Accessing Urgent Primary Care in Waltham Forest

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Waltham Forest Clinical Commissioning Group Accessing Urgent Primary Care in Waltham Forest A consultation on the future of the walk-in service at Oliver Road, and improving primary care services in the borough Have your say at oliverroad.consultation@walthamforestccg.nhs.uk All comments and feedback must be received by 5pm on 17 December 2015

2 Foreword As GPs in Waltham Forest we have always taken a lead in developing local health services, but now, as members of NHS Waltham Forest Clinical Commissioning Group (CCG), we have a much greater responsibility to commission (which means to plan, buy and monitor) NHS services. This ranges from cancer care to mental health, hospital operations to prescriptions. To do this, we work very closely with important partners like Waltham Forest Council, NHS England, providers of healthcare, voluntary and community organisations and, of course, patients and residents. There are opportunities to improve the health of our local population. However we also face many challenges: Waltham Forest is one of the most deprived boroughs in England, there are significant health inequalities and our population is growing rapidly. We are determined to tackle these challenges head on and work together to improve the health of our residents. The CCG has been reviewing urgent care services such as walk-in services as part of its Urgent Care Strategy. We recognise that urgent care services could be improved, that the current system is difficult to navigate and it faces increasing demand. Key aims of the strategy are to create an urgent care system that is simple to use, reduces duplication and meets the needs of local people. The CCG has also developed a Primary Care Strategy with the following aims: to improve access, to deliver more proactive care (including self care), and to support coordinated care between services. We face some difficult decisions. In common with other parts of the public sector the CCG has limited resources so we have to continually review the services we commission and take decisions about whether they deliver the best value for the residents of Waltham Forest. We want to be open about these service reviews, and to listen to feedback from patients and the public before taking any decisions. Waltham Forest CCG s strategic objective is to improve the health outcomes of our local population through the effective commissioning of high quality services by: Meeting our statutory requirements Being clinically-led Strengthening collaboration with neighbouring CCGs and local providers, and establishing commissioning arrangements Improving the patient experience across all services Involving patients, communities and hard to reach groups Challenges in Waltham Forest include: A growing population likely to grow over 30% in the next 25 years An ageing population Health inequalities within and between different parts of the borough certain groups of people can find it harder to get the care they need Limited funding, which must be prioritised to deliver the best value for our patients A national and London-wide shortage of GPs Waltham Forest Clinical Commissioning Group

Walk-in services 3 NHS walk-in services where people can walk in without an appointment for medical help have been in the spotlight in a number of areas across London. Clinicians are concerned that, rather than easing pressure on other services like A&E, they are creating extra demand and duplicating existing healthcare options such as GPs, pharmacists, out-of-hours services and sensible self-care. As a result, many walk-in services have already closed. Waltham Forest CCG has a contract with Forest Community Health Limited to provide a walk-in service at the Oliver Road polyclinic in Leyton, which is coming to an end in March 2016. This is the only walk-in service that we commission. We have begun a review to help decide if we should continue to invest in this service. The first stage of this has been to look at data to see who is using it. The data shows that the majority of the people using the walk-in service are already registered with a small number of GP practices in Leyton and Leytonstone. Evidence from other walk-in service highlights that people who visit the services often require little or no treatment many are using it to get a second opinion or to save them waiting to see their own GP. Based on this, we have decided to consult with the local community on the future of the walk-in service. At this point in time, our preferred option is to close the walkin service and re-invest the money saved in improving access to primary care across the whole of the borough, which will give more people better access to local GPs. We would like to know what you think. Please take the time to look at the information in this document and send us your thoughts. We look forward to hearing your views. Dr Anwar Khan, Chair, Waltham Forest CCG Dr Naheed Khan-Lodhi, Clinical Director for Cancer, Urgent Care and End of Life Dr Johra Alam, Clinical Lead for Urgent Care This consultation closes on 17 December 2015 Further details can be found at www.walthamforestccg.nhs.uk Email your comments to: oliverroad.consultation@walthamforestccg.nhs.uk Accessing Urgent Primary Care in Waltham Forest

