Health Access Centre (GP walk-in service)
Accrington Victoria Community Hospital
November 2013
Save
Our
Walk In
Centre
Walk in centre
could face
cuts
“Provide clear, simple and
concise information outside
of the surgery…educate and
empower those who are
capable of helping themselves
and free up valuable GP time
and services for illness,
disease and needs that
GPs can help with…”
“You have to book an
appt on the morning of
that day, ringing from
8am and then when you
get through there aren’t
any appointments left
and you are told to start
all over again
tomorrow”
“The walk in centre at AVH is invaluable. I have chronic asthma and heart failure.
On 2 occasions I have started with chest infections on Saturdays, I was able to go
the walk in centre and get antibiotics. If I had to wait until Monday I would
probably have ended up in hospital.”
“Having children, like most people it is
important that they can be seen that day……”
Listening to the Community
Accrington market “meet and greet”
Questionnaires – Walk in Centre, GP practices, ELCCG website, HBC website, Hyndburn
Pharmacies (906)
Receipt of petition from local residents (4566)
Visit to HAC by Di van Ruitenbeek, CCG Chair to talk to staff and patients
Meetings with Councillor Pam Barton, Rob Grigorjev and other stakeholders
Hyndburn CCG Steering Group Meeting
Hyndburn Council Meeting
Commitment to Openness and Transparency
What You Said
What Matters Most to Local People?
Being able to see their own GP
Being able to see a GP without making an appointment – especially same day
urgent appointments
GP appointments available at wider range of times (evenings and weekends)
GP services offered at a location which is easy for them to get to by car or public
transport
GP services where they are treated with empathy, dignity and respect
What You Said
What Concerns Local People the Most?
The difficulty of accessing GP appointments at their own practice – especially same
day urgent appointments
Fears that patients might not be able to get same day urgent appointments if the HAC
were to close
Concerns about where unregistered patients would need to go to access GP services
if the HAC were to close
Concerns that patients might have to go to A&E or the Urgent Care Centre in Burnley
instead
Concerns about the longer term future of Accrington Victoria Community Hospital as
an NHS facility
Our key challenges as a CCG
What type of service(s) do we need to commission in Hyndburn to ensure that
patients are able to get GP appointments when they most need them?
Which of these offers the best value for NHS money?
How do we deliver the required CCG cost savings of £33m over the next three years?
How do we ensure fairness in GP access across all 5 CCG localities?
How can we ensure that decisions about the future of the services currently provided
at Accrington Victoria Community Hospital are made in collaboration with our other
NHS partners - e.g. NHS England and East Lancashire Hospital Trust?
Responsibilities for commissioning primary care
Before 01.04.13
Responsibilities for commissioning primary care
After 01.04.13
NHS ENGLAND






Contracts for registered
population (0800 – 18.30 Mon –
Fri)
Essential and additional services
Performance management
Nationally defined enhanced
services
QOF
Improving the quality of primary
care
Lancashire County Council
CCGs





Contract for GP Out of Hours
Contract for walk-in services
Local Improvement Schemes
Locally commissioned services
(previously LESs)
Supporting quality
improvement

