Deborah McBeal, Director of Primary Care Commissioning/ Deputy Chief Officer and Laura Andrews, Senior Engagement Manager from Enfield Clinical Commissioning Group will provide a verbal update on walk-in services at the four geographic hub sites. A letter from Enfield CCG to Health Scrutiny is included for reference.
RECEIVED a verbal update from Deborah McBeal and Laura Andrews
1. Cllr Boztas introduced this item and referenced the meeting that representatives from the Health Scrutiny Panel had with the CCG in August, when the issue was discussed initially.
2. Deborah McBeal outlined the minor amendments to be undertaken across the 4 geographic GP hubs – Eagle House, Evergreen, Carlton House and Woodberry.
3. The GP hubs offer extended hours, 6.30pm-8.pm Monday to Friday and 8.00am-8.00pm on Saturday and Sunday.
4. There are 2 elements to the current service. The pre-bookable appointment system (in person or via telephone) and the walk-in service, however, it has been established that this is not an efficient use of resources. The walk-in service is provided in 3 of the 4 hubs (not available at Woodberry)
5. The pre-bookable appointment system will remain but the walk-in service will be withdrawn. When somebody presents at the hub, they will be offered an appointment that day, rather than wait an unspecified amount of time. This will allow the pre-bookable system to be fully utilised, providing a more efficient and cost-effective use of resources.
6. In addition, hub staff will re-direct patients as necessary, including to pharmacy services or self-care..
7. Neighbouring CCGs have been advised of this proposal.
8. The engagement and communication plan was explained which will include work with community groups, patient groups and GP member practices. Signage will be adjusted as necessary and websites updated.
The following questions/issues were raised:-
Cllr Boztas queried when the amendment to service provision would take place. Deborah McBeal confirmed that the transition will begin on 1St October.
Cllr De Silva commented that it was very useful to meet with the CCG in August and then hear how the proposals have developed to date.
In response to a question on how the modelling would be implemented, the CCG confirmed that numbers of patients presenting for a walk-in appointment would be tracked and services amended as appropriate.
Cllr Brett commented that it was important to dispel any thought that this is a rationing of services and it was important to publicise which services are available. The CCG responded by confirming that comments from community groups would be addressed and patients would be directed and treated as appropriate.
Cllr Brett further commented that Patient Participation Groups are not necessarily representative of community groups and the CCG agreed that this needs to be addressed.
The Panel agreed with Cllr Neville’s comment that with better management of how we use the extended hours services and with appropriate pathway advice, this change to service provision could be viewed as an improvement.
Cllr Pite, referring to triage processes, commented that the 111 service asks a range of questions when a patient calls, however when a GP surgery is called there is very little triage undertaken. A concern was raised that GP administrative staff should be adequately trained in being able to re-direct patients to the most appropriate care-pathway.
Patricia Mecinska (Healthwatch Enfield) asked the CCG whether the proposal could be considered as a service change? In response, Deborah McBeal confirmed that as the outcome would be the same, i.e., seeing a GP, then the proposal should not be considered a change to service. The national model of care is for pre-bookable appointments where patients can still access the services, achieving the same outcome. Unpredictable waiting times for walk-in services are not manageable or cost effective.
The inclusion/exclusion criteria should be publicised widely, advising patients of services and pathways available. In response to a question from Cllr Brett, it was confirmed that hub GPs would not be able to issue fitness for work certificates, this should be obtained from the patient’s own GP.
Cllr Boztas questioned whether the number of hubs would be reduced in the longer term and the CCG confirmed that the current number of 4 hubs would remain. The CCG advised that as the demand is less in the south-west (Woodberry Practice), the service is slimmed down as appropriate.
The CCG stated that the hubs could be better utilised and revising the offer in relation to walk-in services will allow greater utilisation to be achieved.
A member of the public asked that public perception is suitably managed. The CCG agreed to clarify amendments to walk-in services and emphasise the availability of pre-bookable appointments.
It was asked whether this would be an added pressure on A&E services? Deborah McBeal confirmed that there is no correlation. The introduction of walk-in services did not see a decrease in numbers attending A&E. The CCG have discussed the proposals with North Middlesex Hospital and the Trust have no concerns.
Cllr Taylor referred to a recent newspaper article which stated that GPs in North West London will be urged against referring patients to hospital specialists and consultants and some outpatient appointments will be axed as part of a programme of NHS ‘rationing’ to be introduced in London. Cllr Taylor queried whether this is something that the Enfield Health Scrutiny Panel would be discussing at some stage?
Deborah McBeal would review the article and provide a response.
ACTION: Deborah McBeal
Deborah McBeal and Laura Andrews were thanked for their presentation.
AGREED to note the presentation and the comments above.