4 The current walk-in service The Oliver Road walk-in service provides a service for patients with minor illnesses and injuries to see a GP without having to be registered and without needing an appointment. The current service sees around 35 patients a day. The walk-in service is provided by Forest Community Healthcare. It is based in the Oliver Road Polyclinic in Leyton, in the south west of Waltham Forest. It is open from 8am to 8pm, seven days a week including bank holidays. The service is open to all; patients are not required to register with the practice. As well as walk-in appointments, the service takes referrals from the NHS 111 phone line and urgent care centres. It is a GP-led service and is run from and managed alongside the Orient GP Practice. Unlike some other walk-in services, no extra diagnostic services (such as x-rays) are available. This part of Waltham Forest has quite a large population and high levels of deprivation. Patients who use the service are mostly in younger age groups - there are many parents with young children as well as adults aged between 20-35 yrs. This is similar to other walkin services and also reflects the local population. A large proportion of the patients using the walkin service are registered with GP practices located nearby. In fact, many of the patients are registered with practices located in the same building as the walk-in service. Sixity seven percent of all the walk-in appointments are for patients who live in Leyton and Leytonstone. Our data suggests between 25 and 30% of people using the service are not registered with a GP. The Orient Practice is located in the same building as the Leyton Orient Football Club Stadium. There is another practice called Leyton Healthcare located in the polyclinic and there are two other practices within half a mile of the Orient Practice (Crawley Road and Francis Road). Residents tell us that access to the walk-in service site is poor. Oliver Road does not have any bus stops and there is limited parking in the area - this is particularly the case during match days. The walk-in service is a six minute walk (450 metres) to the nearest bus stop (Ruckholt Road), and an 11 minute walk (900 metres) to the nearest tube station (Leyton station). This poor access means that most of the patients who use the walk-in service live in the nearby area. Waltham Forest Clinical Commissioning Group

Case for change 5 We need to reconsider the current contract for the walk-in service in light of the CCG s new Primary Care and Urgent Care strategies. The CCG is working to extend access to GP services for people across the whole borough. For example, 252 weekend GP appointments have recently been made available each week that s more appointments than the walk-in service offers. If we close the walk-in service we will invest any money saved into increasing access to existing GP services, as we think it will provide far greater access for patients right across Waltham Forest. There are a number of reasons to consider changes to the current service: The service is only used by a small part of the Waltham Forest population. Sixty seven percent of patients are from one area, Leyton and Leytonstone. People in other parts of the borough mostly do not use the walk-in service. The walk-in service is not easily accessible for most people within the borough. There is limited public transport to Oliver Road, no nearby bus stop and limited parking in the surrounding area. Access is especially bad on Leyton Orient match days. The walk-in service duplicates services that are available elsewhere in Waltham Forest it doesn t offer anything that can t be provided through regular GP appointments, the Urgent Care Centre at Whipps Cross or the GP out-of-hours service. The CCG has developed a primary care strategy focused on improving access to GP appointments across the borough see the next section. The walk-in service may deter some people from registering with a GP. We know that registering with a GP benefits people by improving the coordination and continuity of their care, and results in better health outcomes, particularly for those people with long term conditions. The walk-in service complicates the local urgent care system, and many people aren t clear on what services it offers. National policy recommends having a streamlined set of services with strong coordination between these services. People should easily understand what kind of service they will get at each kind of NHS site. This would improve experiences for patients, reduce the need for multiple trips to see different doctors, and increase the efficiency of the overall service. The walk-in service does not appear to ease the pressure on our A&E services. GP practices whose patients regularly use the walk-in service also have patients who use A&E more often. The poor location of the walk-in service means that many patients in the borough who might otherwise benefit from extended GP access, often go straight to A&E. The walk-in service doesn t offer any additional diagnostic services (such as x-rays). Accessing Urgent Primary Care in Waltham Forest

