Our plans for urgent care in Worcestershire. Have your say February 2014

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1 Our plans for urgent care in Worcestershire Have your say February

2 Introduction In April 2013, GP practices across Worcestershire came together to form clinical commissioning groups (CCGs). We are responsible for arranging health services on behalf of local patients. There are three CCGs in Worcestershire; NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG. Through a process called commissioning we plan and pay for health services, and ensure that the quality of those services is very good. We have been working closely with all local providers of health and social care (Worcestershire Acute Hospitals NHS Trust, Worcestershire Health and Care NHS Trust, West Midlands Ambulance NHS Trust and Worcestershire County Council) to look at how we can make sure that urgent care services in the future are delivered in a way that best meets the needs of our local population. This document outlines our proposals to work together to improve urgent care services across Worcestershire. 2

3 Some of the terms used in this document In this document we talk about making changes to some of the urgent care services in Worcestershire. Some of the services we mention include: Accident and Emergency (A&E) department An Accident and Emergency department assesses and treats people requiring immediate medical attention for serious and life-threatening illnesses or injuries. Ambulance Service The Ambulance Service cares for people with serious injury or illness at the place of that illness or injury. It also transports patients to hospital and other departments. Minor Injury Unit (MIU) Minor Injury Units are facilities which treat a wide range of minor injuries including cuts, grazes, wounds, sprains, strains, minor burns and broken bones. Primary care services Primary care services (GP practices, pharmacies and dentists) provide communitybased health care services, usually near people s homes. They provide an easily accessible service, whatever the patient s problem. Primary health care is based on caring for people s general health needs. Urgent Care Centre An Urgent Care Centre is a service that primarily treats injuries or illnesses requiring immediate care, but which may not be serious enough to require a visit to an Accident and Emergency department. Urgent Care Centres can often be located near Accident and Emergency departments. Worcester Walk-in Health Centre Worcester Walk-in Health Centre is a GP practice which provides GP appointments for patients who are registered there, but also provides a walk-in service for those who are not currently registered with a local GP, or who are unable to attend their own surgery. In the last 12 months more than half of the walk-in attendances have been patients who are registered with another GP in Worcestershire. 3

4 What is urgent care? Urgent care describes the range of health care services available to people who need medical advice, diagnosis or treatment quickly and unexpectedly. We currently have a wealth of services available to residents. These all support the current urgent care system in Worcestershire. These services include: Ninety-eight pharmacies Sixty-six general practices One Walk-in Health Centre in Worcester City One Out of Hours (OOH) Primary Care Service One NHS 111 non-emergency medical advice service Five Minor Injury Units (MIUs) which have a variety of different opening hours and services - located in Bromsgrove, Evesham, Malvern, Kidderminster and Tenbury Some social care services ( such as the Social Care Access Service, resource centres, enhanced packages of care and some bed-based services) One Ambulance Service Two Accident and Emergency (A&E) departments - one in Worcester and one in Redditch. What is the problem? The Worcestershire urgent care system is very complex and contains a number of different services. We know that many people find it difficult to work out where to go when they need urgent care, so we want to create an urgent care system that is easier for patients to use, with a straightforward set of options that are obvious and easy to understand. Additionally, the population of Worcestershire is set to grow from currently around 569,000 to 594,000 in This will see more people needing urgent care services. In particular the increase in the older people s age groups will have the most significant impact on Worcestershire s urgent care system. We predict that this growth may result in a 33% increase in emergency admissions for people aged over 75, and a 43% increase for people aged over 85. Our urgent care system won t be able to cope with such anticipated demand in its current state. We also know that finding enough suitably qualified doctors and nurses, and having enough funding to pay for the current range of services will become increasingly more challenging. 4

5 Why look at this now? Now is a good time for us to look at Worcestershire s urgent care system because: Our Accident and Emergency departments are struggling to complete patients treatment within the national target of 4 hours We continue to see people attend Accident and Emergency departments with injuries or illnesses that could have been treated more appropriately somewhere else (e.g. a Minor Injury Unit, their GP or a local pharmacy etc.) Some contracts for existing services are nearing their end. For example the contract for the Worcester Walk-in Health Centre ends later this year, so it s a good time to consider whether these services work as well as they could do, or whether there are better ways of delivering them A review of acute hospital services in Worcestershire is currently taking place and so it makes sense to look at the overall provision of urgent care services across the county at the same time People are living longer and our population is getting older, meaning they need different services. 5

