1. Access to Urgent Care and GP services
General Public

2. This session:
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
Updates for St Albans:
Rolling out urgent care approach
GP extended access

3. Setting the scene

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

5. 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

6. 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
Hertsmere
Watford
& Three Rivers
Dacorum
St Albans
Dacorum
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
St Albans & Harpenden
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

7. St Albans

8. Rolling out urgent care in St Albans
Phase one
Discussions Locality GP leads / Locality GP’s / SAPG:
Acknowledge area patterns of urgent care access /use of existing resources
Agreed on Urgent treatment approach, starting from locality bases
Outline plan for discussion with locality by end of March
Phase two
Discussion as part of UTC & WHMC public consultation
Consider feedback options for outline plan
Discuss outline plan with Locality GPs/ SAPG
Agree plans with WHHT re: staffing/ area use / equipment
Potential for development of community based urgent care services
Agree plan and stepped approach for implementation
Phase three
Implementation
Extended Access rollout - Use of MIU as one of the Extended Access Hubs
Base development for Urgent Treatment access point
Options for utilising Minor Injuries Unit (St Albans)
Development of multi-disciplinary approach
Modelling for best use of Urgent Treatment access points

9. Consultation on Hemel Hempstead UTC and West Herts Medical Centre

10. Urgent care and GP 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

11. 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 hours (contracted hours)

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

13. 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
Urgent Treatment Centre
NHS 111
Clinical Assessment Service
NHS 111
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
Out-of-hours GP
Clinical Assessment Service
Less demand
Peak demand

14. Average UCC/UTC Attendance per day by hour of the day
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
N/A
7.2
5.3
0.0
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

15. West Herts Medical Centre consultation
WHMC established in 2009 on a time limited contract - expires October 2018
Walk-in (approx 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

16. Overview of options:
Option 1: Do not renew the contract and support 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

17. 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

18. 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?

19. Consultation and decision-making
Eight week consultation to 28 March 2018
CCG website has information, event details and online questionnaire
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