Integrated GP Out of Hours and Extended Access Consultation Report

Integrated GP Out of Hours and Extended Access Consultation Report September 2016 Authors Helen Pressage Senior Commissioning Manager Katie Horan Engagement Manager 1

Introduction and Background The Prime Ministers Challenge Funding in 2014/15 allowed for the trial of extended access to GP appointments across the town, with a service delivered from Bath Street Health & Well Being Centre by Bridgewater Community Healthcare Trust, via a sub-contract arrangement with Warrington Health Plus. In April 2016, in order to mainstream and maintain this service, a process was undertaken to review similar provision. GP Out of Hours (GPOOH) operates during the same timeframe from the fracture clinic at Warrington Hospital, which offered the opportunity to deliver the 2 services within an integrated delivery model. Bridgewater Community Healthcare NHS Foundation Trust currently provides both GP Out of Hours and Extended Access services from two separate bases Prior to being delivered from the Fracture Clinic base, GPOOH operated over a significant time period from Garven Place. The move to fracture clinic was instigated to enable the dual redevelopment of the Garven Place and Bath Street sites. The GP Forward View paper [April 2016] states the intention to develop the concept of Primary Care Access Hubs: CCGs will be required to ensure that this extra investment in general practice dovetails with plans to develop a single point of contact to integrated urgent care and GP out of hours services, accessed through a reformed 111 service. In addition, we will be seeking more joined-up services, for instance, hubs hosting GP out of hours bases, community nursing teams and greater access to diagnostic services. Proposed Model The proposed model would see the GP Extended Access provision integrated with the GPOOH service and delivered from Bath Street Health and Well Being Centre. This would co-locate the service in high standard accommodation at a centralised location, with evening and weekend district nursing provision, emergency dental services, Paediatric Acute Response Team (PART), Children s Community Respiratory Team (CcResT), Integrated Sexual Health Services and Pharmacy services. Well Pharmacy currently provides the pharmacy provision at both clinical sites under contracts with NHS England. Three way discussions have reached agreement that a single provision at Bath Street is achievable. Branding of the service would be as Warrington Primary Care Out of Hours Hub. The model would develop a clear base for people presenting with a primary care need during the out of hours period and enable greater service efficiency and flexibility. There is also the opportunity to work collaboratively with a range of other services and to develop a complete primary care out of hours offer for Warrington The accommodation within Bath Street HWC will be located on the ground floor and is fully disability compliant Accommodation in Fracture Clinic for the current GPOOH service has been commented on in several reports (CCG Quality Visit, BCHT self-assessment against CQC Standard 15) due to small cubicles which would not be suitable for resuscitation, no access to hand basins within cubicles and poor privacy due to curtain only screening. 2

Access by public transport would be improved and car parking during out of hours is good. This includes free on-site parking, access to on-street parking and low charges within town centre short stay car parks Access to appointments would be via 3 routes: 111 for same day/urgent primary care access Registered GP practice for pre-bookable appointments From Warrington Hospital A&E department for people who have inappropriately attended emergency service provision The proposed service change would commence on 5 th October 2016 with a revised service specification varied into the Bridgewater Community Healthcare Trust contract from this date Consultation Methodology of the Consultation The CCG undertook a statutory consultation on the proposals as they constituted a substantial development of or variation in the provision of health services, in accordance with regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. When undertaking any public consultation the Gunning Principles must be applied, see Appendix 1 for the process relating to this consultation. An Equality Impact Assessment (see Appendix 2) was undertaken to assess the potential impact on the nine protected characteristics covered under the Equality Act 2010. It was identified from this assessment that the proposals should have positive impact. For the full audit of engagement activity please see Appendix 3, in summary, we attended four public events, presented at two Third Sector groups, presented at three clinical or stakeholder meetings. Information was sent to key stakeholders including all GPs, MPs, all Councillors, Health and Wellbeing Board and provider organisations, over 1200 Third Sector organisations via Warrington Voluntary Action, the CCGs membership scheme approximately 200 members, Healthwatch database (500+) and Patient Participation Groups, totalling over 2000 members of the public and representatives of Third Sector Organisations. Information was sent and displayed at GP Practices across the town, as well as at Bath Street Health and Wellbeing Centre and GP Out of Hours. In regards to the media, there were two press releases that were issued to the local media, including the Warrington Guardian (online and paper readership of 140,741) and Warrington Worldwide (5,000 daily online visitors), information was published on the CCG website. The social media reach was 5,601 followers on Twitter and Facebook: 209 Likes. The Engagement Manager spent time in GP Out of Hours asking patients their views on the relocation, this took place on a Saturday evening, Sunday afternoon, two weekday evenings and a Thursday afternoon when Practices were closed due to Protected Learning Times for GPs and Practice Nurses. Breakdown of Respondents 3

