Microsoft word - healthwatch leicestershire+rutland uc-miu briefing 18feb2014.docx

Healthwatch Leicestershire and Healthwatch Rutland
Briefing and update: Urgent Care/Minor Injury and Illness Services
Consultation 26 February to 23 April 2014

Introduction
Urgent care is treatment for minor il nesses and injuries, without an appointment, at
hospitals, walk-in centres and GP surgeries. It refers to health conditions which are urgent,
but are neither life-threatening nor emergencies. They include things like bruises, sprains,
minor burns, cuts and wounds, coughs, colds, vomiting or stomach troubles. East
Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) wants to make sure
good quality urgent care is available when people need it, and believes there are
compel ing reasons to make changes.

Why do we need changes?
At the moment urgent care services in East Leicestershire and Rutland differ in
effectiveness and in what they offer from place to place. Their opening times are confusing
for patients and clinicians alike.
Local doctors and other health professionals have listened to people’s views on these
services, while careful y examining the effectiveness of the care on offer, how the services
are used and how much they cost to run. We think that there is room for significant
improvement.
Like many other areas across the country, it is important that we ease pressure on busy
accident and emergency departments. One of the ways we can help achieve this local y is
to make sure that there are other good services available every day.
The Urgent and Emergency Care Review (NHS England, January 2013) also highlights the
need to improve urgent care, and sets out what good care looks like:
“Services must provide care that is efficient, consistently high in quality and safe, seven
days a week. It must be simple and it must help patients and clinicians make good choices.
It must also provide the right care in the right place, by those with the right skil s, the first
time.”

We want to make changes to ensure better quality care is available that meets these aims.
So we would like to know what people think about our plans for the future of these services.

The consultation document and questionnaire
The consultation document sets out the urgent care services available today, how they are
used, and three options for improving them. It also asks people to answer some questions.
After reading the background information, we would like people to choose one option and
tel us why they prefer it. It also invites them to suggest further improvements.
Pre-consultation engagement
We have worked hard to gather and understand people’s views, and people told us they
supported local urgent care services, and asked us to consider how we could improve
opening times and access, as wel as highlighting the need for better information about
local services. We have taken these views on board. Leicestershire Healthwatch and
Urgent Care Consultation - Healthwatch Briefing: 18/2/2014 1 Rutland Healthwatch have given us some important insights into patients’ needs which
have also shaped our thinking.
All these views of local people have shown us the need for improvements. Now we would
like the public’s help again to make sure the decisions we make are the right ones.
A consultation update – Oadby, Wigston, Blaby and Lutterworth
There have been one or two changes since we spoke to local people about this subject,
which have led to us revising our options for the future. We are now including Oadby and
Wigston in al of our proposals, because we wil take over responsibility for the local walk-in
centre from April this year. It is NHS England’s responsibility at the moment and their staff
have been working closely with us on this consultation. Including Oadby and Wigston in our
options would offer more choice to patients in the surrounding area.
We have also re-examined how to help people in the Lutterworth area. The walk-in service
at Feilding Palmer Hospital, Lutterworth, was temporarily suspended last year, and many
local people have been going to Rugby St Cross Hospital instead, as it is only about eight
miles away. We are now offering Lutterworth people a choice of local urgent care services
based at any East Leicestershire GP surgery.
What is currently available?
We offer urgent care in the fol owing places, which are open for different hours and days of
week. They do not al provide the same diagnosis and care services.

Location
Service available Opening times
Minor Il ness (nurse-led), Monday to Friday 8.30am to 6pm Rutland Memorial Hospital, Minor Injury and Minor Injury, 9am to 5pm No services at weekend or Bank Holidays Market Harborough District Minor Injury and The following service is temporarily suspended:
* Minor injury services provided from the unit in Lutterworth have been suspended since April 2013. In the past the service here has always been provided by staff working on the Urgent Care Consultation - Healthwatch Briefing: 18/2/2014 2 adjacent hospital ward, who also have minor injury experience. When a walk-in patient
arrived for minor injury treatment the staff had to leave their ward to treat them. With an
average of only 13 patients a week using the unit, this meant that staff did not regularly
practice their minor injury skil s, which had the potential to affect the quality of care. The
temporary closure was also partly due to difficulties in recruiting appropriately qualified and
experienced staff for these dual roles.

