Healthcare Hubs in our City

Healthcare Hubs in our City This is your opportunity to tell us what you think about the new healthcare hubs and how they will run in the future.

What we are proposing in summary Many patients have told us that they find it difficult to get appointments with a GP. This includes during the day, in the evening and at weekends. When their need is urgent, many patients often do not know where to turn. This can lead to patients who need help waiting longer than they should, which sometimes means their condition gets worse. These patients may then need to be taken to hospital, which might not have been necessary if they had been able to access appropriate help sooner. Other patients might go straight to A&E, even if this is not necessary or appropriate. To help address this, we have been trialling three healthcare hubs in the city. In these hubs GPs and nurses provide extra appointments to patients who can t get one with their own practice, or who need help when their practice is closed. One of these existing hubs is already being developed to become a community healthcare hub. This includes the ability to perform some routine tests currently undertaken by the main hospital sites so that patients can be quickly diagnosed and treated in the community wherever possible. We believe that these trials have been a success and wish to make these three hubs permanent from April 2017. Alongside this we are proposing to replace the current walk-in service (provided at the Merlyn Vaz Health and Social Care Centre) with an extra community healthcare hub when the current contract ends in September. This service would also offer extended access to general practice, as the walk-in centre does now, along with a range of diagnostic testing to rule out or confirm an illness, the level of which would depend on where it is located. We are asking patients for their views on whether this additional hub service should be provided from the current location at the Merlyn Vaz Health and Social Care Centre, or from the Leicester General Hospital campus where there is potentially more room to grow the range of services offered to patients. Unfortunately, we do not believe that it would be possible to fund services in both locations. No decision has yet been made and feedback from patients will help us decide on our preferred model. What is Leicester City Clinical Commissioning Group? Every year, Leicester City Clinical Commissioning Group receives a budget from the Government to plan and buy the health services needed by the local population. In our case this is the 390,000 people who are registered with a city GP practice. In 2017/18 we will receive around 490m to fund hospital services, urgent and emergency care, the care you receive in your GP practice, community health care, mental health and learning disability services, and rehabilitation. GP practices in the city We have many good GP practices in Leicester, but also some that are struggling to meet the needs of patients despite their best intentions. We also hear from patients about how the service they receive from their practice does not always meet their expectations, and difficulties they have in obtaining an appointment on the day they need it and at a time that is convenient. We have been assessing how we can make this better for patients. What are healthcare hubs? Since September 2015 we have been testing an idea in the city for a number of healthcare hubs. These offer you the opportunity to have an appointment with a GP or a prescribing nurse during evenings, weekends and bank holidays. The hubs can be used by any patient that is registered with a GP practice in Leicester. There are currently three hubs that patients can use. Appointments for the same day or up to 48 hours in advance can be booked by your GP practice, by calling NHS 111 or by calling the designated healthcare hub phone number. 2

This service has proved to be extremely beneficial to patients, many of whom are able to get an appointment on the same day even when their own practice cannot fit them in. On average the hubs provide around 1500 extra patient consultations per week. One of the hubs, operating at Westcotes Health Centre, has recently been extended to become a community healthcare hub. This offers appointments with a GP or prescribing nurse and will soon include some diagnostic testing to rule out or confirm an illness. These tests include things such as ultrasound, blood tests and heart monitoring. It is open 8am to 8pm, seven days a week. Patients will be referred for tests by a GP, that they have seen either at their own practice or at one of the healthcare hubs. This is important because a large proportion of patients receive outpatient appointments at Leicester s Hospitals to have this testing carried out. We believe it would be much more convenient and a better experience for patients to have this carried out in the healthcare hubs instead. We believe this will help to reduce pressure on services provided by Leicester s Hospitals. Due to their success, we are planning for the three existing hubs to become permanent services from April 2017. We are proposing to open a second community healthcare hub, our fourth hub overall, which would replace the walk-in service currently provided at the Merlyn Vaz Health and Social Care Centre when the current contract ends at the end of September 2017. We are asking for the views of patients and stakeholders on these proposals, including the location of the new hub. This could be either at the Merlyn Vaz Health and Social Care Centre site or at the Leicester General Hospital campus. No decision has yet been taken and feedback from patients, alongside ongoing detailed costings and feasibility work, will help us decide on our preferred option for the site of the service. Unfortunately, due the financial challenges facing the NHS, we can only afford to provide a hub at one of these locations. We do not believe that there is the money available to fund services at both sites, which is why it is important that patients tell us what is most important to them and the considerations we need to make when deciding which location is most suitable. 3