6 Our plans for developing primary care services in Waltham Forest Enhanced GP service The CCG is aware that many patients are going to A&E when they don t need to because they can t (or don t try to) get an appointment with their GP. This was demonstrated in the responses to our recent Urgent Care Strategy and is why we decided it was critically important to increase the availability of evening and weekend GP appointments for patients across the borough. The Enhanced GP Service started as a pilot in June 2015 after GPs across Waltham Forest formed a network, known as Waltham Forest GP Federated Network (or FedNet). The network is currently offering routine GP and nurse appointments at weekends. Appointments are offered at three sites, or Hubs, across Waltham Forest one each in Walthamstow, Leytonstone and Chingford (see map). unregistered patients to register with a GP and offers advice on how to do so. The Enhanced GP service has access to patient records and, after an appointment, this information is shared back to the patient s registered GP The service is currently running as a pilot. We will shortly be undertaking an evaluation to find out how it has impacted on patient experience, local primary care access and the wider healthcare system, and where there are still gaps. Responses to this consultation will help with this evaluation. Patients can book appointments by calling 020 8519 3999. The service has been actively marketed to patients across Waltham Forest, and in the future the NHS 111 phone line will be able to directly book appointments in to the service. The service provides 42 GP appointments as well as nurse appointments at each site per day - that s 252 GP appointments every week, more than is provided by the Oliver Road walk-in service. The service is available to all patients registered with a Waltham Forest GP practice, as well as to any unregistered Waltham Forest residents. It proactively encourages Waltham Forest Clinical Commissioning Group

7 We will use the evaluation to help decide on the best future shape of the service location, opening hours and so on and make sure that it fits well with what patients actually want and need. The CCG hopes to have a finalised version of the service in place for October 2016. Improving online access to primary care and self-care We have been working with local GP practices to upgrade IT systems and introduce new technologies that will mean local people will be able to book and cancel appointments, order repeat prescriptions and view their summary care record online or with a smartphone app. We are also running a pilot to offer patients appointments over Skype. All of these new online technologies will make access to GP services easier and enable GP practice staff to spend more time helping people with more complex queries and specific issues. The CCG is aware that more could be done to support patients to manage their own conditions. In 2016 we will be looking at options to expand the range of self-help options for residents. We will also be commissioning a new and expanded 111 telephone advice service. Weekend GP Appointments You can book a weekend appointments at your GP Hub by telephoning 020 8519 3999 between 10am and 4pm, Monday to Friday and 9am - 5pm on Saturday and Sunday Accessing Urgent Primary Care in Waltham Forest

8 Our proposals The options below have been considered by the GPs on the CCG s Governing Body: Option 1 Re-procure the walk-in service in its current form This option would keep the service as is and maintain access to the Oliver Road walk-in service. While we know that patients who use it value the service, this option would do nothing to address the needs of residents and patients in other parts of Waltham Forest. It does not encourage the continuity of care which is provided by attending your registered GP practice. It also does not address the issue of costly service duplication, where we know that the majority of people who attend the walk-in service are already registered with a GP. Option 2 Close the walk-in service and invest in three local GP Hubs providing additional access to GP appointments out of hours (preferred option) This option would provide fairer access to extended GP opening hours provided at three hubs located across the borough. These hubs currently provide access to appointments at weekends, in line with the CCG s Urgent Care and Primary Care strategies. People would be encouraged to register with a GP and use their GP as their first point of call, which is essential if we are to help keep patients healthier and support them to better manage their long term condition. The Orient Practice would continue to operate as a regular GP practice at the Oliver Road site. The CCG s preferred option is to close the Oliver Road walk-in service. There would be no changes to the GP practice (the Orient Practice) or the other services located at the Oliver Road polyclinic site. This would: Encourage people to use their GP as their first point of contact. This is essential if we are to help patients keep healthier and better manage their long-term conditions. Free up funding so that the CCG can invest in alternative access to primary care. The CCG is currently piloting a model that gives additional access to GP and nurse appointments at weekends Make the system more efficient by reducing duplication Mean all patients that require urgent care but cannot be seen by their GP can still access NHS 111, GP out-of-hours services and the Urgent Care Centre at Whipps Cross Hospital. Improve the likelihood of residents registering with, and accessing, health services (including urgent care) through their GP practice Waltham Forest Clinical Commissioning Group

