Agenda item
Cricklewood Health Centre
This papersets out the proposals fortheCricklewoodwalkin service,whichis commissionedby BarnetCCGundera standardNHScontract,Brent CCGare associateto thiscontractandworkclosely withBarnet CCGas theleadcommissioner.
Minutes:
Dr Jahan Mahmoodi (Clinical Director, Brent CCG) introduced the report, setting out the context of the paper and explaining proposed changes. Dr Mahmoodi said that evidence suggested that far fewer patients were seeking walk-in access to primary care. He went on to highlight the stated benefits of a joined up approach being developed by Primary Care Networks where all clinicians seen by a patient have access to that patient’s notes digitally, therefore ensuring the best possible care for the patient. Rather than the patient potentially seeing a number of different clinicians when making multiple visits to the walk-in centre, it was preferable for the patient to be treated in a facility where their notes were available to whomever they saw or had been referred to, so that clinical decisions could be made with all the information to hand. The CCG aimed to provide a seamless service with efficiency, choice and accessibility being the presiding ambitions.
Dr Mahmoodi confirmed that the CCG was working towards consolidating services over the next few months and was influenced by the evidence of patients preferring alternative methods of accessing primary care such as online consultations. The lease on the Cricklewood premises was due for renewal next year and there were restrictions on the re-procurement process which would be taken into account.
Andrew Pike (Assistant Director of Communications and Engagement NHS North West London CCGs) spoke about the 14-week Consultation which started on 12 August 2019 engaging the walk-in patients and nearby GP practices. Documentation in respect of the Consultation was available in libraries and other public places and its aim was to explore thoroughly with walk-in users why they used the service and what factors needed to be taken into consideration. Stakeholders, including the Committee were strongly encouraged to participate. Dr Mahmoodi added that the consultation would illustrate how the CCG planned to seek the engagement of users and stakeholders in creating a joined up non- fragmented service.
The Chair thanked the CCG representatives for the introduction and invited questions from the committee.
In the subsequent discussion, the committee queried the validity of evidence that walk-in centres were dated and under-used and asked what risks there were for residents and how they would be mitigated. They asked what would happen to people who were not currently registered with a GP and how the closure of the walk-in centre would affect those patients needing an emergency provision. In relation to other available healthcare resources, they queried if there would be adequate and improved provision going forward with enough GPs available and ease of registration. Further questions were raised about the engagement with the current users of the walk-in service, how it was being promoted, how would elderly people and those with language barriers be included and if there was sufficient time before the proposed closure date to let patients know about the alternative provisions so that there would be no gap in service or health implications. It was also asked if feedback had been received as part of the engagement so far and whether there were any processes in place to measure the effectiveness of alternative services.
The Committee raised the question of why the technology for universal access to medical notes could not be installed at the walk-in centres and expressed concerns that the deprivation of readily accessible health services damaged community cohesion. They confirmed that Barnet councillors also wanted to save this service.
With the permission of the Chair, Councillor Colacicco (Deputy Mayor) spoke on behalf of the Mapesbury ward residents whom she said hadn’t been consulted. She went on to say that, while she understood the sentiments of the proposal, she questioned why people were attending the Walk-in centre if there were alternative services available. Councillor Colacicco went on the say that local people had said there were no GP appointments and, Cricklewood being a poor area, they couldn’t travel easily. She wondered if the residents knew about the proposal and whether there was enough provision for the increasing population in Cricklewood.
In response to the committee’s queries Sarah D'Souza (Director of Commissioning, Barnet CCG) reported that there were just under 20k attendances at the walk-in service, 58% of which related to patients registered in Brent. This represented a 10k drop on the previous year and an on-going decline of 21% over the last twelve months. Ms D'Souza could not confirm how many of the 20k were GP referred as the walk-in centre had no access to medical records and could not therefore refer patients on. Dr Mahmoodi advised that the general direction of travel within the NHS was the closure of walk-in units or non-renewal of contracts. In promoting a seamless service, Dr Mahmoodi went on to explain that a patient’s notes which contained details of any allergies, medication and their medical history were solely held by their GP and, if that patient presented, for example, to hospital, this information was not available to the hospital team. A seamless service meant that a data sharing agreement would be in place to ensure that wherever the patient went for medical care, whomever treated them was fully informed of all the factors that would enable them to make the best clinical judgement.
Dr Mahmoodi went on to explain that there were always risks with change. Initially patients may go to the walk-in centre, unaware that it was closed, but the aim was to mitigate risks and he reported that a comprehensive quality impact and inequality assessment would be undertaken by the health commissioning service to consider any impact on residents. He advised that the result of the reinvestment of resources would give patients better access to their own clinicians and would meet the terms of the Government’s plans to move away from a fragmented service. He continued that it was likely that the Government would invest additional funding to implement its plans, resulting in more choice for patients and better access to primary care. Fana Hussain (Assistant Director for Primary Care, Brent CCG) added that the report outlined how the guaranteed funding and Primary Care Networks’ investment planned to support identified local patient population needs.
Members also wanted to know about why there was a Consultation taking place about the walk-in centre if the CCG was saying that they were acting according to NHS England guidance.
In response to the Committee’s questions, Rashesh Mehta (Assistant Director, Integrated Urgent Care, CCG) reiterated that there was a national directive to close walk-in centres and replace them with extended hours hubs which Cricklewood already had onsite. She advised that Brent GPs conducted more than 80k appointments over 56 practices and patients additionally had 24-hour access to the NHS 111 line for out of hours advice. Fana Hussain advised that within her remit she led on workforce development and recruitment which was looking at the utilisation of other clinicians with specialist skills (such as diabetes nurses, paramedics and pharmacists) to alleviate GP time and proactively manage patient care. For example, the introduction of ten clinical pharmacists every year for next four years. Ms Hussain confirmed that they were working towards having all people registered and the GP hub was providing help in this respect. She advised that utilisation was currently about 76% for GPs and 56% for nurses with the expansion of the Brent hubs meeting capacity. Additionally, Brent was at the forefront of digital access to healthcare. Dr Mahmoodi advised that all GP practices had open lists at all times and there were no obstacles to registration. He confirmed that telephone and in-person language services were available at all GP practices.
Fana Hussain advised that a pre-engagement event identified that walk-in users were not aware of the 8-8 extended hours primary care service and the on-going communications would promote the expanding services. She said the engagement process surrounding the walk-in centre aimed to share information and to develop access not only via face to face appointments but through video and online consultation. The goal was concerned with improving access not reducing it. Sarah D’Souza added that the contractual requirement to give three months’ notice of the closure would allow sufficient time to complete a consultation and distribute information leaflets. Andrew Pike confirmed that they had previous successful experience in this area and were proposing a comprehensive engagement process and marketing campaign, utilising GP staff and libraries, targeting users of the walk-in centre in the run up to its closure.
The Committee was informed that a final decision would not be made until the consultation was completed and that the CCG wanted to take the views of all stakeholders into consideration. It was advised that it would technically be possible to recommission a walk-in service but in a national context it was against the trend and the main goal was to take this opportunity to invest in improving fundamental primary care and redistribute the resources across the Borough. Academic research findings and statistical information would be provided to the Committee in support of the increased demand for online services, particularly among students and people with no fixed abode.
The Chair brought the item to a close and thanked the NHS officers for their contributions. There were NO RECOMMENDATIONS on this item
Supporting documents:
- 07. Community Wellbeing SC_Cricklewood walk in service v10, item 7. PDF 365 KB
- 07a. Appendix A Cricklewood_Engagement 6pp 4pp insert, item 7. PDF 3 MB