6 So what do we want to do? There are six things that we want to do: 1. Create a simple urgent care system where patients know which option is the right one to choose This means: Decommissioning the walk-in element of the Worcester Walk-in Health Centre and instead developing alternative services (such as an Urgent Care Centre located near Accident and Emergency at the Worcestershire Royal Hospital where patients will be seen and treated quickly by a range of doctors and clinicians) Changing opening hours for Minor Injury Units to ensure that they are available when they are most needed Ensuring that NHS 111 helps patients to access the right service first time. 2. Put primary care at the heart of urgent care This means: Increasing the number of doctors supporting the staff working in Minor Injury Units, enabling them to see patients with more complicated health needs instead of just minor cuts and bruises Arranging for GPs to work more closely with the Ambulance Service to help treat more patients in the local community and reduce trips to hospitals where they are not needed Supporting patients with health advice and support through community pharmacists. 6

7 3. Make sure that patients are only admitted to hospital when necessary and only stay as long as they need to This means: Ensuring that doctors in A&E departments have quicker access to community services (such as district nurses) to enable patients to return home with appropriate support, rather than be admitted to a hospital bed Enabling GPs to have more direct, same-day access to consultant advice, meaning clinical tests and treatment can be provided locally without the need to travel to hospital Involving patients and their family members in the planning for their safe discharge from hospital to make sure that they return home with the appropriate level of support and information. 4. Make better use of the full range of local community and social care services This means: Improving access to community and social care services and ensuring that they work more closely with GPs and the ambulance service to allow patients to receive more treatment at home rather than in hospital, where it is safe to do so Investing more of our budgets in community-based services, such as community teams and virtual wards to enable more people to be cared for without a visit to hospital. 5. Make sure that urgent care services are provided 7 days a week This means: Increasing seven day working, meaning that patients will receive the same standard of urgent care, regardless of the day of the week or the hour of the day Ensuring the availability of all essential services (e.g. X-rays and blood tests) 7 days a week and improving access to urgent primary care appointments on weekends Reviewing patients on a daily basis when they are admitted to hospital and having access to social care and health assessments 7 days a week. 7

8 6. Share information more effectively to improve patient care This means: Sharing relevant information about patients with all of the care professionals involved in their treatment so that the best, safe clinical decisions about care can be made by doctors who are fully informed about a patient s previous medical history. This will involve all GPs using a single information system which hospital staff will be able to access Developing websites, mobile applications and other means of communication so that people can access more information about local services. What are we asking you? To ensure that that services we provide are as effective as possible, we need to make changes to how they are provided. We will need to improve some services, but change or close others. We are planning to improve Accident and Emergency services, in particular through the development of Urgent Care Centres where hospital doctors and GPs will work alongside each other to provide the service. We are also planning to improve Minor Injury Units through closer working arrangements with the main Accident and Emergency departments and local GPs. To make these improvements we need to direct money from elsewhere in the health service there is no additional money available to pay for them. As part of this we are proposing to close the walk-in element of the Worcester Walk-in Health Centre as this service in particular will no longer be required with the other improvements in place. However the Health Centre will continue to operate as a GP practice so any patients who are currently registered there will continue to be able to access their primary care services, and new patients will still be able to register there if they wish to do so. We are not asking you about the provision of other GP services. GP services are managed by a separate organisation NHS England. We are, however, looking at how access to GP services could be improved. To read the full draft Urgent Care Strategy for Worcestershire visit: Please tell us what you think by 9th April

