Agenda item

Report of the Managing Director, Harrow Clinical Commissioning Group.

The Committee received a report of the Managing Director, Harrow CCG (Clinical Commissioning Group), updating the Committee on the Review by Harrow CCG of the existing Walk-in provision at Pinn Medical Centre and Belmont Health Centre and the proposed change of both medical facilities to GP Access Centres in 2019, subject to the approval of the CCG Governing Body.

In accordance with Committee Procedure Rule 4.1, the Committee agreed that the Chair of the Health and Social Care Scrutiny Sub-Committee who was not a member of the Overview and Scrutiny Committee be allowed to address the meeting in respect of this item.  Another Member who was not a member of the Committee was also allowed to address the meeting.  The report on the Walk-in Centre ought to have been submitted to the Health and Social Care Scrutiny Sub-Committee at its meeting in November 2019 but had been brought forward to this meeting to allow for its earlier consideration because the decision of the CCG Governing Body was imminent.

The Managing Director of Harrow CCG introduced the report and drew out the salient points from her report.  She explained the rationale behind the proposed changes and reported that:

-               the direction of travel for all health services was set by NHS England;

-               the changes proposed to the Walk-in Centres would give local residents better access to services and continuity of care which was central to the proposals;

-               the changes made to Alexandra Avenue Walk-in Centre had been well received and the change from a Walk-in and Wait Service to an appointment only service for Harrow residents had been beneficial to local residents as shown in a recent survey. Similar changes were planned for the Belmont Health Centre from November 2019;

-               a resolution of a contractual dispute at Pinn Medical Centre would dictate the implementation date.

Members of the Committee asked questions on how they could influence the decision, savings that would be made as a result of the changes and the cost of the changes proposed.  The Managing Director of Harrow CCG responded as follows:

-               given the direction of travel and the requirement for the CCG to adhere to the guidance issued by NHS England, Councillors were not in a position to have any influence on the proposals except that the CCG would welcome any assistance and support that Councillors could provide to help get the message across to their constituents and to help change public behaviour.  The opening hours for the two Centres would remain the same;

-               given the financial situation of Harrow CCG, which was in deficit of £29.4m, no savings would result from the proposals.  The money from PMS (Personal Medical Services) would be ring-fenced towards support for primary care.  As part of the PMS Review, a sum of £1.9m was available for distribution across 33 practices in Harrow;

-               the proposed changes were expected to cost £47,000.

The Chair and Vice-Chair of Harrow CCG’s Governing Body together with the Managing Director of Harrow CCG and another representative of the CCG responded to additional questions from Members of the Committee.  They explained that:

-               it was not intended to take money out of the service area but to distribute it, as it was not viable for one centre to have two walk-in centre facilities and the intention was to make additional facilities available in the Centres;

-               communication was an issue and GP surgeries were at the forefront and key to getting the message through to their patients.  The CCG did not have such visibility, except through its range of Forums, but to take on board communications which were key for all residents;

-               residents had been anxious about the changes that had been proposed at Alexandra Avenue but their concerns were minimised once the rationale behind the changes had been communicated by the CCG to all stakeholders.  However, lessons had been learnt from this experience and it was recognised that there was a need to be open and upfront at the outset when making changes.  Petitions had been received from residents and GPs were also entitled to voice their opinions.  Any suggestions from Councillors that would help improve future communications would be welcomed;

-               the cost of using a Walk-in Centre was £20 - £25 per patient and for minor injuries it was £51 - £70.  Moreover, the continuity of care was lacking when patients living outside the borough used the Walk-in Centres as patient records were not currently accessible;

-               other than Harrow CCG, no other CCGs had been fortunate to have had so many Walk-in Centres.  Change was always difficult to accept and manage. However, the changes made at Alexandra Avenue had proved to be fruitful and the proposed changes at Pinn Medical Centre and Belmont Health Centre would also help improve patient safety and access;

-               the CCG was confident that the proposed changes would provide a better service to the residents of Harrow.  A Member agreed with this sentiment and stated that, as local ambassadors, it was important to get this message across to constituents;

-               those Harrow residents who were not registered with a GP, would be assisted in the following ways: they would be encouraged to register; assisted and supported to allow them to make contact with local charities; and, should they have a medical emergency, they would be seen by a GP or assisted in the appropriate way;

-               to ensure good clinical care, it was essential to register with a GP.  A raft of services would then be available and people need to be encouraged to register.  People were under an impression that, in order to register with a GP, various documentation was be required but this was not the case and this message need to be publicised further;

-               the decision on the proposals would be made the following day by the CCG’s Governing Body.  The impact of change would be measured and there would be ongoing reviews.  There were many levels of monitoring undertaken in order to ensure improvement in care and patient safety when the change was carried out at Alexandra Avenue. The Governing Body were going to be asked to for an implementation date of 1 November 2019 for Belmont Health Centre. The Pinn Medical Centre was on hold whilst discussions were resolved with the PMS contract;

