Report of the Managing Director, NHS Harrow CCG.
Minutes:
The Sub-Committee received a verbal report on the Pinn Medical Centre from representatives of Harrow CCG (Clinical Commissioning Group) present at the meeting. Members were informed that:
- the direction of travel for all health services was set by NHS England and in order to adhere to the guidance, the CCG had changed two of the three Walk-In Centres in Harrow to GP Access Centres. The Alexandra Avenue Health and Social Care Centre had changed in November 2018 and the Belmont Health Centre in November 2019;
- the CCG had recently decided to retain the Walk-In Services at the Pinn Medical Centre. The decision had been based on the volume of representations received.
Prior to the consideration of the report, in accordance with Committee Procedure Rule 4.1 of the Council’s Constitution, Members had agreed that Councillors who were not members of the Sub-Committee be allowed to address the meeting in respect of this item. A number of Councillors had indicated their wish to speak on this item. The Chair initially invited Members of the Sub-Committee to ask questions.
Q1 – How would the Pinn Medical Centre be funded? Would the money that would have been saved as a result of changing the Centre to a GP Access Centre been distributed amongst Harrow GP Practices?
A representative of the CCG stated that there were two elements to the funding. Funding was available for patients registered with the Pinn Medical Centre and a separate element available for those not registered with this Centre. The Walk-In services would be available to all, including non-Harrow residents. Central to the proposals for change to GP Access Centres was to give local residents better access to services and provide continuity of care. It was not intended to be a money saving exercise.
Q2 - Would the Walk-In Service at the Pinn Medical Centre remain open indefinitely or for a fixed period?
A representative of the CCG replied that discussions between the CCG and the Pinn Medical Centre had not yet concluded, including how the services would be reviewed. To ensure flexibility, the CCG was working to a 5-year plan but it was recognised that the situation might alter due to changes in legislation and government plans.
Q3 – What had changed between the decisions made in 2018/19 and the recent decision in respect of the Pinn Medical Centre?
A representative of the CCG explained that representations received from and in relation to the Pinn Medical Centre, by way of patient engagement, had resulted in the decision to retain the premises as a Walk-In Centre. The changes to Alexandra and Belmont had been achieved through collaboration.
Q3 – Did the maintaining of Walk-In services in one part of the borough yet removing them from other parts mean a postcode lottery in local healthcare?
A representative of the CCG stated that it was too early to provide a response to this question. It was important to recognise that all patients in Harrow and elsewhere would have access to the various Walk-In Centres such as the Pinn, one at Edgware and the Urgent Care Centre at Northwick Park Hospital. Anyone from Harrow - whether or not they were registered with a GP - could access all three Centres.
Q4 – How easy was it to register with a Harrow GP or change to another?
A representative of the CCG replied that all GP practices were open to see new patients. Patients could complete their applications online. They could also switch to another GP and the facility was available online. Online applications provided a quicker way of achieving a change.
Q5 - It was not always possible to book an appointment at Walk-In Centres. As a result, patients attended the Urgent Care Centre at Northwick Park Hospital. What impact was this having on patients who then resorted to the A&E?
In response, representatives of the CCG stated that:
- when feeling unwell, patients should always contact their GP as this was considered to be a ‘gold standard’ service. Some 40,000 appointments were available at the two GP Access Centres in Harrow. Flexibility was built-in at Walk-In Centres, which provided a mixture of appointments;
- patients should always try their GP first prior to resorting to the Urgent Care Centre or the A&E;
- the GP Practices worked as a team and there was a skill mix available at most Practices, such as a doctor, pharmacist and nurse. The diversity within the team allowed patients to access various services within a single unit.
Q6 – Equalities Impact Assessments (EqIAs)had been completed for Alexandra Avenue and Belmont – was an EQIA completed for the Pinn Medical Centre to help inform decisions?
In response to the Chair’s question, a representative of the CCG informed Members that an EqIA in respect of the Pinn Medical Centre had been initiated but was not completed due to the recent decision to retain the Centre as a Walk-In facility.
Q7 – How could Councillors help to explain messages to residents about the changes, especially regarding better access and improved outcomes?
A representative of the CCG explained that where patients were not sure how to access medical services, they could telephone the NHS 111 Service who would guide them and provide advice on how to navigate the various services. The NHS 111 Service would support decision-making and help redirect patients to the most appropriate service.
Additionally, the representative explained the role of patient ‘champions’ who would help with various questions such as registering with a GP.
