Agenda item

This document is to present the Panel with the public engagement report on the proposal to relocate the GP-led Health Centre to the Royal United Hospital.

It is also present to the Panel the health & equalities impact assessment on the proposal.

The rationale for this service change is based on the following factors:

·  An ageing population

·  Increasing demand and expectations

·  People living longer often with several long term conditions

·  Finite resources and inequitable use of existing resources

·  It has the support of local clinicians whose services will be affected by the proposals

·  It supports the principle that patients should have access to the right treatment, at the right place and at the right time

·  It has taken account of clinical evidence and best practice drawn from reports published by the Primary Care Foundation, Royal College of General Practitioners, NHS Alliance, the Department of Health and the Foundation Trust Network.

The Panel is asked to note both reports and agree the proposal to relocate the GP-led Health Centre to the Royal United Hospital to create an Urgent Care Centre can proceed.

The Chairman invited Peter Jovcic-Sas to read out his statement.

Peter Jovcic-Sas said that the NHS belongs to us all and BANES CCG has legal duty to involve people who use health service in decisions about those services.  The CCG did not make meaningful attempt to engage current users of the walk-in centre.  There is also no information how local GPs will take on the pressure if the walk-in service gets closed nor there was information on how the proposed £500k saving would be invested in services elsewhere.  The Equality Impact Assessment did not fully engage with the local representatives or wider communities (i.e. Bath Racial Equality Council).  Over 1,000 people signed the petition to keep the centre.  Over 70% were concerned about the new model based at the RUH.  Peter Jovcic-Sas said that in his view the consultation was too shallow and too basic.  The CCG did not provide enough information to allow people to make informed judgement on what they are planning to do.  Peter Jovcic-Sas asked the Panel not to support the recommendation and ask the CCG to review their proposal in light of the all the comments on this subject.

The Chairman commented that Peter Jovcic-Sas was quite specific that the CCG haven't been effective in engaging the public and then went on to identify certain representations made through the consultation period.  The Chairman said that appears to be conflict in the statement about the engagement process.  The Chairman said that there was consultation period where the CCG went out across the authority to engage with the public and get their opinion.

Peter Jovcic-Sas said that there was no enough meaningful engagement with the public.  The CCG could do more in terms of the public engagement.  The other CCGs across the country take much longer to engage with the public.

Councillor Jackson said that she read in the report about the consultation process and while she thinks that efforts were made to engage with the public the fact is that most of the engagement took place via social media whilst there was no enough information via radio.

The Chairman invited Sarah Mitchard to read out her statement.

Sarah Mitchard thanked the Panel to give her opportunity to speak and also thanked the CCG for their interest in concerns raised and for meeting with Bath Labour Action Team and answer their questions.  Sarah Mitchard also welcomed that the CCG worked hard to record the objections and criticism as well as setting out suggestions for how these could be addressed.  The overwhelming view that came from the public was that they did not want to lose the GP walk-in service in this form, or from this location.  People were worried about the reduction in access to primary care if these proposals went ahead.  Therefore, Bath Labour Action team initiated the petition to enable people to express their views.  To date 1,100 people signed the petition with 500 of them who left their comments.

Sarah Mitchard said that Wellbeing Scrutiny Panel should consider two main points before making their decision. 

Firstly, the proposals in their current form do represent a substantial variation of services.  People will lose access to urgent care and everyday primary care in the centre of Bath.  The message from people who signed the petition is that they use GP led service at the Riverside when they are unable to access the service they feel they need from their GP.  The loss of the GP led walk-in service in Riverside will amount to a reduction or rationing of access to primary care, with the majority of the 30,000 contacts per year expected to go to a GP instead  and therefore unable to be seen as quickly or as conveniently as they would have done previously.

Secondly, it is the objection to the availability of financial information.  In Sarah Mitchard's opinion there was no clear information how much money would be saved.  There was an estimate of potential saving and the public did not have the opportunity to consider if the level of saving would justify to proposal.  Sarah Mitchard said that when those questions were asked at the public meeting the CCG did estimate a cost saving of approximately of £500-600k.  These savings were based on the expectations that both B&NES Emergency Medical Out of Hours service and proposed GP-led urgent care service at the RUH would be run by the same provider though those services have not been put out to tender yet.

Sarah Mitchard concluded by asking the Panel to reject the plan and instead refer these proposals for a review.

A full copy of the statement from Sarah Mitchard is available on the minute book in Democratic Services.

Councillor Brett said that she was approached in her Ward by few vulnerable people who were concerned that all services will be closed in the Riverside and asked Sarah Mitchard how did Bath Labour Action Team communicated the proposals to the public, particularly to vulnerable people.

Sarah Mitchard replied that people were told that the other services in the Riverside (dental services, sexual health, etc.) will remain open.  The group had no intention of being misleading.