Through the Equality Impact Assessment no negative impacts were highlighted regarding any specific characteristic, however respondent s age and disability were asked to ensure no negative impacts. The breakdown is below: Table 1. Age Answered 196 Skipped 40 Table 2. Do you consider yourself to have a disability Answered 194 Skipped 42 Main Findings and Themes From the online survey and the discussions at the engagement activities patients and the public were asked if the relocation would have any impact on themselves or their family. Overwhelmingly the public stated there would be no negative impact as a result of the relocation, and there was overwhelming public support for the relocation. There were 236 completed surveys from patients and the public and 13 emails received, from these respondents 96% stated there would be no negative impact to them or their family. 4

The majority of comments and participants who attended the various events, groups and meetings were also in support of the proposals. Specific engagement took place with disability groups and people with learning disabilities, for a write up see Appendix 4. There were no issues raised by either these groups that the relocation would impact them accessing the service. There was an opinion amongst people with learning disabilities that they should only be directed to the hospital for emergencies, therefore the relocation would benefit them. Warrington Disability Forum stated there would be no issues with accessing Bath Street as Warrington Disability Partnership were involved in the planning and development of the building in terms of accessibility. The CCG s Health Forum were also in support of the relocation. The Forum raised some issues relating to the environment, which are included below. Warrington Borough Council s Scrutiny Committee were also in support of the relocation, however they raised some concerns, which again are themed below. Below are comments that highlight the overwhelming positive themes from all the surveys and discussions. Better place, more accessible for people without transport I believe it will benefit the system and will be easier to access With free parking it is one less thing to worry about There were a number of queries raised throughout the consultation, these are themed below: Is the current car park adequate for patients attending Out of Hours? Will there be any impact on patients accessing Springfield Medical Centre? Would there be any potential impact on patients who need to be referred to Warrington Hospital? Would a Pharmacy be open the same time as Out of Hours? Is the environment adequate at Bath Street in terms of downstairs toilet facilities, refreshments and staff? To ensure Warrington and Halton Hospital NHS Foundation Trust is not negatively impacted due to the relocation. Through the Equality Impact Assessment it was identified the proposals should have positive impact. However it was raised by a minority of patients through the consultation that the change of location could impact a minority of patients due to distance from bus route. This has been explored further in the full impact assessment (Appendix 2) Partners and health professional s respondents 19 online surveys were completed, these ranged from GPs, other health professionals, a Councillor and Bridgewater Community Healthcare NHS Foundation Trust staff. The relocation proposal was also presented at the CCG Primary Care Development Group and the Integrated Commissioning Board (Appendix 4 for extracts from minutes), no issues were raised regarding the relocation by either group. From the online survey the majority of partners and health professionals stated the relocation would have no negative impact. Issues that were highlighted for clarification are: 5

