Minutes:
The Chair reported that the Council had recently learnt that:
- from 1 November 2018, the Alexandra Health and Social Care Centre would become a GP Access Centre dedicated to treating patients registered with a Harrow GP practice only;
- the new service would require patients to have booked an appointment before arriving at the Centre and this would ensure that patients would not need to spend time in the waiting area in order to be seen by a GP. Appointments would be available from 8.00 am – 8.00 pm on all days of the week and could be made by patients by either contacting their GP surgery or calling 111 for an appointment;
- patients who had used the Centre but were registered with a GP in other boroughs such as Ealing or Hillingdon would be able to book a same day appointment in a GP Access Centre located in their respective boroughs on all days of the week, including weekends and evenings, by calling their own GP or 111.
The Chair stated that the Council was extremely disappointed that it had not been consulted and asked representatives of the NHS Harrow CCG about the consultation exercise. It was unfortunate that the implementation dates were close and that the Council had not been given any opportunity to voice its concerns on behalf of its residents.
Having been invited to speak, the Leader of the Council cited examples of how the new service would impact adversely on the residents of Harrow and was concerned that the appointment process would reduce the number of available appointments drastically. He added that the Centre was situated in one of the most deprived areas of the borough and the new service would have an adverse impact on the disadvantaged.
The Leader stated that there had been a form of an engagement exercise with the Council’s Health and Wellbeing Board but that the CCG was not able to share some of the information at that time due to commercial sensitivity. It was essential that the CCG consulted in a meaningful way with the appropriate bodies of the Council on such important issues and that the relationship between the Council and the CCG needed to improve. There were a number of opportunities for partnership working and these ought to be explored. The CCG ought to have engaged fully with the Council in this regard as free and easy access to health was important.
Members of the Sub-Committee also expressed their disappointment about the lack of any meaningful consultation and made comments and asked questions as follows:
- the proposal went against the direction of travel;
- what was the rationale behind the reduction in walk-in centres, why and how had this Centre been selected as it was in a deprived area and whether other options had been explored;
- was the lack of funding a major driver;
- who had the CCG consulted;
- would the CCG be proposing other changes and when would these be rolled out;
- the borough had a high number of transient residents and how would the proposal impact upon them;
- there were a number of residents who lived in South Harrow who were registered with doctors just over the border in Hillingdon or Ealing and who had previously used this walk-in Centre. Many of these residents had been allocated these practices as the surgeries in the locality within Harrow were to capacity. How would these Harrow residents continue to access the service at the Centre in the future;
- at the last meeting of the Sub-Committee, the CCG had noted that walk-in centres helped manage care outside of the hospital environment, with an estimated 7% transfer of cases from the Accident and Emergency (A&E) Services. What would be the impact of the proposed changes at Alexandra Avenue at Northwick Park Hospital.
Representatives of the CCG acknowledged the different points made by Members and apologised on the lack of information made available. A representative added that she had attended a meeting in July 2018 with a colleague to explain the rationale behind the change and stated that there had previously been discussions, albeit brief, at meetings of the HOSC and the Health and Wellbeing Board. The EIA and the EqIA processes carried out to assess the proposed changes confirmed that the CCG was not required to carry out a formal consultation. However, as with any change, the CCG had tried to engage with various bodies/communities and had continued to do so widely since the proposals to go ahead had been approved.