9 Get involved There are a number of ways you can get involved: Join the conversation on Twitter #urgentcareworcs Fill in our survey online: urgent-care Complete and return the survey in this booklet by post: Freepost Plus RTCU-KZKZ-EJZZ, NHS South Worcestershire CCG, The Coach House, John Comyn Drive, Worcester, WR3 7NS us at How will we use your views? At the end of this engagement period we will write a report. The Worcestershire Urgent Care Strategy Group which includes representatives from all health and care organisations across the County will look at the report and will use the information and views to decide how best to improve urgent care services across Worcestershire. We know it s really important that we share feedback with you, especially when you have taken the time to share your thoughts and views with us. We will therefore share this report with you and make sure it is available on each of the CCGs websites. 9

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11 Urgent care survey Question 1 Are you completing this form as yourself or as part of a group? Myself Group Question 2 After reading the information do you think we need to change how urgent care works in Worcestershire? Yes No Don t know Question 3 Do you think we are trying to do the right things for urgent care? (please tick) Aim 1. Create a simple urgent care system where patients know which option is the right one to choose 2. Put primary care at the heart of urgent care Strongly agree Agree Disagree Strongly disagree 3. Make sure that patients are only admitted to hospital when necessary and only stay as long as they need to 4. Make better use of the full range of local community and social care services 5. Make sure that urgent care services are provided 7 days a week 6. Share information more effectively to improve patient care Which one of these six things do you think is the most important and why? Any other comments about the six things we want to achieve? 11

12 Question 4 Our proposals involve decommissioning the walk-in element of the Worcestershire Walk-in Health Centre and using the money instead to develop services where GPs and hospital doctors work together on the main hospital sites. Do you agree with this approach? Yes No Any other comments? Question 5 How important is it for you to be able to access GP services 7 days a week? Very important Important Don t mind Not important Any other comments? Question 6 Most patients are treated and discharged at our Minor Injury Units very quickly after arrival. Since April 2013 only 7 patients of the 50,000 that have been seen at a Minor Injury Unit have had to wait longer than 4 hours for their treatment. In comparison more than 4,600 patients of the 53,000 seen at A&E in Worcester and more than 2,300 of the 42,000 seen at A&E in Redditch had to wait more than 4 hours for their treatment. What would encourage you to be more likely to attend a Minor Injury Unit than an Accident and Emergency department? (tick as many options as you wish) Better awareness of the service and what conditions they can treat Clearer opening times More medical expertise available Ease of access (such as parking access or costs) Better treatment facilities Other (please state below) Better public transport links More experienced staff 12

13 Question 7 Would you object to doctors in Accident and Emergency departments and in Minor Injury Units being able to see relevant information about your health (typically held by your GP) if it improved the quality and speed of care that you received? Yes No Any other comments? Question 8 How often have you used the following services in the last 12 months? (please tick) Service Never Once Twice Three or more times A&E Worcester Redditch Dentist Emergency Ambulance (999) GP surgery Bromsgrove Minor Injury Unit (MIU) Evesham Malvern Kidderminster Tenbury NHS 111 Pharmacy Worcester Walk-in Health Centre Question 9 If we go ahead with our proposals, is there anything else that we should think about? 13

14 Information about you The following questions are about you. You don t have to fill these in, but your answers will help us to know whether or not we are getting opinions from a wide range of people. Sex Age Male Female Transgender Under Ethnicity White - English/Welsh/Scottish/Northern Irish/British White Irish White - Gypsy or Irish Traveller Any other White Background Mixed/multiple ethnic group - White and Black Caribbean Mixed/multiple ethnic group - White and Black African Mixed/multiple ethnic group - White and Asian Any other mixed/multiple ethnic background Asian/Asian British Indian Asian/Asian British Pakistani Asian/Asian British Bangladeshi Asian/Asian British Chinese Any other Asian Background Black/Black British African Black/Black British Caribbean Any other Black/African/Caribbean/Black British Background Other ethnic groups Arab Any other ethnic group If you would like to be kept up to date with the results of this engagement exercise please complete the following details: Name... i Please place your completed survey in an envelope (no stamp necessary ) and return before 9th April 2014 to Freepost Plus RTCU-KZKZ-EJZZ NHS South Worcestershire CCG, The Coach House, John Comyn Drive, Worcester, WR3 7NS ... Address (if preferable to )... 14

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