What local people told us
When we asked people for their views on minor injury units last year, many people told us it
is important to have them close to home and to be seen quickly by appropriately trained
staff with the necessary medical equipment.
Many of the people, who had used minor injury services before, think the current services
are good, but would like opening times to be extended. However, they are confused about
where, when and how they can access different urgent care services. Additional y, patient
feedback shows people want these services to be provided local y, such as in GP surgeries
and community hospitals. Good transport links and parking are also important.
Patients recognise that keeping urgent care services local helps people avoid going to A&E
for anything other than emergency care. The way people use these services also tel s us
when it is best to have services open and when the demand is likely to be low.
We heard from some local people that they have difficulty being seen by their GPs, and as
a result we are working hard with local practices to improve appointment systems and
information about available services. All these views have played an important part in
helping us to shape the options for improvement.
Average costs for a visit
It costs the local NHS between £20 and £47 every time someone uses the current minor
injury and minor il ness services in East Leicestershire and Rutland. These are very similar
to the average costs elsewhere in the country.
However, when someone goes to A&E for minor injury or il ness treatment it costs the NHS
about £81, almost twice as much as if they had used their local urgent care or GP service.
Avoidable A&E attendance can also increase waiting times and puts extra pressure on busy
A&E staff attending to patients needing emergency treatment.
What is more, when people choose to use their local services, not only are they normal y
seen faster than at A&E, and in a more appropriate setting, but is also al eviates pressure
on A&E staff. Going to an urgent care centre wil also be helping the NHS to spend its
budgets more effectively.
At the moment the costs of our units in Market Harborough, Lutterworth, Oakham and
Melton Mowbray include payment for il ness services during the day. The NHS also pays
GP practices to provide the same illness services in the daytime. So by opening minor
il ness units at times when people can see their GP, the local NHS is paying twice for
making the same type of service available.
Urgent Care Consultation - Healthwatch Briefing: 18/2/2014 3 The fol owing table shows what we are spending on these services in the current year. Urgent Care
Current Budget
Harborough
(£'000)
(£'000)
(2013-14)
(£'000)
(£'000)
(£'000)
1,957,474
Total Current Budget
1,022,500
2,051,138

Developing the options
Local GPs, other clinical experts and healthcare managers examined current services, their
quality, effectiveness and costs, as wel as how they are used. They compared what was
available with national and local y agreed aims. Options for change began to emerge from
these discussions.
We then asked people to give us their views on these services. From 16 April to 31 May
2012 we invited people to help us identify the services they wanted from their community
hospitals and MIUs. A survey was sent out to people online, and a paper version was given
to those who do not use the internet or email, to make sure as many people as possible
had the opportunity to take part. Staff working in these services and other healthcare
functions were also invited to take part. Organisations, such as the voluntary sector, were
invited to send us the views they had previously col ected about these services.
We also welcomed the involvement of Leicestershire Healthwatch and Rutland
Healthwatch, who gave us further insights from a patient’s point of view and who have been
involved in the review throughout.
Towards the end of 2013 we extended the scope of our review to include Oadby and
Wigston Walk-in Medical Centre, for which we wil be responsible from April 2014. So we
invited local people to take part in a survey about their use of this centre. Their responses
helped us develop our options.
We also re-examined the future of the minor injury and il ness service at Feilding Palmer
Hospital, Lutterworth, temporarily closed last year due to low use and concerns over
staffing levels and ensuring continued patient safety.
So in December 2013 we launched a further survey, asking people to comment on whether
our three draft options were the right ones to take out to a ful public consultation. Fol owing
this survey, which ended in January 2014, we further revised the draft options.
Public health experts at Leicestershire County Council analysed the make-up of the
population in different area, and the location of places where urgent care is available. The
aim of this study was to help identify the right places for future urgent care services that
would best meet people’s needs. We also commissioned a review of public transport
services that could help people get to GP surgeries and urgent care centres. Since then
there have been some changes to public transport services, however we continue to work
with Leicestershire County Council to measure their effects on our options.
Urgent Care Consultation - Healthwatch Briefing: 18/2/2014 4
The three options
The mainstay of weekday urgent care services would be our 34 GP practices. For minor
injury and il ness patients would probably want to be seen by their own GP, but would also
be able to go to any ELR surgery. All our urgent care centres would have the same daytime
9-5 opening hours in the week, and be open at weekends and Bank Holidays 10-3. There
would be no evening services.
OPTION 1:
Weekdays - daytime
• Minor injury and minor il ness services at any ELR GP practice during normal • Minor injury only services at 3 urgent care centres in Market Harborough, Melton
• Minor injury and minor il ness services at 1 urgent care centre in the Oadby &
Weekends and Bank Holidays - daytime
• Minor injury only services at 3 urgent care centres in Market Harborough, Melton
• Minor injury and minor il ness services at 1 urgent care centre in the Oadby &

