather than having to be taken to hospital, working with your GP and out of hours. Patients who need urgent primary care should be seen by the right person, in the right place at the right time, so they receive quality care first time, every time in their own locality. A single point of access - your GP Practice s phone number would ensure services are easier to access and less confusing. Dr Bal 2 3

Doctor Shelley Why do we need to change? Rather than one central Urgent Care Centre / Walk in service for around 250,000 Oldham residents, Oldham GP Practices are joining together in 5 local clusters. Each of the 5 clusters serve around 50,000 patients. This enables the clusters to make better use of existing practice staff and community resources to deliver urgent primary care in patients local areas that are tailored to the specific needs of that area, helping us to Challenges Oldham s urgent primary care services have served us well for many years and have changed over time to try to keep up with rising demand and reflect the latest thinking about how best to deliver care to our patients. The Walk in Service at the Integrated Care Centre opened a November 2009, to provide additional urgent primary care access and stop patients going to A&E who could be better cared for outside hospital. The Walk in Service is not linked into the clinical systems of either patients own GPs or the hospital, leading to fragmented care and the need to repeatedly take medical histories. A lack of access to diagnostic systems such as x-rays and blood tests, and additional support such as community services, mental health teams, the voluntary sector, housing etc. And perhaps most importantly it has not solved the issues it set out to fix many patients still have difficulty seeing a GP urgently and A&E continues to be used by patients who could have been treated in primary care. However, numbers of patients attending A&E and GP services for minor conditions that could be treated by self-care or advice from community pharmacists are also rising. We have to look at how we use our resources most effectively to stabilise service and meet the ever growing demand. Opportunities Greater Manchester Devolution brings with it both encouragement to innovate and financial support to bring about clinically-led change across health and social care - including urgent primary care. This is reinforced by national NHS England serve the diverse population of Oldham. Dr Shelley It has proved to be a popular and wellused service. However, the main downsides to this single centrally-located, turn-upand-wait-to-be-seen service are: For all of these reasons, we feel that the centrally-located, turn-up-and-wait-to-beseen approach is no longer fit for purpose. guidance (must do s) around providing urgent care across the country, managing primary care patients in A&E and Urgent Treatment Service standards. Patients who would otherwise have self managed their minor ailments at home, seen their local pharmacist or waited to see their own GP have decided to go to the Walk in Service instead. It attracts a significant number of patients who live outside the borough of Oldham. It is not equally accessible by all residents across the borough. Royal Oldham Hospital A&E routinely struggles to meet the four hour target for seeing, treating, and either admitting or discharging patients. There are many factors influencing this. There are a rising number of patients attending A&E, GPs and community services often with multiple complex medical conditions, leading to rising pressures in both A&E and general practice. These patients need coordinated care and support from other agencies in The development of Oldham Cares brings together the whole of the health and social care and gives us the potential to take a more holistic approach, building joined-up services around patients and linking into the voluntary sector and local communities. These new ways of thinking within the Health and Social care system have made us question whether we can deliver urgent primary care in Oldham in a better way. A lack of bookable appointments and, at times, long waits to be seen. health and social care. In times of crisis GPs and A&E doctors need the time to focus on these vulnerable and sick patients. Links to the national guidance can be found on the CCG website at 4 5

