Right care, first time: Developing a new, integrated model for urgent care services in Scarborough and Ryedale Feedback report from stakeholder event held at Downe Arms, Wykeham on 27 November 2013 Urgent Care Stakeholder Event Summary Report Downe Arms, 27 November 2013 1
Contents 1.0 Introduction 3 2.0 Aims and format of the event 4 3.0 Areas of support 4 4.0 Areas of concern 5 5.0 Actions 7 5.1 Good information 7 5.2 Communication 8 5.3 Staffing 8 6.0 Next steps 8 2
1.0 Introduction NHS Scarborough and Ryedale Clinical Commissioning Group (CCG) is currently reviewing urgent care services in the area with a view to introducing a new, integrated urgent care service by April 2015. As part of this review, the CCG has plans to engage with the wider public between 6 January and 30 March 2014. In preparation for this, and to ensure that the proposed model for urgent care is fit for purpose and has the backing of local stakeholder groups, the CCG held an event to share the proposal and the case for change, whilst giving attendees the opportunity to provide feedback to help the CCG develop its proposal further. This report provides a summary of the main themes identified in the feedback received. 3
2.0 Aims and format of the event The event was held at the Downe Arms in Wykeham on the afternoon of Wednesday 27 November 2013. A delegate list and agenda for the event can be found in the appendix. The aims of this event were to: Ensure that key stakeholders appreciate the case for change; Obtain feedback from specific groups about the proposed model, for consideration alongside the feedback obtained from members of the public; Ensure that key stakeholders are aware of the CCGs plans to engage the wider public. Throughout the event participants had the opportunity to contribute concerns and support for the proposal of an integrated model for urgent care services in Scarborough and Ryedale. The event began with a short presentation from the two clinical leads for the urgent review Dr Omnia Hefni and Dr Peter Billingsley. Both clinical leads are local GPs as well as members of the CCG s Governing Body. The presentation was followed by two interactive group sessions which gave participants the opportunity to share their views; firstly with other participants who had a similar interest and then with participants with differing interests. At the end of each discussion, groups were asked to write down on red and green card the areas of support and areas of concern they had identified. Later, they were also asked to identify actions for the CCG to take away and consider. 3.0 Areas of support The areas of support for the proposal focussed on the need for change and the potential within the plan for improvements to current services alongside the development of new and better services. The impact on accident and emergency services, currently under great pressure from increasing numbers of patients, was welcomed. It was felt that waiting times may be easier to achieve through movement of patients to more appropriate services and the resulting reduction in duplication across services. Value for money would be improved and there would be more ability to attract good staff. However, it was highlighted that we must not lose sight of the good practice and targets currently being achieved. The proposal is taking the opportunity to be clearer about service delivery and to ensure the right systems are in place, including support systems. This should lead to 4
improved quality across services. There was enthusiasm for the potential to create more holistic integrated services, working closely with social services and the voluntary sector to develop a wellbeing service. It was recognised that the proposed model would provide care in one place with all the necessary support services providing 24/7 access, diagnostics and pharmacy on site and telemedicine allowing access to wider consultation across disciplines. The availability and access to other teams, such as mental health teams, was also identified as being essential. Some hoped to see even wider access for patients including the possibility of home visits. The one-stop shop model is likely to be easily understood by the public providing equity of access if both centres are kept open. The model will need to clearly define the choices available to patients with the current 111 system, accident and emergency (A&E) and GPs working closely with patients to communicate the choices. 4.0 Areas of concern Concern was expressed about the level of detail within the proposal which a few found to be limited at this stage (although the CCG did emphasise that the purpose of this event and the wider public engagement was to develop the detail). More detail was requested regarding specifications for integrated services, the numbers used to determine need, demand management, impacts on other services and affordability. Clarity is needed in the plan to understand exactly what will continue and what service and location will no longer be available. The impact on General Practice caused concern with some not understanding why a 24/7 service is needed if a GP is available during daytime. There is a possibility if the centre offers excellent services that patients will make this their first choice and the correct pathway