1. Access to Urgent Care and GP services
General Public

2. 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
Updates for Hertsmere:
Rolling out urgent care approach
GP extended access

3. Setting the scene

4. 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

5. Locality based approach to Urgent Care
Aligned with the national development for UTCs we have adopted the approach as part of our Urgent Care Strategy
UTC development across west Herts
Dacorum
UTC live 1/12/17
Development to Feb 18
Consultation on hrs Jan – Mar ‘18
St Albans
UTC plan by 31/3/18
MIU & Extended hrs 31/3/18
Engagement - Jan – Mar 18
Hertsmere
Watford
& 3 Rivers
Dacorum
St Albans
MIU to UTC development with GP Extended hours hub Jan–Feb 18
Development of MDT approach Mar - Jun
Development of MDT approach – Pharmacist, MH liaison, Community nursing Jan - Feb 18
Watford & Three Rivers
Hertsmere
UTC plan by 31/3/18
UTC development at Watford Hospital
Locality discussions Jan 18
Planning - Feb 18
Implementation start – Apr 18
Options for UTC approach Outline discussions – Jan 18
All areas
Joint protocols across services
NHS111, UTC, GP’s, Acute, Ambulance – Mar 18
Booked appointment systems
St Albans
Watford
Hertsmere
Near patient testing
Introducing point of care testing across all urgent treatment access points

6. Locality based approach to Urgent Care
Hemel Hempstead
GP led Urgent Treatment Centre with above criteria opening hours, onsite blood testing, x-ray, access to pathology, multidisciplinary team and direct booking from NHS111
In place with ongoing development. Public consultation Jan - Mar
St Albans
GP led Urgent Treatment Centre approach with onsite blood testing, access to x-ray, on-site blood testing and potential for direct booking from NHS 111, 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
Watford & Three Rivers
GP/Consultant led Urgent Treatment Centre, with above hours opening time, on-site blood testing with access to pathology, multi-disciplinary team, direct booking from NHS 111 and access to emergency care where needed.
Options for UTC development from GP in ED service with Watford locality, Fed and WHHT
Hertsmere
GP led Urgent Treatment Access points with potential for central hubs serving main geographic areas of Hertsmere. Extended hours hub, walk in centre with near patient testing and direct booking for NHS111 to be considered with site options
Options for UT access across locality, with options for PB and Borehamwood areas to LMG in March 18
Near patient testing
Introducing point of care testing across all urgent treatment access points

7. Hertsmere

8. Rolling out urgent care in Hertsmere
Phase one
Discussions Locality GP leads:
Acknowledge area diversity in terms of geography
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
Agree plan and stepped approach for implementation
Phase three
Implementation
Extended Access rollout across Hertsmere
Urgent ‘on the day’ pilot in Borehamwood
Base development for Urgent Treatment, access points
Options for utilising Chase Farm UCC
Development of Elstree hub/centre
Demography modelling for utilising UTC development in Watford

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. 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

14. 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
Two contractual options for remaining service for approx 2,000 patients registered with West Herts Medical Centre.
Option 1: Do not renew the contract and support patients to re-register with other practices
Option 2: Renew the contract when it expires in October 2018

15. Looking at the options If the decision is not to renew the contract:
Provide support for patients who will require assistance in transferring and registering with GP practices whose boundary they live.
Provide transitional support for GP practices registering patients transferring from West Herts Medical Centre
If the decision is to keep West Herts Medical Centre:
Undertake a full commercial and competitive procurement for a new contract, starting November 2018
The current contractor and other potential providers can bid
Proposition to prospective bidders: small number of patients + short term contract (five year contract) = less financially attractive?

16. Summary
Need to see both of these 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 and we want 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
Want to be realistic and find a viable solution
Important to hear from patients and the public – views matter, but not a referendum

17. Consultation details 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

18. Decision-making
Questionnaire responses and feedback from events reviewed by independent research company
Responses presented to Herts Valleys CCG board meeting in public for decision in early May 2018

19. Questions?

20. Discussion Discuss each of the consultations For each consultation
Consider the pros and cons of each option
Give your views on each option and say whether you are for or against each
Highlight any other issues that you think the CCG needs to consider