The Big Conversation – Urgent Care

Introduction A conversation with local people not a public consultation. We will undertake a formal consultation with options if we need to after we have heard what people have to say We want you to use your views and experiences to help us design urgent care services for the future Focus on this being a conversation and us hearing what people think. This will inform an online survey later in July which in turn will inform options and whether we need to undertake a formal public consultation. You are not likley to see any changes to services until 2020.

The decisions we will have to take The type and location of urgent care services in the future The service models that will serve our population in the future and how we best utilise community buildings Before we take these decisions we will: Review all the information we have gathered during our conversations Launch an online survey Develop options about the next steps Decide whether we need to proceed to formal consultation We will have to take decisions but want to inform options and ultimate decisions on what matters to local people

Process We want to understand more about people’s views and experiences. We have written an Issues Paper with more detail. It can be found on our website Community groups are being visited to understand the views of groups who use urgent care more than average We will review the information from these conversations and launch an online survey When we have all this information we will develop a set of options and decide whether we need a public consultation Public meetings – Ascot, Bracknell, Sandhurst, maidenhead, slough and Windsor Groups Overrepresented White (other) (2.2%) Pakistani ( 1%) Other Ethnic Group (2%) 45-59 (12%) 85-89 (2%) 75-84 (7%) 65-74 (3%)

What do we mean by urgent care? A condition or illness needing attention the same day, but that is not life-threatening or changing. Urgent care is NOT emergency care. Emergency care is suitable for people whose life is at immediate risk from severe illness, injury or serious worsening of a condition We have tested these definitions with a wider group of people including patients and feel this is clear

Why do things need to change?

Quality of Care We do not always achieve our constitutional standards We have heard that people can find it difficult to know which services to go to when they have an urgent need We have also heard that people can have difficulties in accessing appointments at their GP surgery We want to be able to provide care for people in mental health crisis in a timely manner and in the most appropriate place We will have to make sure our local services meet new national requirements for urgent care for example ,4 hour wait in the Emergency Department. The 4 hour target is in place as there is evidence that outcomes are better for people if they have an urgent need and they are seen in this time window which can impact on the quality of care and patient experience. We want to ensure that the sickest and most injured patients are able to access emergency care quickly and that all patients are able to be cared for on the same day, if their clinical need requires it. New national standards for UTCs are: available for at least 12 hours a day seven days a week, including bank holidays be staffed by a range of healthcare professionals, including GPs, nurses and others provide both pre-booked same day and “walk-in” appointments, with an emphasis on patients contacting 111 for a booked appointment help patients to self-care, providing health information and education provide a range of testing (such as blood tests and ECGs) and access to x-ray issue prescriptions where clinically appropriate and have access to mental health services be able to offer British sign language, interpretation and translation services

Changes in the needs of our population Advances in medicine and public health mean that people live longer than they used to Some people require care in hospital but many can stay at home with the correct support People are living with several long term conditions Advances in medicine - meaning that people also live longer with a number of long term conditions (e.g. diabetes, heart disease and dementia) and become increasingly frail. Examples of when people can stay at home and don’t need to be in hospital – COPD and Heart failure and support from wider health and social care through integrated teams We want to offer services in the community We want to work better together to identify and respond to those who are at risk of becoming hospitalised National evidence shows that patients who stay for a long period in hospital lose their independence and usual levels of fitness and health.

Meeting needs in the most appropriate way People often go to the Emergency Department because they are unclear where else they should go Some people who are admitted to hospital stay longer than they need to because effective arrangements are not in place at home If urgent care is delivered well, it can support people before they reach an emergency or crisis The way people access everything including booking holidays and ordering shopping is changing This leads to the Emergency Department being overcrowded, resulting in those needing emergency care waiting longer for critical treatment. People with a mental health problem often do not get the support they need at an early stage People are using mobile devices to access advice about their health. Some people also use technology to access assessments of their health.

Financial challenges The cost of providing NHS care is rising because:- the NHS is treating more people than ever before Costs are increasing at a greater pace than the additional money we receive We are spending money on maintaining old buildings, some of which are unused e.g. of why the NHs is treating more people – demand is increasing due to population changes and the way in which people expect services to be delivered. e.g. of why costs are increasing - to medical advances and the range of treatments available and

Workforce challenges There is a national shortage of qualified staff such as GPs, nurses, paramedics and therapists The age profile of current staff and high turnover rates add to the workforce challenges Demand for general practice is increasing rapidly. If things stayed the same we would require an additional 81 GPs in East Berkshire by 2020. Staff shortages due to to the high cost of living in our area. Nationwide GPs have 330 million consultations a year (a 10% increase in recent years). The high demand for general practice - workload pressures, flexible working patterns, sometimes negative media coverage makes recruitment and retention very difficult. so we need primary care staff such as nurses, pharmacists and GPs to work differently to support patients. Some practices are already grouping together to share skills and services collectively. E.g Community pharmacists in general practice advising patients on their medications.

Opportunities to do things differently We have an opportunity to commission a new model as the current contracts we have for urgent care services outside of hospital come to an end at the same time We may be able to access national money to improve the community estate across East Berkshire There are new national urgent care standards which local services will have to meet

What we want to understand Why people choose a particular urgent care service What is important to people about who they see for their urgent care needs What alternative services people would like to use What is important about location of services What is good about and what can be improved in current services Are there better ways of providing urgent care

How could Patient Groups help? Encourage your patients to have their say Attend public meetings Complete online surveys Become involved in virtual patient panel Circulate details of the engagement in your newsletter Work with your PPG to see how they could support engagement Volunteer to lead some of the conversations Help us to identify target groups to discuss with

Local events 15 June, 1 – 3 pm Open Learning Centre 19 June – 2.30 – 4.30 pm Lynwood 21 June – 7 – 8.30 pm Cover It Live 27 June - 7 – 8.30 pm Cover It Live 19 July – 6.30 – 8.30 pm Easthampstead Baptist

Keep In touch/ Find out more You will find more information and updates at https://www.eastberkshireccg.nhs.uk/our-work/transforming-urgent-care-services/ If you have any questions/ need any documentation in another format, please contact: eastberksccgs.enquiries@nhs.net or 01753 636 836