Q and A from CCC’s meeting on Croydon CCG’s urgent care review

The Croydon CCG have produced a Q and A, detailing the discussions at the CCC meeting on Urgent Care, held on 6 January 2016.

You can download a copy of the document here:
Croydon Communities Consortium Meeting Q&As CCG doc

Croydon Communities Consortium Meeting Q&As

Wednesday 6 Jan 2016

Q: (From MH Forum member). Is there going to be a GP hub in the north of the borough? We know that there is a high BME population there and that will grow and there are also very poor areas in that part of the borough? And will the GP hubs allow for specialisms, such as mental health?

A: (Dr AF) All of our modelling is based on public health figures and clinical data. The public health figures tell us about levels of deprivation and other population level data e.g. ethnicity. Our modelling has involved projecting forward so allows us to design for future needs as well. Our mental health strategy will support our urgent care strategy as well.

Follow up comment: The urgent care facilities in New Addington and Edridge Road are in very poor areas, more community development and support is needed, better working with local communities will help to reduce the need for care services.

Q: I currently walk to my GP as its only 10 minutes. Will I now have to walk to the GP hub? Where will all these GP’s at the hub come from? What if I don’t want my records shared?

A: (AF) Your GP won’t change, you will still see your own GP if you choose to. The GP’s at the hubs will be from GP’s already working and based in the current urgent care facilities. We need to make the best use of the staff we already have by using them differently and in different ways e.g. telephone and virtual consultations. If you don’t wish your records shared they wont be.

Q: There is no mention of the north of the borough. Is there less clinical need in the north?

A: Need is based on lots of things, one of the main causes of need is deprivation. The north and New Addington have a big need for urgent care services. We already have clinical services in the north and these services have been increased. But we need to look at how we can change thinking and meet the needs in the north. So it’s the 3 options plus something else for the north.

Comment: I want healthcare provider to be able to access my records so they can treat me properly.

Reply: (AF) The majority of people do want their records shared but some people don’t. They have a choice.

Q: Concerns about the safety of the IT services. You may have the capability but is the system secure?

A: (Paul Young) it’s as secure as it can be. If you choose to opt out then your records will not be shared. The IT system operated on N3 connection. It’s not hack proof but it nearly is. The internal security is very good. As for shared records, your records are shared within your practice.

Comment: I don’t want my records outside the NHS, I don’t want them sold. Back to New Addington. The emphasis is on the north of the borough. Is New Addington being robbed? Its two estates put together, it’s huge. There is nothing in Selsdon. You have already made the decision, in September [2015].

Response: (AF) No decision has been made. It will be made on 2 February [2016]. The Governing Body won’t make a decision until after 2 February, after the engagement period has closed.

(PY) Option 1 and 3a and 3b show one GP hub in New Addington so they will be served.

Q: Why not have them [GP Hubs] in the existing MIU sites?

A: We can’t say where it is definitely going to be. We can’t say to a potential new provider you must do it there. This would break procurement laws so we can’t do that.

Q: I live in South Norwood and go to Kings, so do lots of people. I don’t want to go to Croydon University Hospital [Mayday]. Why do I have to go to Mayday for blood tests?

A: (AF) You shouldn’t have to go to Mayday for blood test, we have a community phlebotomy service. (PY) This is an opportunity to look for value added services, what extra are providers prepared to offer us? What extra can we get?

Q: Please can you clarify what the difference will be from what we currently have? In Purley will GP’s be able to access the X-Ray. Will it extend the X-Ray?

A: (PY) Most of the facilities will have extended hours. The table [page 7 of the engagement document] shows the additional services. This will also increase the skills available in the workforce. The X-Ray in Purley will still be available as it is now.

But if you have broken something you need to know it can be diagnosed and treated in one place. What’s important is getting the best treatment quickly. The UCC has full access to diagnostics and can treat fractures.

Q: Why not make more use of Purley? Surely this will take more strain off the UCC?

A: (PY) We have put more services into Purley. We need to do this in a piecemeal way to ensure safety. Soon we are potentially looking to introduce more ambulatory services e.g. infusions, at Purley.

(AF) We are thinking about mental health too and how the urgent care strategy links in with the CCG’s mental health strategy. CAMHS (Child and Adolescent Mental Health services) has been very neglected for years. This will allow much more joining up of services.

Stephen Warren: Hubs are just the beginning of the journey. They will link into mental health and sexual health services. Hubs will be able to signpost people more effectively. There is a much wider role for GP hubs. This is very much in line with the urgent care national strategy.

Q: Chair of south Croydon Residents Association: Nobody is looking at the whole picture. There is a crisis of care. Better receptionists are needed, some Practices are just chaotic.

