Agenda item

The Board considered a report of the Director of Strategy and Integration, Sheffield Clinical Commissioning Group concerning Urgent Primary Care. The item was presented by Kate Gleave, Sheffield CCG.

The report stated that the Clinical Commissioning Group’s Strategy for Urgent Care articulated a need to improve urgent care services, in recognition of national policy to improve access and because people found the existing service arrangements confusing and difficult to use appropriately.

The Strategy recognised that local urgent primary care and services needed to be reorganised and the CCG had considered how this might be achieved with a view to agreeing a set of options for the delivery of services on which to consult from September 2017. The report summarised the case for change and the principles upon which the options had been based and it outlined the timescales involved.

The Board was informed that engagement with patients had found that patients did not always access urgent care based on the level of need and patients were confused as to what services to use and when. There was inequality and a differing experience and knowledge of services depending on where people lived in Sheffield. People were not always treated by the most appropriate service and there were issues relating to systems not operating cohesively and with regard to communication. The cost of travel on public transport was a barrier for some people, as were language issues.

The Board was asked to consider whether it could confirm that the objectives of the Urgent Primary Care review and redesign were in line with its own objectives; whether the Board would support and inform the formal public consultation; and whether the Board supported disproportionate re-investment into the areas of greatest need.

Members of the Board made comments and asked questions with reference to the questions outlined above and these are summarised below:

A question was asked about the consequences of moving financial resources if there was disproportionate re-investment into the areas of greatest need. The response to this was that the NHS would usually make the same service offer to everyone. In this case, it had been identified that greater resource could be deployed to where need was greater and the need/demand was something which could be shown geographically and was highlighted in relation to urgent care. Such an intervention and investment in those communities would provide the best value for money and it would lead to improved health outcomes. 

It would be considered helpful to communicate what changes to urgent care provision would mean for people and for particular groups of people. There was support for differential investment based on a clear understanding of need and there would also need to be transparency and consistency with regards to services which were available.  The Board might also look at engagement in a similar way and apply disproportionate effort or investment to mobilise people and also ensure that they had a voice. 

It was not intended that capacity for planned care would be adversely affected by the proposed changes to improve access to urgent care. The approach which had been taken recognised the relationship between planned and urgent care.

The Board would inform the options relating to consultation. There was no ability to give the perfect level of urgent care and therefore, it was proposed to provide a generic offer and also a more specific one for those communities which had particular circumstances, for example people who were homeless. There was also a wish to make sure patients with ‘urgent’ care needs received triage in a timely manner and were transferred to appropriate ‘planned’ care as soon as possible and also to ensure that there was capacity in primary care for a patient to be seen the same day or urgently. Whilst there were many fragmented services in the NHS, patients wished to see continuity of care.

It was confirmed that the issue would be submitted to the Board for further consideration and, at this point in time, the Board was being asked to confirm that it supported consultation in relating to urgent care. It was important to properly frame questions in the consultation and address uncertainty with regards to need and to recognise that there might be a range of different public opinion.

It was considered that proportionate re-investment would be a suitable approach and that there should be clarity as to what was meant by greatest need and in relation to where investment would be made.

The Board RESOLVED to:

1.     Note the plans and intentions with regard to consultation on Urgent Primary Care as outlined in the report of Director of Strategy and Integration now submitted;

2.     Confirm that the objectives of the Urgent Primary Care review and redesign are in line with its own objectives; and

3.     Support proportionate re-investment into the areas of greatest need.