Agenda item

The Committee received a presentation from the Integrated Care Board (ICB) regarding the Urgent and Emergency Care offer in Leicestershire outside the Leicester Royal Infirmary site. A copy of the presentation slides, marked ‘Agenda Item 9’, is filed with these minutes.

The Committee welcomed to the meeting for this item Nilesh Sanganee, Chief Medical Officer and Rachel Dewar, Associate Director of Urgent and Emergency Care, both of the ICB.

Arising from discussions the following points were noted:

(i)           The Chairman emphasised that a significant proportion of LLR residents lived in the outskirts of Leicestershire and it was important to keep Urgent and Emergency Care services as local as possible so that patients did not have to travel into Leicester City. In response to a query from the Chairman it was confirmed that data regarding population hotspots in the county was used when considering the location of Urgent and Emergency Care services and whether need was being me. With regards to the locations it was important to take into account that there were nearby services across the county border which Leicestershire residents could access. For example, Hinckley residents were close to the George Eliot Hospital in Nuneaton.

(ii)         In response to a query from a member as to why some Urgent Care Centres were only open in the evening between 7.00pm and 10.00pm it was explained that the hours GP Practices were open had been extended later into the evening, and the Urgent Care Centres were intended to be open during the time GP Practices were not open.

(iii)        Not all Urgent Care Centres/Urgent Treatment Centres offered the same level of treatment or had the same level of facilities. For example, although the Loughborough Urgent Treatment Centre had x-ray facilities these were not available 24 hours a day and a patient at Loughborough that needed an x-ray out of hours would have to be transferred to the Leicester Royal Infirmary.

(iv)       A significant proportion of patients that attended Urgent and Emergency Care sites could have been seen in Primary Care. Some issues that patients themselves believed were urgent, would not have been classified by the NHS as urgent. The ICB was proposing improvements to same day access to health care services and was conducting a review in this regard. The review would cover unmet need with regards to patients seeking emergency treatment. Some issues patients presented with were not suitable to be dealt with by Primary Care but not of a severity to be dealt with at the Emergency Department and therefore intermediate services were required. It was agreed that further details regarding the same day access review would be circulated to members after the meeting.

(v)         The Urgent and Emergency Care offer was broader than just Urgent Care Centres and Urgent Treatment Centres. EMAS offered the Hear and Treat service over the phone and also the See and Treat service in person. There was also the Urgent Community Response service which aimed to react within 2 hours. There were also services available for the frail and elderly population such as the home visiting service run by Derbyshire Health United.

(vi)       Patients could also visit a pharmacist and receive treatment for 7 conditions under the Pharmacy First scheme.

(vii)      The NHS 111 clinical navigation service played a role in navigating patients to the right place and at the right time. The needs of some patients were nuanced and it was of benefit for them to have a discussion with the call advisor before deciding which service to access.

(viii)    In order to help the problem of patients having to wait a long time for GP Practices to answer their phone calls, cloud telephony was being introduced which included a callback feature so patients did not have to wait on hold. This was working successfully. The number of GP Practice appointments available had also increased significantly.

(ix)       An Artificial Intelligence triage service was being trialled in a small number of GP Practices.

(x)         In response to a suggestion that notices to the public about where to go for emergency treatment could be placed on rubbish bins or prescription bags it was explained that many similar initiatives had been tried in the past such as fridge magnets but there were budgetary constraints.  The ICB welcomed ideas for disseminating messages but were looking for cheaper ways of getting messages to the public. The ICB’s Get in the Know campaign featured web pages with all the information about where to go for different health problems. The webpages had the advantage that they could be updated more quickly than paper notices. The NHS app also had a lot of information. Members pointed out that not everybody had access to the internet.  A member submitted that it could be cost effective to pay for the publicity in the short term as it would have a positive impact in the longer term by preventing patients from requiring more serious and expensive treatment.

(xi)       Members raised concerns that due to being unable to get appointments at dental practices, patients were presenting at Emergency Departments with urgent dental issues. In response reassurance was given about the work ongoing to improve access to dental appointments such as the flexible commissioning scheme which aimed to make NHS dental contracts more adaptable, increased payments for units of dental activity, and the offer of incentive (‘golden hello’) payments.

RESOLVED:

That the update regarding the Urgent and Emergency Care offer in Leicestershire be noted.