Onsite Pharmacy facilities The rationale behind the decision to relocate and The potential issues for transfer of patients if A&E or acute treatment is needed Recommendations and Mitigations Implement the relocation of GP Out of Hours from Warrington Hospital to Bath Street Health and Wellbeing Centre to start from Wednesday 5 th October 2016 1. Clarify the Pharmacy service Well Pharmacy currently provides the pharmacy provision at the current site at Warrington Hospital and at Bath Street under contracts with NHS England. Three way discussions have reached agreement that a single provision at Bath Street is achievable for this date 2. Ensure car parking is sufficient. The barrier at Bath Street Health and Wellbeing Centre is permanently closed, operating a token system to leave. Therefore only patients who are accessing the Centre will be able to park. Due to the nature of the Out of Hours, only a limited number of services will be operating so the car park should be adequate. There is potential to open the barrier to the staff car park as this won t be at capacity during out of hours at busier times. There is also alternative free parking available which will be advertised (Town Hall after 6pm, street parking after 6:30pm and free parking after 4pm at the Golden Square Multi Storey and Ground Floor car park on Thursday (when the practices are shut on the last Thursday of the month for Protected Learning Times) and 8am midnight (Multi Storey) and 10:30am midnight (Ground floor car park) on Sundays. 3. Ensure the environment is adequate in terms of downstairs toilet facilities, onsite security and refreshments NHS Warrington CCG to ensure that Bridgewater Community Healthcare NHS Foundation Trust mitigate the issue concerning toilet facilities. Regarding refreshments this is not a requirement in GP Practices: patients are allocated an appointment time therefore due to the short amount of time that patients will be in Bath Street this won t be necessary. Following implementation if this is felt to be needed, this will be reviewed. 4. Produce and implement a comprehensive marketing and communications plan to provide feedback on the outcome to the public and other key stakeholders. A Communication Plan will be developed to inform the public, health providers and health professionals of the relocation. This will include: Full information on the location of Bath Street Health and Wellbeing Centre Information on car parking facilities Fully explain the rationale behind the relocation Reassure patients of the pathway and referral process to A&E and secondary care from GP Out of Hours Reassure patients from Springfield Medical Centre that GP Out of Hours is a separate service so there will be no impact Briefings to NHS 111 staff on the relocation 6

Appendix 1 GP Out of Hours Consultation Process and the Gunning Principles When undertaking any public consultation in the UK the Gunning Principles must be applied. This has been confirmed by the Court of Appeal in 2001 (Coughlan case) When assessing the Medicines Management Consultation the four principles were applied as evidenced below. 1. When proposals are still at a formative stage - Public bodies need to have an open mind during a consultation and not already made the decision, but have some ideas about the proposals. The consultation question was open so any comments on the proposed relocation could be recorded. The question asked if the relocation would have any impact. At presentations at public meetings and Third Sector Organisations it was made clear this was a consultation and if the majority of the public did not agree it would not happen. During the consultation any impact, positive or negative was asked for. 2. Sufficient reasons for proposals to permit intelligent consideration' - People involved in the consultation need to have enough information to make an intelligent choice and input in the process. Equality Assessments should take place at the beginning of the consultation and published alongside the document. A Frequently Asked Question sheet was produced for the public to further understand the implications of the proposals. This was added to if any further questions were raised. An Equality Impact Assessment was undertaken to determine where specific engagement should be undertaken. The assessment highlighted little impact for patients. 3. Adequate time for consideration and response - Timing is crucial is it an appropriate time and environment, was enough time given for people to make an informed decision and then provide that feedback, and is there enough time to analyse those results and make the final decision? The consultation was undertaken for eight weeks. The engagement and communications methods used were wide and varied, which included press, social media, emails, printed documents in various places and targeted engagement at groups and public events. After the consultation there will be one month to analyse the results and mitigate any risks identified. 4. Must be conscientiously taken into account - Think about how to prove decision-makers have taken consultation responses into account. There was overwhelming agreement to the proposals, however some issues and concerns were raised. The mitigating actions to these concerns are listed in the Equality Impact Assessments, which includes, actions, lead and timescales: 7

1. Clarify the Pharmacy service available 2. Ensure car parking is sufficient 3. Ensure the environment is adequate in terms of downstairs toilet facilities, onsite security and refreshments 4. Produce and implement a comprehensive marketing and communications plan to provide feedback on the outcome to the public and other key stakeholders, this to include: Full information as to the location of Bath Street to all patients, GPs, health professionals and 111 staff Information on car parking facilities car park outside Bath Street, and where other free parking is available Fully explain the rationale behind the relocation Reassure patients of the pathway and referral process to A&E and secondary care from GP Out of Hours Reassure patients from Springfield Medical Centre that GP Out of Hours is a separate service so there will be no impact. 8

Equality Impact and Risk Assessment Stage 2 Relocation of GP Out of Hours Equality & Inclusion Team, Corporate Affairs For enquiries, support or further information contact Email: equality.inclusion@nhs.net Equality & Inclusion Page 1

