Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG) and Gerrie Adler (Portfolio Programme Director (Consultant), NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG) were in attendance for this item.
(1) The Chair welcomed the guests to the Committee. Ms Adler began by explaining that the papers covered two different clinical models for NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG. The models included nationally mandated changes to include the provision of a 111 service supported by an Integrated Clinical Advice Service (ICAS) and the requirements of the Five Year Forward View to extend primary care access. She highlighted the range of engagement events which had taken place including Patient and Clinician Reference Groups in 2015, GP engagement event in November 2016; urgent and emergency care whole systems event in November 2016 which brought together over 80 patient representatives, voluntary sector organisations, hospital clinicians, GPs and commissioners. Three further listening events were held in February 2017 in Shorne for NHS Dartford, Gravesham & Swanley CCG residents and Sittingbourne & Sheppey for NHS Swale CCG residents. She stated that feedback from the events had helped to shape the case for change and emergent model of care.
(2) Ms Davies explained that feedback from Swale residents was that they liked the existing services but would like them to be more responsive and coordinated and this was reflected in the CCG’s proposals. She stated that Dartford, Gravesham & Swanley was a growth area with an expected 26% gorwth over the next 7 years. She reported that the CCG was looking to form an urgent care centre at the Gravesham Community Hospital site which would include the existing minor injuries unit and relocation of the walk-in centre from the Fleet Healthcare Campus located 1.3 miles away. She noted that the Gravesham Community Hospital was located near to the train station and had good bus services. She stated that the four GP practices at the Fleet Healthcare Campus were looking to merge, consolidate nursing and back office staff and extend primary care access.
(3) Mr Pugh encouraged the CCGs to work with the planners in growth areas to develop and implement services prior to residents moving in. Cllr Pugh, in accordance with his Interest as a as a non-voting member of NHS Swale CCG’s Primary Care Committee, then withdrew from the meeting for this item and took no part in the discussion or decision.
(4) In response to a specific question regarding the recommissioning of the 111 service, Ms Adler explained that the reprocurement would include an enhanced ICAS which would assess and advise on the most of appropriate course of action including self-care and onward referral to a clinician; call handlers would be able to refer up to 60% of calls to clinicians from the current 25%. Ms Davies noted that the current service was provided by the South East Coast Ambulance NHS Foundation Trust (SECAmb) and there were some issues with call handling and onward referral and the new model would look to address this.
(5) A Member enquired about the relocation of the walk-in centre from the Fleet Healthcare Campus to Gravesham Community Hospital. Ms Adler explained that the CCG had taken advice from the Consultation Institute who had recommended that a community impact assessment be carried out; telephone interviews and face-to-face engagement with 85 people wasundertaken in June 2016 and the feedback was detailed in Appendix 4. She noted that 71% of the respondents thought the move to Gravesham Community Hospital was positive particularly due to its co-location with the minor injuries unit. She noted that there were some concerns about parking but she reported that the site was in a town centre location and located two minutes from the train station with good public transport links.
(6) Members asked about services in Swanley, the CCGs’ confidence levels in the proposals and the opportunity for Swale residents to comment on proposed changes at Medway Hospital. Ms Davies noted that there was a significant patient flow from Swanley using the walk-in centre at Queen Mary’s Hospital in Sidcup. She reported that the Oak and Cedar GP practices in Swanley were looking to develop a virtual hub which would include extended opening hours. Ms Adler reported that the CCGs were confident about the proposals as they were supported by the engagement feedback and were within the financial envelope. Ms Davies states that the changes were required to make primary care sustainable and was confident that the proposals would address growth and workforce challenges.
(7) Ms Davies reported that NHS Medway and Swale CCGs were working together to ensure that Swale residents had the opportunity to comment on the proposed changes at Medway Hospital. She noted that 99.5% of Swale residents accessed services in Sittingbourne and Shepway areas and 0.5% accessed services in the Medway area.
(8) RESOLVED that:
(a) the Committee does not deem the proposed changes to urgent and emergency care by the North Kent CCGs to be a substantial variation of service.
(b) the North Kent CCGs be invited to submit a report to the Committee in six months.