Our current healthcare hubs 1. Healthcare hub at Belgrave Health Centre, 52 Brandon Street, Leicester, LE4 6AW Pre-booked appointments with a GP or nurse. For patients registered with any GP practice in Leicester City. Monday to Friday: 6:30pm to 10:00pm. Weekends and bank holidays: 12:00pm to 8:00pm This service is already in place as a pilot. It is proposed that this is made a permanent service from April 2017. 2. Healthcare hub at Saffron Health, 612 Saffron Lane, Leicester, LE2 6TD Pre-booked appointments with a GP or nurse. For patients registered with any GP practice in Leicester City. Monday to Friday: 6:30pm to 10:00pm. Weekends and bank holidays: 12:00pm to 8:00pm This service is already in place as a pilot. It is proposed that this is made a permanent service from April 2017. 3. Community healthcare hub at Westcotes Health Centre, Fosse Road South, Leicester, LE3 0LP Pre-booked appointments with a GP or nurse. Will include a diagnostics service to rule out or confirm health problems, such as blood tests, ECGs and ultrasound. 8:00am to 8:00pm, seven days a week This service is already in place as a pilot for a healthcare hub. It is proposed that this is made a permanent service from April 2017 as a community healthcare hub. Opening hours could be extended to 10:00pm in the future. Belgrave Health Centre Westcotes Health Centre Saffron Health 4

The options for a fourth healthcare hub In addition to the healthcare hubs, there is currently a walk-in centre for Leicester City patients located at the Merlyn Vaz Health and Social Care Centre. This is open 8am to 8pm, seven days a week. The contract for this service is due to come to an end on 30 th September 2017. We are proposing to replace the walk-in centre from 1 st October 2017 with an additional community healthcare hub. The hub could be located at the Merlyn Vaz Health and Social Care Centre offering a small range of routine testing services (Option 1). However, there is already a healthcare hub in close proximity in Belgrave and space constraints mean that it would not be able to offer a comprehensive range of test facilities. A further option is for it to be located at the Leicester General Hospital campus, where there is potential for it to become a community healthcare super hub in the future. This could have the ability to carry out observations on patients as well as more advanced testing (Option 2). If this option receives support from patients as a permanent location, it would not be ready for October 2017. In the short-term the hub would be located at Merlyn Vaz Health and Social Care Centre, before moving to the General Hospital at some point in the future. Currently a large number of patients are admitted to Leicester s Hospitals for six hours or less while observations and some of these tests are carried out. We believe this community healthcare super hub could prevent many of these admissions from being required and would be more convenient for patients. It should also help to reduce pressure on services provided by Leicester s Hospitals. Walk-in and pre-bookable appointments The service currently provided at the Merlyn Vaz Health and Social Care centre is an exclusively walk-in led service. This means that patients, including those who are not registered with one of the GP practices in the building, can walk-in between the hours of 8am and 8pm and sit and wait for an appointment to become available. Depending on how busy the service is, that can be several hours. While this can have advantages for patients, it often leads to excessive peaks and troughs in demand (times when it is either very busy or very quiet) which makes it difficult to make best possible use of health professionals time. We know from feedback from patients that at busy times they can get frustrated with the length of time they need to wait to be seen. Under the hub model there is a greater emphasis on pre-booked appointments that are either made on the day or up to 48 hours in advance. These appointments can still be used by any patients from anywhere in the city and are made by calling NHS111, a dedicated local telephone line or via the patient s own practice. We believe that a timed slot helps to keep waiting times for patients to a minimum and it means that we can make maximum use of the GPs and nurses time who are working in the service. Pre-booking also means that a decision can be made about which service is best for your needs. This could help reduce the number of walk-in patients who wait several hours for an appointment only to be referred onto another part of the service, such as A&E, following consultation with a doctor. However, we recognise that not everyone has the ability to be able to book an appointment in advance, which is why the hub, could continue to offer some appointments on a walk-in basis. This could also apply to any of the three existing hubs. We want to understand whether people agree with us that this focus on timed appointments is better for patients. 5