The same representative added that:
- that the driver behind the change was not linked to withdrawal of funding. Currently, there were three walk-in centres in Harrow which did not meet the core criteria required by the Minor Injury Unit or Urgent Treatment Centre. NHS England required all CCGs to develop a GP Extended Access Model of care. NHS England required every CCG to every improve access to primary care, seven days a week until 8.00 pm, and this was one of the drivers behind the change;
- the change would ensure timely access and make better use of the available facilities in Harrow;
- the CCG was a public body that was accountable and as such it was required to make effective use of the available finances;
- a meeting had been held with the Leader of the Council and two local MPs to explain the proposals in detail;
- the CCG had received communication from the GLA London Assembly Member for Brent and Harrow and had offered a meeting to discuss the local changes should this be helpful. She explained that the Assembly Member had asked why these changes had not been discussed at the Assembly and the CCG had clarified that it was not required to consult the London Assembly on local changes;
- she would welcome the opportunity for her team to attend meetings should Members feel that this would be helpful in order to explain the rationale behind the change but emphasised that the changes were planned to proceed on 1 November 2018;
- the usage of the Centre had been a consideration. Patients used the Centre at certain times of the day only. The configuration of the building had also been a factor. An option appraisal had been undertaken to determine the most appropriate location and, as part of the appraisal, all three local Hubs has been considered. The service at Belmont Walk-in Centre had only recently been opened and needed embedding. Any other plans that would involve the rolling out of any further changes would be reported back;
- the impact of the change would be monitored and reported to the next meeting of the Sub-Committee. The impact of the change on transient patients had been considered. Non-Harrow patients would need to de-register and register again in a Harrow Practice should they want to continue to use Alexandra Avenue for GP appointments or they could use one of the two alternative Walk-in Centres in Harrow. The options appraisal, EIA and EqIA were intended to minimise and mitigate the impact.
The Leader of the Council was concerned about the post code lottery in healthcare and that he had previously been informed that anyone registered in Harrow would also be able to access the appointment system and even if they were registered in another borough.
Another representative of the CCG reported that it was important that the GPs in walk-in centres were able to access medical records of patients but that they could only access these if the patient was registered with a GP in the borough. This pathway was the preferred option and followed the national directive. For example, the medical records of those registered with a GP in Ealing or Hillingdon would not be available to the GPs at Alexandra Avenue Health and Social Care Centre. Patient care and the quality and safety of care provided were important. Continuity of care was crucial, especially for patients with long term or terminal conditions.
Members and advisers of the Sub-Committee, including the Leader of the Council, made the following comments and asked additional questions:
- patients were not always able to telephone during working hours. How would they be able to make appointments;
- would the change require additional GPs to be employed at the Centre;
- it was appreciated that the GPs needed to know a patient’s background to make an informed diagnoses but this issue could have been resolved by the provision of printed notes until an all inclusive electronic access system was available;
- would the change result in increased costs;
- what would happen to those who would no longer be able to walk-in to the Centre to obtain medical care;
- how was the issue of provision of parking being addressed and had any representations been made to the Transport for London (TfL) for additional bus routes;
- the number of appointments at the Centre would drop from 40,000 to 20,000 which would result in a large number of patients being disadvantage by the change.
A representative of the CCG explained that primary care services could be accessed in two ways – an online appointment system via the GP or by telephoning the 111 service which would prioritise sick or injured people according to the seriousness of the condition or injury (triage) and allocate an appointment. Overall, it was expected that this would result in better use of a patient’s time. The number of appointments available was not expected to reduce but that the new system would mean that people could not walk-in for an appointment. It was essentially redirecting individuals to their own GP. The change would not result in increased costs. It would create extra capacity to support Primary Care for Harrow registered patients.
Members were informed that should individuals walk-in to the Centre from 1 November, their clinical needs would be assessed. If they were in need of immediate care, it would be provided. Any person attending with an immediate, urgent or life threatening condition would be treated immediately in any setting as part of the CCGs duty of care. Otherwise, they would be directed to their own GP or the 111 service. Members noted that the CCG would support any lobbying for additional bus routes.
An officer asked if an impact assessment had been carried out. A representative of the CCG replied that an Equality Impact Assessment (EqIA) and an EIA had been carried out and could be shared with the officer. She invited information on any communities impacted upon.
In concluding the discussion, a representative of the CCG stated that she understood the concerns expressed by Members and that her colleagues had had similar conversations prior to proposing the change. She assured Members that the impact of the provision would be monitored.
RESOLVED: That
(1) the verbal report be noted;
(2) the concerns expressed by the Sub-Committee and the assurances provided by Harrow CCG be noted.