Wednesday, 27 April 2016

Will a closure of Accrington Victoria walk in centre for a new GP hub be beneficial for patients?

East Lancashire Clinical Commissioning Group are proposing to change your access to GP services. In short they are proposing to close Accrington Victoria Walk in Centre (known also as  the HAC or Health Access Centre) and replace it with an alternative hub service; and for access to that service to be though your GP and a new GP telephone hub.

UPDATE: It has now received the thumbs down from the two local patient groups. Patient Voice and the Patient Participation Group who have similar concerns as I do.

The CCG's explanation is on their website and I have copied and pasted it all at the foot along with with their email, their website, their postal address (at the bottom) and importantly their online questionnaire for you to register your views.
(Please also take my two question survey which is bit fairer and more balanced. Please distribute the link on social media.) 
Question: Do you think the closure of Accrington Victoria Walk in Centre, to be replaced by a GPs telephone hub service (with some face to face by appointment) will provide you with a better patient service? Answer here
The CCG case for closing Accrington Walk in Centre. Much of the reasoning in the press release on their website is by the Chair of the CCG, Dr Huxley who quotes a recent (and little known) CCG survey of Hyndburn patients as the justification. I have major concerns about how this survey was conducted, the questions asked and to whom, when it took place and how it is being presented now. I received a reply from the CCG on 26 Nov 2013 that referred to a similar survey. Reading the quotes in the current press release does not inspire confidence in the results.

The main problem is that it conflates two issues for the purpose of benefiting the CCG closure proposal. It states that "[The CCG] know that many people want later appointments, to fit in with work, other commitments or if they just find it difficult to get an appointment during working hours. We also know that some people would prefer to see a doctor at the weekend." Of course Hyndburn patients would respond by saying they want their GP access to be improved! Why would you not want better access? People are frustrated with the difficulty in getting GP appointments but at no point have they ever said they want the Walk in Centre to close. Rather the opposite. They like the Walk in Centre because of frustration at GP access. The absence of this question on the Walk in Centre closure undermines the CCG's credibility.

My own view of NHS restructuring. The CCG are being forced to cut back and save money. The CCG spend 80% of all NHS money. CCG's are groups of local GPs who buy (and pay for) NHS services collectively - from Royal Blackburn for example. Some Hyndburn GPs have previously been rated as amongst the poorest in East Lancashire by the Primary Care Trust (predecessor to the CCG) (see chart on page 17 of this HBC report in 2013 on local health care and Walk in Centre) and the Care Quality Commission (and here) an improvement programme was brought in to improve standards.



Walk in Centre closure impact. The walk in centre at Accrington Victoria is popular and was saved from closure two years ago following a public campaign. ELMS, a local social enterprise delivers health care at Accrington Victoria (a GP practice and the Walk in Centre) providing extra GPs within Hyndburn to relieve the pressure and provide an alternative. The issue here is that GPs who run the CCG procurement of  'outside GPs' through ELMS contract are in doing so providing a rival (or complementary depending on how you see it) GP service at Accrington Victoria Walk in Centre. So firstly I would ask this; will the ending the ELMs contract restrict patient choice?

With the closure their will be an immediate loss of GP capacity. The CCG have not explained if or where any extra (replacement) GP provision will come from if the Walk in Centre is closed and the ELMS contract ended. Last year the Walk in Centre had 34,000 patent visits. That is a lot. GPs are inaccessible for many people who don't have the flexibility or time in the working day to wait in the morning in a telephone queue or turn up at their GPs and wait till the GP can see them. The Walk in Centre by comparison is accessible and outside of working hours too. That's why people use it and why it is liked.

So the second question is this; if the CCG are going to end the ELMS contract where will the extra GP provision come from?

Government policy. The CCG are fulfilling a Governments policy to shut walk in centres and provide instead 24/7 GP access. I have raised this in the House of Commons with the Health Secretary Jeremy Hunt and at PMQs with the Prime Minister.

How in reality will you get hard pressed GPs in Hyndburn to give up even more time and give up time at weekends? Seems totally unrealistic.