may not be used (ie patients will default to using the urgent care service rather than their own GP). On the flipside, some believed numbers would not be sufficient to maintain the level of delivery expected. Clarity is needed in the relationship between Scarborough Hospital A&E department and the urgent care centres in terms of patient access and referral onwards to more appropriate settings. It can be difficult to move a patient to a different location once they have accessed your service. Some questioned whether the new centres could destabilise the Scarborough A&E department and consequently make it unsustainable. If this were the case, what would be the eventual financial and staffing implications of the changes? The walk-in centre is popular and successful, is it being sacrificed unnecessarily and how do these changes fit with the national guidance? 5
More detail is needed to fully understand the design of pathways and how the diverse elements of that pathway will work together. These will need to be more than just medical to ensure the scope that will be needed, including social care and prescribing and 24 hour diagnostics leading to the right follow-up care. The use of language needs to be considered to ensure that all terms are understood across a wide spectrum of both professionals and users. These pathways and options will need to be very clearly communicated if the service is to reach all groups in the community. There will also be a need for access through technology to patient records, common use of SystmOne, wider diagnostics and NHS 111. Location is key to the design of the service, and some believe that co-location with other services would be best. Transport to the services must be widely available in as many forms as possible. This will be crucial when considering access for those in the rural areas. Wherever they are based, the public must be clearly signposted. This may be an issue for visitors from outside the CCG area and for those on the borders. We should all be striving for equity and could learn from models elsewhere. The message to patients will need to be very clear and their expectation managed. The right pathway will need to be strongly promoted to ensure that the right service is accessed and other services are not undermined. The impact on A&E is not certain. In some cases success can create additional demand and the outcome will not then be a reduction in the use of A&E, just additional visits to urgent care. Alternatively, some patients may not have confidence in anything but A&E. There may be a specific problem with summer visitors if the walk-in centre closure takes place in summer leading to an increase in A&E attendances. Some believe the public are very able to make changes to their behaviour, but it is important to make the right information available to them and to raise the awareness of services, including self-help. This will lead to the required change in expectations and perceptions. There were concerns that all the necessary steps would be taken to address these issues. Concerns were raised regarding the impact on the workforce, where the necessary skills would come from and if resilience will be built into staffing levels. In terms of the plan for engaging with the public, there is a risk that young people and the seldom heard may be missed. The voluntary sector could be used to provide a diverse community with which to engage. Clinicians must be engaged and other models, including those in national guidance, must be considered. Finally, the timescale caused some concern as it was seen as a very short timescale for preparing to engage with the wider public. 6
5.0 Actions The groups of participants with varied interests were asked to consider actions that will need to be taken in order to address the concerns outlined above. Although many of the outputs from this session were phrased as comments, it is possible to draw-out the direction they would wish the action plan to take. The priorities were identified as 1. Good information on the need for change and the resulting change in pathways. The outcomes for patients must be clearly stated and monitored. 2. A communication plan covering all user groups across the community should be drawn-up in partnership with all interested parties. This will ensure access to accurate information and provide the necessary education messages to both user and professional groups. 3. Staffing of the new service and how to attract staff to the area. 5.1 Good information In putting together the plan, current good practice for walk-in centres and successful models, both on our borders and more widely, should be included. The CCG should be careful not to lose good services - especially the more holistic approach in the walk-in centres. Consideration should be given to the wider impact, both positive and negative, on other services. It is expected that A&E will benefit but evidence will be needed to show this. Good information and accurate data are needed in both design and monitoring and shared IT systems will be needed to underpin this. Accurate data should be used to identify need initially. Links to other services will be required to meet all these needs once the urgent care centres are working 24/7. Social care, mental health and onward referrals will require sharing of information and access to their services at all times. There is an opportunity here to develop the model of wider sharing of services to meet need and some suggest shared governance. The financial model will need to be sustainable. Some believed that co-location with emergency services would be required and others believe the location must be more accessible to more people with transport included in the plan. Once established, robust monitoring of use and outcomes must be put in place and regularly reviewed, with appropriate flexibility within the model to make changes. Performance monitoring should be part of the process. 7
