Agenda item

The Committee received a presentation on Urgent and Emergency Care Services in South East London, covering emergency departments (A&E), urgent care services, urgent treatment centres (which had to have access to x-rays  and blood tests and appointments bookable through 111), GP hubs, GP at hand, NHS 111 and the 999 service. It was important to help people access the right service, so that they were not passed from one service to another. GP hubs enabled people to book appointments up to 8pm. GP at hand was an option often favoured by young people, and involved de-registering from the normal GP service. The NHS 111 service had been re-commissioned to be an integrated care service, with more clinicians. The service included GPs, nurses and paramedics; the service could book GP out of hours services, GP home visits and urgent treatment centres. It was hoped that by the end of the year 111 could book patients into normal daytime GP appointments, although there were some cultural issues to overcome. It was hoped that 111 would be the central point of contact – the glue – for all urgent care services. The Long Term Plan included the ambition that 111 would become integrated urgent care services, and north east London and south east London were the only areas in London to have achieved this. The other aim in the Long Term Plan was that everyone should have better access to same day services.

Cllr Diment commented that one of the problems in Bexley was that people had a perception that they could not get reasonable appointments with their GPs, so they went straight to the urgent care centres. They had also found that people were travelling from well outside the area to attend the urgent care centre at Erith, leading to capacity problems. Dr Bhan agreed that access to GPs was a real problem – GP access hubs were part of the answer. It was often the case that there were appointments available at weekends, but the overall answer was to communicate better with the public and respond to their needs. Urgent treatment centres could also book into GP hubs, which should help. It was also hoped that booking through 111 would be an option. The Long Term Plan also included the development of Primary Care Networks – groups of GPs working more closely together providing services for populations of around 30,000 to 50,000 people, enabling them to take advantage of economies of scale to provide wider ranges of services and urgent appointments. GPs were expected to join these networks by May.  Dr Bhan agreed to raise the issues of low awareness raised by Cllr Diment with her colleagues in Bexley.

Cllr Dowling commented that a patient with a broken leg turning up at the urgent care centre at Queen Mary’s Hospital could be x-rayed, but could not have their leg plastered. Dr Bhan accepted that more severe injuries could not be treated there, but commented that an ambulance would deliver a patient to an A&E department rather than an urgent treatment centre, and patients needing further treatment could be transferred from Queen Mary’s.

Cllr Adilypour asked about progress with enabling people to book appointments at urgent treatment centres. Dr Bhan reported that this service had only been introduced a month previously and the only centre where it was not available was St Thomas’ Hospital. Cllr Adilypour commented that not many people in Lambeth seemed to be aware of the SELdoc service, and GPs were not very good at signposting to it. Dr Bhan commented that all GPs should have answerphones referring after-hours callers to the 111 service, and she offered to check whether this was happening. Cllr Adilypour also commented that when he had been at St Thomas’ it had always seemed overwhelmed by patients with mental health issues. Dr Bhan responded that all hospitals had psychiatric liaison teams to direct people to the right services, but she was aware of the problem and SLAM, Guys and St Thomas’ and Kings were working together to address the issue. 

Cllr Noakes reported that the normal waiting time for an appointment at his GP surgery, part of the Nexus Group, was three to four weeks, but he was never offered evening or weekend appointments. He also asked whether patients were re-directed back to their GPs at urgent care centres, particularly as he expected that the cost of a consultation would be greater at an urgent care centre. Dr Bhan responded that patients should be re-directed to GP services, and that urgent care centres should be able to book appointments. Julie Lowe added that this approach would be required once primary care networks were in operation later in the year.

Cllr Normal asked for information about the challenge of integrating the NHS 111 service with GP hubs, and about how messages about 111 were being publicised. Dr Bhan responded that the technology around booking into GP services was being sorted out, including an online app, and that there had been a big publicity campaign on 111, although she accepted that this needed to be ongoing.

Cllr Cooke commented that she found the variety of services confusing, and in particular she was unsure how to steer her constituents. Dr Bhan responded that the main message was for people to ring 111.

Cllr Muldoon commented that he was pleased with developments at Lewisham Hospital, where a number of services were co-located, but there was active re-directing of patients to more appropriate services. There was good practice and he encouraged other Members to conduct visits to see this in action.

Cllr Downing asked whether it was possible to book appointments via the internet for the GP hub. Dr Bhan responded that this needed to be looked at; at present this was only possible with your own GP or via 111.