Agenda item

The Leicester City Clinical Commissioning Group submits a briefing paper relating to the Primary Care Hub Access at the Merlyn Vaz Heath and Social Care Centre. Members are asked to consider the briefing paper which looks at the rationale and impact of moving from a walk in appointment system to a combined pre-bookable and walk-in appointment system. In addition to the briefing paper, there may be contributions from stakeholders who have indicated their intention to speak. 

The Leicester City Clinical Commissioning Group submitted a briefing paper looking at the rationale and impact of moving from a walk-in appointment system to a combined pre-bookable and walk-in appointment system at the Merlyn Vaz Heath and Social Care Centre.

Richard Morris, Director of Corporate Affairs, Leicester City Clinical Commissioning Group, introduced the briefing paper, drawing attention to the following points:

·           The Merlyn Vaz Centre received 24,000 – 26,000 patients per year.  Approximately two-thirds of these were from the city, the remainder being from the county and Rutland;

·           When it was set up, it had been anticipated that operating a walk-in appointment system at the Centre would reduce demand on the hospital emergency department, but the number of people attending that department continued to increase;

·           Three GP hubs had been established to improve routine access to pre-booked primary care appointments by providing an additional 1,500 additional GP and nurse appointments across the city.  These were well used;

·           At the time that the walk-in centre contract was due to end in 2017, government guidance indicated a move towards providing pre-booked appointments, rather than a walk-in service;

·           Engagement with patients showed a desire to keep the service in the community, but also a desire for pre-bookable appointments in addition to a walk-in service.  The new service therefore was commissioned as a hybrid model, with approximately 20% walk-in activity.  This equated to approximately 400 bookable appointments and 100 walk-in appointments per week;

·           A decreasing number of patients had been deflected from the “front door” over the last 6 – 12 months;

·           Most patients regarded the service received in the hub as “good”, although there was some frustration that the walk-in facility had been reduced; and

·           The new hybrid system appeared to have resulted in a better dispersal of patients across the city.

At the invitation of the Chair, the Right Honourable Keith Vaz MP addressed the Commission.  For clarity, he explained that the Merlyn Vaz Centre had been named after his mother and that Professor Farooqi, Co-Chair of the Leicester City Clinical Commissioning Group, was his GP.

Mr Vaz noted that, when people were unable to see their own GPs in a timely manner, the walk-in centre provided an alternative means of accessing health care.  It was recognised that funding for services had been reduced, but as the walk-in centre was intended to provide an alternative means of accessing a GP to introduce an appointments system was against the purpose of the Centre.  Lack of walk-in facilities also meant that patients were diverted to hospital Accident and Emergency services, so moving the problem of access to services to a different part of the system. This showed that the current balance of appointments and walk-in services at the Centre was wrong.

Mr Vaz asked the Commission to consider undertaking its own survey, to identify what people were looking for from GPs and GP hubs, and offered to help run a local referendum, with the Ward Councillors, to identify if there was a desire for the Merlyn Vaz Centre to return to being a walk-in centre.

In response, Mr Morris explained that the survey undertaken to assess the impact of the change in services at the Merlyn Vaz Centre had largely been face-to-face with people in the building and patient participation groups.  There had been 258 respondents, which was considered a normal rate of response for this type of engagement work.

Mr Vaz queried why the results had been given in percentages, rather than actual numbers and sought reassurance that the questions used in the face-to-face discussions had not been designed to provide a particular result. 

Professor Farooqi, Co-Chair of the Leicester City Clinical Commissioning Group, expressed the view that both walk-in and appointment services were needed at the Centre, as the hubs provided services for GP practices, due to the city not having enough GPs.  Bookable appointments resulted in a better flow of patients, with less waiting time and a levelling out of peaks and troughs in demand. 

Professor Farooqi also noted that booked appointments catered for city residents, while a lot of the people using the walk-in facilities lived in the county.  Ideally, both facilities would be provided, but it was recognised that resources were limited.

Mr Morris advised Members that no evidence had been found of an increase in the number of people attending hospital Accident and Emergency services as a result of reducing the walk-in service, but an audit of people attending these services was being undertaken and could provide more information.  Professor Farooqi noted that some correlation was possible to people who had recently arrived in the country, as some countries had limited GP services, so people were used to using hospital services.  Also, it was known that homeless people would attend hospital as they often were not registered with a GP.  It also was know that people in the 0 – 30 age group used hospital services the most.