5.2 Communication A communication plan containing clear information describing exactly what would be provided across primary, urgent and emergency care and how to access the appropriate service according to need. The information should be designed according to the specific group (including young people) and always be simple and straightforward. Effort should be made to target all patient groups and patient education regarding the services must be consistent. Access to information is likely to be improved if the voluntary sector is consulted and local politicians should be kept informed and aware of the issues. Overall, an open and honest process with consistent information available from a variety of sources is needed. If done well, expectations will be managed and services will be appropriately used with better outcomes for everyone. The location of services will affect the public perception of availability and transport issues should be addressed early in the plan and maintained as a priority throughout. Gateways to the service will need to be created to ensure the right use of a service at the right time with continuous education of the public and clinicians in signposting services. There is a role for GPs to assist access, both in terms of signposting and follow-up patients attending the urgent care centres. The role of telemedicine in the proposal requires clarification and all the underpinning technology must be accessible, provide patient information and data on which to base decisions. 5.3 Staffing The skill mix will differ over a 24 hour period and staff will be required to recognise need outside a medical model. A robust workforce plan is needed modelled on these varied needs and demands. Learning should be taken from good practice elsewhere and a joint education and training plan put in place across services. This could be a great opportunity to attract staff to an area where recruitment and retention have been a challenge; this model could be made very attractive. 6.0 Next steps The themes identified in this report will be used alongside feedback from the public engagement phase (6 January to 30 March 2014) to inform the final specification for an integrated urgent care service. This specification will be shared later in 2014. 8
Appendix A: List of participants Name Dr C Diggory Sarah Harrison Dr Donald Carrie Sue Nicholson Sally Skelton Robert Peacock Mandy McGale Richard Weightman Dee Colam Owen Southgate Mark Leese Becky Case Robert Rose Judy Dawes Tom Elrick Joanna Dodds David Hickson Dr Dougy Moederle-Lumb Ian Holland G Black J Darley S Roche M Dennis Alan Wittrick Role/Organisation Malton Surgery Healthwatch North Yorkshire GP Partner Danes Dyke Patient Rep Sherburn and Rillington Scarborough and Ryedale Patient Rep Group York Hospital Seachange Community Trust North Yorkshire County Council NHS England NHS 111, Yorkshire Ambulance Vale of York CCG Filey PPG GP- Prospect Road Surgery Primecare Belgrave Surgery Belgrave Surgery YORLMC Ltd Hambleton, Richmondshire and Whitby CCG Castle Health Centre Falsgrave Surgery 9
Dr Phillip Foster Loraine Hobday Chris Jones-King Ed Smith Melanie Liley Julie Nicol Dr Sunni De Pont Dr J Lawrence GP David Ames Chris Whilde Ian Legg Yorkshire Ambulance Service Primecare North Yorkshire County Council - Health and Adult services York Hospital York Hospital MIND Norwood Surgery SMG- South Cliff Norwood House Surgery Castle Health Centre York Hospital North Yorkshire County Council S. Whitefield Castle Health Centre Kath Halloran Malcolm Abrines S Jordan Adrian Snarr Phil Garnett W Quinn S Etches Donna Dudding Simon Cox Carrie Wollerton Andy Hudson Philip Hewitson Primecare York Hospital York Hospital 10
Appendix B: Event agenda 1.15 Registration 1.30 Welcome and introduction to event 1.40 Presentation by CCG on current position 2.00 Group work 2.30 Feedback 3.00 Break In groups representing your own or similar area of service: Consider the plan and the impact it will have on your services/roles/patients. After discussion place: 1. Concerns to be addressed on red paper 2. Positives to be maintained on green paper There should be one comment briefly described on each sheet 3.15 Working in small mixed groups and after introductions share the issues for your organisation. Listen to other participants, ask questions but do not challenge. Confirm the positives for your organisation. Are there risks to your service/organisation or to others? How could that risk be reduced? 3.40 Identify specific actions based on input so far today 4.00 Feedback 4.20 Chaired discussion What next? 4.30 Close 11
www.scarboroughryedaleccg.nhs.uk 12