The Urgent and Emergency Care System Clinical
Director for LLR and the Deputy Chief Operating
Officer of Integration and Transformation, the Engagement and
Insight Manager and the Senior Engagement and Insights Lead from
the ICB presented the item. As part of the presentation, it was
noted that:
- There was lots of work across
services to improve access, whether this was GP practises, urgent
treatment centres, pharmacies or the Emergency Department
(ED).
- The number of patients who presented
at ED was growing 4-7% each year which had increased the pressures
on the NHS and pathways for access.
- There were peaks in the demand such
as winter or heat waves but a large proportion of the patients
required care that was not an ED issue and was more suitable for
presentation elsewhere.
- Patient presentation at the wrong
place was not just an ED issues, it was seen across all primary
care areas. It was ultimately down to patient choice but this was
putting a lot of onus on the patient, and where they presented may
be out of their control. All areas were needed to address this
challenge.
- Despite the ongoing funding
challenges that faced the service, extra capacity was being
provided. This included 100 extra urgent centre appointments per
day and an expansion of Pharmacy First appointments.
- When a patient presented at ED, they
were offered an appointment at another premises that was more
suitable. This was to prevent overcrowding in ED. It also reduced
risks to patients who came into the ED with time critical
illnesses.
- There had been work with health
partners and wider partners within the community to understand how
to direct patients and to right size services, to ensure access was
available where it needed to be. This had been hindered by
historical arrangements and old contracts. There were 3 hubs in the
city which were a suitable solution historically but Pharmacy First
and other new arrangements provided more suitable access. These
services were put into place as a safety net while the future was
considered.
- A clinical audit was planned to
assess use and the needs of the patients.
- Engagement was occurring with
communities on how services would best be accessed. The feedback
was to be reviewed and themes identified. There had been previous
work with communities, the Local Authority and Adult Education
Service on keeping people out of ED which had been very
successful.
- There was to be a focus on promoting
and educating NHS 111 services, Pharmacy First, self-care and
translation services. Through partnership working with GP’s
and PCN’s there was going to be interactive sessions and
practical workshops that would be facilitated by communities.
- It was important to work differently
with different audiences.
- There was funded engagement aimed at
those who lived on the main route into the city, families with
babies and young children under the age of 10, people within the
age categories of 21-30 and 31-40, homeless, asylum seekers and
refugees, Eastern European, Black, Asian and Minority Ethnic
Communities and Groups with Plus to healthcare access.
- A meeting was scheduled with the
VCSE to understand what the communities wanted and needed for
understanding services.
- An independent report was intended
to consider the decision making, as well as an independent review
process to identify gaps.
In response to comments and questions, it was
noted that:
- The 3 hubs that were operating in
the city were closing in Autumn 2025. They were a legacy
arrangement from before the PCN’s and accessibility was poor.
This was to ensure access was meeting the needs of the population
in the right areas and to create capacity. The PCN’s were
working across 8 sites and Pharmacy First was being provided by 97%
of community pharmacies in the city. A lot of work was occurring
with pharmacies to ensure this was being done right.
- The hubs were going to be used for
same day access appointments. Additional same day access
appointments were to be kept separate from core GP contracts.
- If there were issues identified in
accessing services, it needed to be fed back so it was monitored
and addressed.
- There was a drive for better triage
in walk in’s and this was an ongoing process as best practise
was implemented. There was a steering group to target pharmacies
and GPs to address any issues. Clinical audit work was being done
which PCN’s were working to utilise.
- The Choose Better campaign that had
ran previously had a large impact with the imagery used for the
public.
- Members were reassured that where it
was necessary to see a GP, the patient would be seen by one.
- There was a growth in the number of
appointments being delivered, including a 1% increase in GP
appointments and more face-to-face appointments.
- It was emphasised that ED cannot be
the default provision so other services needed to be easier to
access and this was the message the health service wanted to
disseminate.
- Pharmacy First was a national
contract and cost £12 per appointment. There was no cap on
the number of appointments that could be provided.
- The unintended consequences of the
changes had been assessed as much as possible, but this was why
evaluation was so important so it could be monitored moving
forward.
- There had been discussions with
GP’s ahead of the changes but it allowed 111 to offer better
support in localised provision as they were able to access city
wide appointments.
- Redirection of patients from ED on
the day was likely to help deter it being the default
provision.
- It was clarified by officers that
this was engagement, not consultation.
AGREED:
- The report was noted.
- Numbers for uptake of Pharmacy First
to be shared by ICB.
- Further details of 8 hubs to be
shared once information is available.
- Details of the communications
campaign was to be shared.