Agenda item

Paper to follow

The Chairman invited the following to the table:

• Sarah D’Souza, Director of Commissioning, Barnet CCG
• Ruth Donaldson, Director of Commissioning, Barnet CCG
• Don Neame, Leathgo Consultancy Ltd

Ms D’Souza reported that Leathgo Consultancy had analysed the responses to the consultation and put together the results and was here to respond to any questions associated with the analysis of the consultation process.

Ms D’Souza reported that the decision to close the service when the current contract came to an end had been made on 13 February by Barnet CCG and 12 February by Brent CCG. The report included further recommendations for Barnet and Brent Clinical Commissioning Groups (CCGs) to support the implementation of the service change. Ms D’Souza then explained the reasons for the decision made by both CCGs to close the Walk In Service (WIS).

She noted that the GP Practice at the Cricklewood site was due to be re-procured at the end of June 2020.

Ms D’Souza reported that at the 11 July 2019 HOSC meeting there had been a discussion about national and local changes since the WIS had been commissioned nine years previously. Views of local people using the service had been taken into account with 24% of attendances  being by Barnet GP registered patients. An Equalities Impact Assessment had also been undertaken.

Ms D’Souza reported that demand for the WIS had reduced by 24% since 2016/17 and reviewing the data it looked likely to continue to go down for the current year. At the RFH there had been an increase in A&E attendances for Primary Care needs so, rather than attending the WIS, many patients are still attending A&E. Although the WIS is convenient, she added that it did not always address the long-term health needs of patients as it provided episodic care and did not have access to health records or the ability to refer patients on to other services.

With the move to Primary Care Networks (PCNs) there would be significant additional investment into PCNs and integrated care.

The case for developing the WIS into a UTC had been considered. There was already a UTC close to the site and this would require additional funding to meet national standards for example for x-ray equipment, estate changes and specialist staffing as well as the national tariff for UTC attendances. Significant funding would be required and the throughput was not sufficient to justify this.

Fundamentally the concerns raised about the closure of the WIS were around access to Primary Care. The CCGs had considered what both Brent and Barnet were doing to improve this access, with the introduction of extended access GP Hubs and other measures. The CCG had invested in the GP Hubs with additional appointments now available at weekends, evenings and on Bank Holidays. The CCG had also increased online access to make appointments. 

Ms D’Souza reported that, as well as closing the WIS, the CCG had agreed to several recommendations:

• Continue with awareness raising about services, particularly extended access Hubs. The Chairman had informed the CCG that GPs were not always advising people about the option of Hub appointments. Therefore the CCG would be providing information at GP Practices and in Barnet First to highlight this
• The new APMS GP Practice would have additional appointments during core hours when the WIS closes
• Work would be carried out with the GP Federation to ensure that extended access appointments were deployed  in the right places and times.
• Also Barnet CCG had committed to work with Brent on a Primary Care and Urgent Care Development Group which would be in operation during the changes onwards. This group would help to identify where residents needed to go for their care and to pick up any issues regarding access to care.

Ms D’Souza concluded that the CCG appreciated all the input from the community which had helped to shape the CCG’s decision and associated recommendations.

A Member asked whether the additional hours would replace those lost by the closure of the WIS, otherwise patients would still need to attend A&E. Ms D’Souza responded that the extended Hub hours are 6.30pm-9.00pm. Currently the WIS closed at 8pm.The GP Federation had offered to be flexible and offer extended access appointmentsto best meet demand . This would vary depending on the local community.

A Member asked about the other WIS close by. Ms D’Souza noted that there were two other Walk In Centres in Barnet and several UTCs in Brent. The RFH also has a UTC.

A Member enquired about the number of residents using the WIS and what evidence was available. Ms D’Souza responded that there had been a downward trend since 2016/17. Some of this was likely to be due to the availability of other Primary Care access points.

A Member asked about transport links to the Hubs and also mentioned that the demographic in Barnet is different to Brent and may require more Sunday appointments. Ms D’Souza noted that the nearest extended Hub to Cricklewood is Greenfield, half a mile away on a main bus route. There were a few more Hubs in Brent and Kilburn and Wembley GP Hubs have extended access. She noted that the demographics would be taken into account and she was keen to engage locally on this to ensure that appointments were deployed in the best way for the local community. There is a national requirement for 25% of appointments to be bookable online and Barnet CCG has asked for 50% to be bookable online. She would attend the 9 July HOSC meeting and was keen to receive feedback on overall progress then.