About the Merlyn Vaz Health and Social Care Centre and who uses it The Merlyn Vaz Health and Social Care Centre opened in 2009. Since then it has provided a range of services for the local community and the city as a whole. It currently houses three GP practices, a dental clinic, and a range of community health services. This includes children's and young people's mental health, district nurses and more. None of these other services are affected by the proposals in this document. The walk-in centre opened at the same time as the building. Its aim was to provide improved access to GPs for patients who were finding it difficult to get an appointment at their own practice. It was hoped that this would help lead to a reduction in A&E attendances but, since the service opened, the number of people attending A&E has continued to rise. The walk-in service is provided by one of the three GP practices that are currently in the building. It does this as well as providing care to its own list of registered patients. Over time that registered list has grown to around 5,500 people. On average around 450 to 500 patients from across the city use the walk-in centre each week. The centre is relatively well served by a local bus network and does have some limited on-site parking for patients. However, patients often tell us that the lack of parking, particularly during the week, is an issue. Because the walk-in centre and one of the registered GP practices share the same space, it is becoming more and more difficult to develop the service. This is because with all of the other services in the building there are not enough extra clinical rooms available to significantly increase appointments. While we think we would be able to provide some basic test facilities it is likely that the range would be constrained by these space issues. However, we also understand that the walk-in centre is well known by patients across the city and changing the location could be potentially confusing and disruptive for patients particularly those who live close by. This is why we want people to tell us their views about what is important to them. Possible services at Merlyn Vaz Health and Social Care Centre We believe the following services could be available if the fourth hub was located at Merlyn Vaz Health and Social Care Centre: GP-led services, 8am to 8pm (could be extended to 10pm in the future), 7 days a week: Appointments with a GP Appointments with a prescribing nurse or advanced nurse practitioner In total we estimate the service could have the capacity to provide approximately 500 such appointments each week. Testing services could include: Point of care blood tests Urine tests Pregnancy tests Electrocardiographs (ECG) for monitoring the heart Ultrasound tests for a restricted range of conditions 6

About Leicester General Hospital The Leicester General Hospital is located in Evington. It is around 3 miles from the city centre and just over 1.5 miles from the Merlyn Vaz Health and Social Care Centre. It currently delivers a range of medical services for patients either where they have to stay in overnight or as an outpatient. Services are mainly provided by University Hospitals of Leicester NHS Trust. It is also home to the Leicester Diabetes Centre and the Evington Centre, which provides some community beds for city patients. We believe that there is vacant space on the site which could be used to provide the hub. Because of the amount of space that is available it would be possible to provide more appointments for patients and a potentially wider range of test facilities than is likely to be the case at the Merlyn Vaz Health and Social Care Centre. It might also allow us to create an observation area. This is an area where patients can have their vital signs (such as pulse, breathing, blood pressure and temperature) monitored over a period of time to see how their condition either improves or gets worse. This would be helpful for doctors and nurses in making more informed decisions about the needs of those patients. Because the Leicester General is a working hospital it benefits from relatively good transport links including the city s Hospital Hopper bus service. It also has extensive car parking facilities, though these can get busy during the day and there is a charge for use. It is also a very big site, which we know can be difficult for some people to find their way around. The Leicester General Hospital site would likely offer us more opportunities to improve and develop the services we are able to offer as part of the hub, both now and in the future. However, it is important that we hear from patients about how any such move would impact on them and their families. Possible services at the Leicester General Hospital site We believe the following services could be available if the fourth hub was located at the General Hospital site: GP-led services, 8am to 8pm (could be extended to 10pm in the future), 7 days a week: Appointments with a GP Appointments with a prescribing nurse or advanced nurse practitioner In total we estimate the service could have the capacity to provide approximately 750-800 such appointments each week. Testing services could include: Point of care blood tests Urine tests Pregnancy tests Electrocardiographs (ECG) for monitoring the heart Full range of ultrasound X-ray (in the future) Histology (analysis of cells and tissues with a microscope) Microbiology to diagnose infections Eye examinations Observations on a patient over several hours to monitor how their condition changes 7