Nurse Irene What does really good urgent primary care look like? 3. There are not enough staff to meet demand and more use could be made of the voluntary sector. within any new systems of access to Urgent Primary Care. 13. IT systems should enable the secure What do patients say? During the pre-consultation period between June and September 2017, we surveyed the Oldham public to ask them What matters most to you in choosing and accessing urgent primary care?. The following were rated as very important: We also asked What would a world class urgent primary care service look like to you? and you told us the following were very important: at a GP practice other than your own at The Royal Oldham Hospital Strongly agree Somewhat agree 76.7% 16.7% 86.9% 8.2% What does good look like? 4. Accessible by good public transport and adequate parking. 5. Use of triage in Urgent Primary Care services and A&E to determine whether patients are best treated within the Emergency Department or an adjacent GP-led primary care service 6. Joined up care with shared of patient records supported by robust IT systems. 7. Services such as pharmacies and third sector agencies working in partnership with and located alongside Urgent Primary Care Services. How might we change things to make them as good as they can be? 8. Triage streaming in A&E and the Walk In Service to ensure patients are sharing of patient records between GPs and hospital clinicians. 14. A phone number to call which will help navigate the system for you (such as your GP number). The full results of both surveys, as well as the Citizens Jury report have been placed on the CCG website at What do the clinicians say? We think that urgent primary care should be Simple patients shouldn t have to self triage to decide which service to use depending on when they are ill and how ill they feel Accessible - delivered in community settings in your local Cluster area. To help us understand patient views in detail, in August 2017 the CCG hosted a Citizens Jury on Urgent Primary Care with16 members of the public recruited through the CCG s Health Huddle, social media and community groups across Oldham. streamed to the right service. 9. A strong programme of education for the public and staff on what Urgent Primary Care services are available, how to access them and where they are located, as well as training on self-care and treating minor ailments. Safe - A&E is able to focus on patients who really need emergency care. Urgent primary care, like all NHS services needs to be sustainable within our current budget and with our In a supplementary survey on sharing GP records, we asked patients whether, if receiving treatment in the following locations, they would want the doctors treating them to be able access their medical records held by their GP: The Jury considered the evidence of four experts on the topic of urgent primary care and came up with the following recommendations to these questions: What s wrong with what we have now? 1. Services are confusing and seem to overlap each other. 2. GPs in Oldham are not providing enough urgent appointments. 10. Good transport links to urgent primary care services, with the Integrated Care Centre continuing to be used as a base for the delivery of Urgent Primary Care services. 11. Urgent Primary Care provision should ultimately be 24/7 to mirror A&E with bookable urgent and routine appointments within each cluster area. 12. That the needs of vulnerable and disabled patients should be supported current workforce there is no more money or staff available to us to deliver it. In short patients receive the right care, in the right place at the right time, every time. Nurse Irene 6 7

Doctor Shelley What are our proposals? After the end of the preconsultation period, an options appraisal exercise involving members of the public, clinicians and other experts was held to: agree a set of criteria which are essential and desirable for proposals to have, and consider what options exist which would OPTION A: Urgent Care Treatment Service delivered by locally tailored Urgent Care Hubs in each cluster offering bookable urgent GP appointments. Oldham s Urgent Treatment Service to be based around bookable urgent appointments at Urgent Care Hubs in patient s local cluster areas (not necessarily their own GP practice), alongside a GP led urgent primary care stream at A&E. Option A is the CCG s recommended option because: Patients would be able to have extended access to a broad range of health and social care professionals, 7 days per week, in a local community setting. Locally developed and delivered care would mean the Urgent Care Hubs can be tailored to local demographics, geography, clinical needs etc. We believe that bookable urgent appointments at the cluster Urgent Care Hubs will meet patients needs better so that, over time, less people will present to A&E with conditions treatable by primary care. We also believe this would be the simplest system to navigate, as patients will simply phone their own GP practice at any time of day to be directed to the best place for care. This option would be compatible meet at least the essential criteria and with the relevant national and make recommendations on which should go before the public for consideration. Any options we offer must be deliverable and be compliant with national and Greater Manchester guidance. The options in the consultation include the CCG s recommended proposal (Option A) and a modified version of the service as it is now (Option B). Both options include plans for primary care streaming which is a mandatory requirement from November 2017 onwards. Based on a great deal of work, discussions amongst Oldham s clinical leaders and the involvement of patients, the CCG is recommending the following proposal which is (Option A) in the consultation. This option reflects, as far as we feel we can, the views of patients expressed in the pre-consultation phase. A&E to triage patients on arrival into either the emergency or primary care stream co-located on site, based on their medical needs. A&E primary care stream to be open 12 hours per day with a multidisciplinary team, access to a range of diagnostics and links to a range of health, social care and voluntary sector services. The current Walk in Service would be relocated out of the Integrated Care Centre when the new Urgent Care Hubs begin operating. A Single point of entry at patients own GP practices with patients no longer having to self triage to decide whether to go to their GP, A&E or a Walk in Service. Creation of a single care plan for patients with medical records shared in a timely fashion between GPs, hospital clinicians and other health and social care professionals. We believe that by the use of a single care plan, a single point of access and multidisciplinary teams linked into a range of other services, this model would produce more joined up integrated care, improved clinical outcomes and patient experience and a reduction in duplication of work. Dr Shelley Greater Manchester guidance on Urgent Treatment Centres and primary care streaming. We also believe this option would be deliverable within existing resources by maximising use of existing facilities and broadening the range of clinicians delivering care. Further details of the recommended option are contained in the service specification on the CCG s website at An Equality Impact Assessment has identified that individuals with a disability and/or low income have the potential to be disadvantaged if public transport from home to the location of their local Urgent Care Hub is limited. Further work will be undertaken with these groups to understand this potential impact during the consultation. 8 9

