Potential Changes to Local NHS Services

NHS North West Surrey CCG

 

We were recently forwarded some communication from the NHS North West Surrey Clinical Commissioning Group as they are in the process of re-thinking how ‘out of hospital’ services work and trying to improve them – this includes GP practices, walk-in services, community services, most mental health services.

It isn’t clear how wide this consultation will last beyond the 2 remaining ‘Interactive Workshops’ in Woking and Weybridge nor is there an indication of when this engagement period will close.

Something that immediately caused us concern was the following paragraph suggesting that the enforced unavailability of the Weybridge Walk In-Centre led to a decrease in demand for ‘out of hospital’ services…

Sadly it doesn’t take much of a leap in imagination to assume this will be used as evidence to support the closure of similar community services in the future or indeed to support a much more scaled down version of the Weybridge Walk-In Centre.

“It may have been presumed that patients who would have gone to the walk-in centre in Weybridge attended the other walk-in centres in North West Surrey or A&E at St Peter’s Hospital.

However, data shows that, whilst Ashford and Woking walk-in centres saw a 12% increase in attendances in 2017/18 compared to the previous year, overall attendances to these walk-in centres were 18% lower: 19,000 fewer attendances in total…(seeking)…care elsewhere e.g. calling NHS 111; booking to see their GP; seeking advice from a community pharmacist or perhaps self-caring.”

Please take some time to review the details below and ensure your view is heard either via one of the workshops or the contact details at the end of the post.

The following text was published by the Communications and Engagement Team at North West Surrey Clinical Commissioning Group.

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What’s important to you when you need care urgently?

Join one of our interactive workshops in Weybridge, Woking and Staines in November/December

If you live in North West Surrey you are invited to an interactive workshop to discuss how urgent care services could be improved for you.

Local health and care organisations want to hear your thoughts and experiences to help shape future services.

These events are part of The Big Picture – an opportunity for local people to join an open and honest discussion about the future of care delivered outside of hospital.

How to get involved

During these interactive workshops we will:

• Discuss what we mean by the term ‘urgent care’
• Ask you to share your experiences and how you decide what to do when you need care urgently
• Discuss what is important to you when you need this type of care
• Explore what else healthcare services could do to respond

Monday 26 November – 19:00 – 21:00

H.G.Wells Centre
Church Street East
Woking
GU21 6HJ

Thursday 6 December – 19:00 – 21:00

The Ship Hotel
Monument Green
70 High Street
Weybridge
KT13 8BQ

To help manage venue capacity please register beforehand by visiting http://nwsccg.eventbrite.com

Background – what’s this about?

The majority of health and care support happens outside our main hospitals and we know the system isn’t working as well as it could. Increased demand from a growing population, the changing needs of people living with long-term conditions such as diabetes and heart disease, and continual difficulties in recruiting the right staff are all putting pressure on our health and care system.

We have published a case for change – full version and summary version and produced a short film. These explain why change is needed and the emerging thinking around how we can support people to stay well for longer and reduce the burden on urgent and emergency services.

We are also thinking about how we support NHS England’s recently published standards for Urgent Treatment Centres – this is the new name being given to all walk-in facilities such as Urgent Care Centres and Walk-in Centres which will improve and standardise how these services are provided.

You can also follow the conversation on Twitter and Facebook #BigPictureNWS.

The Case for Change

Why change is needed and the emerging thinking around how they can support people to stay well for longer and reduce the burden on urgent and emergency services.

Introduction

Health and care services are under increasing pressure. Rising demand from a growing and aging population, combined with tighter budgets and difficulties in recruiting the right staff means that many services aren’t working as well as they should.

This is particularly so for services outside the big hospitals.

People tell us they find services confusing and it can be difficult to get an appointment with a GP.

People often don’t get the help they need until they reach crisis point and, as a result, end up in A&E and might need admitting to hospital. With the right initial support, for many people this could be avoided, keeping A&E for those who really need it.

Our ambition in North West Surrey is to create a much more joined up way of providing care that improves the health and wellbeing of all our local population. We believe the best people to help us do this are the people using our services, their carers and the wider population.

We want to hear your thoughts about how we can improve services outside the big hospitals.

As well as this, we have also been tasked by NHS England with implementing new standards for walking services across North West Surrey.

NHS England has published new requirements for what they are calling Urgent Treatment Centres; the aim is to standardise services such as Urgent Care Centres, Minor Injuries Units and Walk-in Centres.

