Governing Body Enhanced Primary Care Access (EPCA) Tuesday 28 th June

1. Governing BodyEnhanced Primary Care Access (EPCA)Tuesday 28th June Sarah Burns, Director of Commissioning

2. Why Did We Propose Change? Changes in April 2017 Retained minor injury units in Bishop Auckland and Peterlee for injuries Expanded same day appointments during the day across DDES (via practices or hubs in Easington) for illness Evening and weekend hubs in 9 areas across the geography Getting care right for you/Right care, right place, right person, right time/Talk before you walk Capacity provided was not fully utilised leading to concerns about value for money and sustainability of services

3. Consultation Ran from November 2018 for six week Nine public meetings Extended for a further six weeks throughout January Attended local venues e.g. supermarkets, community events Extension boosted responses by 35% It is recommended that wherever possible, more notice is given for events in future, more community drop in events are held to supplement public events, a directory of local Facebook groups is collated as they can be highly effective in communicating messages locally.

4. Key Issues Identified and Considered

5. Awareness of the NHS 111 Service • Twice as many people in DDES use NHS 111 than the national average (compared to findings of NHS Benchmarking Urgent Care Project) • Huge step change in April 2017 when appointments became bookable via NHS 111 • It is recommended that further and ongoing communications are issued to patients in this respect using a variety of methods to suit the needs of local communities

6. Services Patients Were Sent to After Contacting NHS 111 • Biggest change was in patients asked to contact primary care, which was always the highest disposition, however, proportionally the dispositions haven’t changed • Less people needed urgent treatment than we thought once they had been triaged

7. If More Patients Used 111 Why Weren’t the Hubs Busier? More patients were booked into their own practice. This data suggests over 500 more per month were referred to their own practice which equates to c16 per day or c6000 per year. It is recommended that the increase in patients seen in their own practice is recognised as a success given this was the preference of patients based on the original engagement work carried out.

8. 2019 audit 10% calls missed opportunities Varied between: 15% in the Dales, 7% in the Easington area and 13% in the Sedgefield area Were Some Hubs Quiet as Patients Weren’t Directed There? 2018 audit Many valid reasons why a patients would be sent to an alternative service Audit last year for Barnard Castle area suggested 1 missed opportunity per week Audit in 2019 suggested c1,000 missed opportunities (40 per week across 9 hubs – less than one per day, per hub) It is recommended that use of services by site and GP practice are monitored and any issues addressed by NHS 111 with regular training and updates provided for staff.

9. Usage increased for three practices, one in Seaham and two in Easington - 111 calls didn’t increase at the same point All other hubs usage remains static It is recommended that use of services by practice are monitored and triangulated with NHS 111 usage data to ensure that practices are not routinely using hubs to replace capacity in their own practices. Is Usage Increasing? Heathwatch recommend that two years isn’t long enough for the change to embed Consider value for money and sustainability It is recommended that services are not extended for a longer period before changes are considered as services have been operating for two years now without significant change in demand for services.

10. Transport Darker areas have most access to 1+ car/van and the lighter areas have least access Transport was raised at every event and was a major concern for people It is recommended that the transport criteria for transport to hubs are amended to remove financial restrictions on access to transport.

11. Specific Findings Patients with a Learning Disability Easy read booklets should be developed for patients with a Learning Disability It is recommended that training is provided for NHS 111 staff and staff providing home visits to ensure that appropriate adjustments can be made to the service to meet the needs of patients with a learning disability. Community Hospitals It is recommended that providers are encouraged to continue to publicise the services that are available at community hospitals via their websites. Housebound Patients It is recommended that the register of housebound patients continues to be regularly updated by practices. It is recommended that further clarity is sought on the accessibility issue for parents of young children

12. Findings and Recommendations

13. Dales Sharing 32% of the DDES population, Durham Dales accounted for 50% of all responses and 65% of all comments in this consultation 60% majority of respondents opposed their proposal, 21% supported their proposal and 19% were unsure or did not know Key issues were: Travel and transport issues (20% of all Durham Dales respondent comments), a potential loss of service (particularly to Richardson Hospital, Barnard Castle) (20%), a lack of awareness with both the consultation and the existence of the extended hubs (15%) In terms of weekend opening times, 66% of Durham Dales respondents preferred the Bishop Auckland 10am to 2pm opening time option The majority (47%) were unsure whether the proposals still allowed for same day and booked extended GP access and 37% thought that booked appointments would help make the proposal work The service will operate 12 noon-8 pm during the week and 10am – 2pm on a weekend from one site at Bishop with better transport options, more booked appointments and enhanced frail/housebound services

14. Sedgefield Sharing 33% of the DDES population, Sedgefield accounted for 14% of all responses and 8% of all comments in this consultation. 43% majority of respondents supported their proposal, 25% opposed their proposal and 32% were unsure or did not know. Key issues were the difficulty in accessing GP appointments (20% of all Sedgefield respondent comments), the loss of service and travel (19%) and transport (14%). In terms of opening times, 61% of Sedgefield respondents preferred the Spennymoor, Newton Aycliffe and Sedgefield 10am to 2pm opening time option The majority (54%) were unsure whether the proposals still allowed for same day and booked extended GP access and 48% thought that Booked Appointments would help make the proposal work. This service will operate 12 noon - 8 pm during the week as an overflow service to practices from Newton Aycliffe with an additional service from Spennymoor 6-8 pm.  The service will operate weekends 10am-2pm from Sedgefield, Newton Aycliffe and Spennymoor with better transport options, more booked appointments and enhanced frail/housebound services.

15. Easington Sharing 35% of the DDES population, Easington accounted for 36% of all responses and 27% of all comments in this consultation. A 42% majority of respondents opposed their proposal, 28% supported their proposal and 30% were unsure or did not know. Key issues were the difficulty in accessing GP appointments (21% of all Easington respondent comments), the loss of service (18%) and travel and transport (13%). In terms of opening times, 52% of Easington respondents preferred the Peterlee and Seaham 8am to 1pm opening time option The majority (50%) were unsure whether the proposals still allowed for same day and booked extended GP access and 43% thought that booked appointments would help make the proposal work. This service will operate 12 noon – 8 pm during the week at Peterlee and from Seaham 6-8 and 8am – 1pm on a weekend from Peterlee and Seaham with better transport options, more booked appointments and enhanced frail/housebound services

16. Questions?