Proposed Changes to Urgent Care (Out of Hospital Services) Across North East Essex

Consulting the Community

Proposed changes to urgent care (out of hospital services) across north east Essex

Public Engagement Exercise

4th January–1st March2017

North East Essex Clinical Commissioning Group

Feedback REPORT

Dr Steven Wilkinson

Consulting the Community

March 2017

This is a Two Part report containing a;

Consultation Feedback Summary Report; and

Expanded Feedback Report

Contents

1. Consultation Feedback Summary Report

Table 1 – Response count

Expanded Feedback Report

2 Introduction

3 Methodology and Methods

Table 1 – Response count

Feedback Report

4. Proposed changes to urgent care (out of hospital services) across north east Essex

4.1 Walk in Centres and Minor Injury Units

Qu 1a If you selected 'Another Approach', please give us your thoughts:

Qu 1a Findings

Qu 2 How would any changes to these services affect you?

Qu 3 Findings

5. Funding

Qu 4 Do you have any views or ideas on how the CCG could improve its financial situation?

Qu 4 Findings

6 About You

Qu 5 – I am a

Qu 6 What would help you to be confident about self-treatment?

Qu 6a. If you selected Other, please specify:

Qu 6a. Findings

Qu 8 During the hours when your GP practice is closed and you need immediate health care, which of the of lowing best describes what you would do? (select only one box)

Qu 9 Please use this space to provide further comments to your responses to questions 6, 7 or 8 above.

Qu 9 Summary

7 Additional Feedback

8 Report Outcomes

Appendix – Responders Information

Part One

1. Consultation Feedback Summary Report

Background

To further understand the local need for out of hospital urgent care services, North East Essex Clinical Commissioning Group (the CCG) undertook a listening exercise with users and the wider public. This assisted in developing three options.

The options were as follows:

To continue to commission a Walk in Centre service in Colchester and Minor Injury Units at Clacton and Harwich
To stop providing the Walk in Centre and Minor Injury Unit services. Patients requiring these services would be directed by NHS 111 and seen by their local GP, Out of Hours GP or encouraged to self-care.
The establishment of a minor injury service

An Engagement Exercise document was produced and a Survey was developed, publicised and distributed within the public engagement plan;

Healthcare needs are changing across the UK, and we have an opportunity to plan for changes in this area. Things have to be different because more and more of us are living longer, some of us go on to live with complex conditions that place an enormous strain on local health and social care services. This pressure is increasing at a rapid rate which means that the NHS can sometimes struggle to cope with demand. This scenario is not unique to north east Essex – it is a national challenge.

As part of a five-year plan, known as the Five Year Forward View, the NHS is taking action to review urgent and emergency care services across the country.

Contracts to provide services at the Walk in Centre in Colchester and the Minor Injury Units at Clacton and Harwich are due to expire at the end of March 2018. Therefore, this provides the CCG with an opportunity to assess whether these services are meeting the needs of local people and to consider any changes if these are deemed appropriate.

The CCG is also keen to have a system that is less confusing for people seeking urgent care support and treatment. This arrangement would be complemented with an improved NHS 111 and GP out of hours service which will give patients a single point of contact for all urgent care needs. There will also be a focus on encouraging patients to self treat minor illness and injury and seek advice from pharmacists, where appropriate.

( - accessed March 2017).

Data Collection

The on-line survey tool that was used was the Bristol On-Line Survey ( - which served to both collect feedback and to form a database of responses. Hard copy responses to the survey were manually entered into this database.

Other response types (correspondence, electronic responses and meeting notes) were also collected and/or provided.

Response

The following table indicates the number of responses received (rounded up);

Table 1 – Response count

Questionnaires3,400

Correspondence (email & hard copy) 200

Public meetings1,550

+ Additional information including petitions, on-line comments, & media.

North Essex CCG – Communications and Engagement Plan

(Accessed December 2016)

The largest groups of responses predictably came from Colchester, Clacton–on–Sea and Harwich, and from Postcodes CO15, CO4, CO12, CO16, CO7, CO5, CO13, and CO3. >29% of respondents were aged between 65 – 74, >18% between 55 – 64 and 14% 35 – 44. 92% of respondents were White British, with >68% being female and 31% male. >15% of respondents claimed to have a disability. (Details about this information are at the appendix.)

Feedback

[1]

(The ‘word cloud’[2] illustrates the 100 most often occurring words within the responses to all questions. The larger the word, the more often it occurred.)

Approaches Feedback

The CCG sought views on four potential approaches:

1)To continue to commission a Walk in Centre service in Colchester and Minor Injury Units at Clacton and Harwich.

2)To stop providing the Walk in Centre and Minor Injury Unit services. Patients would be required to contact NHS 111. They would be directed by NHS 111 to their local GP, Out of Hours GP or encouraged to self-care (helping people to look after themselves).

3)The establishment of a minor injury service - This proposal would see the establishment of a minor injury service which would see and treat a range of minor injuries, from fractures, wounds requiring stitching to infected bites, taking the pressure off A&E. This service would have sites in Colchester and Tendring - dependent on where there is greatest need.

4)Other views and ideas from members of the public.