A Member asked how Brent Cross South would impact on the changes. Ms D’Souza noted that the report mentioned the corridor of growth, meaning Brent Cross, Colindale South and the Cricklewood Health Centre area. The impact of these and the health infrastructure need of the expanding population are actively being considered by the CCG. When new GP Practices were set up the usual process was to work with developers to understand the phasing of population into the new development and the CCG was working closely with Barnet Council and developers to understand  when the Primary Care infrastructure needs to be in place. Cricklewood Health Centre is not expected to provide for care for all the existing and increased number of residents in the area. Also Section 106 Community Infrastructure Levy funding would be paid by developers to help pay for the health infrastructure.

A Member asked about waiting times at GP Hubs. Ms D’Souza responded that patients were often seen at the time of their appointment or before and there had been no report of significant waiting times so far as these are bookable.

A Member asked about pharmacies and their input. Ms D’Souza responded that it is expected that patients would visit pharmacies for minor conditions and one-to-one meetings with pharmacists were available. They can also carry out structured medication reviews. She offered to forward details of pharmacies in Barnet as this did not appear to be on the Barnet website. A Member noted that some pharmacies provided details of other pharmacies in the area.

Action: Ms D’Souza

A Member stated that she was not convinced that the closure of the WIS was not going to cause a decrease in A&E attendance. She commented that when people are under pressure they find it easier to go to A&E. Even phoning 111 to get information was not always straightforward and not everyone could make appointments electronically. Given the huge regeneration going on in Cricklewood, she was concerned about the closure of the WIS.

Ms D’Souza stated that she understood this and took it seriously. Awareness raising would take time. More work would be ongoing around the specifics of the Cricklewood area. Two community based WICs at FMH and ECH would continue. It was important to raise awareness as previously patients had been attending the WIS with minor illnesses.

A Member noted that he was concerned that patient records were not available at  WISs and asked whether a new model for the future was planned. Ms D’Souza responded that the UTCs at Finchley and Edgware would continue and there were plans to link these to Primary Care which would be able to use their records. Work would be ongoing with the PCNs to deliver improvements.

Update on Integration Barnet CCG

Ms Donaldson reported that the CCG is required to have integrated care systems set up by April 2021. The Executive Director for Adults and Communities is leading on the Barnet Integrated Care Partnership. The Delivery Board of the Partnership includes PCN Clinical Directors, Barnet Council representatives, CLCH, BEH and the RFL. Also Healthwatch attends representing patients and there is a voluntary sector member.

The overall focus is on how to move towards an increased preventative approach to healthcare. A lot of data and ideas have been gathered by the CCG and it became clear that the biggest concerns were frailty, dementia, elderly residents with often complex conditions and the increasing population. The two main priorites are to expand the PCN’s Frailty Multidisciplinary Teams (MDTs) as these produced better oucomes and lowering admissions to hospital and better patient experience. This would include building domiciliary care into the business case.

Ms Donaldson reported that there were financial constraints across North Central London with only a 2% increase in the budget for the following year. Building the business case together was a key step.

The Chairman requested a map showing the location of the GP Hubs when Ms Donaldson returns in July to discuss these and the PCNs. Also it would be helpful to have details of how many appointments were available at each Hub, and the uptake at each.

Ms Donaldson would also include an update on how the integrated care system works with the other CCGs. The Executive Director for Adults and Communities would also attend on 9 July.

The Chairman also requested information on the services available and their providers at  Finchley Memorial Hospital (FMH) and also feedback on the CQC inspection of FMH.

A Member asked whether the CCG would work with Children’s Centres and 0-19 Hubs to encourage the cultural change towards online appointments. This cohort would be most likely to take this up. Ms Donaldson noted that the CCG was working with Age UK and other providers closely on this so would be keen to explore it. The CCG had already undertaken some useful work with schools on asthma management.

A Member requested information on services and providers at Edgware Community Hospital. Ms Donaldson noted that a new strategy would be needed for Edgware Community Hospital so she would feed back to the HOSC on the this as well as on its current services at the 9 July meeting.

The Committee RESOLVED to note the update.