THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Board Paper - Cover Sheet
Date 23rdMarch 2016 / Report Title North Tyneside Urgent Care Consultation / Agenda Item A7(ii)
Lead Director
Report Author / Louise Robson, Executive Director of Business and Development
Kate Simpson, Deputy Director of Business and Development
Classification / NHS Unclassified
Purpose (Tick one only) / Approval / Discussion / For Information
Links to Strategic Objectives / North Tyneside CCG’s Urgent Care Strategy
Newcastle Hospitals Out of Hospital Agenda
Putting patients and carers at the centre of everything we do
Maintain financial viability
Links to CQC Domains/
Fundamental Standard(s) / North Tyneside’s proposed Urgent Care Centre should meet all of the CQC’s fundamental standards and domains, particularly effective and responsive services.
Consideration needs to be given as to whether the closure of Battle Hill or Rake Lane would make services less responsive or effective
Identified Risk? (If yes, risk reference) / Yes (Freeman Clinics)
Resource Implications / Potential:
· Loss of income for Freeman Clinics
· Battle Hill building owned by Newcastle Hospitals
· Newcastle Hospitals staff may need to be redeployed
Legal implications and equality and diversity assessment / Potential:
· Loss of service at either Battle Hill or Rake Lane
· TUPE of Freeman Clinics staff to a new provider
· CCG seeking advice re: procurement of the new Urgent Care Centre
Benefit to patients and the public / Consultation states that this will make it easier for people to navigate the Urgent Care system.
Closure of either Battle Hill or Rake Lane.
Report History / Previous updates to the Board on Urgent Care developments, consultation and Walk in Reviews. The Consultation ended January 21st 2016.
Next steps / The Trust Board is asked to i) receive the briefing and ii) note the content.
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
NORTH TYNESIDE URGENT CARE CONSULTATION
1. Introduction
The Board is aware of the recent consultation on the future of urgent care in North Tyneside and the potential changes to services in the locality. This paper provides an update on the consultation and procurement process as at 15th March 2016.
2. EXECUTIVE SUMMARY
Four potential scenarios are being proposed:
i) A single North Tyneside Urgent Care Centre based at North Tyneside General Hospital (Rake Lane).
ii) A single North Tyneside Urgent Care Centre based at Battle Hill.
iii) A single North Tyneside Urgent Care Centre based at North Tyneside General Hospital (Rake Lane) supported by locality based “minor ailments” services in the other 3 localities (Killingworth, Wallsend and Whitley Bay).
iv) A single North Tyneside Urgent Care Centre based at Battle Hill supported by locality based “minor ailments” services in the other 3 localities (Killingworth, North Shields and Whitley Bay).
As a result of these proposals the following services will be decommissioned (closed):
i) The Urgent Care Walk-in-Service (situated at North Tyneside General Hospital, Rake Lane).
ii) Walk-in-service at the Battle Hill Health Centre
iii) The Shiremoor Paediatric Minor Injuries Unit
In addition, consideration will be given to the North Tyneside contract for GP out of-hours services, provided by Northern Doctors Urgent Care in the light of recent national guidance on commissioning integrated GP Out of Hours and 111 services.
3. RECOMMENDATION
To i) receive the briefing and ii) note the content.
Kate Simpson
Deputy Director of Business & Development
Louise Robson
Executive Director of Business & Development
15th March 2016
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
NORTH TYNESIDE URGENT CARE CONSULTATION
1. Introduction
The Board is aware of the recent consultation on the future of urgent care in North Tyneside and the potential changes to services in the locality. This paper provides an update on the consultation and procurement process as at 15th March 2016.