EQUALITY IMPACT AND RISK ASSESSMENT TOOL STAGE 2 ALL SECTIONS MUST BE COMPLETED SECTION 1 - DETAILS OF PROJECT Organisation: Warrington CCG Assessment Lead: Katie Horan Team responsible for the assessment: Commissioning, Contracts and Engagement Responsible Director/CCG Board Member for the assessment Who else will be involved in undertaking the assessment? Helen Pressage, Pam Broadhead and Katie Horan Date of commencing the assessment: 31/05/16 Date for completing the assessment: 01/08/16 SECTION 2 - EQUALITY IMPACT ASSESSMENT Please highlight which group(s) this project will or may impact upon? Patients, service users * Carers or family * General Public * Staff * Partner organisations * Background of the project being assessed: Equality & Inclusion Page 2 Yes No Indirectly Following the trial of extended access across the town and the Primary Care Strategy consultation the CCG are reviewing the availability of GP appointments. Bridgewater Community Healthcare NHS Foundation Trust currently provide Out of Hours (hours) and Extended Access (hours). What are the aims and objectives of the project being assessed? The review will focus on three areas of service provided by Bridgewater relating to primary care access to ensure proper planning of capacity for both routine and urgent access after core hours of primary care. One potential outcome of the review is that the Out of Hours GP Service relocates to Bath Street Health and Wellbeing Centre which may provide better arrangement regarding parking availability, cost (free) and better accommodation for the service. The process will be a formal consultation as a relocation of service could have the potential to be a substantial variation of service.

Services currently provided in relation to the project: GP Out of Hours Provided by Bridgewater Community Healthcare NHS Foundation Trust Which equality protected groups (age, disability, sex, sexual orientation, gender reassignment, race, religion and belief, pregnancy and maternity, marriage and civil partnership) and other employees/staff networks do you intend to involve in the equality impact assessment? Please bring forward any issues highlighted in the Stage 1 screening How will you involve people from equality/protected groups in the decision making related to the project? A full consultation plan will be devised to ensure that equality groups are engaged with. This will include various engagement and communication methods, including surveys, attending Third Sector Groups, press releases, social media and attending both venues to ask patients their opinions of both settings. Engagement will take place with the main umbrella organisation in Warrington, OPEG, Warrington Disability Partnership, Speak Up, Parents and Carers Forum. EVIDENCE USED FOR ASSESSMENT What evidence have you considered as part of the Equality Impact Assessment? All research evidence base references including NICE guidance and publication please give full reference Bring over comments from Stage 1 and prior learning (please embed any documents to support ENSURING LEGAL COMPLIANCE Think about what you are planning to change; and what impact that will have upon your compliance with the Public Sector Equality Duty (refer to the Guidance Sheet complete with examples where necessary) In what way does your current service delivery help to: How might your proposal affect your capacity to: How will your mitigate any adverse effects? ( You will need to review how effective these measures have been) End Unlawful Discrimination? End Unlawful Discrimination? End Unlawful Discrimination? N/A N/A N/A Promote Equality of Opportunity? Promote Equality of Opportunity? N/A Improved access to service - including Town Centre location, Promote Equality of Opportunity? To consider after consultation phrase if applicable. Equality & Inclusion Page 3

Foster Good Relations Between People free parking and improved bus links Foster Good Relations Between People N/A Improved access to service - including Town Centre location, free parking and improved bus links Foster Good Relations Between People WHAT OUTCOMES ARE EXPECTED/DESIRED FROM THIS PROJECT? What are the benefits to patients and staff? Improved access to service - including Town Centre location, free parking and improved bus links. N/A How will any outcomes of the project be monitored, reviewed, evaluated and promoted where necessary? An evaluation of the relocation will take place six months after any changes are implemented. This will involve engaging with patients who have used the service. EQUALITY IMPACT AND RISK ASSESSMENT Does the project have the potential to: Have a positive impact (benefit) on any of the equality groups? Have a negative impact / exclude / discriminate against any person or equality group? Explain how this was identified? Evidence/Consultation? Who is most likely to be affected by the proposal and how (think about barriers, access, effects, outcomes etc.) Please include all evidence you have considered as part of your assessment e.g. Population statistics, service user data broken down by equality group/protected group Please request guidance on Equality Groups/Protected Groups and their issues, this document may help and support your thinking around barriers for the equality groups Equality Group / Protected Group Age Disability Gender Reassignment Pregnancy and Positive effect Negative effect Neutral effect Please explain - MUST BE COMPLETED * Free parking Improved public transport links * Free parking Improved public transport links * * Equality & Inclusion Page 4

