Urgent Care services in Warwickshire North. Andrea Green Warwickshire North Clinical Commissioning Group

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1 Urgent Care services in Warwickshire North Andrea Green Warwickshire North Clinical Commissioning Group

2 Emergency and Urgent Care The big picture in Warwickshire North Growing demand and population has led to huge pressure on hospital emergency and urgent care services. Growing & ageing population. In Warwickshire North the population +65 years is expected to increase by 60% by In Nuneaton & Bedworth increase expected at 43% by ,000 attendances at George Eliot hospital A&E in 2014/15 up to 50% of these people could have possibly been treated effectively elsewhere

3 Emergency and Urgent Care The big picture in Warwickshire North All 28 GP practices in Warwickshire North provide at least 8 hours of service a day 18 of those GP practices offer extended hours access more than 8 hours a day GP led walk-in service at Camp Hill - 8am to 8pm seven days a week Urgent Care Centre at George Eliot Hospital - 10am to 6.30pm seven days a week pilot service opened October 2014 NHS hour, 365 day, free telephone service Out-of-Hours Primary Care Service weekdays 6.30pm to 8am, but weekends and Bank Holidays open 24 hours at George Eliot Hospital site.

4 We do not have enough GPs! Ratio of GP to registered population shows that each GP has around 200 extra patients compared with national average Extract from NHS England Primary Care Strategy 2014

5 Patient Feedback Informing Vision for Quality and feedback from pre-engagement: Vision for Quality feedback developed over 12 months Preference for face to face consultations, not telephone advice Confusion about how to access the right services quickly - this results in patients going to A&E when they can be treated elsewhere Variability in patient satisfaction with access to GPs. Pre-engagement feedback (277 responses) Need for longer GP opening hours People were prepared to travel to get the urgent care they needed People wanted same-day access to primary care as part of an urgent care system People wanted access to a GP People wanted to be streamed to appropriate urgent care.

6 Why review the urgent care services? We also have a growing and ageing population whose needs have changed. Older people often have more than one healthcare problem Confusion about what local services are available and when for both public and professionals Some difficulty accessing primary care Need to streamline care and ensure it is the best possible and offers equality of access across Warwickshire North Need a sustainable, well trained urgent care workforce that works seamlessly with primary and emergency care.

7 How many people attend urgent care services? Walk-in service at Camp Hill c 6,200 walk-in patients, April March 2015 George Eliot Hospital urgent care growing numbers with 926 in the month of March 2015 George Eliot Hospital A&E attendances from the boroughs of North Warwickshire, Nuneaton and Bedworth rising 45,649 in 2013, 47,233 in Across our population some people attend UHCW and some people may present at GUH from neighbouring CCG localities

8 Activity Walk-in service at Camp Hill The graph below illustrates the number of monthly walk-in attendances during 2011/12, 2012/13, 2013/14 and 2014/15 (10 months). (Source: Camp Hill Health Centre Practice data). It clearly demonstrates the increased activity in 2014/ Comparison of Monthly Activity by Year April May June July Aug Sept Oct Nov Dec Jan Feb Mar Month 11/12 12/13 13/14 14/15

9 Who uses Camp Hill Walk-in Service? Average walk-in presentations by postcode per day 10/2012-9/ /2013-9/ /2014-1/2015 CV CV CV CV CV CV CV other This map illustrates that the Camp Hill Walk-in Service is accessed by patients from all areas of North Warwickshire, not just Camp Hill residents. Key

10 Camp Hill Walk-in Service - most common health problems patients attend with: Ear, nose and throat Respiratory problems Stomach problems Skin problems Urinary tract infections Source: manual audit for the calendar month of January 2015

11 Walk-in attendance by hour and age at Camp Hill

12 Urgent Care Centre at George Eliot Hospital The data below illustrates monthly attendances from the commencement of the Urgent Care Centre and clearly illustrates an upward trajectory. (Source A&E data George Eliot Hospital). Month 2014 Activity seen by Urgent Care Centre Month 2015 Activity seen by Urgent Care Centre October 359 (10.50%) January 385 (13.66%) November 518 (16.02%) February 628 (19.53%) December 489 (16.61%) March 926 (31.67%) April 1,454 (43.7% May 1,595 (45.38%) Activity The top ten presenting complaints attending the Urgent Care Centre are illustrated below with upper and lower limb injury being by far the most frequent: Number of Patients % of Number of Complaint % of Patients Complaint Patients Patients Upper Limb 16.10% 532 RTC 4.56% 151 Lower limb injury 14.26% 471 Headache 2.52% 83 Abdo Pain 7.08% 234 Pregnancy-related 2.42% 80 Back pain/injury 4.66% 154 Chest Pain 1.45% 48 Unwell 4.56% 151 Allergic Reaction 1.16% 38