A: (AF) The CCG is looking at variable outcomes across the CCG to explore whether variations are due to demographics’ e.g. deprivation or something else. There are also other initiatives such as extending the hours of GP’s to include Saturday and Sunday working.

Q: I’m not clear, where would I go with a suspected fracture?

A: Call 111 or your GP. They will take your history or be able to examine you; they can then make sure it is treated properly in the first place. It’s similar to stroke services; you need to go to the right place quickly for the best outcomes.

So contact your GP or 111 first, a clinician can then direct you to UCC to be diagnosed and treated appropriately.

Q: I’ve had lots of treatment at CUH and it’s excellent. What costings have been done for the 3 GP hubs?

A: (PY) A huge amount of work has been done on costings. We worked up some assumptions in September and then undertook a modelling process in October/November. The modelling has included everything in terms of costs, such as the workforce, rent, and consumables. We are now looking at how we contract, e.g. fixed, ceiling, block, key performance indicators and quality.

Q: The 3 hubs, will they be at new venues?

A: (PY) we are in dialogue with providers. We can’t say due to procurement rules. Some existing locations may not have great access or parking, we don’t want to shut down new opportunities.

Q: Is this future proof? What happens in urgent care impacts by location and on social care. A partnership approach is needed across southwest London. There’s also self-care, don’t miss other opportunities.

A: (AF) Pharmacies are integral, they provide most urgent care. The CCG doesn’t commission pharmacy services. We are already working with the local authority, for example, on Outcomes Based Commissioning. Providing more outlets to access urgent care doesn’t seem to make a difference. Self-care is crucial.

Comment: You need flexible contracting.

Q: What will the recruitment process be? Are you going to make sure providers are paying a living wage?

A: (PY) Staff terms and conditions are not stated in the contract. But this is a fair point; we will take it away to think about. Most staff are already on NHS terms and conditions and would be TUPE’d over.

Q: Purley was an urgent care centre which was downgraded. What service will not be offered within the hubs? Will Purley be upgraded?

A: (PY) Purley was never an urgent care centre. It was never developed. It was nurse-led and did not see the full range of patients. What we are proposing is more than the Purley previously named UCC did.

Comment: This is a comment on the engagement process. Can we trust you to put Croydon’s urgent care needs to the Commissioners. A corporate model is being preached. How flexible is the model?

Response: (AF) The modelling has taken all the data on urgent care needs, now and in the future, into account, such as population growth, housing developments. Nothing has been decided.

The slides show there are more services; there is no reduction in services. This is being driven by quality and safety.

Q: You mention providers. Name them.

A: (PY) Croydon University Hospital, Out of Hours, Virgin, AT Medics. The procurement is a European wide process; it will go onto a Euro website. We do not state, we are not allowed to under procurement law, who can bid.

Comment: My GP practice has open appointment. If the GP hub is appointment based then it’s not a good idea.

Response: (PY) We want people to use 111. GP hubs can be accessed through 111 or as a walk in. Your GP surgery will stay as it is.

Q: The CCG committed to a Mental Health expert in every surgery, when will this happens?

A: Antonia Knifton: This comment has been recorded elsewhere and will be addressed.

Comment: Elizabeth Ash: I would make a plea to the CCG. Please work on correctly signposting patients. It’s very difficult for patients to know where to go. This needs to be much clearer and workable.

Screen Shot 2016-01-07 at 00.55.47

Key themes from the meeting (in order of number of mentions)

  1. Plans and facilities in the north of the borough
  2. Geography, demographic (different needs of populations e.g. BME populations, mental health service users) and transport needs across Croydon
  3. Not enough GP’s to staff the Hubs/concerns that current GP practice would be relocated into a new site.
  4. Patient records and data sharing
  5. Signposting/confusion among patients about where to go for the right treatment
  6. Positive impact on environment/health of more local facilities e.g. facilities within walking distance would encourage patients to walk to facilities.

Screen Shot 2016-01-07 at 00.30.17

 

The Croydon CCG’s Frequently Asked Questions have been updated to reflect further points made at our meeting on 6 January 2016 and the meeting held at Purley the following evening.

Screen Shot 2016-01-14 at 15.33.34

 

 

Download a copy, here. FAQs urgent care FINAL January 14 2016

 

 

 

 

Fill in the survey to give your views by 17 January at www.croydonccg.nhs.uk/urgentcare

Paper copies of the Urgent Care information leaflets and the survey can be picked up in Croydon libraries.

Have a question or prefer to speak to someone?

Email: getinvolved@croydonccg.nhs.uk
Phone: 020 3668 1384

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