Conflicts of interest. The GPs who run the CCG may well decide to offer a new contract to increase the provision of GPs to cope with the 34,000 patient visits to the current Walk in Centre at Accrington Victoria. However they have set up their own for profit, private company? So fourthly will they give the contract to themselves? They may choose not to of course but the mere fact a conflict of interest exists is of concern.

The new hub? The good news is the CCG are have accepted that a physical locality, a hub offering late night, seven days a week GP services must remain. A new Walk in Centre? Fifthly then, what will this hub look like, where will it be? Can details be provided?

Lack of clarity on this issue is a major concern as it gives the impression of cuts by fudge. People want to know there will not be barriers access. The CCG/GPs have said that access will not be by walk up, i.e. it will not be a walk in centre. Access will be by appointment by ringing a new GP telephone hub.

Dedicated Care Navigators. The CCG proposal lacks any clarity on the hub. For example the CCG says "Good quality telephone advice can mean that patients don’t always need to see a GP face to face. GPs also tell us that some patients don’t need a GP appointment but could visit their pharmacy or go online for self-care." This would suggest the hub is to replace or complement (confuse?) with the existing but failing government NHS 111 telephone service? So sixthly; will this telephone hub look to provide medial diagnosis by telephone and who will be the "Dedicated Care Navigators"? What does "Dedicated Care Navigators" mean in reality? Will it compete the national 111 service? Will it look to reduce and therefore alleviate the high volume of current face to face GP appointments?

Access to the hub. What problems do the CCG anticipate with telephone hub service and will people be able to ring up and get an appointment at the hub? Is this more convoluted that simply turning up now and waiting in the queue? Will the service be efficient - or just another service with a automated voice that says "you are no 23 in the queue, you are number 22 in the queue"?

It is asserted that an advantage will be that the hub will be "run by your local GPs it means the health hubs, unlike other services will have secure and confidential access to patient’s full medical records" however the CQC rated ELMs patient information service as outstanding. So this justification put forward by the CCG for the hub fails close scrutiny.
CQC identified several areas of outstanding practice by ELMS including: • The use of the Medical Intraoperability Gateway (MIG) electronic system to allow GPs at the service to access the front page of patients records held at their usual GP practice. This allowed GPs at the service to have read only access to patient’s allergies, medication and any recent tests carried out by their GP. This was only available once patients had given their consent. 
Not one hub but several hubs across East Lancashire. The CCG say "the whole system will be integrated which means if one hub (Accrington) is very busy patients can access other hubs (Burnley and Pendle - note Royal Blackburn A and E is nearer as is minor injuries unit at AccVic). So seventhly what does this mean? That it will be hard stretched GPs who are asked to cover the hours in Accrington? Will patient information be shared across all hubs and what if a patient doesn't want to or can't get to Burnley? What if a patient is incapable of fully understanding what is on offer? Surely the point of the Walk in Centre was simplicity and convienence? And what about the hours? The current Walk in Centre at Accrington Victoria operates to past 9pm. This is proposing to close 1 hour earlier. This is a a reduction in service, not an enhancement.

Dr Huxley's comments stress GPs desire to ease GP access. Besides the fact that GPs don't have spare capacity or appointments there is a broader issue. If in practice people are simply sent to other hubs if Accrington hub is unavailable how is that better?

Summary. The CCG appear to have committed themselves to going down this path and follow the government NHS policy against what I believe are the wishes of local people. So finally will the CCG scrap these proposals if the public don't like them? There is nothing more valuable to a GP than the trust between them and their patients and I hope they are listening mode.

Contact the CCG
Online questionnaire which can be accessed on the CCG’s website at: http://www.eastlancsccg.nhs.uk/improving-gp-access/

Email your comments to: communications.eastlancsccg@nhs.net.