Mr Morris advised that currently no follow-up was done on people deflected from the services at the Merlyn Vaz Centre.  However, the service provider had been asked to examine the data and undertake a retrospective audit over the next few months, to see if any links could be found between the number deflected and use of other services.  As part of this, the advice given to those deflected needed to be noted, so that an accurate audit trail could be established.

Sarah Prema, Healthwatch, advised that Healthwatch had visited two hubs to date, to examine patient experiences of services.  These experiences had been mixed, with good clinical care, but some confusion caused by a lack of awareness of the change to a hybrid access model.  Healthwatch hoped to visit the other two hubs shortly, so offered to assist in assessing the impact of the change to a hybrid system.

Mr Vaz suggested that it would be helpful for the Commission to undertake an in-depth review, through which local people were asked whether or not they liked the walk-in facility at the Merlyn Vaz Centre.  He also requested that community languages be used for this.  Professor Farooqi suggested to the Commission that, although he did not oppose the suggested survey, some work also could be done to develop services at Leicester General Hospital, so that both systems could be used.

Members stressed that any such review needed to reflect the demography of the city and expressed some concern that the number of responses on which the decision to move to a hybrid system had been based was a very small proportion of the city’s population.

Mr Vaz also expressed concern about the future use of Leicester General Hospital.  He explained that he considered that the city needed three hospitals, although they did not all need to offer the same services.  Reports already were being received that people had to queue to be admitted to some wards at Leicester Royal Infirmary, so Mr Vaz asked that the site of Leicester General Hospital be retained and not sold to developers.

With the permission of the Chair, Councillor Khote addressed the Commission, echoing concerns raised by the Commission that the shortage of GPs across the city was at crisis level.  For example, no GP appointments were available at some practices by 9.30 am, so people were being told to attend the walk-in centre.  However, at the walk-in centre they were being told to telephone the 111 service, but that service often referred people to services located in parts of the city that people could not get to.  Many of these people were limited in the amount of English they could speak.  They therefore often chose to use the walk-in facilities at the Merlyn Vaz Centre, as the Centre could be accessed by public transport.

She further noted that it took a along time to train doctors, but in the meantime the number of doctors coming in to the country from abroad had been affected by immigration restrictions.  In addition, locum doctors were too expensive for some practices to use.  The walk-in centre therefore was a very important resource, serving people from a wide area, so it either should be kept, or a better appointment system used at GP surgeries.

With the permission of the Chair, Councillor Solanki addressed the Commission.  She concurred with the views expressed by Councillor Khote and suggested that GP appointments needed to be available at times more suited to people’s needs, such as at night.

With the permission of the Chair, Councillor Joshi addressed the Commission, noting that the flow of patients using the walk-in service resulted in peaks and troughs of demand.  Better resources therefore were needed at GP surgeries, to ensure that people could access GPs when needed.  The Councillors representing the Evington Ward would welcome the suggested consultation with members of the public and were happy to assist with this as needed.

Members expressed concern at the potential exclusion of people with lower digital and/or technical skills, due to the increased use in health services of digital access.  Professor Farooqi acknowledged that this was an issue, explaining that work on this was ongoing, along with ensuring that people were not excluded due to language skills.

AGREED:

1)    That the Director of Corporate Affairs, Leicester City Clinical Commissioning Group be asked to provide numerical and demographic data on where people using hospital Accident and Emergency services in the city are from, if possible this information to be broken down to show attendances at times when GP practices are both open and closed;

2)    That representatives of the Leicester City Clinical Commissioning Group and Healthwatch, plus the Right Honourable Keith Vaz MP, be invited to join discussions about how an analysis of patient experiences following the introduction of a hybrid system for accessing services at the Merlyn Vaz Centre can be undertaken;

3)    That as much as possible of the work outlined under 1) and 2) above be undertaken in time for the outcomes to be included in the report scheduled to be considered at the next meeting of this Commission on the Primary Care Strategy; and

4)    That, further to 3) above, the report scheduled to be considered at the next meeting of this Commission on the Primary Care Strategy include if possible:

a)     Consideration of the implications of the shortage of GPs in the city;

b)     Information on how the survey undertaken following the introduction of a hybrid system for accessing services at the Merlyn Vaz Centre was undertaken, including examining equality monitoring information, details of who was surveyed and how the questions were worded;

c)     How issues for people with limited digital and English language skills can be addressed;

d)     What happened to the people deflected from using the walk-in facilities at the Merlyn Vaz Centre, (for example, whether they used services located elsewhere in the city); and

e)     Consideration of how any further evidence required to enable proper consideration to be given to the issues recorded above can be obtained.