Health Access Centre (GP walk-in service) Accrington Victoria
Community Hospital November 2013
Slide 2
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
Slide 3
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
Slide 4
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
Slide 5
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
Slide 6
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?
Slide 7
Responsibilities for commissioning primary care Before
01.04.13
Slide 8
Responsibilities for commissioning primary care
Slide 9
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
Slide 10
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.
Slide 11
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
Slide 12
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
Slide 13
HAC has not reduced demand on other unplanned services
Slide 14
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.
Slide 15
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
Slide 16
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
Slide 17
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
Slide 18
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
Slide 19
Patient satisfaction with appointment systems in Hyndburn is
similar to the rest of East Lancashire
Slide 20
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)
Slide 21
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.
Slide 22
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.
Slide 23
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