Frequently asked questions: 9 Q: Are you planning to close the Orient Practice GP surgery? A: No. If the walk-in service closed, current GP services at Oliver Road would continue. Patients registered there would still see their GP. Q: What would happen if everyone who used to go to the walk-in service goes to the A&E at Whipps Cross? A: We think the vast majority of people who live around Oliver Road would phone or visit their GP, visit a pharmacist, call 111 or decide to care for themselves. This consultation will help us to test that theory. The A&E at Whipps Cross has an urgent care centre, which can treat people who arrive with less serious conditions. We also want more people to use the Enhanced GP service which is now providing more extra appointments each week than the walk-in service offers. Q: What about people who don t, or can t, register with a GP? their ongoing healthcare. The CCG will be looking at fresh ways of encouraging people to register. However, the new Enhanced GP Service offers appointments to any Waltham Forest residents, whether they are registered or not. Other services, such as NHS 111 and the urgent care centre, do not require patients to be registered. Q: Is this not just about cutting back on services and saving money? A: No, this about providing fairer access to GP services for all Waltham Forest residents, providing a better service, and encouraging people to use NHS services in the best way. At the moment services can be confusing and unequal, depending on where you live. We want there to be clear options available for all patients, wherever they live and whatever their health need. Money saved from the closure of the walk-in service would be carefully reinvested in improving access to GP services. A: It is very important that we get as many people as possible to register with a GP this is much better for Accessing Urgent Primary Care in Waltham Forest

10 Q: Will people only be able to get urgent care in hospitals in future? A: No. We know from talking to patients that a great many people using walk-in services just need advice there are more efficient ways for them to get this. During working hours people can ring their GP surgery, or visit a pharmacy. Out-of-hours they can ring the NHS 111 service for advice and referral to other services including the out-of-hours GP service. Q: If people are already finding it hard to get to see their GP, won t closing the walk-in service at Oliver Road make this even harder as they will be even busier? A: Most of the patients who use the walk-in service are from a fairly small area of Leyton and Leytonstone. We will make sure that practices nearby are ready to support their patients when they need an urgent appointment, or can direct them to other services. In addition, the new Enhanced GP Service is offering 252 extra GP appointments every week, across Waltham Forest that s more than is currently offered by the walk-in service. The CCG is committed to making access to GP services easier for patients. Q: Why not open walk-in services in other parts of Waltham Forest to make access fairer? A: This would not have the benefits we have discussed above around encouraging people to register with a GP and developing a streamlined urgent care system. Evidence suggests that walk-in services do not reduce A&E admissions. This would therefore be a very expensive and ineffective approach. For those that do go to A&E the urgent care centres co-located with the A&E services are designed to support patients who need primary care only. Q: When would the walk-in service close? A: If we decide to go ahead with closing the Oliver Road walk-in service, we expect this will happen when the current contract ends at the end of March 2016. Q: The walk-in service is in a deprived area, with lots of people who only stay for a short time, and some homeless people. What are you doing to ensure these people can still get care? A: We encourage everyone to register with a GP. All people who live in Waltham Forest will be able to use the Enhanced GP service. We know that there are concerns about services for homeless people we are looking at this, and would welcome any suggestions as part of this consultation. Q: Would you do a full assessment of who might be negatively impacted by a closure? A: Yes, we would carry out an equalities impact assessment to make sure we know if there are any groups of people who would be disadvantaged by the closure of the walk-in service and we would develop a plan to make sure they get the support they need. Q: Won t more people just go to A&E which we know is already too busy? A: By making sure that we improve access to GPs locally, publicising and improving the NHS 111 service we think that there should not be any more people needing to go to A&E than do at present. Waltham Forest Clinical Commissioning Group

11 Questionnaire Note: you do not have to answer all the questions. 1. Have you used the Oliver Road walk-in service in the past eighteen months? Yes No (please skip to question 6) 2. On this occasion, were you seeking care or advice for yourself or for someone else? Myself Someone else 3. Why did you use the walk-in service (on your most recent visit)? (Please select all that apply) I needed an urgent appointment and the walk-in service was the most convenient I contacted my GP practice but could not get an appointment I know my GP is always too busy, so I went to the walk-in service I needed to see a doctor but I am not registered with a GP I needed to see a doctor at the weekend when my GP practice is closed I needed to see a doctor in the evening when my GP practice is closed Other (please specify) 4. What kind of issue did you use the GP walk-in service for? (Please select all that apply) Minor Injury (e.g. cut or sprain) Illness (e.g. fever or cold) A long term condition (e.g. asthma or heart disease) Your child had an injury or illness To get a second opinion Other (please specify) 5. If you were not able to attend the Oliver Road walk-in service where would you have gone instead? (Please select one) Your GP practice A pharmacy GP out-of-hours service A&E An Urgent Care Centre Called NHS 111 Care for myself Other (please specify) Accessing Urgent Primary Care in Waltham Forest