Maternity Race * Religion or Belief * Sex (Gender) * Sexual Orientation Marriage and Civil Partnership N.B. Marriage & Civil Partnership is only a protected characteristic in terms of workrelated activities and NOT service provision Carers * * * Free parking Improved public transport links Deprived Communities Vulnerable Groups e.g. Homeless, Sex Workers, Military Veterans * Free parking Improved public transport links * Free parking Improved public transport links SECTION 3 - COMMUNITY COHESION & FUNDING IMPLICATIONS Does the project raise any issues for Community Cohesion? No issues What effect will this have on the relationship between these groups? Please state how will you manage this relationship? No effect What is the overall cost of implementing the project??? Please state: Cost & Source(s) of funding: This is the end of the Equality Impact section, please use the embedded checklist to ensure and reflect that you have included all the relevant information Equality & Inclusion Page 5

EI&RA checklist_v1.0_11091 N/A not identified in Part 1 Screening SECTION 4 - HUMAN RIGHTS ASSESSMENT N/A not identified in Part 1 Screening SECTION 5 - PRIVACY IMPACT ASSESSMENT EQUALITY IMPACT AND RISK ASSESSMENT AND ACTION PLAN Below to be completed after the consultation period Risk identified Actions required to reduce / eliminate the negative impact Resources required* (see guidance below) Who will lead on the action? Target completion date Resources required is asking for a summary of the costs that are needed to implement the changes to mitigate the negative impacts identified SECTION 7 ONGOING MONITORING AND REVIEW OF EQUALITY IMPACT ASSESSMENTS AND ACTION PLANS Please describe briefly, how the equality action plans will be monitored through internal CCG governance processes? Date of the next review of the Equality Impact Assessment section and action plan? (Please note: if this is a project or pilot reviews need to be built in to the project/pilot plan) Date: Which CCG Committee will be responsible for monitoring the action plan progress? Who will be the responsible person in the organisation to ensure the action plan is monitored? Equality & Inclusion Page 6

FINAL SECTION SECTION 8 Date sent to Equality & Inclusion (E&I) Team for quality check: Date quality checked by Equality and Inclusion Business Partner: Date of final sign off by Equality and Inclusion Business Partner: Signature Equality and Inclusion Business Partner: CCG Committee Name and sign off date: This is the end of the Equality Impact and Risk Assessment process: By now you should be able to clearly demonstrate and evidence your thinking and decision(s). To meet publishing requirements this document SHOULD NOW BE PUBLISHED ON YOUR ORGANISATIONS WEBSITE. Save this document for your own records Send this document and copies of your completed Privacy Impact Assessment and Human Rights Screening to equality.inclusion@nhs.net Equality & Inclusion Page 7

Appendix 3 Engagement and Communications Audit Patients and Public Web content publication on CCG WCCG EEC Team upload to website Consultation website page The items to be uploaded are: Overview statement Link to survey monkey Frequency asked questions produced will be added to throughout the consultation 06.06.16 Information put on Facebook and Twitter social media pack to be produced From 06.06.16 repeat weekly Information sent to providers for their communication channels 06.06.16 Consultation Documents Warrington Health Forum Warrington CCG s Health Forum is open to the CCG membership scheme and Third Sector organisations. The aim of the forum is to share CCG work and obtain feedback. Disseminated to: All GP Practices The Gateway for public and to all tenant organisations Warrington Disability Partnership Centre for Independent Living and Market Stall Healthwatch Warrington CAB Young Healthwatch LifeTime Carers Drop ins BME Over 50 s group GP Out of Hours Bath Street Health and Wellbeing Centre WCCG EEC Team to send information to their Health Forum members. 06.06.16 25.07.16 Discuss at Health Forum on 25.07.16 PPGs Warrington CCG facilitate and chair a PPG Network, for PPG representatives and practice staff to meet, share ideas and to discuss CCG work areas. CCG Membership Scheme WCCG Engagement Team to send information to the PPG Network WCCG Engagement Team to send 06.06.16 Resend 04.07.16 10