2. SUMMARY OF PROPOSAL
Four potential scenarios are being proposed:
i) A single North Tyneside Urgent Care Centre based at North Tyneside General Hospital (Rake Lane)
ii) A single North Tyneside Urgent Care Centre based at Battle Hill
iii) A single North Tyneside Urgent Care Centre based at North Tyneside General Hospital (Rake Lane) supported by locality based “minor ailments” services in the other 3 localities (Killingworth, Wallsend and Whitley Bay)
iv) A single North Tyneside Urgent Care Centre based at Battle Hill supported by locality based “minor ailments” services in the other 3 localities (Killingworth, North Shields and Whitley Bay)
As a result of these proposals the following services will be decommissioned (closed):
i) The Urgent Care Walk-in-Service (situated at North Tyneside General Hospital, Rake Lane)
ii) Walk-in-service at the Battle Hill Health Centre
iii) The Shiremoor Paediatric Minor Injuries Unit
In addition, consideration will be given to the North Tyneside contract for GP out of-hours services, provided by Northern Doctors Urgent Care in the light of recent national guidance on commissioning integrated GP Out of Hours and 111 services.
3. CONSULTATION
The consultation closed on 21st January 2016. A response was submitted by the Chairman on behalf of the Board on 20th January 2016 and is attached at Appendix 1.
It was anticipated that feedback would be given to existing providers at a meeting scheduled for the 3rd March 2016. However, this was cancelled at short notice.
North Tyneside issued a statement as follows:
“We have been reviewing the timescales that we set out for the urgent care consultation and on reflection we feel that we need more time to really consider the detailed feedback that we received. This will include carrying out further analysis to ensure that we review the clinical evidence, the travel implications, financial challenges and the resources that we have available.
Once this process has been complete, then we will issue a revised timetable that will include new dates for the feedback event.
In the meantime, we would like to thank everybody for contributing to this process”.
4. PROCUREMENT
Whilst there has been no formal feedback from the consultation North Tyneside did issue a “Request for Information” (RFI) as a precursor to any future tender. Information requested was as follows:
1) Please could you briefly describe how as a provider you foresee the delivery of urgent care services that may incorporate; Out of Hours primary care services, Minor Injuries Unit services and Walk-in- urgent care primary care activity. Potential providers may wish to provide a diagram to support their response.
2) Please could you provide feedback in respect of the Scenarios which have been outlined in the Urgent Care Consultation Document
3) Information with regards to “Market Capability and Capacity” including organisational, financial and workforce information
4) The intended contractual model including indication of any partnership, collaboration or sub contracting arrangements
5) How could your proposed service model improve the economic, social and environmental well-being of the area?
6) Preferred contract length
7) Preferred payment mechanism; Financial risks and considerations
8) Mobilisation; Time to mobilise, main challenges and risks to mobilisation and support needed to mobilise from the CCG
9) Details of premises and Information Management Systems
10) Barriers to integration of the “Urgent Care Landscape”
11) High level service risks associated with the proposed model
The Trust, along with other providers including Freeman Clinics, submitted information as part of this RFI although this was necessarily limited due to the lack of relevant information currently available from the CCG e.g. details of the agreed clinical model, the future location(s), the likely procurement process and potential implications such as TUPE.
The Trust was subsequently invited to a 1:1 with the CCG and NECs representatives on the 28th January 2016 to discuss the RFI in more detail.
More recently CCG and NECs staff from the Service Planning and Reform team have visited Battle Hill to meet with some of the clinicians to discuss “the types and volumes of activity currently coming through the walk-in centre and helping to identify any gaps in our current thinking”.
The Board will be updated as and when any further information around the consultation outcomes or future procurement is available.
5. RECOMMENDATION
To i) receive the briefing and ii) note the content.
Kate Simpson
Deputy Director of Business & Development
Louise Robson
Executive Director of Business & Development
15th March 2016
NHS Foundation Trust
Headquarters
Freeman Hospital
High Heaton
Newcastle upon Tyne
NE7 7DN
Tel: 0191 233 6161
20th January 2016
Dear Sir,
Response to North Tyneside Urgent Care Consultation from the Newcastle upon Tyne Hospitals NHS Foundation Trust
The Newcastle upon Tyne Hospitals NHS Foundation Trust does welcome the opportunity to comment on published proposals for changes to the provision of “Urgent Care” in the North Tyneside population catchment.
