Consultation on Hemel Hempstead UTC and West Herts

Consultation on Hemel Hempstead UTC and West Herts Medical Centre Your Care, Your Future: Working together for a healthier west Herts

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 Your Care, Your Future: Working together for a healthier west Herts

Setting the scene Your Care, Your Future: Working together for a healthier west Herts

Access to urgent care Pharmacy 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 • Watford Extended Access scheme - GP appointments available to 10 pm weekdays. Appointments also available weekends and bank holidays. • Access to GP out-of-hours via NHS 111 • Free, confidential advice to help with many common illnesses and complaints. • Late opening pharmacists (up to 11 pm) + weekends too

NHS 111 / Clinical Assessment Service and Urgent Care Access to Urgent Care in the community Your Care, Your Future: Working together for a healthier west Herts

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 Your Care, Your Future: Working together for a healthier west Herts

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 GP led Urgent Treatment Centre onsite blood testing, x-ray, access to pathology, multidisciplinary team. Opened Dec 17 with ongoing development Dacorum Watford & Three Rivers GP/Consultant led Urgent Treatment Centre at Watford Hospital. Options for St Albans Watford & Three Rivers Hertsmere UTC development from GP in ED service with Watford locality, GP federation and hospital trust. All areas Joint protocols across services NHS 111, UTC, GPs, hospital A&E, Ambulance 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 Hertsmere Options for GP led Urgent Treatment Access points with options for PB and Borehamwood areas to locality group in March 18 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 • Health centre staffed by GPs nurse practitioners, treatment nurse and assessment nurse • Hours: 8 am - 8 pm every day • Temporary hours: 8 am to 10 pm (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 • 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 - 8 am – 10 pm (current temporary hours) • Option 2 - 8 am – 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 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 8 am to 10 pm General Practice and extended hours • Overnight or late shifts may mean GP can’t be in practice next morning 10 pm to 8 am Urgent Treatment Centre NHS 111 Clinical Assessment Service Peak demand Out-of-hours GP Less demand

Key considerations: Use of resources • Low levels of activity in the UCC after 10 pm (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 2015/16 by hour of the day 2016/17 2017/18 Total Av to date 15/16 16/17 17/18 12 am to <3 am to <6 am to <8 am 2. 4 1. 8 3. 1 1. 7 1. 2 2. 4 0. 0 7. 2 5. 3 0. 0 8 am to <12 pm to <3 pm to <6 pm to <10 pm 23. 0 15. 9 15. 2 20. 1 24. 3 15. 9 15. 6 21. 2 27. 5 18. 4 17. 4 21. 7 74. 2 76. 9 84. 9 10 pm to <12 am 3. 7 2. 8 0. 0

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 ü Streamline services ü Make best use of GP resource ü 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

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!