We want your help in considering how we implement these new standards across North West Surrey. Listening to what local people tell us, we will be developing a set of proposals for how we provide this type of urgent care. This may or may not require a formal public consultation, depending on the level of change that is proposed.

We will involve the public in the development of these plans and any decisions that are taken in any event.

Many people reading this will also be thinking about the devastating fire that happened last year at Weybridge Hospital and will be wondering what new healthcare facilities will be provided on the site.

We will be considering this within the wider thinking outlined above, so we can maximise opportunities for local people.

Join our conversation and let us know what you think. There are lots of different ways to get involved, please see all the details below

Dr Charlotte Canniff
Clinical Chair
North West Surrey Clinical Commissioning Group

 

Who we are

A new local partnership

The local health and care organisations, including local authorities, are working together in a new partnership. This is helping us think more creatively about how we can improve and join up services across health and social care.

Our partnership includes:

• The local hospital Trust (Ashford & St Peter’s Hospitals NHS Foundation Trust), community healthcare (CSH Surrey), mental health and learning disability services (Surrey & Borders Partnership NHS Foundation Trust), ambulance services (South East Coast Ambulance NHS Foundation Trust)
• Local GPs and the local GP Federation* NICs (North West Surrey Integrated Care Services Ltd)
• North West Surrey Clinical Commissioning Group (responsible for planning and funding your healthcare)
• Surrey County Council, responsible for public health and adult social care
• The four local councils: Elmbridge, Runnymede, Spelthorne and Woking.

What are out of hospital services?

Out of hospital services

All health and care services that take place outside major hospitals – this includes GP and other primary care services; walk-in services; community services; most mental health services; health visiting services and so on.

Urgent care

All non-routine services that people may need to access quickly; it includes GP out-of-hours, non-emergency walk-in facilities such as walk-in centres, minor injuries units and urgent care centres and NHS 111.

Emergency services

A&E and 999 ambulance calls for life-threatening and emergency situations.

Why things need to change

Similar to other parts of the country local health and care services are under considerable pressure which means we are often fire-fighting just to stand still. This is creating a system with an over-reliance on emergency and urgent care services which is at risk of becoming unmanageable.

A growing population

Across the boroughs of Elmbridge, Runnymede, Spelthorne and Woking the number of residents is expected to grow by 5.1% by 2026. This is similar to the rest of Surrey which is due to grow by 5.4% during the same period. We need to make sure our services can cope with this growth.

Increasing demand

Demand on local health services is continuing to grow and is only likely to increase as a result of the growing population and additional local development. Currently there are 362,000 people registered with a GP in North West Surrey; with an expected population growth of 5.1% this is likely to increase to over 380,000 by 2026.

Last winter GPs in North West Surrey provided an additional 3,000 appointments yet people tell us they still struggle to get a GP appointment. In addition, local GPs have a higher average number of patients than other nearby areas. In North West Surrey this is 2,500 per GP compared with an average of 2,100 across the wider Kent, Surrey and Sussex area.

Visits to A&E are also increasing – at St Peter’s Hospital the number of attendances last year increased from 99,500 to 102,000. This reflects the national picture: during 2017/18 there were 23.8 million A&E attendances across the country, which is an increase of 2%, compared to 2016/17 and 22% since 2008/09.

Demand for same-day urgent care in our walk-in centres tells a different story.

It may have been presumed that patients who would have gone to the walk-in centre in Weybridge attended the other walk-in centres in North West Surrey or A&E at St Peter’s Hospital.

However, data shows that, whilst Ashford and Woking walk-in centres saw a 12% increase in attendances in 2017/18 compared to the previous
year, overall attendances to these walk-in centres were 18% lower: 19,000 fewer attendances in total.

So where did people go instead?

We know that attendances at A&E also increased – by 2,500 in 2017/18 – but this leaves a significant number that potentially sought care elsewhere e.g. calling NHS 111; booking to see their GP; seeking advice from a community pharmacist or perhaps self-caring.

Whatever the case, our local system needs to evolve to keep pace with this changing demand. We will need to do more work in understanding this data to help inform the development of our proposals on urgent care.

Changing needs of patients

There are 63,000 people living in North West Surrey aged over 65 and this is expected to increase by 21% by 2027. At the same time, there is an increasing number of people living with more than one health condition; those with three or more long term conditions are expected to increase by 11% by 2030. And of the 31,000 local people over the age of 75, approximately 15,000 are either frail or very likely to be in the short-term.

