Consultation on Hemel Hempstead UTC and West Herts Medical Centre

Purpose of today Consultation on two services that serve residents across the whole of west Hertfordshire: Opening hours of Hemel Hempstead Urgent Treatment Centre Future provision at West Herts Medical Centre

Setting the scene

Access to urgent care Doctor / GP Free 24/7 NHS non-emergency number Calls answered by trained healthcare adviser, backed by a GP-led medical assessment team to make best decisions Can arrange visits from out-of-hours GPs or nurses 24/7 or book into appointments Advises on self-care or signposts to best service Will call ambulances directly in serious cases Doctor / GP Watford Extended Access scheme - GP appointments available to 10pm weekdays. Appointments also available weekends and bank holidays. Access to GP out-of-hours via NHS111 Pharmacy Free, confidential advice to help with many common illnesses and complaints. Late opening pharmacists (up to 11pm) + weekends too

Access to Urgent Care in the community NHS 111 / Clinical Assessment Service and Urgent Care Access to Urgent Care in the community

West Herts urgent care approach Treat urgent care needs locally and release pressure on A&E Making sure patients receive effective, timely care first time, in the right place. NHS 111 should be ‘front door’ into urgent care for patients Tailored approach for each locality

Urgent Treatment Centre Approach Aligned with national development for UTCs we are taking this approach as part of our Urgent Care Strategy UTC development across west Herts St Albans Dacorum Hertsmere Watford & Three Rivers Dacorum St Albans GP led Urgent Treatment Centre approach with onsite blood testing, access to x-ray. Hosting extended hours hub for St Albans locality Options for MIU development with Locality GP federation and WHHT. Plan to be in place by March 18 GP led Urgent Treatment Centre onsite blood testing, x-ray, access to pathology, multidisciplinary team. Opened Dec 17 with ongoing development Watford & Three Rivers GP/Consultant led Urgent Treatment Centre at Watford Hospital. Options for UTC development from GP in ED service with Watford locality, GP federation and hospital trust. Hertsmere Options for GP led Urgent Treatment Access points with options for PB and Borehamwood areas to locality group in March 18 All areas Joint protocols across services NHS111, UTC, GPs, hospital A&E, Ambulance Booked appointment systems Hemel Hempstead St Albans Watford Hertsmere Point of care testing Introducing point of care testing across all urgent treatment access points

GP and urgent care services at Hemel Hempstead Hospital Urgent Treatment Centre West Herts Medical Centre Led by GP working with emergency nurse practitioners, treatment nurse and assessment nurse Temporary hours: 8am to 10pm (official contract 24 hours) Supports range of urgent care needs Urgent Treatment Centre = ‘Urgent Care Centre Plus’: booked appointments via NHS 111 more on-site tests Health centre staffed by GPs Hours: 8am - 8pm every day 8,000 walk-in; 2,000 registered patients Fixed term contract ends October 2018

Urgent Treatment Centre consultation What hours should we provide for the Urgent Treatment Centre at Hemel Hempstead hospital? Three options: Option 1 - 8am – 10pm (current temporary hours) Option 2 - 8am – midnight Option 3 - 24 hours (contracted hours)

Considerations: Access to urgent care Various options for accessing urgent care throughout the day / night Urgent Treatment Centre 1 2 3 NHS 111 and the clinical assessment service/GP out-of-hours gives everyone access to 24 hour urgent care NHS 111 with Clinical Assessment Service GP (surgery hours) GP (out-of-hours) Pharmacy 8-10 10-12 12-2 2-4 4-6 6-8

Considerations: Use of GP time GPs at the heart of urgent care but big demands on their time 8am to 10pm Overnight or late shifts may mean GP can’t be in practice next morning General Practice and extended hours 10pm to 8am GPs at the heart of urgent care but huge demands on their time National shortage of GPs - west Herts below national average for number of GPs per patient Addressing shortfalls will take time – immediate pressures will continue, especially with extended hours Urgent Treatment Centre NHS 111 Clinical Assessment Service NHS 111 Out-of-hours GP Clinical Assessment Service Less demand Peak demand

Average UCC/UTC Attendance per day by hour of the day Key considerations: Use of resources Low levels of activity in the UCC after 10pm (when offered 24/7) Demand during core hours broadly the same. No big increase in A&E attendances or demand for out-of-hours. Apr - Mar Average UCC/UTC Attendance per day by hour of the day 2015/16 2016/17 2017/18 to date Total Av 15/16 Total Av 16/17 Total Av 17/18 12am to <3am 2.4 1.7 0.0 7.2 5.3 3am to <6am 1.8 1.2 6am to <8am 3.1 8am to <12pm 23.0 24.3 27.5 74.2 76.9 84.9 12pm to <3pm 15.9 18.4 3pm to <6pm 15.2 15.6 17.4 6pm to <10pm 20.1 21.2 21.7 10pm to <12am 3.7 2.8

West Herts Medical Centre consultation WHMC established in 2009 on a time limited contract - expires October 2018 Circa 2,000 registered patients Walk-in (circa 8,000 patients) to be merged with adjacent urgent treatment centre Streamline services Make best use of GP resource Patients benefit from enhanced service at UTC

Overview of options: Option 1: Do not renew the contract and support circa 2,000 registered patients to re-register with other practices Support patients who will require assistance in transferring and registering with GP practices whose boundary they live. Transitional (financial) support for GP practices registering patients transferring from West Herts Medical Centre Option 2: Renew the contract when it expires in October 2018 Undertake a full commercial and competitive procurement for a new contract, starting November 2018 The current contractor and other potential providers can bid Need to attract prospective bidders but small number of patients + short term contract (five year contract) so possibly less attractive

Summary Need to see both issues as part of a bigger picture – changes and improvements such as NHS 111 and GP extended hours GPs are at the heart of these services – need to make best use of their time and also NHS resources We have a duty to spend NHS money in a way that will bring the greatest benefit to patients Need to be realistic and find a viable solution Important to hear from patients and the public – views matter, but not a referendum

Questions?

Your views What are the pros and cons of each option? Which are the biggest factors for you? Are there any other issues that you think the CCG needs to consider?

Consultation and decision-making Eight week consultation to 28 March 2018 CCG website has information, event details and online questionnaire www.hertsvalleysccg.nhs.uk/urgentcareconsultation Paper questionnaire in Hemel Hempstead Hospital and GP surgeries Groups and organisations can send views in writing All feedback analysed by independent research company Responses presented to Herts Valleys CCG board for decision in May 2018

Thank your for your time! General Public