Welcome

1. Welcome Dudley Borough Healthcare Forum Tuesday 24th September 2013

2. In this session we will • Explain what we mean by urgent care • Look at why we are thinking of making the changes • Look at the issues within urgent care

3. What is Urgent Care? • A&E • Your GP Practice • Primary care out of hours service • The 111 telephone system • The ambulance service

4. Why Urgent Care needs to change • It is not meeting the needs of our patients, carers, public and community • There is a new financial environment • The system is complicated and confusing to navigate • People do not know where to go for help when they need it

5. Why look at making changes now? • Our contract for the Walk In Centre (WIC) ends next year so it is a good time to look at how the service works and whether it needs to stay the same, change or be improved • Our contract for primary care out of hours service ends next year too, so again it is a good time to look at how the service works and whether it needs to change, stay the same or be improved • Our local hospital (Russells Hall) is struggling to see people within the national standard of 4 hours in A&E • The 111 telephone service is now provided by the West Midlands Ambulance Service as NHS Direct have told us they can no longer provide the service. This gives us an opportunity to help shape the service when it is recommissioned

6. Urgent Care in Dudley Borough • If you go the Walk In Centre (WIC), you are twice as likely to be sent to A&E than if you saw your own GP • If you go the Walk in Centre (WIC), the GP there will not be able to see any of your medical history – they can only go on what you tell them • The Walk In Centre (WIC) opens from 8am until 8pm, 7 days a week, is based at Holly Hall Clinic and sees 47,000 patients a year • The primary care out of hours is based at Holly Hall Clinic and manages about 22,000 cases a year – of these about 7300 patients receive advice or guidance over the telephone, 1000 patients are sent directly to A&E, 4300 patients receive a home visit from a GP and 9200 attend the clinic to see a GP • About 32,000 people attend A&E with minor conditions which could have been treated in primary care • About 66,000 people attend A&E for major conditions

7. Urgent Care in Dudley Borough When patients attend A&E: • 38.4% of patients are discharged immediately without treatment. Half of these are sent back to their GP • 24.7% are admitted to a ward • The rest either have immediate treatment or are referred to another service The costs are: • Walk in centre - £35 • GP same day appointment - £25 • A&E attendance (no treatment) - £58 • Seen by primary care out of hours doctor service - £73 • Ambulance 999 - £208 • Emergency admission - £1,739 (average)

8. What you have told us already • The urgent care system is too complicated and needs simplifying • If you need to see a GP, you would rather visit your own practice • You would like it to be easier to make and get an appointment with your practice • You would like more appointments to be available especially outside of ‘routine’ hours • Sometimes you just need reassurance from a medical person • You have not got much confidence or trust in the 111 telephone service • You would rather be treated at home than have to go into hospital • That if people go to A&E, it needs to be for a real emergency • That if people really aren’t that poorly – they should make use of other services but need the help and information to make the right choices • You still need somewhere to go/or someone to speak to get help

9. What GPs have said • They would rather see their own patients in their own surgery • They recognise that if the Walk In Centre was taken away, there would have to be additional capacity in primary care • That they would like people to stay at home and be treated rather than be admitted to hospital • We need to maintain existing resource for primary care in Dudley borough

11. Urgent Care Map

12. What could the future look like? • We believe that your own GP is the best ‘navigator’ to your health needs and care • An effective triage system in Accident & Emergency so that we challenge people in the right way if they turn up and it’s not an emergency but we still give people the right help and in the right way • More appointments available in primary care including extended hours • A primary care out of hours service that meets the needs of our local people • A 111 telephone service which gains trust and confidence from you

13. What are we proposing? • Close the Walk In Centre at Holly Hall and improve access to your own GP during routine hours • Redesigning access to urgent care through a single point of access

14. We would like you to help us shape the public consultation 1. As a group can you think about advantages and disadvantages of the proposals 2.Identify solutions that might help overcome any concerns 3.In 2 years time what would perfect look like to you?