Frequently asked Questions: making Urgent Care work better in Sheffield

 

Urgent appointments at a GP practice

Will GPs be supported to deliver improved access to urgent care?

GP practices will be supported to work together to offer urgent appointments within 24 hours. In Sheffield, GP practices already work together in small groups known as neighbourhoods to serve their local area. These neighbourhoods each have their own health and social needs so it would be up to their practices collectively to decide the best local approach for handling urgent appointments together; there’s no one size fits all to this. Neighbourhoods are currently at various stages of development we would continue to support and work through this with practices if the proposals go ahead.

 

Do these changes mean I won't be able to use my local GP practice anymore?

Absolutely not. Firstly, these changes only relate to urgent care - there are no changes to planned appointments and care whatsoever.

If you have an urgent care need and you need continuity of care (seeing the same healthcare team for your ongoing condition) then you will be seen in your own GP practice in practice hours. If you need an urgent GP appointment but it is not for an existing or long-term condition, you may be seen at a practice close by.  Alternatively you can choose to be seen at the urgent treatment centre instead. 

In the evenings and at weekends, urgent GP appointments will be still be available but you might have to travel a little further, or you will be offered a booked appointment at the urgent treatment centre. 

 

What about urgent GP appointments when practices are closed?

At evenings and weekends, you will simply need to call your GP practice or NHS 111 who will assess if you need to be seen urgently. Your appointment could be at one of four satellite GP hubs - so no change to what happens right now – or at the urgent treatment centre.

 

How would the GP urgent appointment system work in neighbourhoods?

The advice to everyone would be to contact your GP practice or NHS 111 first to ensure they are signposted to the right person and place for their healthcare needs.

Patients would be offered an appointment within their neighbourhood during GP ‘core’ hours, which are 8am to 6.30pm. If they have ongoing health problems and need continuity of care, they will be seen at their own GP practice. If they don’t need continuity of care, they will be seen at a GP practice in their area but it might not be their own GP practice. They will be seen by a GP or other health care professional, as appropriate.

From 6.30pm to 11pm and at weekends (8am to 11pm) patients will be offered an appointment at one of four satellite GP hubs as currently happens.

Overnight (11pm to 8am) patients will access the Out of Hours Service, which for the majority is based at the Northern General Hospital, again as currently happens.

The CCG is not proposing any change to the evening, weekend and overnight service model although the current location of these hubs will be reviewed to ensure that they are accessible by public transport as well as by car.

 

How will each of the neighbourhoods work to provide the urgent care service?

There are currently 16 neighbourhoods within the city, although they are at different stages of development. Each neighbourhood will determine how best to provide the urgent care service within its area and where the service will be sited. This will be based on a combination of factors including the needs of the local population and how these can best be met, the workforce, the estate available and the accessibility of this.

This work is in its early stages but we are committed to continuing to develop the neighbourhood model of working as we strongly believe this is the right thing to do for a variety of reasons – to tackle the national shortage of GPs, to provide strong primary care services tailored to local community needs and because people have told us again and again that they want care closer to their homes.

 

How will GP practices manage the extra demand on their services?

GP practices will be supported to work together to offer urgent appointments within 24 hours. In Sheffield, GP practices already work together in 16 small groups known as Neighbourhoods to serve their local area. These Neighbourhoods each have their own health and social needs so it would be up to their practices collectively to decide the best local approach for handling urgent appointments together; there’s no one size fits all to this.

Neighbourhoods are at various stages of development across the city and the CCG would continue to support and work through this with practices, if the proposals go ahead, with access to additional funding.

 

Urgent treatment centres

 

Why do we need urgent treatment centres?

Evidence shows that it isn’t just people in Sheffield that find the current system confusing. People across the country find it confusing too. Walk-in centres, urgent care centres, minor injury units and others with their own local names and all with differing levels of service, make it really difficult for people to choose the right service for urgent care or advice.

