Agenda item

The panel will consider the attached reports from:

Innes Richens, Chief Operating Officer, Portsmouth Clinical Commissioning Group

Paul Fisher, Minor Injuries Unit/ Minor Illnesses Unit Service Manager, Penny Daniels, Hospital Director and Dr Deb Jeavans-Fellowes, Operations Manager, St Mary's Walk In Centre.

The panel will also hear from Kim Dennis, Service Manager, Guildhall Walk Healthcare Centre whose report is to follow.

Innes Richens (Chief Operating Officer), Dr Hogan (Chief Clinical Officer) and Katie Hovenden, (Director of Professional and Clinical Development for NHS Portsmouth CCG) introduced their report which included the following points:

·         This was an update on the consultation and engagement which was due to end on 31 August and no decisions had been made on the future of Guildhall Walk Healthcare Centre (GHWHC).

·         The CCG had received support from Portsmouth City Council, Healthwatch Portsmouth University, PHT and Solent with promoting the survey.

·         The CCG is also working with the Portsmouth Pensioners Association, Portsmouth Disability Forum and the Carers Network to promote the online survey.

·         Focus groups are taking place with the Salvation Army.

·         An Equalities Impact Assessment is being finalised.

·         It was anticipated that a final decision on the CCG's preferred options will be made at the CCG board meeting on 23 September and the CCG will formally report these to the HOSP meeting on 18 September.  

Dr Janet Maxwell added that she had offered to support the CCG by asking her team to complete a needs assessment to understand the homeless population and their current access to healthcare.  Officers were working to ensure this was completed by early September.  This would include recommendations on future models of care.

In response to questions from the panel the following points were clarified:

·         Public transport to St Mary's Treatment Centre (STMC WIC) and parking were considerations in deciding whether to move the walk in service from GHWHC to STMC WIC.  The CCG were working with the council to consider options for improving public transport links.

·         With regard to the number of GP's retiring, Innes Richens advised that figures from the last local medical committee survey 18 months ago suggested that 39% of GP's plan to retire in the next 4-5 years.  This is around the same figure as for other parts of the country.  Dr Hogan added that because of this it was important to ensure not to be too dependent on GP's and look at other models of care.

·         All surgeries in the city offer same day access to appointments however some are more effective at allocating appointments the same day for patients than others.  The CCG are working with practices to find the best systems.

·         The GHWHC is under a contract with APMS which is provided by Portsmouth Health.  The cap on numbers felt like a pragmatic approach as the contract is due to end at the end of March.

·         The CCG have met with Portsmouth University recently.  There are 22,000 students registered at Portsmouth University and students have a choice on where they can register, with other surgeries such as the John Pounds Centre nearby to the university.  There are a number of practices in the city who have students registered at their practices. The age breakdown of patients at the GHWHC shows that a significant proportion of the patients are in the age range of students but it cannot be confirmed that they are students.

·         Dr Maxwell advised that Dr Stuart Ward, Medical Director and representative board member for Health Education England team is looking at workforce development of primary care and tying this in with health practitioner work. Dr Hogan added that there are many pilots taking place in the city at present to ensure that patients are seen promptly and by the correct person.

·         Councillor Read raised concern about the location of STMC WIC, especially for visitors to the city.  He advised that the STMC WIC did not appear on some satellite navigation systems and felt that the majority visitors would enter the city via the M275 and therefore the GHWHC was the best location for a walk in centre. Innes Riches advised that access to both of the current walk in centres in the city was monitored.  The results indicated that two thirds of patients are residents and suggest that in terms of access both sites are currently being used equitably. It was the role of the CCG to look at the needs of the entire population of the city.  Dr Maxwell added that in terms of the homeless population, many of the services they use such as the Housing Options Team are based nearer to STMC WIC rather than GHWHC and work is taking place to consolidate this so services are closer together.

·         In response to concerns raised about the additional housing being built in the PUSH area, Innes said that the growth in the south faces all services and the CCG are working closely with Portsmouth City Council to plan the future options.

·         Concerns were raised by the panel about the effect on the student population if the GHWHC were to be moved, particularly as there are a number of additional halls of residence due to be built in the next few years.  Dr Maxwell said that the university has its own medical centre and discussions with the university need to take place to see whether this needs to be developed to accommodate additional students. She advised that other GP practices such as the John Pounds Centre and Somerstown Hub are all due to be developed so could accommodate additional patients in the future. It was suggested a map be provided to the panel on GP practices in the city.

·         Councillor Edgar said that telephone conversations with a GP to establish whether an appointment is needed was a good idea and appeared to be working well in his experience.  He asked whether this is being used as a template nationwide.  Dr Hogan advised that there are various pilots taking place including one at the Croookhorn Surgery who are looking to triage every call to manage patients in a more proactive way.  There is an agreement to move to single IT system which is merged with the community provider and the CCG are about to look at the business case for wider Hampshire to allow them sight of all systems. All Portsmouth doctors surgeries have joined together in a federation to ensure that they all moving in the right direction and it was important to ensure doctors are attracted to Portsmouth who will stay long term.

