1. Urgent care - consultation on services at Hemel Hempstead Hospital
David Evans, Director of Commissioning
Dr Vipul Parbat, Clinical Lead Integrated Urgent Care
Lynn Dalton, Assistant Director of Localities and General Practice Development
General Public

2. Purpose of today
Discuss consultation that Herts Valleys CCG is currently running with two elements:
Information – facts and factors that we need to consider
Discussion – look at options for each consultation – pros and cons
Feedback - your comments go to the CCG board
1. Future opening hours of the Urgent Treatment Centre in Hemel Hempstead Hospital
Question: Do we keep the current temporary hours? What are the alternatives?
2. How we provide GP services to patients currently registered with West Herts Medical Centre when the contract ends in October 2018
Question: Do we go out to the market to put in place another five year contract or do we support patients to register with other GP practices?

3. GP and urgent care services at Hemel Hempstead Hospital
Urgent Treatment Centre
West Herts Medical Centre
Led by GP with support from emergency nurse practitioners, treatment nurse and assessment nurse
Temporary hours: 8am to 10pm (official contract 24 hours)
Supports full range of urgent care needs
Urgent Treatment Centre = Urgent Care Centre + :
booked appointments via NHS 111
increased 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

4. Urgent care services across the Herts Valleys area
Free 24/7 NHS non-emergency number
Calls answered by trained healthcare adviser, backed by a GP-led medical team, assessing patients early on to make sure people get the right care
Can arrange visits from out-of-hours GPs or nurses 24/7 or book people into appointments
Provides advice on self-care or signposts to best service
Will call ambulances directly in serious cases.
Doctor / GP
Extended GP access to GP appointments - 50% evening and weekend availability by March Full coverage by October.
Access to GP out-of-hours via NHS111
Pharmacy
Free, confidential advice to help with many common illnesses and complaints.
Late opening pharmacists (up to 11pm) and open weekends too.

5. Approach to urgent care
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

6. 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)

7. Key considerations: Access to urgent care
Various options for getting professional urgent care advice or treatment throughout the day / night
Urgent Treatment Centre 1 2 3
NHS 111 and the clinical assessment service/GP out-of-hours gives everyone access to 24 hour urgent care
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

8. Key considerations: Use of GP time
GPs at the heart of urgent care but big demands on their time
Overnight or late shifts means GP can’t be in practice next morning
Day/early evening
Late evening/overnight
General Practice and extended hours
Urgent Treatment Centre
GPs at the heart of urgent care but huge demands on their time
National shortage of GPs - west Herts below national average for number of GPs per patient
Addressing shortfalls will take time – immediate pressures will continue, especially with extended hours
Urgent Treatment Centre
Out-of-hours
Out-of-hours
NHS 111
NHS 111
More demand
Less demand

9. Average UCC/UTC Attendance per day by hour of the day
Key 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
0.0
7.2
5.3
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

10. Key considerations: Patient safety
Service must be reliable and deliverable - not vulnerable to ad hoc closures
Offer to patients must be consistent

11. 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

12. Key considerations
If the final decision is to close West Herts Medical centre:
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 final 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 a range of other potential providers can bid for the service
Proposition to prospective bidders: small number of patients + short term contract (five year contract) = less financially attractive?

13. 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

14. Consultation details
Eight weeks consultation - 31 January to 28 March 2018
Working with Healthwatch, patient groups and local community and voluntary organisation to reach as many people as possible
Public meetings: Berkhamsted; Hemel Hempstead; Borehamwood; Watford and St Albans
Drop-in sessions targeted at patients registered with WHMC
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

15. Decision-making
Questionnaire responses and feedback from events reviewed by independent research company
Responses presented to Herts Valleys CCG board for decision on 26 April 2018

16. Questions?

17. 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