The fight steps up to save minor injury units with a round of four extra public meetings which begin tonight
- Credit: Archant
The fight has stepped up as Steve Barclay MP has powered in to make sure minor injury units at Doddington, Wisbech and Ely remain open.
Instead of closing them he wants to see them upgraded to Rapid Access Centres or Urgent Care Centres so they become efficient throughout the day instead of experiencing lulls interspersed with busy spells.
Mr Barclay’s vision has three options which are outlined in full below.
There are also four extra public meetings arranged because meetings last month were so packed people were turned away.
His update follows a meeting with Tracy Dowling, chief officer and Dr Gary Howsan, clinical chair of Cambridgeshire and Peterborough CCG to discuss the future of the Minor Injuries Units at Doddington, Wisbech and Ely
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THE THREE OPTIONS - by Mr Barclay.
My vision is to transform them into either Rapid Access Centres or Urgent Care Centres given the slightly different needs for each site.
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This would involve combining the existing Minor Injuries element with services already provided and paid for locally but which are currently scattered around the district.
There is an opportunity for the CCG to enhance the walk in element which as a standalone facility they say is not efficient, by combining it with GP urgent care access and other services such as Out of Hours and Outpatients clinics as well as additional services such as Community nursing services, Mental Health provision, Children’s services and co-located services like housing, citizens advice and chemists.
In respect of an Urgent Care Centre, I will need to discuss with the Department of Health flexibility on the national standards which require them to be open until midnight.
MINOR INJURY UNITS
I emphasised the importance of retaining local walk-in access for minor injuries, given our growing population, public transport constraints, and the time and cost of travel to hospital.
Closing the Minor Injury Units will not only be very unpopular locally but it is unlikely to deliver significant savings for the CCG.
The CCG told me they do not believe the existing MIUs are busy enough for sufficient hours of the day to deliver value for money.
During peak times, such as 9am to 10am and 4pm to 6pm, the MIUs are busy whilst at other times of the day they are under-used.
They also say the patient pathway, in terms of accessing urgent treatment, is too confused between using the 111 phone service, phoning a GP for an urgent appointment, going to the minor injury unit, and going to A&E and this needs to be simpler to avoid duplication.
THE THREE OPTIONS
Keep the MIUs as they are.
The CCG say the demand during off peak hours is insufficient for them to support this, and whilst their budget from government is increasing so is the increase in patient demand, which means they cannot stand still and need to deliver existing services more efficiently. The CCG also tell me that these staff have specialist skills which need to be put to better use.
NHS England guidance is responding to this increase in patient demand for urgent care, which is why they are running the national pilot schemes including in Cambridgeshire seeking greater efficiency than stand alone units like the Minor Injury Units currently offer.
The CCG could shift funding and staff from the MIUs to a small number of local GP surgeries for them to expand and offer the services currently offered.
This was the option supported in the internal paper leaked by a whistleblower.
This model currently exists at Sawston, where the GP surgery offers minor injury treatment and other services such as physio.
I am against option 2 because not all local GPs wish to expand, many cannot expand on their existing sites due to space constraints, highways issues or limited parking.
Also, using some GPs but not others for these services risks adding confusion to patient access, particularly for the patients of GP surgeries who do not expand.
GP and staff recruitment in rural areas is difficult and existing GP surgeries are already facing increased patient demand and would struggle to absorb significant expansion, whilst also treating existing capacity.
Turn Doddington, Wisbech and Ely into Rapid Access Centres or Urgent Care Centres where people can retain the ‘walk in’ for minor injury treatment – a crucial requirement locally – whilst also making better use of these sites to bring together other services in a way that is more convenient for the patient.
This option would also expand GP services on these sites. This may include one or two GP surgeries who are constrained by their existing sites considering re-locating to the Doddington, Wisbech and Ely sites respectively.
Increased GP activity on these sites would offer benefits in absorbing the demand for same day emergency GP appointments, which are difficult for a single GP surgery to predict but more predictable if covering a larger patient population.
It would re-locate and consolidate other health services which are often located in a wide range of premises eg out-of-hours provision, children services, sexual health, mental health support, addiction treatment, even council services like housing advice.
This offers patient convenience, has scope to reduce pressure on GPs by getting patients to the additional expert advice for their condition rather than the default option of their GP, as well as greater efficiency for the CCG funding when multiple services are provided in one location.
It would include a unit to reduce the need for acute hospital admissions and or end of life care. Doddington Court care beds in particular are currently being paid for by the CCG but not used.
It would leverage the scope to expand outpatient services on these sites when the Cambridgeshire Community Services contract ends in April 2017.
The CCG stated at the recent public meetings that it is already in discussion with local hospitals to expand the number of outpatient clinics on these local sites, which brings the benefit of shorter patient journeys for treatment.
This additional treatment activity on the three sites at Doddington, Wisbech and Ely would therefore offer the CCG scope to address their concerns regarding the efficiency of the MIUs as stand-alone facilities. It would also retain the essential walk-in provision to treat minor injuries locally without a trip to A&E, or the questionable promise of an existing GP surgery offering these services as effectively as is currently available at the Minor Injury Units.
TO FIND OUT MORE ATTEND A PUBLIC MEETING
• Thursday September 8 at March Community Centre, March, 6.30 to 8pm.
• Tuesday September 20 at Queen Mary Centre, Wisbech, 6.30 to 8pm.
• Wednesday September 21 at Chatteris Parish Church, 6.30 to 8pm.
• Tuesday September 27 at The Maltings, Ely, 6.30 to 8pm.
GET IN TOUCH
It was informative to listen to feedback from the meetings at Doddington and Wisbech and I am grateful also to the constituents who have contacted me directly.
Due to my work in Parliament and my ministerial role I will not be able to attend all of the remaining meetings although I have discussed the points being made at the presentation in detail with the CCG.
If anyone has any further feedback, please do get in touch. I will be chairing a meeting with all senior health stakeholders, including the CCG, next week.