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Consultation on the impact of the ongoing transformation of the IW Urgent Care Service, including Walk-in Access Monday-Friday

The Isle of Wight Clinical Commissioning Group (CCG) is consulting on the impact of changes to the walk-in access to GP Urgent Care Service based at St. Mary’s Hospital, during weekdays. The decision is to close Walk-in Access to the service during routine working hours, when GP Practices are open. The current access to the GP Out-of-Hours services, including Walk-in Access during daytime hours at weekends will remain. The proposal does not change access for emergency care in the Emergency Department at St. Mary’s Hospital. The consultation with the Public runs from today 25th January until 22nd February, 2017.

To clarify:

Urgent care – typically non-life threatening but may be time sensitive in that delays in delivering it may result in a deterioration in the person’s health and wellbeing.

Emergency care –is delivered for an unexpected illness or injury or accident which is life threatening and without which the patient would suffer serious harm, or death.

Current Services

The Urgent Care Service which was previously called the Beacon Centre, for the provision of primary care medical services 24/7, including urgent and non-urgent “walk-in” care was set up seven years ago under an agreement which ended on 30th September 2016. A number of challenges had become apparent in running the service including recruitment of GPs to the service, and their availability to cover the number of shifts required; a reduction in numbers of people using the service; and, financial implications of rising premium costs in securing GP cover. Staffing both the original walk in primary care service at the hospital and General Practice in the community is becoming increasingly difficult and this is reflected in the Primary Care Strategy consultation which is open for public consultation (posted 23rd December on the CCG website and communicated island-wide). In addition, the quality of care delivered on a walk-in basis can be limited by lack of continuity and consistency of management, compared to that delivered by a patient’s registered GP, Nurse Prescriber or Nurse Practitioner.

The IW CCG and IW NHS Trust worked together to ensure that a safe, ongoing service for provision of GP Out-of-Hours services from 1st October 2016 would be in place. As part of continuing to secure Out Of Hours services, the Beacon Centre became the Urgent Care Service. IW residents were urged to consider accessing the redesigned service only if signposted by a health professional, or through the NHS 111 service. The Urgent Care Service was also redesigned to make most effective use of scarce GP time so that, depending on need, those attending the service could be seen by a nurse, community practitioner or a GP.

Case for Change

The Urgent Care Service implemented on 1st October 2016, was a response to lack of GPs and the unsustainable cost of continuing to provide a service which was duplicating what is already being offered by GP practices and community pharmacists in daytime hours, during the working week. The walk-in service, which was originally put in place in 2009, does not reflect what NHS England now requires local systems to provide in terms of access to urgent care.

Over the last year, walk in attendance rates into the Urgent Care Service have begun to reduce through the increased use of the NHS 111 service and people are being directed to other healthcare professionals instead. Patients wait for up to four hours to be seen following a walk-in attendance and a patient’s need can be more quickly met if signposted via 111 to a more convenient or appropriate service.

Daytime - Monday to Friday, the urgent care service now sees an average of 29 walk-in access patients each day, when the Walk-in Access is open – a reduction of 42% compared to a year ago.

The costs for running this service have not reduced over this period and are now considered to represent relatively poor value for money, especially where other services are available to support the urgent care needs of patients. Given the continued pressure to identify savings across all services funded by the CCG, the next stage of the urgent care service future vision for the Island is to reduce the walk-in element of the weekday Urgent Care Service when GP practices are normally open, and ensure that other services are in place so patients can be signposted to a more appropriate service.

In the evenings during weekdays, access to the GP Out-of-Hours service will continue to operate as it has done since 1st October 2016, based at the Urgent Care Service at St. Mary’s, with access via the 111 phone number, from 6.30p.m. – 8.00am.

At weekends, the GP Out-of-Hours service operates from 6.30 p.m. Friday through to 8.00 a.m. Monday, and all day Bank Holidays. The walk-in access to the service during the daytime during the weekend (8:00 am – 6:30 pm) will not be changed as a result of this proposal.

By 1st April 2017, IW residents and those visiting the Island requiring urgent, non-emergency care will be asked to do the following:

  • Call 111 if you need urgent medical advice, or if you are unsure which service can best help you
  • For visitors to the IW, the first point of contact at all times is to ring the NHS 111 service
  • If calling 111, it is possible that you will be asked to contact a local community pharmacist or other community healthcare services

People who require emergency treatment for a serious/life-threatening injury or illness should call 999, or attend the Emergency Department immediately. This proposal does not change the walk-in access to the Emergency Department (Accident and Emergency).

Definitions:

Urgent care – typically non-life threatening but may be time sensitive in that delays in delivering it may result in a deterioration in the persons health and wellbeing.

Emergency care –is delivered for an unexpected illness or injury or accident which is life threatening and without which the patient would suffer serious harm, or death.

Despite this it is recognised that demand for urgent on the day access to medical services is defined by patient expectation, experience and level of understanding of conditions and services.

Urgent Care Service - provides help for a minor illness or injury at times you can't wait to see your GP, or another healthcare professional.

GP Out of Hours service - the period that GP practices are closed to patients. This is between 18:30 and 08:00 on weekdays and from 18:30 on Friday night until 08:00 on Monday morning. GP practices are also closed on Bank Holidays.

Walk in - the ability to access to a service without first booking an appointment.

Emergency Department (A & E) – 24/7 response for emergency care.

Advice and Urgent Care is now provided in a range of services and locations including:

  • Online e.g. www.nhs.uk , www.what0-18.nhs.uk , Isle Find It (and see mental health below)
  • Telephone advice e.g. 111, Parentline, Isle Help, Action on Hearing Loss, Healthwatch IW, People Matter, Travelline, Alcoholics Anonymous, British Red Cross, Age UK, Carers IW, Disablement Information and Advice Line (DIAL), Cruse Bereavement Care, Dental Advice, Frank, The Silver Line, etc. (and see mental health below).
  • Pharmacy – there are about 30 across the Island open longer hours than GP practices with a minimum of 8 open each day at weekends. Under the Pharmacy First scheme you don’t need to get a prescription from your GP for some conditions.
  • GP practices – there are 16 across the Island where both GPs, nurses and other health professionals provide services
  • Dentists and the emergency dental service – for problems with teeth
  • Opticians – for problems with eyes
  • Mental Health - mental health crisis line, IAPT (Improving access to Psychological Therapies), Silver Cloud, Positive Mental Health, Big White Wall

This consultation seeks views on how to manage the impact of the proposed closure of all walk in access to the Urgent Care Service during the week. Please help us by giving us your views on the proposed changes that are being suggested by completing the online survey: http://www.smartsurvey.co.uk/s/UrgentCareSurvey/

or by accessing a word version which you can download from the CCG website returning it to the CCG using the contact info supplied. A paper copy of the survey can be sent to you on request – please email or telephone.

Isle of Wight Clinical Commissioning Group (CCG), Building A, The APEX, St. Cross Business Park, Newport, Isle of Wight, PO30 5XW

Telephone: (01983) 552064

CCG website: http://www.isleofwightccg.nhs.uk/

Email: ccg@iow.nhs.uk

Background

The Isle of Wight (IW) Clinical Commissioning Group (CCG) is made up of 16 member GP practices on the Island and primarily commissions secondary care, community, mental health, continuing healthcare and ambulance services on behalf of the residents of the IW, with an annual funding allocation of £233.6m. Further information on the IW CCG can be found here: www.isleofwightccg.nhs.uk

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