The CCG have developed a membership scheme with approx. 200 individual and Third Sector representatives on the mailing list. GP Out of Hours and Bath Street Media Press releases information WCCG Engagement Team to attend GP Out of Hours and Bath Street Health and Wellbeing Centre to obtain the views of patients attending 2 press releases Follow up being produced Sat 23.07.16 Sun 24.07.16 Tues 25.07.16 Wed 26.07.16 Thurs 27.07.16 02.06.16 19.07.16 Public Meetings Carers Conference To attend and promote the consultation to carers 08.06.16 Speak Up Health Event MELA To attend and promote the consultation to adults with learning disabilities and their carers To attend and promote the consultation 26.07.16 24.07.16 Disability Awareness Day To attend and promote the consultation 16.07.16 Third Sector Organisations Warrington Voluntary Action Warrington Voluntary Action have an email bulletin which goes to over 1400 Third Sector groups Healthwatch Healthwatch have a database of over 500 individuals and group representatives. WCCG Engagement Team sent information 06.06.16 04.07.16 Information sent to Healthwatch to send to their wider database. Stakeholder briefing to be sent 06.06.16 04.07.16 Warrington Disability Partnership The Disability Forum is made up of representatives from a range of organisations who support people with a physical or learning disability or with a mental health issue. Warrington Ethnic Communities CCG to present at Warrington Disability Partnership CCG to present and facilitate discussions to gain public views 11 09.06.16 18.07.16

Association The group is made up of a range of different people from Warrington s ethnic communities Clinical Engagement GPs WCCG EEC Team will send to all local GPs in weekly bulletin Presented at Primary Care Development Group 03.06.16 23.07.16 Federations Meeting Healthier Warrington Phoenix Teaching Warrington Alliance Internal Engagement Information to be sent via the GP Bulletin 03.06.16 23.07.16 CCG Staff Information to be sent via Staff bulletin 07.06.16 Quality Committee HP to present at July Quality Committee 29.06.16 Stakeholder Group Health and Wellbeing Boards Information sent to the Board 03.07.16 Integrated Commissioning/ Presented at Board Transformation Board Bridgewater Community Healthcare NHS Stakeholder briefings to be sent 06.06.16 Foundation Trust Warrington and Halton Hospitals NHS Stakeholder briefings to be sent 06.06.16 Foundation Trust Warrington Borough Council Stakeholder briefings to be sent 06.06.16 5 Boroughs Partnership Stakeholder briefings to be sent 06.06.16 Local Medical Committee Stakeholder briefings to be sent 06.06.16 Political Engagement Overview and Scrutiny Information to be sent 06.06.16 MPs Councillors Stakeholder briefings to be sent Chair and Chief Clinical Officer to update MPs at briefing sessions. WCCG Engagement Team to inform all councillors 06.06.16 06.06.16 Appendix 4 12

Write up of Third Sector Organisations and Statutory Meeting discussions 1. Primary Care Development Group 22.06.16 Extract from minutes Proposed Future Model for an Extended Access Service Dr Jaish Puri gave a presentation around the proposed re-location of the GP Out of Hours Service and explained that as per the General Practice Forward View, CCGs will be required to ensure that the extra investment in general practice dovetails with plans to develop a single point of contact to integrated urgent care and GP out of hours services, accessed through a reformed 111 service. In addition the Forward View seeks more joined up services, for instance hubs hosting GP out of hours bases, community nursing team and great access to diagnostic services. Dr Puri explained that the proposal is to move the GP Out of Hours services from the hospital into Bath Street, which has six clinical rooms which are fully fitted out, plus a treatment room, all on the ground floor. It was noted that other services within the building are already open until 7 p.m. on week nights and between 9 and 12 on Saturday mornings. Paediatrics, dental and sexual health all have services within the building. There is good parking at the building and in the Golden Square car park, which is cheaper than parking at the hospital. Dr Puri explained that the proposal is to make this a Primary Care GP led service, and not led by either the Acute or Community Trusts. Dr McCarthy agreed that patients should expect to experience the same experience at this service that they do within the daytime and should be run by the town s most experienced GPs who have access to patient notes and who are familiar with the town. Following a question from Dr MacBeth around whether GPs could refer patients to out of hours if they have a patient wishing to book an appointment late afternoon when the surgery is full, it was agreed that the out of hours service should link in with the daytime practice and should not be a separate service. Helen Pressage explained that the discussion today is solely around the first stage of the proposal, which is the relocation of the service to Bath Street. A working group will be put together to discuss the further stages of how the service will be run. The provider of the service will remain the same at this first stage, and any decision to change the provider during the next phase of the proposal would result in an open tender process. Concern was raised that many surgeries within the town are reaching saturation point and are closing their lists due to massive capacity issues, particularly in those areas of the town that are expanding. Justin explained that this provides a good opportunity to look at training requirements for less experienced staff in a place where they will be mentored by experienced clinicians with a high throughput of patients. It was noted that NHS England are not yet sure about where the extra resources will be coming from, however this centre does not depend on that funding for the first phase. 13