NHS England has said that all areas across the country need to introduce urgent treatment centres to standardise this confusing range of options and simplify the system so that patients are clear where to go.

Nationally, the plan is to roll out for all patients to have access to an urgent treatment centre by December 2019. In Sheffield, these changes won’t happen this year but once we’ve reviewed all the consultation feedback, we’ll be in a position to give a more definitive timeline and details of how urgent treatment centres will work in Sheffield.

 

Why can’t the Urgent Treatment Centre be sited at the Royal Hallamshire Hospital instead of at the Northern General Hospital?

This was considered as an option in the early stages of the process but was ruled out because:

• It was not logistically feasible – the lack of space is a key issue and it would not help us to manage the workforce challenges effectively 
• It meant that patients would have to travel to a different site (Northern General) if their condition was more serious than they initially thought
• Guidance nationally requires that urgent treatment centres are co-located with A&E departments to provide treatment for minor illness and injuries in one place removing confusion for patients.

Whilst we adhere to these requirements, we need to make sure we site the urgent treatment centre correctly and ensure we support people as much as we can with how they can access urgent care and the urgent treatment centre should they ever need it.

 

What assessment has been made of the Northern General Hospital estate’s capacity to site an urgent treatment centre?

Our initial assessment of the capacity required at the hospital indicated that it is a feasible option.  This assessment will be reviewed following the feedback from the consultation (particularly what proportion of patients would rather be seen in their local practices rather than travel to an urgent treatment centre).

 

Why do the shortlisted options not include a city centre urgent treatment centre? 

This was considered as an option in the early stages of the process but was ruled out because:

• It meant that patients would have to travel to a different site (Northern General) if their condition was more serious than they initially thought.
• National guidance recommends that urgent treatment centres are co-located with A&E departments to provide treatment for minor illness and injuries in one place removing confusion for patients.
• It would not help us to manage the workforce challenges effectively. 

 

How would booked appointments for an urgent treatment centre be balanced/prioritised against patients who show up without an appointment? 

The service would work to national guidance provided by NHS England which states both need to be provided. Below are two points taken from the guidance which relate to the issue raised:

• The urgent treatment centre should ensure that there is an effective and consistent approach to primary prioritisation of “walk-in” and pre-booked appointments, and the allocation of pre-booked routine and same day appointment slots.
• Patients who “walk-in” to an urgent treatment centre should be clinically assessed within 15 minutes of arrival, but should only be prioritised for treatment, over pre-booked appointments, where this is clinically necessary.

 

The walk-in centre and minor injuries unit

 

Moving the walk-in centre and minor injuries unit will put more pressure on services elsewhere because it will be harder for people to get there.

These plans are about easing the pressure on services and at the same time improving access to urgent care. We know that demand for urgent appointments in the daytime can have a knock on effect for other healthcare providers in the city. If we can improve access to GP services in the daytime, this will help to reduce some of the pressures on A&E.

 

Can I still turn up and wait to see someone if you are planning to close the walk-in centre and minor injuries unit?

The proposals are for the walk-in centre and minor injuries unit to be replaced with urgent treatment centre(s). People would still be able to get walk-in appointments as well as booked appointments.

 

The walk-in centre is convenient for lots of people in town. How are these changes better?

These changes will improve access to urgent GP appointments, so that everyone can get an appointment for the care they need within 24 hours. This includes practices in the city centre so it will be easier for people at these practices to get urgent GP appointments.

Replacing the walk-in centre with urgent treatment centre(s) will make it simpler for people to get the treatment they need as quickly as possible.

 

The vulnerable groups who use the walk-in centre will be disadvantaged.

The biggest users of the walk-in centre are students and city workers.

However, this was a big concern for us and we carried out extensive engagement with vulnerable groups to understand their experience of using urgent care services and their needs. Many people told us that they only used the walk-in centre if they were sent there by another service and that they were confused about where to get the care they need.

