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South East Clinical Senate. Review of town centre primary care proposals for Eastbourne and Hastings. (Aug. 2019)

The two CCGs of East Sussex, Hasting and Rother, and Eastbourne, Hailsham and Seaford, identified the need to develop a consistent networked model for urgent care, that is aligned with the requirements set out in key national documents, including the NHS Long Term Plan and the prior Five Year Forward View. This involves the establishment of urgent treatment centres (UTCs), and the NHS 111 service alongside a Clinical Advisory Service (CAS). There are agreed plans to establish a UTC on the site of the Conquest Hospital in Hastings, and at the Eastbourne District General Hospital.

In parallel, there are major changes being directed nationally to the way primary care and community services are delivered and better integrated, also outlined in the NHS Long Term Plan and the General Practice Forward View.  This involves the establishment of Primary Care Networks, improved access, and integrated care hubs, that will ensure patient centred, coordinated and integrated care for the local population and ‘fully integrated community-based healthcare’[1].

This context has required the CCGs to review the status of their current ‘Walk-In Centres’ (WICs). Whilst there is no standard definition of an NHS WIC, Monitor defined them as ‘a site that provides routine and urgent primary care for minor ailments and injuries with no requirement for patients to pre-book an appointment or to be registered at the centre or with any GP practice[2]. WICs are classified as type 4 A&Es in the NHS Data Dictionary[3] (though they are far from the normal understanding of A&E) and provide primarily a same day GP-based service to attendees. Current NHS England guidance[4] is that: ‘it is expected that 100% of Type 3 & 4 A&E services should either meet the UTC standards, become another alternative non-urgent primary or community based service, or close by December 2019. Any exceptions to achieving this timeframe should be signed off by the Regional Director.’

The Sussex and East Surrey STP is quoted as concluding that, as WICs are primarily providers of primary care rather than urgent care, they are not being developed in to UTCs. Commissioners therefore need to consider the future of their WICs taking account of NHS England guidance as quoted above, and alongside the plans for primary care (same day and more generally). Both Eastbourne and Hastings have a town centre WIC, and they are developing plans for future alternatives to each WIC. As it is considered likely that these plans would require public consultation, and in line with best practice as outlined in NHS England guidance[5], they have sought an independent clinical review of their proposals to date, prior to the finalisation of any pre-consultation business case (PCBC).

[1] NHS Long Term Plan. https://www.longtermplan.nhs.uk

[2] Walk-in centre review: final report and recommendations. Section 1.1. Monitor 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/283778/WalkInCentreFinalReportFeb14.pdf

[3]  Accident and Emergency department type. NHS data dictionary. https://www.datadictionary.nhs.uk/data_dictionary/attributes/a/acc/accident_and_emergency_department_type_de.asp?shownav=1

[4] Urgent Treatment Centres – FAQs to support implementation. Acute Care Team, NHS England and Improvement, June 2019. See page 18. https://www.england.nhs.uk/wp-content/uploads/2017/07/urgent-treatment-centres-faqs.pdf

[5] Planning, assuring and delivering service change. NHS England 2018. https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service-change-v6-1.pdf

Clinical Senate

Kent Surrey Sussex

Date:

29/08/2019

Status:

Completed

Types of Work:

Clinical Review