Public Health locally
commissioned
services
Key Facts
5 year contract November 2009 – October 2014. The current contract is with ELMS, an
independently run social enterprise
2 elements:
• Unregistered patients on a walk-in basis 8am to 8.30pm, 7 days a week, 365 days per
year (commissioning responsibility with NHS EL CCG)
• A GP Practice with a registered patient list size of 1358 (commissioning responsibility
with the Area Team at NHS England)
High levels of patient satisfaction with GP walk-in service
Patients registered with the GP practice at the HAC
Area Team is commencing patient/stakeholder engagement process in November
Briefing was submitted to Overview and Scrutiny last week
Options currently identified include re-commissioning a GP practice through a
transparent procurement process or dispersing the patient list to nearby practices.
No decision has been taken by the Area Team – this will be made following patient
and public engagement process.
Whatever decision is taken, patients will be able to register with a GP practice.
Any decision taken will have regard to capacity within existing local GP practices, the
possible impact on other NHS services and the NHS health economy as a whole.
NHS EL CCG has to make cost savings in the region of £33m over
the next 3 years
Year
Financial saving
2014 – 15
£9m
2015 – 16
£15m
2016 – 17
£9m
2017 – 18
£9m
2018 – 19
£9m
The number of attendances is currently 3 times more people than originally
planned & costs £1.4 million more AND there is no cap on the cost of the
current service as the contract is based on a fee of £55 per attendance
Year
(Nov – Oct)
Attendances at the GP
walk-in centre
Over performance
Over spend (£)
1
2009-10
12,729
4,845
266,475
2
2010-11
24,276
16,392
901,560
3
2011-12
33,885
26,001
1,430,055
4
2012-13
33,342 (at end month
25,458
1,400,190
11)
HAC has not reduced demand on other unplanned services
900.0
800.0
700.0
600.0
500.0
400.0
300.0
200.0
100.0
0.0
Burnley
Hyndburn
Pendle
Ribble Valley
Rossendale
Higher proportion of
attenders than ‘expected’
based on population
profile, especially
females.
Lower proportion of attenders than
‘expected’ based on population
profile
Greater proportion of attendances in 0-4 age group than expected based on the population
profile.
Key Facts
GP practices everywhere are under pressure
None of the other 4 CCG localities have a similar walk-in service
The numbers of patients with long-term conditions managed in primary care
continues to increase
Minimal growth in funding of primary care since 2005 - 06
Data source/s: http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130305_anatomy-health-spending_0.pdf
Estimated cost for the HAC in 2013-14 is £2.2m compared with a
cost of £8.5m for all other GP services in Hyndburn
(Does not include APMS which is the contract mechanism for the HAC)
(Excl. Slaidburn)
Burnley
Hyndburn
Pendle
Rossendale
Ribble Valley
£11,055,487
£8,590,081
£8,324,911
£7,194,000
£4,594,260
Cost per Patient Raw list
£114.60
£113.58
£116.53
£109.14
£127.38
Cost per Patient weighted list
£107.30
£107.57
£111.17
£101.60
£129.37
Total Payment
Activity – Consultation Rate – Locality level
Locality
Burnley
Hyndburn
Pendle
Ribble Valley
Rossendale
CCG Total
16
16
12
4
7
55
Population Represented in Survey
96,716
75,666
71,448
37,086
43,606
324,522
Number of Consultations in Week
9,385
6,775
7,826
3,644
4,073
31,703
Extrapolate Number of Consultations in Year
488,020
352,300
406,952
189,488
211,796
1,648,556
Estimate Consultations per Person per Year
5.0
4.7
5.7
5.1
4.9
5.1
Burnley
Hyndburn
Practices Completing Activity Section
6.0000
Locality
Consultations
5.0000
per Person per
Year
4.0000
CCG Total
Consultations 3.0000
per Person per
Year
2.0000
National
Consultations 1.0000
per Person per
Year
0.0000
.
Pendle
Ribble Valley
Rossendale
.
0%
Y02606
P81756
P81218
P81003
P81182
P81170
P81025
P81099
P81736
P81118
P81036
P81160
P81020
P81147
P81731
P81032
ROSSENDALE
P81686
P81780
P81797
P81215
P81132
P81123
P81212
RIBBLE VALLEY
P81130
P81088
P81757
P81028
P81166
P81197
P81699
P81095
PENDLE
P81053
P81078
P81047
P81730
P81070
P81659
HYNDBURN
P81065
P81165
P81137
P81778
P81100
BURNLEY
P81755
P81027
P81104
P81641
P81749
P81035
P81726
P81146
P81738
P81017
P81634
P81779
P81008
P81732
P81711
P81677
P81069
Y02605
P81620
P81134
Patient satisfaction with appointment systems in Hyndburn is
similar to the rest of East Lancashire
2012-13 Patient Survey
Q18 - Overall experience of making an appointment is 'Very Good' or 'Fairly Good'
EL CCG
100%
90%
80%
74.4%
70%
60%
50%
40%
30%
20%
10%
Options
1
Keep the status quo and tender a service in its current format
2
Tender the current service as a fixed price contract rather than a fee per attendance
3
Let the current contract expire without a replacement service
4
A walk-in service to remain, with opening times and access limited to hours outside GP
core contract hours. This would be funded at a fixed price. Options include:
a) Evenings
6.30pm – 8.00pm
b) Weekends 8.00am – 8.00pm
5
Commission individual practices or groups of practices working together to provide
extended hours to offer guaranteed extra access. This would be funded at a fixed price
and apply across East Lancashire. Options include:
a) Evenings
6.30pm – 8.00pm
b) Weekends 8.00am – 8.00pm
6
Decommission the GP walk-in service and extend the contract for the Minor Injuries Unit
(MIU) to include minor illness (walk-in, nurse led, fixed price contract)
Things we will take into account when making our final decision
The needs of local people to access GP appointments when they most need them especially same day urgent appointments
The views of patients and stakeholder groups in Hyndburn about the types of GP
services they would prefer
The conclusions of the recent Monitor Report on NHS Walk in Centres
The cost, value for money and affordability of future GP service provision
The need for the CCG to make cost savings of £33m over the next three years
Fairness of primary care access and provision across East Lancashire
NB. Any GP members on our Governing Body who may have a conflict of interest in relation to this issue, will be required to declare this interest in
keeping with the rules of the CCG Constitution. The final decision on any recommendation made by the CCG Governing Body, will be the responsibility of
the CCG Remuneration Committee which does not have any GP members.
Involvement and consultation
NHS Act 2006 (Section 242) - Duty to involve and consult:
•
•
•
•
The user of those services
Planning of services
Development and consideration of proposals for changes to those services **
Decisions to be made by that Body affecting the operation of those services.
**Current position
Guidance says:
• Carry out pre-consultation **
• Involve users **
** i.e. Engagement exercise up to end October 2013.
Formal Consultation
Local Authority (Overview and Scrutiny Committees, Health Scrutiny Functions) Regulations 2002 require:
• Consultation with OSCs when they are considering ‘substantial’ development of health services in the area
of the Local Authority, or for a ‘substantial variation’ in the provision of services.
Save
Our
Walk In
Centre
Walk in centre
could face
cuts
“Provide clear, simple and
concise information outside
of the surgery…educate and
empower those who are
capable of helping themselves
and free up valuable GP time
and services for illness,
disease and needs that
GPs can help with…”
“You have to book an
appt on the morning of
that day, ringing from
8am and then when you
get through there aren’t
any appointments left
and you are told to start
all over again
tomorrow”
“The walk in centre at AVH is invaluable. I have chronic asthma and heart failure.
On 2 occasions I have started with chest infections on Saturdays, I was able to go
the walk in centre and get antibiotics. If I had to wait until Monday I would
probably have ended up in hospital.”
“Having children, like most people it is
important that they can be seen that day……”