Prior to commencing public consultation, perhaps it would have been appropriate to undertake a full assessment of the population requirements and the true current costs of the services at Battle Hill and Rake Lane as well as considering the impact on other services from the proposed changes. Nevertheless, we are pleased to be given this opportunity to comment.
i) What are your views on the clinical model for an urgent care centre?
The Urgent Care Centre concept is in line with national policy and available evidence. In general terms, the Trust feels that the service principles are appropriate and in line with public views. However, there are a number of exceptions which are set out below;
· The current Walk-In model enables patients to wait to be seen whereas the proposal does not make clear that this will remain the case. Whilst it is proposed that patients can walk in, as well as being referred initially, the focus appears to be on bookable appointments post-triage. We know from patient feedback that some patients prefer to wait to be seen (for convenience or concern especially the parents of young children) and, if given a later appointment, are likely to present at other services, especially the Great North Children’s Hospital and the Major Trauma & Emergency Centre at the Royal Victoria Infirmary (RVI).
· The proposal suggests medical cover 24/7. Although this is clearly desirable from the public point of view, we are not aware of any analysis undertaken of existing or likely demand at different times of day. It may well be that between 12am and 6pm existing A&E services provide effective medical cover for the small number of primary care patients presenting at this time and provision of this at the Urgent Care Centre may be unnecessary duplication.
Whilst appreciating that the model is still under development, there needs to be greater clarity around access to mental health services (these are listed under the conditions to be treated but not mentioned in the diagrams or workforce specification) and clear distinction around what constitutes minor ailment services, as we know that this frequently creates confusion for patients and their families, as well as health professionals.
The Trust would also support co-location of pharmacy and out of hours GP services at the proposed Urgent Care Centre.
Overall, the clinical model could be more ambitious in terms of potential changes to meet the needs of local people, as it largely represents a transfer of existing services between locations. For example it may also be helpful to give some consideration to services other than the existing portfolio in primary care which are currently provided elsewhere that could be safely managed in primary care. The Urgent Care Centre could provide an opportunity to extend services beyond what is currently done in order to reflect the aspiration of the North Tyneside health and care system to address local population needs.
ii) What are your views on scenario one and scenario two?
There is no obvious difference between the two scenarios other than the physical location (which is addressed in question iv) below).
It is unclear how it was determined that there should only be one Urgent Care Centre for the Borough and how this decision best serves the needs of local people. Therefore it can be concluded that apparent affordability is the only key driver for change and this appears to have been determined solely based on existing activity information from the current locations. The assessment itself could be considered flawed, as only 6 weeks data was available for the Rake Lane service.
An objective assessment of demand which is based on population characteristics and national evidence of population needs should be used to determine how many locations would be needed for the North Tyneside population. This would need to include addressing how predicted activity levels benchmark against other similar locations to ensure that an appropriate level of demand is being met and to be aware of any unmet demand locally.
iii) What are your views on scenario three and four?
Providing services as accessible and as close to home for patients as possible is a key national policy; and, taken on face value, four locations would seem better than one or two. However, this proposal is difficult to assess with the limited information as to the different service provision proposed between the hub and the spokes. Indeed the limitations placed by proposing only bookable appointments may also offer no added value to the public. It is unclear how four locations meets the affordability challenge.
iv) Where do you think the North Tyneside Urgent Care Centre should be located – Battle Hill, Rake Lane or Other - and explain why?
As stated earlier, the documents contain no objective assessment as to need within North Tyneside and demand is estimated based on existing facilities. A more objective assessment is critical to determine where the greatest need is within the Borough and therefore where services would be best located. Without this objective assessment, there is inevitably an element of subjectivity in any response to this question.
If it is proven that only one Urgent Care Centre is required in the North Tyneside Borough, then it should be located as geographically central as possible within the locality. However, location should also be influenced by population characteristics, particularly levels of need and deprivation. As such, the Battle Hill location would appear better placed than Rake Lane.