East Sussex Health Overview and Scrutiny Committee (HOSC) newsletter

HOSC satisfied Hastings walk-in centre proposals no longer constitute a ‘substantial variation in services’

The updated proposals for the future of the Hastings walk-in centre do not constitute a substantial variation to services, HOSC recently agreed.

The NHS Clinical Commissioning Groups (CCGs) had published plans in March 2018 to close the walk-in centre located at Hastings Station Plaza but agreed revised proposals at their joint governing body meeting on 25 September to turn the walk-in centre into a primary care led hub instead.

HOSC considered these revised proposals at its most recent meeting. During the meeting the Committee asked what the difference was between the new service and the current walk-in centre.

Jessica Britton, Managing Director of the CCGs, explained that the key differences people would notice would be an earlier closing time of 6:30pm rather than 8:00pm – due to very low demand after 6:30pm and the availability of GP extended access appointments on site – and the shift from a GP-led to an advance nurse practitioner-led service. This would mean patients attending the hub would see an advanced nurse practitioner in the first instance, who would be able to manage a wide range of need, but they would be able to see a GP if they needed to.

The Committee asked whether this meant patients without a registered GP would find it difficult to access one at the hub.

Jessica Britton said that research showed the majority of patients using the walk-in centre are registered with a GP. This means that they have access to a GP if required but choose to use the walk-in centre for various reasons. There are, however, a small number of unregistered patients who use the walk-in centre and arrangements will be in place to ensure that they can access a GP at the hub if required.

Jessica Britton added that the new hub would introduce a range of non-medical services, such as social prescribing and mental health services, enabling patients to access these services at the Station Plaza rather than being signposted to other services around Hastings. She stressed this would not be in place at the start of the new service in December but would be added over time.

Having considered the CCGs report and responses to its questions, the Committee agreed that the proposals for Hastings Station Plaza did not constitute a substantial variation, meaning that the CCGs would not need to consult formally with the HOSC ahead of implementing the proposals, as required under health legislation.

The primary care led hub will be established from 1 December 2019 for a test period until April 2021, after which time a permanent service will be commissioned based on the findings of the test period.

HOSC asked for a follow up report on the primary care led hub at its 25 June 2020 meeting that will also include the details of the proposed permanent service for the site.

You can read the full discussion in the minute of the 26 September meeting.

HOSC hears plans for new NHS 111 service

From next year residents of East Sussex will be able to receive enhanced over the phone advice from GPs and other clinical staff when they call 111, HOSC has learned.

Under the new NHS 111 service, which goes live on 1 April 2020, members of the public will, if necessary, be passed from a 111 call-handler to a qualified clinician working in the new Clinical Assessment Service (CAS). The clinician will be able to either offer treatment and advice over the phone, or book them into an appointment at an Urgent Treatment Centre (UTC) or a GP practice.

Responding to questions from HOSC about whether sufficient staff could be recruited to the service by 1 April, Colin Simmons, 111 Programme Director, explained that the providers of the new service, South East Coast Ambulance Service NHS Foundation Trust (SECAmb) and Integrated Care 24 Ltd (IC24), already run between them both existing 111 services and an out of hour GP service, which includes over-the-phone clinical assessments. They are currently in the process of understanding the gap between their current workforce and the number of staff they will need to run the new service.

Asked by HOSC whether there was a risk the CAS could take clinical staff, including GPs, from other areas of the health service, Mr Simmons said the providers are developing ways to recruit staff in innovative ways that are attractive to prospective staff but that do not take them from other services. He said this may include a contract that allows existing GPs to work for the CAS remotely in their own office, rather than physically from a CAS call-centre, whilst still continuing with their traditional GP role. Mr Simmons said that GPs had shown interest in this proposal.

Asked whether the new service will have access to a patient’s details, Colin Simmons said clinicians in the CAS will have access to a patient’s summary care record, subject to permission from the patient, that is produced by their GP practice. 111 call handlers, on the other hand, would only be able to see basic details such as their name and date of birth.

Charles Adler, Paramedic and Integrated Urgent Care Manager, said access to a patient’s summary care record will enable clinicians based in the CAS to better diagnose a patient over the phone.

The Committee asked whether there are concerns that patients will not properly articulate their symptoms over the phone to the clinicians working in the CAS.

Colin Simmons said that it is recognised that it is not always possible to diagnose everything over the phone, so call handlers and CAS clinicians will signpost to face-to-face services, such as UTCs or out of hours services, as necessary. FaceTime and other video calling services will also be developed over time and will aid in remote diagnosis of patients.

The Committee asked how the service would be advertised.

Colin Simmons said there would be a campaign in the new year for 111 and the other new urgent care services, such as UTCs. There was also a separate plan for engaging with seldom heard groups and a plan for ensuring the service is compliant with British Sign Language requirements, as well as having interpreters in place for people for whom English is not their first language.

The Committee requested a future update on the 111 service after it goes live in April.

You can read the full discussion in the minute of the 26 September meeting.

HOSC to scrutinise proposals for the future of Eastbourne walk-in centre

HOSC will consider at its next meeting whether updated proposals for the future of Eastbourne walk-in centre constitute a substantial variation to services, requiring formal consultation with the Committee in accordance with health legislation.

The Committee considered the original proposals – the planned closure of the walk-in centre – to be a substantial change back in March 2018, however, the CCGs paused the process and have since undertaken a period of engagement with stakeholders in Eastbourne in order to review their plans.

At its most recent meeting, the HOSC questioned whether the proposals to turn Hastings walk-in centre into a primary care led hub would also be developed at Eastbourne walk-in centre.

Jessica Britton explained that it was difficult to comment on the Eastbourne proposals in advance of the plans being finalised in November. She confirmed, however, that the issues raised by people during the engagement work in Eastbourne will be given due consideration ahead of any proposals being published.

The Committee will also consider a report on the procurement of a new Patient Transport Service (PTS) for 2020 onwards and the East Sussex health and social care system’s plans to deal with increased demand over the winter period.

The meeting will be webcast live on 28 November at 10am.

Further HOSC work

HOSC will also consider a preliminary report about the future reconfiguration of inpatient mental health beds in East Sussex and a report about proposals to reconfigure Ear, Nose and Throat (ENT) services currently provided by East Sussex Healthcare NHS Trust (ESHT).