Councillor Hall said that she went to one of the engagement meetings where one of the Labour representatives said that £500k was not a lot of money and asked Sarah Mitchard if she thinks that £500k is not a lot of money.

Sarah Mitchard replied that public were not given a lot of information about financial position on proposal.  Sarah Mitchard said that £500k was quite a lot of money and that the above was an unfair question as there was no conversation then about issues that are discussed now.  Sarah Mitchard said that this information should have been presented by the CCG to the public at those meetings.

Councillor Hall said that she had those figures through the consultation process and she couldn't understand how the speaker could make the statement that there was no financial information.  Those figures were not there at the beginning so Councillor Hall asked for them to be publicised.  Those figures were pointing to potential saving of £500-600k out of total budget of £2.9m, which was significant amount of money.

Councillor Jackson asked Sarah Mitchard if she felt that the CCG had established that the sum of £500-600k was the actual saving.

Sarah Mitchard replied that she was under impression that the figure was an estimate and not the final saving.

The Chairman invited Dr Ian Orpen, Corinne Edwards and Tracy Cox to give the presentation.

Dr Orpen, Corinne Edwards (PCT) and Tracy Cox (CCG) highlighted the following points in their presentation (a full copy of the presentation is attached as Appendix 3 to these minutes):

•  Rationale for service change

•  B&NES demographic change

•  Financial pressures

•  Engagement Process

•  Addressing key concerns

•  Risks of doing nothing

•  Other key issues considered by CCG

•  Next steps

•  Questions and comments

The Panel made the following points:

Councillor Brett said that one of the concerns raised during the consultation was about the parking at the RUH and asked what had been done to enable easy access.

Corinne Edwards said that access issues had been one of the main issues during the engagement process.  The RUH said that they would be more than happy to work on solutions with the CCG and PCT. 

Steve Boxall from the RUH Estates Team said that the RUH would certainly look at ways of improving the access as part of the plans to develop the Urgent Care Centre.

Councillor Clarke commented that the walk-in service was only 3 years in existence and asked if there was any clinical risk involved.

Dr Orpen said that he was quite satisfied that no clinical risk is involved in the proposal.

Councillor Clarke asked if it will be possible to register with two separate practices in future.

Dr Orpen said that is correct.  The Government is piloting that scheme currently in London and it will be possible, in near future, to be registered with two separate practices.

Councillor Hall commented that she was pleased with the consultation process.  The numbers of concerns were met though there is still some work to be done.  Councillor Hall welcomed the financial information as well as information on parking.  Potentially there will be better quality of care.  Councillor Hall said that she spoke with large number of people, including the users of the centre.  Councillor Hall also said that she welcomed the work that was done with students and that she was pleased that a smartphone app was set for students.  Councillor Hall felt that the proposal was positive and that the Panel should have a review on this service change in 6 months if the Panel support the proposal.

The Chairman said that should the Panel decide to support the proposal there will be no opportunity for the decision to be reversed and for the urgent care service to go back to the walk-in centre.

Councillor Jackson thanked the CCG and PCT representatives for coming to Radstock as a part of the consultation process.  Councillor Jackson said that there are 30,000 visits per year at Riverside.  We are in a consumer led culture when people are expected to have medical attention they need when they need it.  Councillor Jackson said that she recently visited Riverside centre because she could not get an appointment with her own GP.  Councillor Jackson felt that this is a substantial variation of services.  It is not only geographical change, it is also cultural change.  It will create different way of accessing things.  The questions that the Panel should ask is are the benefits outweigh the disadvantages.  Councillor Jackson said that until GP surgeries improve their service she is not convinced that this is the right proposal.

Councillor Simmons commented as someone who lives in Keynsham, the RUH is in fact closer than the GP-led Health Centre, but that more and more people don't bother contacting their GP surgery so they use walk-in centres instead. 

Corinne Edwards said that the PCT and CCG want to understand why people are wasting that capacity. This had led to the development of the incentive scheme to address telephone and appointment access.  She also explained that across the practices in B&NES there was a 3% to 10% do not attend rate for GP and nurse appointments.  This is wasted funded capacity and the CCG wants to work with practices on reducing this as part of the incentive scheme

The Chairman commented that walk-in centre had been in existence for short time but it became quite popular to those who use it.

Tracy Cox replied that the PCT and CCG recognise the value of the service and that their intention is to transfer those services.  Tracy Cox also said that many of the 30,000 visits are repeat visits by the same people.

The Chairman thanked everyone who took part in the debate.

The Chairman asked the Panel to vote on this proposal.

Voting:

•  7 Panel Members voted in support of the proposal by saying that this service change did not constitute a substantial variation of services.

•  1 Panel Member voted against the proposal by saying that this service change did constitute a substantial variation of services.

•  1 Panel Member abstained.

It was RESOLVED that the proposal to relocate the GP-led Health Centre to the Royal United Hospital to create an Urgent Care Centre did not constitute a substantial variation of services and that the Panel agreed with the proposal.