Writing to Communications, Walshaw House, Regent Street, Nelson, Lancashire, BB9 8AS. You can also call us on 01282 644627 for more information.

http://www.eastlancsccg.nhs.uk/2016/04/20/primary-care-consultation-launched-across-east-lancashire/

Primary care consultation launched across East Lancashire


A consultation on a proposed new model to improve access to GP services in East Lancashire has been launched by NHS East Lancashire Clinical Commissioning Group (CCG).
The model which has been developed by local GPs, and after initial feedback from patients, incorporates the vision for same day access, 8am-8pm 7 days a week to a GP wherever you are in East Lancashire.
Over the last 18 months, the CCG has been working alongside patients, carers and wider stakeholders such as doctors and pharmacists to develop a vision for how they would like GP services to develop in future. This vision is for GPs and partner organisations to work together more closely; to provide quality joined up care; with equal access to services wherever you live in East Lancashire.
Dr Phil Huxley, Chair of NHS East Lancashire CCG, said: “We have been listening to patients for over 18 months and this consultation builds on that feedback.  We want to improve access to GP services and make it easier for patients.  Our proposals therefore, are based on what we have been told.  We know that many people want later appointments, to fit in with work, other commitments or if they just find it difficult to get an appointment during working hours.  We also know that some people would prefer to see a doctor at the weekend.
Of all the patients who use NHS services, GPs see 90% of those and this makes the relationship between the GP and their patient very important and extremely valuable to the majority of our patients.  Our proposals seek to strengthen that relationship further.
When we engaged with patients last year, they told us that the first contact with the practice is the most important. Good quality telephone advice can mean that patients don’t always need to see a GP face to face. GPs also tell us that some patients don’t need a GP appointment but could visit their pharmacy or go online for self-care.”
In developing the ideas, local doctors have started to form a plan to improve GP access in the whole of East Lancashire by working more closely together whilst maintaining continuity of care. The plan reflects some of the changes that patients and practices have said they would like to see.
Currently the CCG funds a GP walk-in centre based at Accrington Victoria Community Hospital serving the whole of East Lancashire. This contract is coming to an end and an alternative to this, but still based in Accrington, is being considered.  Rather than just operating one centre for the whole of East Lancashire, the CCG proposes to introduce additional ‘Health Hubs’ in Burnley, Pendle, and Rossendale and Saturday morning surgeries in Ribblesdale.
The proposals are that:
  • Extra appointments are made available in the hubs from later in the afternoon to 8pm Monday to Friday to extend the access that patients have to their general practice. Weekend appointments will be available from two hubs in Accrington and Burnley from 8 am to 8 pm Saturday and Sunday, and Saturday morning in Ribblesdale and Rossendale
  • Access to all appointments in the hub can be made by simply ringing your GP surgery
  • Dedicated children’s appointments would be available in the hubs due to the demand for late afternoon appointments for children
  • Dedicated Care Navigators will be available to advise and help patients decide on the best place for them to access health care based on their need
  • The whole system will be integrated which means if one hub is very busy patients can access other hubs. Because the service is run by your local GPs it means the health hubs, unlike other services will have secure and confidential access to patient’s full medical records. This will only be with the patient’s consent and will ensure that the doctor or nurse knows the patient’s full medical history and they receive the right treatment
  • Each hub will be located with or near to a pharmacy to ensure that any prescriptions required can be obtained easily and quickly
  • The hub would be an additional service to the minor injuries unit at Rossendale and Accrington Victoria Community Hospital, the Urgent Care Centre at Burnley, A&E, and the GP out of hours service. These services are not affected by this proposal
The CCG is asking for people to tell them what they think of these proposals and there are a number of ways that this can be done.
The CCG has created an online questionnaire which can be accessed on the CCG’s website at: http://www.eastlancsccg.nhs.uk/improving-gp-access/
Paper copies of the questionnaire will also be distributed to every GP practice in East Lancashire so that patients can complete these and post them using the FREEPOST survey address envelopes, or they can be given to the reception staff who will send them to the CCG.
In addition, direct comments are welcome.  You can email your comments to: communications.eastlancsccg@nhs.net.  Or you can write to Communications, Walshaw House, Regent Street, Nelson, Lancashire, BB9 8AS. You can also call us on 01282 644627 for more information.
The survey will run until the 8th July 2016.  The findings from the survey will be published as soon as possible after the closing date.