-               patients would be supported if they needed access to Urgent Care Treatment Centres and associated costs would be reimbursed.  Patient Champions would also assist in the process.  Risks were assessed with a view to minimising them and risks were regularly monitored.  Any issues would also be reported back to the Council’s Health and Wellbeing Board;

-               the provision of GP Access Centres was a better way forward as there were no filter systems in place at Walk-in Centres.  The Access Centres would help triage patients and remain open from 8.00 am – 8.00 pm.  The care provided would be better as GPs would only be seeing patients who had registered with a surgery in Harrow and would have access to patient records. All CCGs in North-West London were now providing GP Access Centres and registered patients in each borough could access these;

-               inequality in the provision of health was evident through out the world.  Life expectancy in Harrow varied and was dependant on the area.  Inequality was associated mainly with inadequate housing, unemployment and poor relationships.  There were 270,000 people registered with a GP in Harrow and it was important to recognise that the Council and the CCG were talking about different populations when raising the issue of inequality;

-               the CCG was not complacent and recognised that the health system was difficult to navigate.  There was a need for all to understand on how best to access the various services.  No GP surgeries in Harrow were full and new registration was welcomed.  The 111 Service was an incredibly safe one as the repercussions of making a mistake were enormous.  However, they often defaulted to directing patients to A & E as they worked on a safety first principle.  The NHS Choices website provided information on registration.

A Member highlighted the importance of communicating that Harrow GP surgeries were taking registration of new patients.  He asked if there was any evidence, other than the survey carried out at Alexandra Avenue, which showed that the proposed changes would benefit Harrow residents.  He asked about outcomes and accessibility of services.  He had reservations when services were classified as ‘excellent’ such as that referenced to in the report in respect of the changes made at Alexandra Avenue and asked how representative the samples used were in order to avoid bias. 

In response, a representative of the CCG reported that outcomes were better as continued care could be given to patients who were also able to make appointments at a time that suited them.  The Vice-Chair of Harrow CCG’s Governing Body explained how Walk-in Centres had worked adversely for doctors and assured the Committee that the proposed move to Access Centres was a safer alternative.  The Managing Director of Harrow CCG explained how the survey had been conducted but only 150 people had responded.  She welcomed suggestions from Members on how the survey ought to be conducted in the future and ways in which the questionnaire could be improved.

A Co-opted Member was of the view that for the model to succeed, a change in people behaviour was required but that education and communication were key to changes in behaviours.  She added that the change in the model would result in reduced choices and, by withdrawing a layer of service, the proposed changes would ultimately result in pressures on other health services such as the A & E and Urgent Treatment Centres.  Education was fundamental to ensuring that other services were not disadvantaged as a result of proposed changes to Pinn Medical Centre and Belmont Health Centre.  A gap in education would also result due to the previous increased use of the Centres by non-Harrow residents.

The Managing Director of Harrow CCG stated that the CCG would welcome any help in this area and recognised that an open and honest communication was necessary.  She explained how other CCGs were addressing this issue and added that there was no obligation on a surgery to treat those living out of the borough unless the person required urgent medical treatment.

Some Members expressed concerns and challenged the rationale behind the proposed changes. A Member was of the view that existing services were valued and used appropriately and the proposed changes would result in residents waiting to be seen in A&E.

The Chair of the Health and Social Care Scrutiny Sub-Committee was proud of the NHS and agreed that education was key. She was appreciative of the service she had received. She also thanked the CCG for their attendance at the Committee that evening and supported the proposed change.

The Chair of the Overview and Scrutiny Committee expressed concern that services were being limited to residents when the NHS was universal and open to all.  Better health care provision was required in some areas to address the issue of inequality.  With reference to the response to the first question, he stated that it was the remit of the Overview and Scrutiny Committee to scrutinise decisions, not to “help get the message across”. The Chair of Harrow CCG’s Governing Body recognised the need to improve IT systems which would allow patient records to be accessed across boundaries.  She added that some practices received large amounts of money but this was not based on factors such as depravation, but on how funding requests had been made and allocated previously.  The proposed changes would allow for the redistribution of £1.9m across Harrow and make patient care a priority.

The Chair of the Overview and Scrutiny Committee thanked all for their participation and attendance.

RESOLVED:  That

(1)          the update on the review by Harrow CCG of the existing Walk-in Centre provision at Pinn Medical Centre and Belmont Health Centre be noted;

(2)               it be noted that the proposal to change Belmont Health Centre (in November 2019) and the Pinn Medical Centre (at a date to be confirmed) to GP Access Centres was subject to the approval of Harrow CCG’s Governing Body.