In response to this question, Potential Option 1 (to continue to commission the walk in centres and minor injuries units) was selected by 82% of respondents. 0.5% selected Potential Option two (to close the centres) and 11.9% selected Potential Option three (a centralised minor injuries unit). 5.5% selected Another Approach and provided an open-ended response.

In the analysis of open-ended responses, key themes were identified from the text, which had been coded. In response to the Another Approach option the following themes were identified;

Theme / % of response / Coded text.
Development / 37 / Expand existing services; increase the number of units and centres and develop GP surgeries
Location / 25 / Local services are needed, retain the units/centre; consider a single provider
Access / 11 / Regulate access to the services
Proposals / 11 / Funding issues, close the centres; disagreement with the proposals, more information is needed
Capacity / 9 / GP, A&E, Ambulance capacity concerns
Travel / 5 / Difficulty with travel and transport
Quality / 2 / Satisfaction with services; some concerns with care quality (e.g. 111 service)

Respondents were also asked an open question relating to how any changes might effect them. The following themes were identified;

Theme / % of response / Coded text.
Capacity / 32 / GP, A&E, Ambulance capacity concerns + potential increased waiting times.
Location / 32 / Patients have a preference for local services & want OOH services.
Travel / 20 / Difficulty with travel and transport
Quality / 11 / Satisfaction with services; some concerns with care quality (e.g. 111 service)
Proposal / 3 / No impact; satisfied with the proposals; more information is needed; funding concerns.
Access / 1 / Regulate access to the services
Development / 1 / Expand existing services

Respondents were asked for any additional comments. The following themes were identified;

Theme / % of response / Coded text.
Capacity / 26 / GP, A&E, Ambulance capacity concerns
Location / 24 / Patients have a preference for local services & want OOH services; some concern about the use of existing buildings.
Quality / 9 / Satisfaction with services; some concerns with care quality (e.g. 111 service)
Access / 8 / Regulate access to the services
Travel / 7 / Difficulty with travel and transport
Proposal / 3 / No impact; satisfied with the proposals; more information is needed; funding concerns.
Staff / 1 / Concerns about staffing.
Engagement / 1 / Concerns about the consultation process

Four Options Findings

Whilst Option 1 is most favoured, a combination of 1 & 3 could be considered.
Services at MIU’s and WIC’s should be expanded making better use of facilities.
Services should be open longer.
Co-locate WIC’s with A&E.
GP capacity is questioned.
Harwich and Clacton need local services – the distance to Colchester is too great.
Access to services should be managed
A centralised service could be considered.
More information is needed about the proposals.
Longer opening GP hours is desirable.
Elderly, disabled, single parents & young children have difficulty travelling.
Care quality and the quality of the 111 service is of concern.

Impact Findings

GP’s do not have capacity to increase their workload.
Walk in centres provide a different service to GP’s and A&E.
WIC’s and MIU’s take the pressure off A&E.
Local services are preferred
Local services should be expanded
Harwich is under-used – and has capacity to deliver more services.
There are quality concerns regarding the 111 service.
Many will need to travel too far and at too great an expense.
The quality of care at Clacton, Harwich and Colchester is highly regarded.
Access to services should be regulated.

Additional Comments Findings

There are insufficient numbers of GP’s in the region
GP surgeries cannot cope with demand.
A&E is overstretched.
The population is increasing
Local services are preferred.
Out of hours care is lacking
Existing services should be retained and/or expanded.
Joined up care is lacking.
The existing units and the quality of care are greatly valued .
There are quality concerns regarding the 111 service.
Access to A&E should be regulated.
Awareness of alternative care options needs to be raised.
Travel is difficult for some groups of people.
Proposal One is preferred
Other ways to save money should be considered.

Finance Feedback

Question four asked for views or ides about how the CCG could improve its financial situation. The following themes were identified;

Theme / % of response / Coded text.
Funding / 31 / Introduce charges; more central funding is needed; introduce fines; review staff costs; reduce service costs; generate income; change of government.
Staff / 15 / Review staff policies/infrastructure; utilise ancillary staff; listen to staff ideas.
Management / 13 / Reduce waste, administration and bureaucracy; address bed blocking; manage suppliers and contractors; review targets.
Development / 8 / Join up care; use technology; invest; merger healthcare providers; avoid privatisation.
Access / 6 / regulate access to services
Location / 6 / Retain local services; provide OOH services
Education / 5 / Invest in training/education (e.g. train more medical staff, educate the public in the use of services)
Estates / 3 / Plan building use and infrastructure
Proposals / 3 / Close the walk in centres
Engagement / 1 / Concerns about the question/consultation

Finance Findings

Introduce charges & fines.
Lobby government for more funding
Review staffing and salaries
Review wasteful service practices
Review supplier contracts
Cut non-essential services
Generate income from estates and facilities.
Reduce locum & agency staff.
Reduce private consultants.
Increase the use of allied health professionals, pharmacists & nurses.
Increase the use of cottage hospitals
Collect staff feedback
Stop investing in underutilised facilities, services and resources.
Save on energy costs.
Re-use equipment and medical aids.
Reduce bureaucracy.
Address ‘bed blocking’.
Develop more joined up care.
Review procurement practices.
Make better use of technology.
Review patient management (i.e. Ambulances)
Invest more into healthcare services.
Merge CCG’s.
Operate a triage system at A&E.
Maintain local facilities and services.
Focus on prevention through education.
Train more doctors and nurses.
Make best use of existing estates.
Review prescribing practices.

