The director of primary care, NHS Herefordshire Clinical Commissioning Group (CCG), explained that the CCG’s governing body was preparing to engage and consult with patients, public and wider stakeholders on the delivery of 7-day primary care medical services in Herefordshire.

Views on the redesign of the urgent care pathway had been sought and the key message was that a more streamlined pathway into care was required.  There were 24 GP practices in the county plus 3 hubs provided by Taurus, and an out of hours service. There was an opportunity for redesign for a number of reasons:

·         a pilot for 7-day Taurus hub pilots was coming to an end;

·         funding was transferring to the CCG in April 2017; 

·         a new out of hours provider was in place under a new contract from November.

A timeline for the consultation process was set out, to March 2017.

The proposal centred around moving a GP practice into the walk-in centre space at Asda giving full access to primary care till 8pm, and to provide planned care through a Taurus hub in the same facility. It also recognised that there was a need for increased primary care access in South Wye to serve an increased population.  

A member commented that the current walk-in centre operated from 8am until 8pm and is used by people from all areas, not just South Wye, and gave encouragement for early consultation with community leaders. He made the point that people would not expect to have to make a ‘phone call to be directed to that centre because they were used to going straight there without an appointment. 

The chairman noted that there were few GP practices south of the river, and asked if the proposals meant that people outside the area would be excluded from access.

The director explained that people could go to any practice but it was necessary to tailor the primary care and to support the population that is there.

The chairman commented further that altering access to the walk-in centre would be a sensitive issue.  It was noted that the service would be extended to provide planned care and walk-in facilities, along with signposting.

A member suggested that the overall object would seem to be to stop people accessing A&E inappropriately in order to take some pressure off that service, and it was not clear how successful that had been so far. It was a challenge to educate and change peoples’ mind-set from making 999 calls.   The director concurred that this was part of the driver for change and a consistent message was needed. Patients would be able to phone and be seen through triage and may be directed to other support such as pharmacy or nursing care, with the emphasis on clinical need.

Referring to the report, a member asked for clarification on what the end offer would look like, and the impact on minor injury units around the county. It was important to ensure the consultation was county-wide and to be clear about what was proposed in order to have meaningful consultation responses at the end of the process.  

The director clarified that the consultation document was in development and more detail would be available in January. She added that the CCG had applied for support from NHS England to develop estates, technology and transformation for the development of a city hub and to develop health and wellbeing hubs. The timing was critical to align with community hospitals and the fast pace was driven by other factors in the system, so opinions were sought as early as possible.  

Members identified a number of groups to include in the consultation:

·         parish councils;

·         community groups;

·         Welsh communities who accessed Herefordshire services as these were closer;

·         South Wye family centres, schools and the women’s refuge

The chairman commented that more time was needed for meaningful consultation and asked about the timing for consultation with walk-in centre users. The director outlined that there would be consultation within the centre supported by a questionnaire.

The CCG accountable officer acknowledged that there was limited timing for consultation opportunities, not least because of the timing of contracts. 

The vice-chairman noted the sentiments expressed regarding South Wye, which resonated with the value placed upon the community hospital by people in Leominster, where there were real examples of how the hospital had aided convalescence and avoided bed blocking in Hereford.

In answer to a question from the chairman regarding the GP hub, the director explained that the proposal was for three city practices to be relocated as one sustainable practice. There were recruitment difficulties in general practice and so it was expected that the hub and spoke model would support GPs to ensure that patients were served appropriately. 

The CCG accountable officer explained that the consultation would inform and provide details for what was currently a broad proposal.

RESOLVED

That

a)    the proposal and process be noted;

b)    the committee’s suggestions regarding the consultation process as identified be taken into account; and

c)    the matter be brought back to the committee in the new year with further detail.