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.