Option 1: Healthcare hub locations from 1st October 2017: the three existing healthcare hubs plus an additional community healthcare hub at Merlyn Vaz Health and Social Care Centre (with limited diagnostics) Option 2: Healthcare hub locations from 1st October 2017: the three existing healthcare hubs plus a community healthcare hub at Leicester General Hospital. This could become a super hub in the future (with a full range of diagnostics). 8

Options for the future B Healthcare hub at Belgrave Health Centre, 52 Brandon Street, Leicester, LE4 6AW Pre-booked appointments with a GP or nurse. For patients registered with any GP practice in Leicester City. Monday to Friday: 6:30pm to 10:00pm. Weekends and bank holidays: 12:00pm to 8:00pm S Healthcare hub at Saffron Health, 612 Saffron Lane, Leicester, LE2 6TD Pre-booked appointments with a GP or nurse. For patients registered with any GP practice in Leicester City. Monday to Friday: 6:30pm to 10:00pm. Weekends and bank holidays: 12:00pm to 8:00pm W Community healthcare hub at Westcotes Health Centre, Fosse Road South, Leicester, LE3 0LP Pre-booked appointments with a GP or nurse. Includes a diagnostics service to rule out or confirm a health problem, such as blood and urine tests. 8:00am to 8:00pm, seven days a week. This could be extended to 10:00pm in the future. plus M G Community healthcare hub at Merlyn Vaz Health & Social Care Centre, 1 Spinney Hill Road, Leicester, LE5 3GH Pre-bookable and potentially some walk-in appointments with a GP or nurse. Would include a small diagnostics service to rule out or confirm a health problem, such as blood and urine tests. 8:00am to 8:00pm, seven days a week. This could be extended to 10:00pm in the future. or A community healthcare hub (with the potential to become a community super healthcare hub) at Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW Pre-bookable and potentially some walk-in appointments with a GP or nurse. Could include an advanced diagnostics service to rule out or confirm a health problem, such as blood tests, ECGs and ultrasound. There could also be the ability to carry out observations on a patient. 8:00am to 8:00pm, seven days a week. This could be extended to 10:00pm in the future. 9

Next steps We would like to hear your views about our vision for the future of the healthcare hubs in Leicester and, in particular, what else we need to consider. The latest that you can do this is 19 th March 2017. You can give us your feedback in the following ways: Complete this survey and send it back to us at our freepost address Complete the survey online at: https://www.surveymonkey.co.uk/r/hchubs How can I check on progress? Once the feedback has been assessed it will be discussed at the CCG s Governing Body. You can check for general updates online at www.leicestercityccg.nhs.uk Further reading The healthcare needs of a population will be different in one area compared to another. The role of clinical commissioning groups like ours is to transform both the national Five Year Forward View and the General Practice Forward View documents into a strategy that will work for our local population. We also have a local Primary Care Strategy which outlines how we will work with our GP practices in the city to make sure they care for patients in the best possible way. The Leicester, Leicestershire and Rutland Sustainability and Transformation Plan (STP) is a recent plan which every area has to produce to show how local services will evolve and become sustainable over the next five years. The Leicester, Leicestershire and Rutland plan builds on what Better Care Together has already paved the way for. If you would like to read more about these plans, please visit the following websites: Five Year Forward View: www.england.nhs.uk/ourwork/futurenhs General Practice Forward View: www.england.nhs.uk/gp/gpfv Sustainability and Transformation Plan: www.bettercareleicester.nhs.uk 10

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Survey Please take the time to tell us your views on the proposals for the healthcare hubs. Please submit your completed survey to reach us no later than 19th March 2017. Q1a. Have you ever used the services at the hubs? Yes No Don t know Q1b. If you have used the healthcare hubs previously, what are your thoughts about what worked well or not so well? Q2a. When the existing two healthcare hubs and the community healthcare hub are made permanent services from April 2017, what do you think are the things we need to consider? 12

