To consider the development of a GP-led walk-in health centre for Herefordshire.

The Committee considered the development of a GP-led walk in Health Centre for Herefordshire. 

Mr Euan McPherson (EM) and Charmaine Hawker (CH), Programme Managers, gave a presentation on the proposed development.

EM said that the national model would not suit Herefordshire’s needs.  The Government had provided £800,000 for the developments in the base budgets of all Trusts although this sum was not ring-fenced.  Finance for the proposed Herefordshire model was therefore not easily identifiable, but it was considered that the proposal would be cost effective, sustainable and meet local needs.

He noted the need to retender for the provision of the out of hours service (6.30 pm to 8.00 am Monday to Friday and weekends) and the potential cost effectiveness and benefits for patients that a single procurement exercise for this service and the Health Centre could deliver.

A national timescale had been prescribed for the development of the Centres across the Country.  However, the PCT had considered that the Darzi model was more suited to urban areas and, notwithstanding the time pressure, had undertaken a local needs analysis.

The key findings were:Herefordshire is currently well provided with GPs and GP services; 87% of local people are happy with existing GP opening times; access to GPs is very good in Herefordshire.  The 2007 patient survey about GP access showed that 92% of patients could make an appointment with a GP within 48 hours (86% nationally) and 80% of patients could book an appointment with a GP two or more days in advance (75% nationally); population growth forecasts showed that the existing GP base should be able to accommodate this increase; there are a substantial number of people who commute into Hereford City each day, any new development should be based in Hereford City as a result of the demographics of the county, commuter travel flows and existing service delivery models; and a Hereford City based service would have the potential to alleviate inappropriate attendances at A&E and provide more appropriate services to some patients.

The County’s demographics suggested the Walk-in Centre should be located in Hereford City, but consideration could be given to the development of satellite facilities and outreach work.

The potential service model envisaged a single point of contact from which patients would be directed to the appropriate service whether it be A&E, GP, Dental Care, Social Care (out of hours), or District Nurse (out of hours).

He explained that the views of 270 individuals, organisations and groups  had been sought and reported the key findings of the feedback from this engagement:

the Herefordshire PCT Model was seen as innovative and rational; the response was generally supportive across all stakeholders; there were concerns about destabilising existing services; respondents were keen to see links and/or referral routes into other Primary Care and Social Care services; and there was a need to address potential risks that could arise from lack of continuity of care and poor communication.  He sought the Committee’s views on whether this obviated the need for a formal 12 week public consultation process.

He concluded by reporting that the Herefordshire model envisaged the walk in centre providing essential general services without undermining the County’s good base of primary care.  However, whilst the Strategic Health Authority and Department of Health had approved a number of local flexibilities to allow the model to be developed the Centre was required, contrary to the PCT’s request, to have the ability to register patients.

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

·         The benefit to the City and the wider County of reduced referrals to A&E was noted.

·         That in addition to the benefit of the increased access to care provided by the Walk-in Centre, the separate national requirement that at least 50% of GP practices had extended opening hours would provide an enhanced service in rural areas.

·         A question was asked about the cost implications of the number of commuters into Hereford City from out of the County on services (estimated at 6,000 per day out of the total of 22,000).  EM advised that, given that residents of the County would also be commuting to neighbouring Counties, the net impact was considered favourable to the PCT.

·         That patients clearly wanted increased access, in particular the opportunity to see GPs on Saturday mornings and the provision of open sessions that could be attended without having to make an appointment.

·         The issue of the clinical governance arrangements for the Centre was raised.  EM acknowledged that there would be practical issues to be addressed but in a sense a similar situation existed, as it always had done, with out of hours provision where patients were seen by a GP from outside their registered practice.  He emphasised that the Centre was intended to provide essential care only, with patients with long-term conditions being referred back to their GPs. 

·         It was asked how feasible it would be to recruit the additional GPs required to staff the new Centre.  EM said recruitment was a national issue.  There would be pressures and it would be important to ensure that quality of care was maintained.  To an extent the solution was dependent on the nature of the bids received to provide the walk-in service.

·         Clarification was sought on the funding for the Walk-in Centre and the implications for other budgets.  CH replied that the single procurement exercise for the Centre and the Out of Hours Service would help to offset some of the cost.  Although the Government had allocated funding of £800,000 it was expected that the cost of providing the Centre would exceed that sum.  The PCT would need to plan for this additional expenditure but the financial commitment could be managed.

·         It was noted that some Wards in the South Wye area, constituting one of the largest population groupings in the County, were not served by a Doctor’s Surgery.  CH commented that the PCT had no evidence that there was insufficient primary care available to residents of these wards, adding that that part of the population would benefit from the Walk-in Centre. 

·         In relation to the location of a Centre the PCT view was that it needed to be aligned to A&E but it was envisaged outreach services would be developed.  It was noted that many of the people self-referring to A&E were from the South Wye Area and the proposal in seeking to reduce such admissions would target services for that community.

·         It was suggested that the PCT should give further consideration to enhanced local provision in the South Wye area having regard to the development taking place in the area.

·         It was asked whether enhanced investment in capacity in existing local practices and facilities might not be preferable to investment in a new central facility.  The reply was that extended opening hours and greater use of existing facilities would enhance local provision.  The Centre in Hereford would be most accessible to the most people.  The commuting pattern indicated that people from the Market Towns would also benefit from the Centre.

·         The work on the local needs analysis and the evidence it provided in support of the Herefordshire model was commended.

·         The single point of contact and the integration with social care was welcomed.

·         The fact that social care out of hours was provided from Worcester was discussed.  It was noted that the current contract had been approved for one year only and would therefore allow for the provision of the service to be incorporated into the proposed Hereofordshire model.

·         The potential impact on local GPs was raised.  In reply it was said that there was a potential risk if a large number of patients chose to register with the Centre.  However, because the County was well provided with primary care services it was planned that the Centre would be restricted to providing essential services only.  This would minimise the risk to local practices and avoid undermining the existing arrangements which were of a high quality as demonstrated by the patients surveys and the quality and outcomes framework.

·         There was consensus that the PCT had consulted extensively and had taken account of the responses it had received in developing its proposals.  No formal public consultation exercise was therefore recommended.

RESOLVED:

That    (a)        the proposals for extended access to GP Services in Hereford City be welcomed recognising that they are demonstrably based on local need and the  proposed Herefordshire Model for equitable access to Primary Medical Care Services therefore be supported;

            (b)       a single provider of out of hours care and the service required to be provided between 8am and 8pm seven days a week would be beneficial to the local population;

            (c)        the additional benefit of reducing inappropriate A&E attendances be noted;

            (d)       the Primary Care Trust be urged to ensure continued engagement with GPs throughout the County to ensure their co-operation;

            (e)       a communication programme be instigated by the Primary Care Trust to ensure the public know how and when to access the appropriate medical care;

            (f)        the public consultation particularly with patient groups has ensured an appropriate level of engagement in the process;

            (g)       the aim of ensuring there is access to GPs across the County on Saturday be supported; and

            (h)       that the future integration of out of hours social care services in the new facility be encouraged.