Self Treatment Feedback

Respondents were asked what would help them to be confident about self treatment. 25.7% selected the NHS telephone line option, 23% selected the NHS website or mobile App option. 18.3% indicated they did not need help and 9.2% selected the leaflets and advice option.

Those who selected the ‘other’ option provided an open text response. The following themes were identified;

Theme / % of response / Coded text.
Preference / 38 / Face to face contact; a lack of confidence to self treat; the earliest treatment possible; A&E, all of the suggestions; shared care and own social network.
Pharmacist / 23 / Pharmacist
Education / 13 / Education and campaigns promoting self care
Access / 11 / Ensure reasonable use of services
Communication / 11 / Issues concerning the internet and telephone
Capacity / 4 / GP capacity concerns

Self treatment Findings

Telephone and on-line support would be used by 49% of respondents.
Speaking to a medical professional is preferred.
Confidence in the advice is needed.
Self-help is an option.
Pharmacists are helpful.
Education is important.
Not accessing medical professional advice could be dangerous.
Information provided on-line is not always helpful.

GP Usage Feedback

Respondents were asked what they would do if they needed immediate health care when their GP practice was open. 63.5% indicated they would go to their GP practice, 11.5% indicated a preference for either the MIU in Clacton or the WIC in Colchester. 5.2% indicated a preference for the WIC in Harwich.

Respondents were asked what they would do if they needed immediate health care when their GP practice was not open. 37.3% indicated a preference for the WIC in Colchester, 24.1% for the MIU in Clacton, 23.9% opted for the 111/OOH GP service and 7.7% for the MIU in Harwich.

Respondents were then given an opportunity to expand on the choices they made for the above three questions. The following themes were identified;

Theme / % of response / Coded text.
Access / 47% / Reasonable use of the services is made; early intervention is important
Capacity / 24 / GP and A&E capacity concerns
Location / 13 / Local and OOH services are needed
Quality / 12 / Concern about the quality (e.g. 111 service); satisfied with the service at the MIU and WIC.
Engagement / 3 / Difficulty to answer
Preference / 2 / Patients should be able to chose; prefer to self care
Population / 1 / The population is increasing and aging.
Funding / 1 / Funding concerns

GP Usage Findings

The course of actions would depend on the problem
Treatment as soon as possible is preferred.
Local Minor Injuries Units are preferred.
111 service quality is variable.
Pharmacy advice is variable.
GP surgeries are excellent – however getting appointments with some remains problematic.

Expanded Feedback Report

The expanded feedback report has been written using (as far as possible) the words and phrases used in the collected responses. No corrections of fact, grammar or syntax have been made.

This report summarises the themes. The themes with the most responses are discussed first followed by the next in descending order. This provides a relative indication of the weighting of each theme. Every attempt has been made to report the feedback provided for each of the respective questions, therefore there is some repetition within this report.

Questions raised by respondents have been summarized and are reported at the end of each section of feedback.

None of the views expressed in this report are those of the author or any organisation for whom the author may work.

Final Report developed by

Dr Steven Wilkinson

Part Two

2 Expanded Feedback Report

To further understand the local need for out of hospital urgent care services, the CCG has undertaken a listening exercise with users and the wider public. This has assisted in developing three options. This engagement exercise intended to seek local views on these options.

The options were as follows:

To continue to commission a Walk in Centre service in Colchester and Minor Injury Units at Clacton and Harwich
To stop providing the Walk in Centre and Minor Injury Unit services. Patients requiring these services would be directed by NHS 111 and seen by their local GP, Out of Hours GP or encouraged to self-care.
The establishment of a minor injury service

Members of the public were also asked for any other option that the CCG might not have thought about and for their healthcare provider preferences and opinions relating to health care spending.

North Essex CCG – Communications and Engagement Plan

(Accessed December 2016)

3Methodology and Methods

An Engagement Exercise document was produced and a Survey was developed, publicised and distributed within the public engagement plan;

( - accessed March 2017) .

The on-line surveytool that was used was the Bristol On-Line Survey ( - which served to both collect feedback and to form a database of responses. Hard copy responses to the survey were manually entered into this database.

All other response types (correspondence, electronic responses and meeting notes) were included into a‘First Stage Analysis’. This process‘coded’the same, or closely similar, response content. A ‘Second Stage Analysis’ then groupedthe coded responses into themes. The first and second stage analysis documents were working documents and were used in the construction of this report.

This report has been written using (as far as possible) the words and phrases used in the collected responses. No corrections of fact, grammar or syntax have been made.

Questions raised by respondents have been summarized and are reported at the end of each section of feedback.

None of the views expressed in this report are those of the author or any organisation for whom the author may work.

The following table indicates the number of responses received (rounded up);

Table 1 – Response count

Questionnaires3,400