Agenda item

Report of the NHS Harrow Clinical Commissioning Group.

The Sub-Committee received an information report of the Harrow Clinical Commissioning Group (CCG), which provided an update on the Alexandra Avenue GP Access Centre in relation to ‘Changes to Walk-in Services’ made in November 2018 and the impact of their implementation.  The changes had been aligned with the Urgent Care Strategy which the CCG had adopted.

A representative of NHS Harrow CCG introduced the report and outlined how the implementation of the Alexandra Avenue Walk-in Centre to a GP Access Centre had been launched and promoted, the benefits the change offered to patients in Harrow, how the change had been marketed, how appointments could be booked through both GP Practices in Harrow and the NHS 111 Service, including other Walk-in Centres and the Urgent Care/Treatment Centre.  He referred to the feedback received which had been included in the report.  He added that individuals who had ‘walked into’ the Centre had had their clinical needs assessed and were briefed on how they could access medical care in the future as a result of the changes made.

The representative added that during the first two months, 85% of available appointments had been booked for Monday-Friday but the appointments during the weekends remained largely unused.  The CCG was working with NHS 111 and the Urgent Care Centre to ensure that the capacity at the Access Centre was effectively used and to help reduce the burden on the Urgent Care Centre and the A&E Services, particularly during the winter months.

The Sub-Committee was also informed that there was no evidence that the change to an Access Centre had had any material impact on the services provided both before and after the change.  Data had shown that patients presenting themselves to the various medical services were presenting themselves to the correct service in light of their condition.  It had been noted that there had been an increase in the number of younger patients presenting themselves to the A&E Service and that, year on year, there had been a 14% increase in Brent patients.

The representative from Harrow CCG added that recent data had shown that the usage at Alexandra Avenue GP Access Centre had gone up to 96% and the CCG was working to ensure maximum utilisation.

·                     What had been the impact on the two Walk-in Centres in Harrow?  Was it correct hat the CCG was looking to take out £1m from the medical centre budget?  Would the Walk-in Centres in Harrow be changed to GP Access Centres?

The representative from the CCG stated that the situation at Belmont Walk-in and Pinn Medical Centres had remained static.  In relation to the budget, he was not aware of any such information but undertook to provide details and clarification in this regard.  A Medical Committee, as part of a PMS (Personal Medical Services) Contract Review (part of a wider development of primary care services), would ensure that matters were dealt with as equitably as possible and that patients were not disadvantaged.

The Member concerned stated that he had heard different views regarding the budget and it was important that the correct information was shared with partners.  The CCG representative stated that he would ask his colleague dealing with this area to provide a summary document in this regard as he did not want to mislead the Sub-Committee.

An adviser referred to the PMS process and stated that not every General Practice in Harrow had applied for the contract.  The PMS Contract (what GPs could do over and above the core services provided) was in addition to the GMS Contract.  There had been a national drive to make the PMS process equitable and General Practices were being asked to return the extra payments and to re-apply.  It was likely that the money added up to £1m.  It was important to ensure that during the re-application stage, all General Practices were given an opportunity to apply to ensure that the money went to the primary care services rather than the CCG.

·                     A large number of housing developments were taking place in Harrow and the population would increase.  How was the CCG planning forward and addressing the issue of patient care when budgets were tight?

The infrastructure would include General Practice, which was the basis of delivering medical care. Funding from NHS England was directly linked to the population.  Additionally, primary care was undergoing change.  The CCG was looking at various housing development sites, such as the Kodak and Belmont sites, with a view to providing effective medical care in those areas.  The CCG would also look at the overall growth in the population, including the growth in both the older and young populations to ensure that all had equal access to medical care.

An adviser clarified that funding for General Practice was provided by the NHS England.  He was of the view that patients, occasionally, inappropriately went to the Alexandra Avenue GP Access Centre as they were not triaged and continual care would not be followed up.

Moreover, the Access Centre was not able to refer patients to other medical services, such as secondary care.  He pointed out that patients still went to see their GP after attending the Alexandra Avenue Access Centre.  He suggested an audit of patient care.

He questioned why the CCG was adding money to GP Services which should be provided by General Practitioners.  He suggested a study on what level of capacity each General Practice in Harrow provided and relate it to those who utilised the services.

In response, the CCG representative stated that he would relay the point on carrying out a study on capacity back to his colleague.  He acknowledged that  NHS England funded the General Practices.  The CCG would consider requests from ‘courageous’ General Practices that wanted to enhance services, thereby improving primary care service provision.  The CCG would evaluate service models for quality.  The provision of GP Access Centres was to start a journey for improved primary care provision and to manage demand. 

The Adviser was of the view that it would be better if services were devolved to General Practices rather than providing them at the Alexandra Avenue GP Access Centre.  He questioned whether there had been a conflict of interest when decisions were made to change Alexandra Avenue from a Walk-in Centre to a GP Access Centre.  In response, the CCG representative stated that conflicts of interests were managed and the relevant people would have ‘excused’ themselves from decision-making.

·                     How many patients (ie those that were not registered with a Harrow GP) had been turned away from the Alexandra Avenue GP Access Centre?  What was the year on year comparative data?

The representative from the CCG undertook to provide the data separately.  He added that the CCG was also tracking the number of patients presenting themselves to A&E but that the figure had not increased.  He explained that the impact of change would be measured and year on year data would be provided. He undertook to share the previous year’s figures.  Additionally, the CCG would not look at the volume of patients but also which areas they were coming from.  He informed Members that only one person arriving as a ‘Walk-in patient’ at the Alexandra Avenue GP Access Centre had been asked to leave and he explained the circumstances behind this.

·                     What was the capacity at Alexandra Avenue GP Access Centre and did the Centre see enough patients?  Were patients losing out due to the appointment only system and were they presenting themselves at Urgent Care Centre(s) or A&E instead?

Members were informed that further work was required on the appointments system, particularly relating to the weekend.  A 100% utilisation was not expected and it was important to retain some gaps.

A Member asked why the appointments were not being utilised.  In response, the representative from the CCG reported that approximately 20-30 appointments were not being taken up and that these could be shifted to during the week when the take up rates were high.  The representative added that the situation would be monitored as the weekend take up had improved in January 2019.  He was of the view that it was important for the service to embed for six months and he would report back on the situation.

·                     Alexandra Avenue Centre was a large building.  How was it being utilised?

The representative from the CCG stated that the CCG would be using the building for other services.  He reported that community clinics for outpatients were also held at the premises and it was intended to introduce ENT Clinics there in order to increase capacity.  Other services were also being considered.

·                     When scrutiny did its review of access to primary care in 2017, Members were alerted to the then new Harrow Health Now app that residents could use to assess their own health concerns in the first instance – had this been promoted any further to align with the changes to primary care access in the borough?

The NHS CCG representative undertook to report back.

·                     The NHS Long Term Plan was published in January – how do the changes planned/implemented in Harrow fit the national strategies for primary care and urgent care?

The representative from the CCG referred to the 10-year Plan, which his colleague was working on.  He referred to the intervention programme for urgent care and referred to the services provided at Honeypot Medical Centre.  He added that consideration had also been given to how best to help elderly patients.  The CCG was testing out a number of theories with a view to expanding services.

The Chair thanked the representative from the CCG for attending the meeting and answering questions.

RESOLVED:  That the report be noted and that a further written report capturing all the issues raised at the meeting, including how have these issues and the change at Alexandra Avenue GP Access Centre impacted on CCG’s plans for primary care provision in the medium and longer term, be submitted to the June 2019 meeting of the Sub-Committee.