Dr Puri explained that this is an opportunity to bring together fragmented services into a single location, to align services and to improve efficiency and resilience. The public consultation will continue until the end of July, however the feedback to date has been positive. The consultation has been circulated in the GP Bulletin, the Warrington Guardian and to the main working groups via Healthwatch. The group noted the impact on Indemnity Compliance as full appointments and access to patient records will mean this is core work and will change the indemnity requirements for clinicians. 2. Warrington Borough Council s Scrutiny Committee The Council s Scrutiny Committee has recently considered the proposals and has asked me to write to you to confirm its decisions, as follows:- Decision 1) To note the report on the public consultation by NHS Warrington CCG about proposals to relocate the GP Out of Hours Service in Warrington; 2) To agree that the Committee does not consider that the proposals constitute a substantial variation such that it would require formal consultation arrangements to be entered into with the Health Scrutiny Committee; 3) To express the Committee s support for the proposals, subject to NHS Warrington CCG considering the following matters:- a) That an assurance be given that the same level of resources which are currently provided for the GP out of hours service based at Warrington Hospital will automatically transfer to the new service due to be delivered at the Bath Street Health and Wellbeing Centre and that any negative implications for the Hospital Trust caused by the redirection of resources be considered and mitigated; and b) That access for patients to a pharmacy at the Bath Street Wellbeing Centre should be considered and that availability should be at least on the same basis and at the same times as is currently provided by private providers and/or in-house services at Warrington Hospital. I should be grateful if the CCG would take these views into consideration when making its final decision on the proposals. 3. Warrington Disability Forum The members of the Forum were all in agreement to the relocation. The group felt the relocation would have no negative impact. The group felt Bath Street was a better fit for purpose building, with no disability access issues. 4. Speak Up Event 26 th July 2016 Approximately 70 people with learning disabilities attended. All people we spoke to were in favour of the move to Bath Street Health and Wellbeing Centre, and stated no negative impact. There was a feeling amongst some people with a learning disability that they should only be told to go to Warrington Hospital in an emergency, so Bath Street would be a better location and less stressful. See below for the display from the day. 14

5. Warrington Ethnic Communities Association 18.07.16 The group felt the relocation would be a benefit to patients. The parking would be better than at the hospital. Free parking is better when people are feeling unwell. People are not thinking about parking when they are unwell, so people have sometimes been fined at the hospital. Experiences were shared when parking has been an issue at the hospital, including unclear signs and disabled patients having to pay. One member stated he was 100% in agreement with the relocation. 6. Warrington CCG s Health Forum 25.07.16 In attendance; Healthwatch Warrington, Contact the Elderly, Home Start, Warrington Wolves, Footsteps and representatives from seven PPGs Extract from minutes Concerns raised: Parking although free, available spaces are limited at times, but this is felt to not be a major issue as the hours that the service will run are quiet times so parking should be available; however, if this is not the case, it was suggested opening the staff car park to the public during these hours for overflow. Downstairs toilets it was reported that they are always closed due to substance misuse taking place. No water machines or vending machines available. Safety concerns Bath Street is open to anyone. With this being said, the general feedback was positive and delegates supported the move as a majority. KH explained that the general feedback was the same with 99% being positive; she thanked delegates as there have been concerns discussed that have not yet been raised. 15