The Chair then invited Councillors who were not members of the Sub-Committee to ask questions of the representatives of Harrow CCG. During questioning, some Councillors also related personal experiences when accessing GPs.
In response to the questions about funding, charging, GP catchment areas, making appointments through the NHS 111 Service, representatives of the CCG stated that:
- all CCGs charged for the services provided to patients from different areas. The CCGs would prefer patients to access their own GPs but would not stop them from accessing Walk-In Centres. In respect of the Pinn Medical Centre, it had become apparent that, in order to maintain the dynamics, it was essential to retain it as a Walk-In Centre instead of a GP Access Centre;
- patients could change their GP if they were not satisfied with the service provided. It would not always be possible to make a same day appointment due to pressures and booking in advance might not help as it would not necessarily allow you to see a GP on the day your require their service;
- patients who lived in Harrow and were registered with a Harrow GP could make an appointment at the two GP Access Centres based in Harrow. These Access Centres would have access to the patients’ medical records. However, if patients from another borough wanted to access the Walk-In facility at the Pinn Medical Centre, their medical records would not be accessible by the staff at the Pinn;
- the NHS 111 Service would help direct patients to the correct surgery or medical facility. The NHS 111 Service could also book appointments for a patient;
- in relation to the personal experience and the difficulties experienced by a Councillor when trying to book an appointment through the NHS 111 Service, the representative undertook to investigate why it had not been possible for the Service to book the appointment at her own GP Practice when one was available.
In response to additional questions about the difference in the representations received in respect of the Centres at Alexandra Avenue and Belmont when compared to the Pinn Medical Centre, representatives of the CCG reported that:
- the volume of representations in respect of the Pinn Medical Centre had made it challenging to change it from a Walk-In Centre to a GP Access Centre. A large petition had been received against the change. In respect of the Centres at Alexandra Avenue and Belmont, the CCG had worked with the providers to move from existing models of Walk-In Centres to GP Access Centres. Patients at both these Centres had also supported the change;
- the CCG was in in discussions with the Pinn Medical Centre and that until these discussions had been concluded, it was not able to answer some of the questions, including those relating to the financing arrangements. Option appraisals had been undertaken and were under discussion between the two parties. Once the discussion had concluded, the CCG would publicise the outcome and present these to the Sub-Committee and the Council’s Health and Wellbeing Board.
In response to questions about the payment systems, appointments and the number of patients including pro-rata payments from the same Councillor, representatives of the CCG stated that the CCG would like to retain the Pinn Medical Centre as a Walk-In facility and to increase the number of appointments. This would help ensure accessibility and equity of service. A representative reiterated that negotiations were underway and answers to some of the questions could only be provided once these had been completed.
Another Councillor referred to the ‘repatriation’ of patients by Hillingdon CCG and whether other CCGs would be following suit, particularly those neighbouring Hillingdon. In response, representatives of Harrow CCG informed the Sub-Committee Watford and Hertfordshire were expected to follow. Each CCG was funding GP Access Centres with a view to ‘bringing-in’ patients to their own Centres. In respect of a further question about the future of the Pinn Medical Centre in such circumstances, a representative of the CCG explained that it was likely that the Pinn would only see Harrow patients if the services were not required by others currently using it. Access to medical notes might remain an issue.
Members of the Sub-Committee asked additional questions and representatives of Harrow CCG responded as follows:
- each GP Practice was run as an entity and was not required to provide information on appointments. The CCG did not monitor the appointments at GP surgeries. No such data was kept by the CCG but Practices were required to keep open some slots for the NHS 111 Service to book. More recently, the CCG was working with Practices to find out how patients were accessing services and the data was being presented back. For example, it had become evident that students from the Kenton area were using the A&E more which was due to the hours of opening of the Practices in the area. In order to manage this situation, Practices in Kenton were now open longer during the evenings;
- the contract for GPs was a national one and set by the BMA (British Medical Association). The CCG did not have powers to gain access to appointments at GP Practices. However, scrutiny would increase and it was important to note that appointment were not ‘wasted’ as GPs spent their time in other ways but the CCG recognised the costs attached;
- the number of people who had signed the petition in relation to the Pinn Medical Centre was in the region of 21,000 compared to up to 15,000 each for Alexandra Avenue and Belmont Centres. However, exact figures would be provided after the meeting, including the number of people who had been surveyed and how these were conducted.
In conclusion, the Chair thanked representatives of the CCG for their attendance and she was pleased to learn that the Pinn Medical Centre would be retained as a Walk-In Centre.