This is putting increasing pressure on some of our urgent care services which are struggling to cope and patients are not getting the best care.

We need to manage these groups of patients very differently to keep them well for longer and reduce the strain on urgent care.

Overall, people are spending less time in hospital.

Innovations in medicine and technology mean that things like operations are less invasive and patients recover more quickly. We also know that patients spending time in hospital is not good for their health particularly for older, frail patients.

An NHS Improvement study in 2017 identified that 10 days in hospital (acute or community) leads to the equivalent of 10 years aging in the muscles of people aged over 80.

Better care also means preventing people from needing hospital admission when they can be cared for more appropriately elsewhere.

Long-term conditions include conditions such as diabetes, chronic obstructive pulmonary disease, arthritis, angina, heart failure, high blood pressure, neurological conditions.

Limited workforce

Workforce is probably one of our greatest challenges, with difficulties in recruitment at the same time as managing increasing demand on services.

For example:

• 16% of GPs in North West Surrey are near or approaching retirement.
• There is currently a recruitment gap of 21.8% for nursing staff at Ashford and St Peter’s Hospitals NHS Foundation Trust and 29% for community nursing staff at CSH Surrey (the local community services provider).

We are competing with other parts of the NHS for skills and experience whilst having one of the highest costs of living in England. We need to make North West Surrey an attractive place to work and live, allowing staff the time and space to invest in the care of patients.

Our ambition for local people

Supporting a healthier population

Overall the local population is healthy with good life expectancy when compared with the rest of England, but there are pockets of deprivation. For example, Sheerwater in Woking is ranked amongst the 20% most deprived small areas in England.

By providing more responsive out of hospital services, supporting people in times of crisis as well as to live healthier lives, we can start to reduce these differences in people’s health. We also want to work with local government and the community, voluntary and faith sector to develop new shared approaches that will support local communities.

Easing pressure on the system

We want to increase the support that’s available to people locally so everyone can access the right care when they need it. For example, we know people often struggle to make an appointment with their GP and can end up seeking support elsewhere – at A&E for example.

This isn’t a good patient experience, puts additional pressure on A&E and can mean admission to hospital which could have been avoided.

Improving the experience for our patients

We also know the different services available for patients is confusing and people often don’t know where to turn, particularly when they need help urgently.

We want to make things less confusing so people understand where to get the care they need, when they need it and in the most appropriate place.

Building our workforce

We need to think creatively about how we could encourage more people to work within our local services. We need to make better use of skilled staff such as pharmacists, paramedics, optometrists, nurses and other professionals.

More flexible and joined up community services

We want to create community services that are more joined up and flexible and that respond to people’s health and social care needs. We think this will mean
different professionals working in partnership with local GPs to deliver community-based care with more focus on self-management and less reliance on urgent care services.

Improving mental health services

Locally mental health and physical health services have not been as coordinated as they should be. We need to change that: more joined up, urgent and out of hospital services with clear points of access and greater use of multi-disciplinary (mixed) teams will help us provide care that supports people’s physical and mental health needs.

Making best use of technology

We must make better use of technology and innovation; for example we are already supporting practices to bring all locations up to a minimum standard in terms of information technology (IT).

We are now part of a shared care record service (the Surrey Care Record) for patients that will eventually allow all NHS and social care professionals to share
and have access to a patient’s medical record. This will help health and care professionals to understand important elements of someone’s medical history
to improve care. We are also exploring other ways of using technology to support access to care – for example through online GP consultations.

Living within our means

We know our growing population means we can expect demand for healthcare services to continue to increase. However, as funding continues to be stretched we need to think about how we can deliver more from the same money.

We need to focus on services so they are able to keep pace with growing demand and keep people out of hospital and well for longer. As well as providing better care and a better patient experience, this also means better value for money.

What’s already happening?

Our first step has been to develop an ‘Out of Hospital and Urgent Care Strategy’ aimed at strengthening the support available for people outside hospital.

This includes increased access to routine GP appointments, seven days a week, more joined up community care which will help to reduce the burden on urgent and emergency care.

At the same time we want people to have prompt access to urgent care as and when they do need it – for example via our new integrated NHS 111 and GP out-of-hours service, which will go live next April.