Q2b. What, if anything, could we do to make the hubs better for patients? Q2c. What can we do to make sure people know about the healthcare hubs and how they can use them more effectively? Q3. Where would you prefer the 4th community healthcare hub to be located in the future? Merlyn Vaz Health and Social Care Centre The Leicester General Hospital Don t know Please give reasons for your answer. 13

Survey continued.. Q4 What is most important to you when accessing health services (please tick your preferred choice): Appointments available at convenient times Being able to have tests carried out in the same place Not having to wait Good parking Easy to get to Other (Please tell us) Q5. We are proposing that most of the appointments at this new community healthcare hub, and our existing hubs, will be booked appointment slots via NHS 111, a dedicated hubs telephone number and patients own GP practices. Do you agree that booked appointment slots should be our focus, with a smaller number of appointments retained for walk-in patients? Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Please give reasons for your answer, and tell us what proportion of appointments you think should be retained for walk-in patients. Q6. Please tell us about anything else that we need to consider in the space below. 14

Equality Monitoring Please complete as much of the information about yourself as you feel comfortable with, as this will help us understand who is taking part in the survey. The information you provide will be kept in accordance with the terms of the Data Protection Acts 1998 and 2000 and will be used for monitoring purposes and questionnaire analysis. Gender Q1. What is your gender? Male Female Transgender Prefer not to say Gender reassignment Q2. Has your gender (sex) changed since birth? Yes No Prefer not to say Pregnancy/maternity Q3. Are you pregnant or have you given birth in the last 26 weeks? Yes No Prefer not to say Age Q4. What is your age? Under 16 16-24 25-34 35-59 60-75 76+ Prefer not to say Disability Q5a. Do you consider yourself to have a disability or suffer from poor health? Yes, I have a disability Yes, I am in poor health Neither Prefer not to say 15

Survey continued.. Condition Q5b. If you have selected yes, please tell us which condition: Physical Partial or total loss of vision Learning disability/ difficulty Partial or total loss of hearing Mental health condition or disorder Long standing illness or disease Speech impediment or impairment Other medical condition or impairment, please tell us here: Race Q6. What is your ethnicity? African Arab Bangladeshi British Caribbean Chinese Gypsy/ Traveller Indian Irish Pakistani Polish Somali Prefer not to say For mixed or other ethnicities, please tell us here: 16

Religion or belief Q7. What is your religion or belief? No religion Atheist Bha i Buddhist Christian Hindu Jain Jewish Muslim Sikh Prefer not to say Other, please tell us here: Relationship Status Q8. What is your relationship status? Single Married/civil partnership Separated or divorced Partnered/living with partner Widowed/surviving civil partner Prefer not to say Sexual orientation Q9. What is your sexual orientation (preference)? Bisexual (relationship with either sex) Gay (male to male relationship) Heterosexual (male to female relationship) Lesbian (female to female relationship) Prefer not to say Other, please tell us here: Many thanks for completing this survey. Please send this survey to: Engagement team Freepost RRUE-JRBR-RGGT Leicester City Clinical Commissioning Group St John s House 30 East Street Leicester LE1 6NB 17

Hadii aad u baahantahay in lagaa caawiyo fahmida qoraalka ku qoran documintigaan fadlan nagala soo xiriir telefoonkaan 0116 295 4743. Jeśli potrzebujesz pomocy, aby zrozumieć treść tego dokumentu proszę zadzwonić pod numer telefonu 0116 295 4743. Caso pretenda ajuda para compreender o conteúdo deste documento, por favor ligue para o 0116 2954743. Every year, Leicester City Clinical Commissioning Group receives a budget from the Government to plan and buy the health services needed by the local population. In our case this is the 390,000 registered people that live and work in Leicester City. In 2017/18 we will receive 490m to fund hospital services, urgent and emergency care, the care you receive in your GP practice, community health care, mental health and learning disability services and rehabilitation. 18