OPTION 2:
Weekdays – daytime:
• ELR GPs provide minor il ness services, but not minor injury care, in their normal Weekdays - morning to evening:
• Minor injury and minor il ness services at 4 urgent care centres - Market
Harborough, Melton Mowbray, Oakham, Oadby & Wigston , 8am-8pm Weekends and Bank Holidays - daytime:
• Minor injury and minor il ness services at the same 4 urgent care centres, 9am-

OPTION 3:
Weekdays – daytime
• Minor injury and minor il ness services at any ELR GP practice during normal Weekdays – evenings only:
• Minor injury and minor il ness services at 4 urgent care centres – Market
Harborough, Melton Mowbray, Oakham, Oadby & Wigston , 6pm-9pm Weekends and Bank Holidays – daytime to evening:
• Minor injury and minor il ness services at the same 4 urgent care centres, 9am-7pm

Notes on the options
Exact opening times at any venue wil remain a matter of discussion until they are agreed
with healthcare providers. Outside of these hours patients wil have use of the NHS 111
Urgent Care Consultation - Healthwatch Briefing: 18/2/2014 5 free helpline service, which offers an assessment and advice on the most relevant local
care options available.
Weekend GP opening is excluded from al the options, and is stil subject to national
discussions. A pilot scheme is being trial ed in some parts of England.
What would each option cost ?
All of our three options for the future come within 5% of the earmarked budget, so future
costs should not be seen as a major issue when choosing the preferred option. This
consultation is about finding the option which best provides the urgent care patients need,
improving services in a cost-effective way and using resources wisely, but it is not about
cutting costs.
The fol owing table show the projected costs for the three options.
Urgent care
Total (£'000)
Forecast Spending (2015-16)
2,119,854
2,048,320
2,082,749

Events and the ‘listening booth
A series of public ‘open-door’ events is being arranged, where people can drop in and see
key information before providing their comments and preferred option. Along with the
‘listening booth’, a portable kiosk where people are encouraged to get involved and
comments, wil be taken around the east Leicestershire and Rutland area. The consultation
document and posters wil be available at al GP surgeries, health centres, libraries,
community hospitals and other locations, and there wil be an online questionnaire, details
of which wil be circulated to hundreds of stakeholders and al 4,000 NHS CCG
membership scheme members in East Leicestershire and Rutland.

What are the next steps?
The answers to this consultation and questionnaire wil be independently analysed and the
results wil be combined into a report. The findings wil be thoroughly examined and
discussed by doctors, healthcare professionals and managers. They wil produce a
recommendation, which wil go before the ELR CCG Governing Body for approval. If
approved, a service specification wil be drawn up for would-be providers. Any necessary
procurement of services wil begin and, if needed, changes in existing provider contracts
wil be negotiated. The new arrangements for minor injuries and il ness wil begin in 2015.
Urgent Care Consultation - Healthwatch Briefing: 18/2/2014 6

Source: http://www.healthwatchleicestershire.co.uk/sites/www.healthwatchleicestershire.co.uk/files/healthwatch_leicestershirerutland_uc-miu_briefing_18feb2014_5.pdf