Our strategy has a number of broad aims:

• Services should be simple to access so people know where they can go for care and support.
• Local people should have prompt access to urgent care in line with national best practice.
• People are assessed quickly by a qualified clinician in the most appropriate place of treatment.
• Services are joined up and people with different needs can access medical, nursing, therapy, mental health and social care through a single point.
• People who need the most complex care and those in care homes should have comprehensive support with a full range of services available and tailored to their needs.
• A wider range of treatments are available outside hospital.
• When someone does go into hospital services can be coordinated and mobilised quickly to support them to return home as soon as possible with the right care in place.
• People’s needs are assessed once without the need for telling their story again as they move between organisations.

Starting to deliver our strategy

We already have a number of new developments in place:

• Supporting new technology that can help patients remain in their own home/usual place of residence for longer such as remote monitoring and virtual consultations.
• Locality hubs up and running from Woking (Bedser Hub), Ashford and Walton – providing proactive and reactive care for older people, often with many long-term conditions, registered with a local GP. The service brings together health, mental health, social care and voluntary sector staff and is helping to keep  people independent for longer and out of hospital.
• A clinical advice line for local care homes which gives staff rapid access to senior clinicians so they can make the right treatment decisions for residents – helping to keep them out of hospital.
• An award-winning partnership (known as the COSI service) between local community services, hospice staff and the hospital which supports people to die in the place of their choice.
• Care Home Team – a mixed team of healthcare professionals (including nurses, pharmacists, therapists) led by a consultant for the elderly who provide support and training to care home staff.
• Psychiatric liaison service at A&E at St Peter’s Hospital to support people with urgent mental health needs.

What else are we looking at?

There are further developments we think will help create a more joined up and flexible service to support local communities and create more capacity for people to get the right help when they need it.

Investing in primary care

We are already investing in local GP services to deliver thousands of additional GP and primary care appointments. Known as extended GP access, these
additional appointments are being offered through the GP Federation at a number of sites* across North West Surrey.

Extended GP access includes pre-bookable and same day appointments available up to 9pm on week days and from 9am – midday at weekends. Patients have
access to these extended services regardless of the GP surgery with which they are registered.

GP practices are also starting to work together in larger groups; this will provide opportunities for better joined up services, for example more consistent home visiting services. This will also help to strengthen out-of-hours services creating a more robust service seven days a week.

• Face to face GP appointments available to 9pm with the potential to expand this further through collaboration with GP out-of-hours services
• Extended GP capacity at a number of hub sites
• GP practices working together in ‘clusters’ across larger catchment areas creates the opportunity to deliver additional services for larger populations
• Pre-bookable urgent same-day appointments
• Development of direct online booking and booking through NHS 111 services
• Joined up IT systems so GPs in extended access clinics can access patients’ medical records, in the same way your own GP can in your surgery
• Online GP consultations

Extended GP access* is currently being offered at the following sites:

• The Red Practice – Walton Health Centre, Walton-on-Thames
• Studholme Medical Centre, Ashford
• Sunbury Health Centre, Sunbury-on-Thames
• Woking Community Hospital, Woking

New models of community services

We want to see community services teams supporting and working with groups of GP practices, based around our locality hubs as wider teams.

These wider teams (known as Integrated Locality Teams) would work closely with primary care colleagues, developing personalised care plans for patients with more complex needs and discussing and managing these cases as a multi-disciplinary team.

These wider teams would include:

• GPs
• Social care services and preventative services aimed at maintaining independence and keeping people well for longer
• Hospital consultants (cardiology, respiratory and care of the elderly physicians)
• Community nursing and therapy teams
• Mental health professionals

New Integrated NHS 111 Service and Out-of-Hours Service

We have recently agreed a new contract for NHS 111 across Surrey which will go live from April 2019. This new service includes NHS 111, a medical assessment and the GP out-of-hours service and is designed to make it easier to signpost patients who call NHS 111 to the most appropriate local service.

As part of the new provision, patients will benefit from being able to talk directly with a clinician (where necessary) and direct bookings into GP out of-hours
appointments.

Meeting the new specification for Urgent Treatment Centres

We also need to think about how we implement new standards for walk-in services across North West Surrey.

NHS England has published new requirements for what they are calling Urgent Treatment Centres that will standardise services such as Urgent Care Centres, Minor Injuries Units and Walk-in Centres.

