Agenda item

To receive a report providing an update on progress in primary, community and acute care in implementing seven day services as directed by the Seven Day Services Forum.

The Managing Director, Leicester City Clinical Commissioning Group submitted a report providing an update on progress in primary, community and acute care in implementing seven day services as directed by the Seven Day Services Forum.

The Managing Director stated during the introduction and in response to subsequent questions from Members that:-

a)         Leicester City GP Practices were successful in receiving an allocation of £3.2m from the Prime Minister’s Challenge Fund to pilot a number of initiatives to promote seven day access to primary care.  The GP practices had formed a Steering Group to oversee the introduction of these initiatives which involved longer opening hours during the week, opening at weekends and greater use of online services including patient registrations.

b)         The CCG had a representative on this Steering Group to influence the alignment of the initiatives with local strategies and to develop key performance indicators so that their operation could be measured and assessed.

c)         The four pilot sites for longer and extended opening hours were Willows Medical Centre (Rowlatts Hill Road), Belgrave Health Centre, Brandon Street, Westcotes Health Centre, Fosse Road South and Saffron Group Practice, Saffron Lane.  There was a phased launch with one centre joining the initiative each week during September.

d)         Each pilot site would have a GP Principal and a Nurse available at all times the service was open.  GP Principals had been encouraged to provide the service rather than rely on locum Doctors. The new arrangements were seen as a success of the GP Federation working in collaboration to change working practices that would be sustainable.  The pilot sites would be able to access patients’ records from other GP practices through IT systems and data sharing arrangements.

e)         Discussions were taking place between the pilot sites and local pharmacies to provide access to pharmacies during the extended opening hours.

f)          It was recognised that effective communication plans had to be in place to underpin this initiative.

g)         The effectiveness of the pilots would be assessed by the CCG in December/January and they would determine whether any improvements to the arrangements were required and whether it was effective to rollout and extend the scheme.

h)        The data collected would identify where patients came from and part of its analysis would identify whether the attendances were genuine and a true reflection of the expected demand for the extended service.

i)          The provisions for seven day access to services were already built into the Better Care Together Fund as it was a key part of work to improve patient flows in and out of hospitals and reduce hospital admissions. This involved a more integrated seven day working model across front-line health and social care services as well as developments in the Clinical Response Team, Unscheduled Care Team and the Planned Care Team.  Each of these has proven that integrated seven day services provide both high quality care for patients and aids the flow through the urgent care system.

j)          Following an assessment of UHL in relation to Keogh’s 10 Clinical Standards intended to improve consistency in services across seven day working, their commissioners required that 5 of the clinical standards required improvement by 31 March 2016 and these were listed in the report.  Currently four of these were ‘Green’ and the one ‘Amber’ relating to ‘Transfer to Community, Primary and Social Care’ was likely to turn ‘Green’ in the near future.  Those services not currently provided over seven days, such as diagnostics etc, would gradually be rolled out.

k)         Recent commercial initiatives offering telephone access to a consultation with a doctor were attracting interest as it provided an opportunity to free up a patient’s doctors’ time and encourage self-care.  Procurement for this service was currently underway by the CCG and it was hoped to offer this service locally in October 2015.

l)          The changes in services involving seven day provision and the new pilot hubs were also being fed into the 111 telephone service provider so that they could direct enquiries to the appropriate point of contact.

m)        The new pilot hubs were not intended to replace a patient’s usual GP services but provide additional and more flexible opportunities of access.  The hubs were also intended to deal with patients who had attended ‘walk in’ centres, urgent care centres or contacted 111 and who could be appropriately treated through GP services.  Nor was it intended that GP practices would refer patients to the hub centres to alleviate their own practice lists.

n)        Seven day working for all services at UHL were important to provide a full range of services for patients, especially for those admitted at week-ends. Evidence currently showed that survival rates were lower for week-end admissions because of the lower availability of some services in hospitals at week-ends, and this needed to be addressed for the patients’ benefit.

o)         It was important to understand that the hub centres were not intended to provide the full range of routine GP services available at a patient’s usual GP practice, but to provide good services over a seven day period to treat patients and keep them out of hospital, when an admission was not necessary.

p)         A number of non-core services had historically been introduced piece-meal.  The challenge locally was to co-ordinate a range of initiatives into a rationalised and coherent provision in the long term.

The Healthwatch representative offered to provide assistance with an independent evaluation of the discharge of patients from hospital to community care.  Healthwatch also commented that the publicity of the changes of service provision was a key issue to success as it was important to make clear to the public what could be provided and what was not provided.  Healthwatch offered to provide assistance with this.  The Managing Director of the CCG welcomed Healthwatch’s offer to be involved.

Members made the following observations and comments:-

a)         Digital access to the health economy could be an item of consideration for a future Board meeting particularly looking at the cross-cutting issues of patient access etc.

b)         There was some concern that the provision of seven day working for GP services could result in some employers not allowing staff to attend regular medical appointments or treatment during the week, which could result in higher weekend attendances.  It was requested that these attendances be captured in the evaluation data to be collected.  

c)         The fragmented arrangements for commissioning services do not easily aid a systematic or strategic approach to health care provision and co-ordination.  For example, the separate arrangements for commissioning dental, pharmacy and specialised services to those of GP and hospital core services. 

RESOLVED:

1)         That the report and developments taking place for the provision of seven day working be noted.

2)         That the issue of seven day working be re-considered when the evaluation of the current hub pilot centres has been completed and that partner organisations also review their position in relation to seven day working and what it means in real terms to the people of Leicester.