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Health Access Centre (GP walk-in service) Accrington Victoria Community Hospital November 2013

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Accrington Victoria walk- in centre vigil staged Save Our Walk In Centre Walk in centre could face cuts Happy with service from current GP practice You have to book an appt on the morning of that day, ringing from 8am and then when you get through there arent 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. My doctor is fabulous, but the practice is not and getting an appointment can be horrendous. Having children, like most people it is important that they can be seen that day Provide clear, simple and concise information outside of the surgeryeducate 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

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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

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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

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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

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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?

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Responsibilities for commissioning primary care Before 01.04.13

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Responsibilities for commissioning primary care

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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

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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.

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NHS EL CCG has to make cost savings in the region of 33m over the next 3 years YearFinancial saving 2014 159m 2015 1615m 2016 179m 2017 189m 2018 199m

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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 performanceOver spend () 1 2009-1012,7294,845266,475 2 2010-1124,27616,392901,560 3 2011-1233,88526,0011,430,055 4 2012-1333,342 (at end month 11) 25,4581,400,190

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HAC has not reduced demand on other unplanned services

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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.

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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

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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.pdfhttp://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130305_anatomy-health-spending_0.pdf

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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) BurnleyHyndburnPendleRossendaleRibble Valley Total Payment11,055,4878,590,0818,324,9117,194,0004,594,260 Cost per Patient Raw list114.60113.58116.53109.14127.38 Cost per Patient weighted list107.30107.57111.17101.60129.37

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Activity Consultation Rate Locality level LocalityBurnleyHyndburnPendleRibble ValleyRossendaleCCG Total Practices Completing Activity Section16 124755 Population Represented in Survey96,71675,66671,44837,08643,606324,522 Number of Consultations in Week9,3856,7757,8263,6444,07331,703 Extrapolate Number of Consultations in Year488,020352,300406,952189,488211,7961,648,556 Estimate Consultations per Person per Year5.04.75.75.14.95.1

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Patient satisfaction with appointment systems in Hyndburn is similar to the rest of East Lancashire

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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)

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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.

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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.

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Accrington Victoria walk- in centre vigil staged Save Our Walk In Centre Walk in centre could face cuts Happy with service from current GP practice You have to book an appt on the morning of that day, ringing from 8am and then when you get through there arent 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. My doctor is fabulous, but the practice is not and getting an appointment can be horrendous. Having children, like most people it is important that they can be seen that day Provide clear, simple and concise information outside of the surgeryeducate 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