Some patients say the range of alternatives can be confusing – Walk-in Centres, Minor Injuries Units, Urgent Care Centres and others, often with differing levels of service. Because of this confusion, A&E has become the default choice for many people who are confused about where to go.

Urgent Treatment Centres will standardise these options and simplify the system so patients clearly know where to go for the service they need.

Urgent Treatment Centres will be GP-led, open at least 12 hours a day, every day, and be equipped to diagnose and deal with many of the most common ailments for which people attend A&E.

The Urgent Care Centre at St Peter’s Hospital has already been designated as an Urgent Treatment Centre in the first wave of NHS England’s national roll-out from 31st October 2018. There are significant differences between the other existing local walk-in facilities and the new specification and we need to consider the best way to bridge this gap.

National criteria for Urgent Treatment Centres

• GP-led service, open at least 12 hours a day, seven days a week, able to diagnose and deal with many of the most common ailments seen in A&E.
• Providing a walk-in service and bookable (on the day) appointments via NHS 111; patients with a pre-booked appointment should be seen and treated within 30 minutes of their appointment time. Walk-in patients would be seen according to clinical need.
• Ideally the Urgent Treatment Centre should be alongside other local urgent care services such as mental health crisis support, community pharmacy, dental,
  social care and the voluntary sector.
• Treated conditions must include minor illness and injury in adults and children of any age, including wound closure, removal of superficial foreign bodies and
  the management of minor head and eye injuries.
• All urgent treatment centres should have access to investigations including pregnancy tests and urine tests. Other tests should include blood testing, electrocardiograms (ECGs) and wherever possible simple X-ray facilities.

What we already know

We continue to engage with different patient, public and voluntary, community and faith groups who use services within North West Surrey to understand different people’s priorities for health and care. We will build on this to develop a further understanding of what’s important to you.

Some initial research

The NHS has been working with Surrey County Council to understand the views of people across Surrey on health and care services. Whilst more focused work is needed as we develop our thinking, there are a number of key messages which we can consider from the outset.

• Residents across Surrey are aware of the pressure on the NHS and are generally open minded to new ways of providing care, but want good access and quality.
• Quick access is universally important for people across all services. People are willing to travel further or see a different clinician if they can be seen quickly and easily, particularly if it is a ‘one off’ illness or complaint.
• Quality is important and when people talk about ‘quality’ they talk about the skill level of clinicians, getting good advice and treatment. People expect to see someone qualified to handle their care and are open minded to seeing nurses or other professionals when appropriate.
• People are in favour of a service that is more convenient for them and the concept of a ‘onestop’ location or ‘hub’ is viewed favourably. People want to know where to go, who to talk to and that they can trust the advice. Provision of one main access point, where people can be easily signposted to the appropriate service (or given self-care), is well received.
• To support the development of this discussion document we have started to work with patient and public representatives to begin a process of co-development. We now want to engage more widely and ensure local people have their say from the outset.

How you can get involved

Over recent years the NHS in Surrey has engaged widely with staff and local people to find out what they think of services and their ideas for improvement.

Recent examples include widespread engagement campaigns resulting in improved stroke services, our new patient transport service and the new integrated
NHS 111 and GP out-of-hours contract (from April 2019).

Our thinking builds on this engagement and we now want to extend and broaden our conversation and hear what you think about some of the ideas described in this discussion document.

We will run a series of different events to give people the opportunity to share their views. You can find out about these on our website www.nwsurreyccg.nhs.uk and they will be advertised to local people through a range of channels.

We will also be talking to a wide range of local patient, voluntary, community and faith sector groups about these particular issues to make sure we hear as wide a range of views from our local communities as possible.

Once this initial engagement period is over, we will publish the results so local people have the opportunity to read and understand what others have said.

Working with partners and building on these conversations we will then develop more detailed proposals, in particular around Urgent Treatment Centres. This
may or may not require formal public consultation depending on the level of change that is proposed.

If this is required, only then, following consultation would we make any decisions about the future shape of local services.

We will involve the public in the development of these plans and any decisions that are taken in any event.

Share your thoughts

For further information and/or to feed in your views go to our website or contact us using any of the details below:

Website: www.nwsurreyccg.nhs.uk
Email: nwsccg.bigpictureprogramme@nhs.net
Post: The Big Picture, c/o The Communications
Team, North West Surrey CCG, 58 Church Street,
Weybridge KT13 8DP
Text: 07880 091328

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