·         Councillor Ferrett asked whether PHT were being consulted on the proposals as he felt this could impact on the Emergency Department (ED) pressures at Queen Alexandra Hospital (QAH).  Innes Richens advised that the CCG were consulting with the people who use the service and they did not think the proposals would impact on the ED at QAH.  It was felt that the proposals to move the WIC from GHWHC to STMC WIC would actually improve pressures at the ED as people will be less confused as to where to go so will not go to the ED.  This proposal would simplify the process giving the public one clear choice.

·         In the last 18 months the GHWHC has been advertised in the urgent care guide.

The panel then received evidence from Paul Fisher, Minor Injuries Unit/Minor Illness Unit Service Manager and Penny Daniels, Hospital Director and Dr Deb Jeavans-Fellowes, Operations Manager at St Mary's Walk Treatment Centre. In response to questions the following points were clarified:

·         STMC WIC currently has no doctor on site apart from when the two clinics are held.  They have access to a senior doctor in the ED at QAH. The staff would welcome a doctor being based at STMC WIC as it would benefit patients.

·         Approximately 300 patients who attend STMC WIC are redirected either to the ED or to their GP out of approximately 4,000 who attend each month.

·         The service is currently out to tender and it was uncertain whether the key performance indicator (KPI) of a two hour wait for patients would be used.  Their current target however is for patients to be seen and assessed within 30 minutes of arrival. This would not include any further tests/x-rays etc.

·         The service has been well established for 10 years and the re-tender gives the Centre the opportunity to grow, develop and become more innovative.  The Centre consistently treats 120-130 patients each day.

·         The walk-in patients are part of the STMC WIC tender but where the service will be located is currently unknown. If the service moved to STMC WIC they would need to increase the number of cubicles and increase staff.

·         STMC WIC has access to language line for any patients who arrive that do not speak English however they find that the majority attend with someone who can speak English so this isn't often needed.

·         STMC WIC has extended opening times compared to GHWHC it is open until 10pm 7 days a week.

·         Dr Maxwell added that the driver for the proposals is to look at the best use of resources to work together to shape the whole system of care to improve the flow.

The Panel then received evidence from Kim Dennis, Practice Manager and Kate Huskinson, Assistant Practice Manager at GHWHC. Kim Dennis made the following points:

·         Six years ago, £500,000 was spent on making the building fit for purpose.  Many other surgeries in the city are not fit for purpose and development would be needed to these surgeries to accommodate the patients registered at GHWHC if it were to close.

·         The students registered at the surgery were contacted via letter however as this was sent to their halls of residence in early June most of the students will not see this until they return in September.

·         The CCG had advised that patient participation groups had been contacted however the patient participation groups at GHWHC have not been contacted.

·         The service currently has 96 patients with no fixed abode who have a chaotic lifestyle and the GHWHC has had a lot of success with these patients and managed to tailor their service to meet their needs.

·         On Saturday 18 July 92 patients were treated, with 86 of these being treated and discharged within 30 minutes. Due to the America's Cup this weekend they are expecting an increase in patients as the service is ideally located for visitors attending the event who become unwell.

·         Part of the confusion for patients is because they have never been able to signpost and the GHWHC was not included on the Choose Well leaflet. 

·         The GHWHC works closely with the ANA Drugs Recovery Treatment Centre which helps patients who have moved to the city to get away from their triggers for drugs use.

·         GHWHC has seven contracted doctors and many more who want to come to work there as it is interesting and diverse.

·         GHWHC have never breached their targets.

In response to questions the following points were clarified:

·         Each day there are two GP's who work 12 hours a day and one nurse practitioner who is able to prescribe.

·         Approximately four patients a week are referred to the ED at QAH if the patients illness is unable to be treated by the doctors at GHW e.g. if a small child if seriously unwell or if there are symptoms of a heart attack.

·         The former PCT and the CCG had asked the providers not to market the service as initially they did not know how many would use the service; however the numbers have always exceeded expectations.

·         The building has a 10 year lease and has four years remaining on the lease.

·         The GHWHC have suggested joining the federation of Portsmouth practices as they have the same IT system and could allow other practices to use their facilities.

The panel felt that it was important that community services meet the needs of its patients and that the GHWHC is serving its population well and was in an ideal location. The Chair asked that the CCG come back to their next meeting on 18^th September with the full business case and the results of their engagement.  It was felt that a number of unanswered questions remained and it was hoped these would be answered when the panel consider the full business case in September and the panel would then decide whether the proposals constitute a substantial variation in services.

RESOLVED that the reports today be noted and the panel's concerns be noted.  The panel will await the formal proposal from the CCG in September.

ACTIONS

(1)  The CCG to provide a map showing the location of all GP practices in the city, indicating which ones are due to be developed and if possible the number of registered patients at each practice.

(2)  The CCG to continue working with PCC to look at how bus routes going east to west in the city could be added to encourage patients to go to St Mary's rather than QAH