To receive a presentation on Primecare’s plans for the out of hours service and GP led walk-in health centre.

The Committee considered a presentation on Primecare’s plans for the out of hours service and GP led walk-in Health Centre in Hereford.

Helen Kelly, Operations Director, and Dr Peter McKay, Local Medical Advisor delivered the presentation. A number of their colleagues were also present to assist in answering any questions.

The presentation set out the background to Primecare’s services in Herefordshire. 

Key changes to current services included: enhanced senior management focus, enhanced local medical and clinical focus, local triage skill mix and seamless care 24/7 and efficiencies as a result of the co-location of services.

Key principles in the delivery of a quality service were that it should: be Patient centred –meeting local need  and offering patient choice, improve access and target the reduction of inequalities, support service progression through innovation/and addressing inappropriate admission strategies to the Accident and Emergency Department (AED), be responsive to changes in need, be a quality driven service with compliance with national quality requirements underpinned by high standards of clinical governance, be clinically effective –creating a learning environment and promoting best practice, and be cost efficient but provide effective care

The Primary Care Trust had identified the need to focus on AED referrals with currently >10% referred to the Out of Hours Service (OOH).  AED peaks were between 8am and 7pm each day, and hard to reach groups tended to use AED as their default.  A pilot GP in Hereford Hospital AED showed that up to 60% of patients could be seen by a Primary Care Team.  The PCT had also identified commuter needs.  In addition some 6,000 migrant workers came to work in the area in the summer months needing healthcare.

Primecare’s aspiration was to deliver Health Equality across populations, support individual wellbeing, ensure care was provided in the right setting, provide timely convenient and responsive care, deliver high quality clinical outcomes achieve efficient and effective delivery of services, and financial balance across the local health economy.

Improved health outcomes would include access to planned care, rather than unscheduled care, integrated patient notes, sound clinical governance, an unscheduled care network, increased integration between Health and Social Care and evidence based interventions.

It was proposed that there would be health promotion outreach to migrant workers’ workplaces, schools, community centres, places of worship, Wednesday markets, Mental Health, and integrated working with the Herefordshire Drugs Service (DASH) and Obesity Services

It was emphasised that Primecare intended that the services it provided would be locally managed and delivered, drawing on support in terms of governance and efficiencies that Primecare corporately could provide.

In terms of the Walk-in Health Centre it was stressed that the service was not designed to compete with existing local practitioners, noting amongst other things the limitation placed on the number of patients the Centre could register.

In the course of discussion the following principal points were made:

·         It was asked where the Walk-in Centre would be located and when it would be operational.  It was noted in reply, on behalf of the Primary Care Trust, that commercially sensitive negotiations were continuing over the location.  Co-location on Hereford hospital site was one option, but there were also potential advantages in a more central location.  Account also needed to be taken of the timeframe within which the project could be delivered.  It was noted that Primecare had commenced recruitment of staff to man the Centre as negotiations continued.

·         In response to a question about prescription of out of hours of medication to those with drug abuse problems Primecare emphasised that it would need to work carefully with the DASH.  Two Clinical Managers would be appointed who would look carefully at care pathways and protocols.

·         Asked about the service currently provided out of hours at Ross Community Hospital, Primecare replied that the service provided on Saturday and Sunday mornings would continue.

·         In relation to recruitment of staff for the social care out of hours service the Director of Integrated Commissioning clarified the respective roles of the Council and Primecare noting that Primecare would be responsible for recruitment to support the triage element of the out of hours service. 

·         A question was asked about the extent to which Primecare worked in an integrated way with the Primary Care Trust.  Primecare commented in reply that working arrangements were good and the Key Performance Indicators in the contract encouraged close working to meet the required performance levels.  The link that had been established between Primecare and the Herefordshire Local Medical Committee was also noted. 

·         The Director of Integrated Commissioning commented on practical arrangements in place to foster co-operation and ensure information on patient care was shared.  Primecare said that these arrangements for sharing information took account of the numerous cross–border patients from Wales.

The Chairman thanked the representatives of Primecare and suggested that their attendance at meetings of the Committee to provide regular updates on progress would be helpful

RESOLVED: That Primecare be invited to provide a regular update to each scheduled meeting and send a senior representative to answer any questions the Committee might have.