Also, vulnerable groups tend to need more tailored support and continuity of care we need to make sure this happens. For example, we run GP clinics in the city for homeless people who are often not registered with a practice and would continue to do this. The key to making sure these people get the right care is making sure they can access GP appointments, which is what we are aiming to achieve with our proposed approach.

 

What guarantee can the CCG provide that the neighbourhood hubs needed to deliver in hour’s urgent primary care will be developed in time to absorb the activity currently being seen at the walk-in centre?

We do not believe that all of the activity currently seen at the walk -in centre will need to be re-provided.  However, we have deliberately chosen not to fully implement until April 2020 to give us the time we believe is necessary to develop the neighbourhood hubs so they can provide access to urgent care appointments for their local communities.

 

Travel and parking

 

People are genuinely worried about extra travelling 

Concerns around travelling to Northern General Hospital and parking at the site is one of the main themes in the feedback we have received so far and we will be considering this feedback very carefully when we look at making a decision. This will take into account both the factual information around journey distances and times that we are collecting and people’s feelings/perceptions.

This information will be included in the analysis and report on the consultation. It will be reviewed by the project team leading this work and also by the CCG’s primary care commissioning committee, which will take the final decision about how to proceed.

 

This is not fair for people in the south of the city who will have to travel further (to get to Northern General)

These changes would improve access to urgent GP practice appointments in their community so fewer people will need to travel outside their local area to get care.

Similarly, we are bringing urgent eye care closer to where people live – it will be provided at multiple locations across the city rather than just at the Hallamshire so will be easier for people in the south of the city to access.

 

Parking at Northern General Hospital

This is a concern that has already been raised and we will we look into it. In terms of costs, people have to pay for parking at the walk-in centre and minor injuries unit so this will not be a change. At the moment, many people have told us they drive to the walk-in centre because they can’t get a GP appointment. 

And if the proposals go ahead, some people have told us they are worried about travel and parking at the new urgent treatment centre at Northern General. If we improve access to urgent appointments at GP practices though, there will be far less need to travel to the urgent treatment centre(s).

 

What consideration has been made of Sheffield’s transport system, limited parking at the Northern General Hospital and the location of bus stops in relation to A&E?

If we improve access to urgent appointments at GP practices across the city, there will be far less need to travel to the urgent treatment centre(s). But we know travel is a concern consistently raised in drop-ins, feedback and meetings so far. We are currently reviewing travel times in detail (public and private transport ‘drive’ times and the frequency of buses) and parking as we know this is a concern that has already been raised. At the moment, many people have told us they drive to the walk-in centre because they can’t get a GP appointment. And if the proposals go ahead, some people have told us they are worried about travel and parking at the new urgent treatment centre at Northern General.

 

The eye clinic at the Royal Hallamshire Hospital

 

Why are you closing the eye clinic?

We are not closing the eye clinic. This was mistakenly reported early in the consultation process in The Star. Our proposal is to keep the clinic at the Hallamshire for emergency eye care and provide urgent eye care at community locations across the city which will be open for longer.

 

Why are you making changes to the emergency eye clinic?

Around half of patients who currently use the Emergency Eye Clinic have an urgent, rather than a sight-threatening problem.  These patients could be treated by clinicians within their local communities, such as local opticians. This would mean less travel for people and many opticians also have longer opening times than the current service. 

We think this would offer more convenience for patients and would allow the staff at the hospital to concentrate on treating patients with emergency sight-threatening problems.

Opticians already provide the successful PEARS scheme in Sheffield, which was set up to provide a quick and convenient way of treating minor eye problems and has been very well received by patients. 

The emergency eye clinic is nurse-led and people are only referred to a consultant if they need that level of care. This would not change if the service was provided in the community; anyone who needed to see a consultant would be booked an appointment as they are now.

 

Why haven’t you given any details of where these urgent eye care services would be provided?

Before we work up detailed plans and start discussions with local opticians, we need to understand what people in Sheffield think about this approach so this is one of the things we are consulting people on.

 

How will the urgent eye appointments be delivered – by who and where? What will the maximum waiting times be? 

