Report of the Director of Commissioning NHS Trafford Clinical Commissioning Group

This report provides the Health Scrutiny Committee with an update on the urgent care changes happening in Manchester in line with Greater Manchester and national strategy.

The Committee considered a report of the Director of Commissioning NHS Trafford Clinical Commissioning Group that updated Members on the urgent care changes happening in Manchester in line with Greater Manchester (GM) and national strategy.

The main points and themes within the report included: -

·         In response to Covid-19, there was a refresh of the GM Urgent Emergency Care (UEC) priorities, which included a 'UEC by Appointment’ model to reduce the risk of crowding within Emergency Departments (ED) with the principal aim of reducing the number of self-presenter attends by 25%;

·         Proving a description of the various elements of the programme that comprised of:

·         NHS 111 First

·         Streaming at the Front Door

·         Clinical Assessment Service

·         Virtual Clinical Hub

·         Urgent bookable appointments

·         Describing progress to date; and

·         Next steps.

Dr Manisha Kumar, Executive Clinical Director MHCC provided the Committee with an oral update on the Walk In Centre located in the city centre. She described that this facility was co-located in Boots and due to the available space and the numbers of people attending changes were required to ensure it remained COVID safe. She described that a Talk Before You Walk model would be introduced to manage patient flow at the site and minimise the risk of COVID infection. She described that a facility would still be provided for the most vulnerable patients to present and wait for treatment. The Chair thanked Dr Kumar for the update and commented that the Committee would consider scheduling an update on this issue for a future meeting.

Some of the key points that arose from the Committee’s discussions were: -

·         The Committee had always advocated for the provision of Walk In Centres across the city and had vigorously opposed the closure of these, noting that the consequence of this would be an increase in presentations at Emergency Departments;

·         Would Emergency Departments still have to comply with national waiting time targets;

·         The model was predicated on an effective  NHS111 service and what had been done to support and adequately resource this service;

·         What consideration had been given to ensure the service was inclusive and accessible to all, including those for whom English was not their first language;

·         Noting the difficulties some patients experienced accessing Primary Care it was understandable that many patients resorted to attending Emergency Departments in the knowledge that they knew they would receive treatment; 

·         Whilst recognising the need to introduce measures to ensure patient safety during COVID-19 was it anticipated that this model would continue post COVID;

·         Noting the importance of assessments being undertaken by clinicians to ensure the most appropriate patient care pathway was identified;

·         To ensure the safe and appropriate transfer of care it was important that patient records were accessible across the various health services;

·         What was the initial feedback on the Clinical Assessment Service that went live on the 4 November 2020; and

·         How was this change being communicated to the general public.

The Director of Commissioning, NHS Trafford CCG responded to questions and comments by advising the Members that initial analysis of the Clinical Assessment Service had been positive with no issues or complaints identified. In response to access she described that Equality Impact Assessment workshops would continue to convene to consider access and develop and refine targeted communication campaigns.

The Urgent Care Reform Co-ordinator stated that a ‘soft’ national advertising campaign had been launched and the local message was designed to complement the national campaign. She explained that engagement with various community groups had been planned and would be reviewed to ensure this method was appropriate and effective.

The Chief Transformation Officer, MFT advised that Emergency Departments would still have to comply with national waiting time targets and the new system was designed to relieve pressure on Emergency Departments; allow for more effective management and staffing; manage patient flow and ensure that patients received the most appropriate care by the service best equipped to deal with their health needs in the most appropriate setting. She advised that all patient assessments would be undertaken by a clinician to manage risk and safety. She explained that if a patient was referred to Primary Care an appointment would be made for the patient. She further described that such referrals would be monitored and reported and any ‘Did Not Attends’ would be followed up.

The Executive Clinical Director MHCC stated that during COVID-19 Primary Care had continued to deliver services to patients and how this had been achieved in the context of the pandemic had been recently reported to the Committee.

The Chief Transformation Officer, MFT stated that national discussions around improving Emergency Departments had been ongoing for many years and was an element of the NHS Long Term Plan, however COVID-19 and the need to ensure patient safety at this time had prioritised the issue. She described that there were many valid clinical reasons for introducing the changes and stated that some aspects of the changes would remain post COVID. She stated that at an appropriate time a review of the model would be undertaken to understand lessons learned and this would include the views of patients. The Chair commented that the Committee would request a further update on this subject at an appropriate time.

The Director of Commissioning, NHS Trafford CCG acknowledged the comment regarding the need to improve integrated IT systems and record sharing across services and she advised the Committee that this work was ongoing.

In response to specific concerns raised by Members the Committee was advised that no patient would be turned away from an Emergency Departments if they required urgent care, including those patients who self-presented. In response to comments made the Committee were informed that the new model was designed to improve patient care and was not driven by cutting costs or staff.

Members were further informed that additional staff had been recruited and trained to deliver the NHS 111 service. The Chair stated that an update report on the NHS 111 service would be scheduled for consideration at a future meeting.

The Executive Member for Adults, Health and Wellbeing described her recent personal experience of accessing emergency care during the pandemic and stated that it had been very positive. She further supported the call for an update report on the implementation of the new model and suggested that this would be most appropriate post COVID.

The Executive Member for Adults, Health and Wellbeing further recognised the importance of Primary Care and the role that they would play in the delivery of the COVID-19 vaccination programme that was planned.

The Executive Member for Adults, Health and Wellbeing concluded by paying tribute to all health professionals and staff delivering services on behalf of the residents of Manchester.

Decisions

The Committee;

1.    Note the report;

2.    Recommend that a report on the delivery of services at the city centre Walk In Centre be submitted for consideration at an appropriate time; and

3.    Recommend that a report on the delivery of the NHS 111 Service be submitted for consideration at an appropriate time.