13 A&E Attendances at George Eliot Hospital A&E Attends April May June July Aug Sep Oct Nov Dec Jan Feb Mar Increases in A&E attendances can be seen throughout the majority of There is a definite increase in the number of attenders based on data. T^he graph illustrates a 6.8% increase in A&E attendances.

14 Attendance by hour A&E 2014/15 3,500 GEH A&E Attendances by Arrival Hour 3,000 2,500 2,000 1,500 1,

15 What s happened since We carried out extensive engagement during summer 2015 with local patients, members of the public, the voluntary sector and partner bodies. More than 200 people (total 274) completed a questionnaire to let Warwickshire North CCG hear their views.

16 What people told us For most people the urgent care service they were most likely to use for an urgent care need was same day access at the patient s own GP surgery. Some respondents also commented on the difficulty experienced when trying to access a GP appointment.

17 The survey also told us that: More local service based at GP surgeries with access to patients own records and experienced GPs If you are ill, you simply want to be seen by a doctor. It s helpful to be able to see a doctor out of your working hours. My GP closed for lunch, my son had injured his foot, I had to use A&E The survey also told us that when people have an urgent care need they are most likely to seek a same day urgent care appointment from their registered GP practice. However we also know that some people have expressed concern about access at their local GP practice. I don t mind where I go as long as I get what I need flexible times Doctors appointments are terrible to you get told call back at 2pm or use online appointments useless! I tried today and found I would have to wait 19 days for an appointment Need better access to trained staff - who know how to deal with urgent care issues

18 What people told us The people of Warwickshire North would like an urgent care service that is seamless with better streaming where people are seen and treated in the right place at the right time first time, with access to a doctor. Good access is essential to people with the request that consideration is given to location, travel times, transport and waiting times.

19 Used the Camp Hill Walk in was dealt with very quickly with excellent care. The survey also told us that: Walk-In service at Camphill is not responsive, waited ended up at A&E anyway My experience of Walk-in service was poor complete waste of NHS money Most people who responded were prepared to travel between 5 &10 miles and between 20 and 30 minutes to access urgent care For a significant number of people public transport was very important whilst for others parking was very important. 93% of respondents accessing the GP led urgent care service at George Eliot hospital felt the service met their requirements to a good or satisfactory level 65% of respondents who had accessed the Camp hill urgent Care walk in service expressed that the service met their requirements to a good or satisfactory level not everyone can get to Nuneaton - no public transport. Lots of people don't have access to a car. Equal access for all not just for the population of Nuneaton I Have to rely on transport by taxi, after 6pm. Camp Hill, how would people who don't drive get there? If walk in is based on the hospital site, patients can be easily transferred to A&E or admitted more effectively if necessary.

20 But what about same day access to primary care? Theme from pre-engagement people would prefer their GP Challenge GP workforce CCG submitted a bid for Prime Ministers Challenge Fund

21 We do not have enough GPs! Ratio of GP to registered population shows that each GP has around 200 extra patients compared with national average Extract from NHS England Primary Care Strategy 2014

22 We considered access and location We looked at national evidence as guidance National Urgent and Emergency Care reviewed by Professor Sir Bruce Keogh (2013) Having an urgent care centre in the grounds of a hospital means that people can be easily redirected to urgent care from A&E where an urgent care service is more appropriate

23 We considered a more flexible system Reducing hours of access would clearly not be a feasible choice for patients and members of the public who want a more flexible system.

24 The survey told us that the following things were important to the public when making decisions about urgent care services: Keep AE for Keep A&E for Emergencies only! Took farther to walk-in waited and then ended up going to A&E any way! GP service at A&E would be great - patients can be triaged down right route. Being treated in the right place at the right time Services that take pressure off A&E so only the people who need it use it Pointless having Camp Hill which is only 5 mins away from George Eliot. Camp Hill is deprived areas in North Warwickshire too Urgent care services working together and more joined up Access to urgent care without having to make an appointment Access to a doctor Urgent care fragmented and complicated Base whole service at George Eliot Hospital make it easy for patients and carers, awareness of a single point of access In an ideal world all urgent care services would be in one place

25 We considered cost The most efficient way of working will provide accessible care to the greatest number of people. It therefore needs to be located in a place where patients can be directed to the most appropriate urgent care and any further treatment they need is easily available.