Doctor Bal What are the alternatives? OPTION B: A modified Walk in Service, serving all Oldham patients from the Integrated Care Centre. Oldham s Urgent Treatment Centre offer to be based around the continued provision of the turn-up-and-wait-to-be-seen Walk in Service at the Integrated Care Centre. Alongside a GP led urgent care stream at A&E. The Walk in Service would be changed as much as possible to move towards the Urgent Treatment Centre standards As per option A, A&E would triage patients on arrival into either the emergency or primary care stream colocated on site, based on their medical needs. As per option A, A&E primary care stream would be open 12 hours per day with a multi-disciplinary team, access to a range of diagnostics and links to arrange of health, social care and voluntary sector services. This option is not recommended by the CCG because: It is felt would fail to deliver key benefits of Option A including delivering more equitable care to patients in their own communities, by being able to develop bespoke urgent care hubs in localities. Sharing of medical records between individual GP practices and the Walk In Service does not currently happen and would be problematic. The Integrated Care Centre lacks access to diagnostics. There would be no single point of entry at patients own GP surgeries. Patients would continue to self triage to decide whether to go to their GP, A&E or a walk in service depending on their condition and the time of day. This option would need to overcome potential staffing and affordability issues which, if unresolved would likely fail the essential requirements as there would be duplication of services requiring the same types of clinicians. Individuals with a disability and/or low income have the potential to be disadvantaged by having to travel to the town centre for urgent care compared to it being delivered in their local cluster area. The Walk In Service in its current form has not been given as an option as it wouldn t meet the new national Urgent Treatment Centre standards. The lack of locally developed and delivered urgent primary care in option B would mean the continuation of a one-size-fits-all approach to care for Oldham patients. You can also suggest your own proposal for delivering urgent primary care in Oldham. This would need to meet the standards listed on the CCG website The Options Compared Both options include A&E front end primary care streaming Desirable requirements 1. 11am-11pm opening for URGENT TREATMENT CENTRE based on local evidence of demand, anticipating peaks at 10-11am and 6-7pm at www.oldhamccg.nhs.uk, including provision of a primary care stream in A&E. Contact details are on the back cover of this prospectus. Option A Urgent Care Treatment Service delivered by locally tailored Urgent Care Hubs in each cluster offering bookable urgent GP appointments (recommended). Option B A modified Walk in Service, serving all Oldham patients from the Integrated care centre. 2. Patients need to have equal access to urgent primary care wherever they live/go 3. A multi-disciplinary team with an appropriate clinical skills mix and access to a range of diagnostics 4.Structured involvement of the local voluntary sector in designing and delivering services 5. Car parking on site/ easily accessible by public transport 6. Access to urgent primary care in your own local community 7. High quality advice and reassurance given 8. Seamless, joined up care linked into other clinical and non-clinical services 9. Patients have only to give their details once 10. Clinical systems enable timely sharing of records between GP and URGENT TREATMENT CENTRE Dr Bal 10 11

Nurse Irene How you can take part in the consultation The CCG has a statutory duty to consult on service change. So the CCG is consulting the public on the proposals for 8 weeks between 9 October and 4 December 2017. alongside other information before coming to a final decision. The outcome will be posted on the CCG website at This will build on pre-consultation activities previously undertaken to gather views and experiences of the public, as well as prior conversations on urgent and primary care. During the consultation, we will be out and about completing surveys in all 5 cluster areas within Oldham as well as surrounding areas. A list of where we will be and when is on the CCG website at www.oldhamccg.nhs.uk/consult We will be making presentations to a wide range of community groups, with a particular emphasis on those representing disadvantaged people. The consultation survey runs until 4 December 2017. After this, we will collate all your responses to identify the key themes to understand the views of the public. We want as many people as possible to complete the survey including people of all ages, ethnicities, areas of Oldham etc. Nurse Irene As this is a consultation and not a referendum, the CCG Governing Body will consider the consultation findings You can make your views known via the survey which is online here: www.oldhamccg.nhs.uk/consult Alternatively you can request a paper survey to complete using the details above. If you would like us to come and talk to your group please contact oldccg.hello@nhs.net or call 0161 212 4419. 12