Agenda item

Consideration was given to a progress report of the Director of Commissioning, Oldham Cares, on the development of plans for urgent primary care. The report also sought to inform the Sub-Committee of the winter planning progress for Urgent Care services in Oldham. This information followed a presentation that had been received by the Sub-Committee at its meeting on 3^rd July 2018 on the draft Urgent Care Strategy.

The Chief Clinical Officer and the Managing Director, Oldham Cares, attended the meeting to present the information and to address the enquiries of the Sub-Committee.

It was reported that Accident & Emergency (i.e.: A&E) continued to support patients who required primary care services. The service was available 7 days a week from 11am until 11pm. Walk in centres continued to operate from 8am until 8pm and they would remain in place until an alternative offer was available in the community.  Work was in progress to develop Urgent Care Hubs as an alternative to the current walk in service offer. This would support urgent care demand in the community and work with a cluster model. Plans were in place to start an area pilot in Oldham in early 2019. The workforce had been identified and work was progressing on the IT element of the project. A data sharing agreement was already in place.

Another aspect of developing urgent care in the community to release pressure at A&E was the Visiting Service; this looked at a team of talents brought to residential settings to make decisions that, currently, were taken at A&E.

With regard to winter planning, the Sub-Committee was informed that, in order to manage the increased demand that had been experienced in December 2017, the plans for 2018/19 focussed on the following areas:

1.    Supply: provision of additional beds for adults and children, contingency plans for Christmas and Bank Holidays, community providers supporting discharge from hospitals, weekly reviews for patients who stayed in hospital longer than seven days. Focus on alternative ways of delivering discharges and patients’ choice.

2.    Capacity: maintain assessment capacity and bed availability to keep pace with emergency admission. Create bed capacity in the community. Work with families to assist children at home when this was feasible.

3.    Seasonal pressures: make plans for increased pressure on Mondays, Christmas and early January.  

Members sought and received clarification / commented on the following points:

-       Positive experience on triage and acute medical unit but care was at times inconsistent;

-       Future of Integrated Care Centres (ICC) – It was explained that the Walk in Centre was not a model for the future; every neighbourhood would try to bring health and social care expertise together around the patients.

-       Out of order x-ray machine at the ICC’s? – It was explained that the lack of sufficient resilience would be addressed.

-       Where urgent primary care services could be accessed in Oldham on Sundays? – It was explained that the seven day services moved around the various GP surgeries in the Borough. Currently, it was based in Royton.

-       Access service to GP appointments – It was explained that via 111, patients could be directed to the 7 day GP surgery. This service could also be accessed at the GP receptions.

-       Alternatives to A&E – It was explained that a very high percentage of patients who used A&E could have their issues addressed by pharmacists or physiotherapists. 

-       Significant reorganisation in progress, ability to identify work force implications – It was explained that, although the requirement for the work force was identifiable, there was a significant shortage of GPs and nurses. Commissioners in Oldham were trying to make the job offer more attractive to avoid using agency work force to cover extra hours.

-       Urgent Care Learning exercise on 6^th- 8^th December 2018 at Royal Oldham Hospital – It was explained that the objective of the exercise was to identify resource requirements and ability to meet the urgent care demand.

-       North West Ambulance Service and issue about not being able to discharge patients at the hospital – It was explained that, in the North East, there was a different offer compared to the rest of Greater Manchester and this needed to be recognised. In the winter period, it was necessary to identify dedicated nursing support for ambulances in order to release queues. 

RESOLVED that:

1.    The progress report on Urgent Care be noted.

2.    The Director of Commissioning, Oldham Cares, inform the Health Scrutiny Sub-Committee of the arrangements for the learning exercise on 6^th-8^th December 2018 at Royal Oldham Hospital , with a view to have two representatives from the Sub-Committee attending the session.

At this point in the proceedings, Councillor Ball left the meeting.