26 Stakeholder Group The stakeholder group had patient representatives, members of the public, public health representation, and provider representation.

27 Stakeholder Group Session one: 15 June 2015 What they did - Helped to design the critical success factors - Agreed the weighting for each CSF - Scored the scenarios' Outcome - The critical success factors were used to help score possible scenarios

28 Scenarios Scenario Description Location Staffing Opening times One Two Three To retain the current walk-in provision, location, staffing and opening hours. Camp Hill GP Led To retain the current walk-in provision, location and staffing but reduce the opening hours of the service. Camp Hill GP Led To retain the current walk-in provision, location and opening hours, but change the staffing to Advanced Nurse Practitioner (including non-medical prescribing Camp Hill Nurse Led Current 08:00-20:00 7 days a week Reduced Opening Times 7 days a week Current 08:00 20:00 7 days a week Four To retain the current walk-in provision and location but change the staffing to Advanced Nurse Practitioner (including non-medical prescribing) and offer reduced opening hours. Camp Hill Nurse Led Reduced Opening times 11:00 19:00 7 days a week Five To relocate the walk-in provision and redirect current activity to GP led urgent care on GEH site. This would be a NHS 111 & existing Urgent Care Centre co-located 2.5 miles away on the GEH site GEH Urgent Care Pathway adjacent to A&E GP Led 24/7 Six Seven A GP led walk in service to be provided at another primary care location within Warwickshire North CCG area. Another Location GP Led This scenario is for an Advanced Nurse Practitioner (including non-medical prescribing) led walk-in service to be provided Another Location Nurse Led To be determined To be determined

29 Critical success factors - scoring criteria No Weighting Criteria 1 15 Conditions appropriately managed in an urgent care setting or appropriately redirected 2 15 I will get the right professional with the right skills and competencies to manage my diagnosis / condition (Supports sustainable Urgent Care workforce) 3 15 Relieve pressure on A&E to facilitate to best quality experience for our patients 4 10 Improve access by simplifying and making it clearer where to go for urgent care (Supports the single point of entry into single care) 5 13 Ability to organise / refer patients for diagnostics or deliver on site 6 12 Accessible parking Public transport / direct bus route 7 10 Promote continuity of care with patients own GP 8 5 Promote Accessibility for the most vulnerable groups of our population 9 5 Remove duplication of urgent care services

30 Stakeholder Group Session two: 25 June 2015 What they did - Reviewed the scores to identify the scenarios that scored highest and agree short list of options - considered the benefits and disadvantages for each of the shortlisted options

31 Key Findings Scenario 5 scored highest Redirect walk-in activity to GP-led urgent care service on GEH site Scenario 1 was the second most popular - leave Camp Hill service as currently stands issue of affordability Lowest scoring scenario was scenario 7 Scores for scenarios were broadly consistent All options which were nurse-led scored the least.

32 Options Appraisal of Scenarios The two top choices were shortlisted: Scenario One, Do nothing Scenario Five, relocate the Camp Hill Walk-In activity to an urgent care service at George Eliot Hospital

33 Stakeholder Group Session three: 14 September 2015 Following the pre-consultation engagement new representatives for BME communities and parents with young children were asked to join the group and attended this session What they did - considered pre consultation feedback and & key message re same day access at GP practice for urgent care - Helped to design future consultation engagement plan

34 Stakeholder Group Recommendations: to address feedback on same day access at own GP for urgent care. Take forward action and response through developing primary care strategy and proposals on out of hospital community services Undertake further engagement with the public as these plans and proposals are developed. The group confirmed their recommended options for consultation

35 The consultation The CCG would therefore like to consult publicly on two options: Option 1: To Do nothing. Option 2 :To relocate the walk-in activity from Camp Hill to GPled urgent care service at GEH site.

36 Revised Consultation Timeline October 2015 Launch of full consultation Monitor of progress against action plan and amend if necessary Information gathering with early analysis of data to assess response November 2015 Collate feedback and begin to identify themes Hold consultation meetings Continue to publicise the public consultation December 2015 Public consultation closes