Around 50% of patients who currently use the emergency eye clinic have an urgent, rather than a sight-threatening problem.  These patients could be treated by clinicians within their local communities with longer opening times than the current service.  We are aiming to provide urgent appointments within 24 hours and mostly the same day.

We think this would offer more convenience for patients and would allow the staff at the hospital to concentrate on treating patients with emergency sight-threatening problems. There are two groups of staff who could provide this service – either the specialist nurses who currently provide the Emergency Eye Clinic service or  opticians who’ve had advanced training.  There are already a number of these currently providing the successful PEARS scheme within the city.  If the proposals are supported, the detail of who and where the service will be provided will be further developed

 

General questions

 

How is this any simpler?

It is simpler because all you will need to do is contact your GP practice or NHS 111 and they will assess your needs and direct you to the right place to get the care you need. If you still want to turn up and wait for treatment, you can visit the urgent treatment centre.

It will also make it easier for people to get the care they need close to where they live by improving access to urgent GP appointments and bringing urgent eye care services into local communities.

Our preferred option for how the UTCs would work would mean that all services for adults would be in one place, and all those for children on one site, so it will make it easier for people to know where to go.

 

Is this about saving money?

It’s not about saving money; it’s about making the best use of resources and the redesign does not result in significant savings to what we spend each year on urgent care. We have a duty to ensure that we buy services which provide value for your money. We believe we can get greater value for money if we invest more of this money in primary care and our GP practices.

Right now in Sheffield, we have too many services that are providing similar treatment, often at the same time. This not only causes confusion for patients about the best place to go but is not good use of NHS resources.

 

What data did you use to come up with these proposals?

We used audit data provided to us by our local providers and GP practices. Before the consultation started, we had to use this data to develop a case for change for NHS England. This was for them to check and ensure we had carried out robust background work first before launching the consultation. 

If the proposals go ahead, there will still be lots more data to consider and review with our partners before we can roll out any changes.

 

Privatisation of the NHS

One of the ways we think we can provide more urgent eye care in the community is via local optometrists (eye specialists). A number of people have fed back that they're worried this means privatisation of the NHS but it would be no different to how the CCG commissions (buys) the services of GPs and pharmacists right now - who are also technically private businesses.

Like GPs, optometrists who work in your local opticians provide NHS services. We already commission a number of optometrists across Sheffield to provide the PEARS scheme which offers quick, convenient treatment locally for minor eye problems.

The same goes for the providers of urgent care services in the city. Currently services are provided by both NHS providers (Sheffield Teaching Hospitals provides the minor injuries unit service) and private companies (OneMedicalGroup provides the walk-in service). As with all services, we go through a tender process to select the best providers for urgent care services in Sheffield.

The Kings Fund produced a helpful short video about how the NHS in England works and is funded which you can view here.

 

What consideration has been given to the increased impact on A&E while services transition, and how will this be managed? 

We do not anticipate an impact on A&E as a result of the proposed changes as the walk-in centre and minor injuries unit would not be closed until the new arrangements were in place. Under our preferred option the UTC would be co-located with A&E which already has a clinical streaming pathway in place to signpost inappropriate attendances back to primary care.

 

When would any changes take place?

If the changes go ahead following the consultation, we expect that they will be fully in effect by April 2020. No changes will be made this winter.

This is to allow time for all the work to be done to implement the changes, including things like:

• agreeing new contracts 
• getting the IT and access to full patient records to happen correctly and safely within practices
• working with GP practices to make arrangements for how they will provide urgent appointments in their local area.

 

Consultation

 

Have you already made up your minds about these proposed changes?

Absolutely not. The aim of a public consultation is to gather all the information to make sure that our decision is properly informed.  We want to hear your views about what we are proposing and how you think we can improve urgent care in Sheffield and there are many ways to give your feedback. Should any alternative viable options come up then we would consider it. 

 

How can people have their say?

The consultation is now closed.