12 Our Proposal 6. Do you agree with our proposal to close the walk-in service at Oliver Road? Yes No Don t know Please explain why: 7. Do you agree with our plan to invest in three primary care hubs offering appointments at evenings and weekends? Yes No Don t know Please explain why: 8. Which of the following would most improve general practice services in Waltham Forest: (please choose up to three) Increased availability of bookable early morning appointments GPs to open later for bookable appointments GPs to open at weekends for bookable appointments Increased availability of same day GP appointments Increased availability of walk-in GP appointments Improved telephone or online access to my GP to be able to make appointments Availability of telephone appointments with your GP practice Availability of appointments by Skype with your GP practice A wider range of services in community pharmacies, such as minor ailment clinics An easier process for helping patients register with a GP practice Other (please explain below) 9. If we go ahead with our proposal (to close the walk-in service and invest in GP extended access), what else should we consider? Waltham Forest Clinical Commissioning Group

13 About You Please tell us a little about yourself. This section is NOT compulsory. If you wish to remain anonymous, your view will still be taken into account, however we would be grateful if you would fill in some of this section so that we can assess how representative respondents are and whether there are differences to the answers given by different groups of people. Are you providing this response: in a personal capacity as a representative of a group. Please state which group you are representing a) Name (optional) b) Would you like to be kept up to date with information about the NHS (including this programme) Yes No If so, please give us your email or postal address c) Are you Male Female prefer not to say Employed by the NHS? Yes No prefer not to say Aged Under 16 41-65 Prefer not to say 16-25 65-80 26-40 81+ d) Are you a resident of Waltham Forest? Yes No e) Which part of the borough do you live in? Leyton Leytonstone Walthamstow Chingford Accessing Urgent Primary Care in Waltham Forest

14 f) Ethic Background (please tick all boxes that refer to you) White Asian Mixed British Asian British White and Black Caribbean Irish Indian White and Black African Any other White Background Bangladeshi White and Asian Black Black British Black Caribbean Black African Any other Black background Pakistani Chinese Any other Asian background Any other Ethnic group Prefer not to say g) Which belief or religion, if any, do you most identify with? Agnostic Atheism Buddhism Christianity Hinduism Islam Judaism Sikhism Other Prefer not to say h) Do you consider yourself to have a disability? Yes No prefer not to say Thank you for your feedback. Please send your completed questionnaire and any comments to us free of charge using the FREEPOST envelope included. Alternatively you can email your comments to oliverroad.consultation@walthamforestccg.nhs.uk or fill in the electronic version of the survey at: www.walthamforestccg.nhs.uk All comments must be received by 5pm on 17 December 2015. Waltham Forest Clinical Commissioning Group

What do you think? We want to know what you think, whether you use the walk-in service, are a carer of someone who uses it, a staff member, representative group or individual, community organisation, clinician or local resident. You can write to us or fill in the questionnaire at the back of this document and post it free of charge to us using a FREEPOST envelope. There should be an envelope included with every paper copy of the consultation document, but if there isn t, contact us and we will send you one, or drop off your response to: NHS Waltham Forest Clinical Commissioning Group Kirkdale House, 7 Kirkdale Road, Leytonstone, London, E11 1HP Alternatively you can email your comments to: oliverroad.consultation@walthamforestccg.nhs.uk or call 020 3688 1615 You can also access an electronic version of the questionnaire at: www.walthamforestccg.nhs.uk For further information about the consultation process or to read the background documents, please take a look at our website at: www.walthamforestccg.nhs.uk Drop in Events We also plan to have two public drop in events where you can come along, ask questions of the experts, share your opinions and find out more. These will take place at: 30 October 2015 9am 2pm Walthamstow Library Foyer, High Street, Walthamstow E17 7JN (5 minutes walk from Walthamstow underground station) 9 November 2015 2pm 7pm SCORE Community Building, 100 Oliver Road, Leyton E10 5JY (opposite the Oliver Road Polyclinic)