Agenda item

The Committee received a report providing assurance that the provision of urgent health care in the community has been maintained through the Covid-19 pandemic period and that the offer to Oldham residents has been improved.  A number of national mandates which created the need to redesign some services were highlighted and the intention of Oldham CCG to engage with residents when possible to ensure that the structures were responsive to Oldham’s needs was advised.

A national mandate had required the CCG to prevent all walk-in’s to primary healthcare settings and to open a Covid Assessment Centre (CAC).  Previously, a consultation had been held in October 2017 to better understand what the community would want to see if the Walk in Service at the Oldham Integrated Care Centre (ICC) was to close, following which the CCG Governing Body had agreed to move towards closure of the Walk In Centre and to a new system offering bookable appointments for urgent primary care closer to home.  Development work was still ongoing at the onset of the pandemic and a review of services going forward was now underway.

The Covid-19 pandemic had required all health and social care organisations to quickly develop services to enable residents to access and receive the right care whilst also learning to manage in a new and changing environment. As well as setting up the CAC and stopping walk-in primary care facilities at the ICC to allow the CAC to deal with Covid-related cases, there was a need for the hospital to have as much space in the emergency department (ED) as possible. At the hospital’s request, the Out of Hours service moved from the hospital into the ICC and the GP working in the ED relocated into the CAC.  As the CCG was required to cease walk-in appointments at the ICC, the same workforce plus extra from IGP Cares was used in the CAC.

The CCG’s commissioning intentions had been to provide a digital service which could offer clinical assessment and treatment to residents easily, quickly and link into other services in order to prevent the resident going into hospital or having to leave their home, and this had been in early stages of planning when Covid-19 arrived.  In light of the changes to services, this digital aspect had been accelerated to support the community and was introduced quickly alongside the CAC using the same workforce, estates and IT systems.  The CAC now sees any patient face to face and the centre in the ICC has been renamed as the “Oldham Clinical Digital Hub” for the time being.  The Hub offers a multidisciplinary workforce, including GP’s, nurses and allied health professionals, and has direct links with community health and social care services, End of Life services and the ED. Examples of digital patient pathways were described to the Committee and examples appended to a submitted report.

A Member noted that the pandemic had shown a need for change, and that the reported changes were good for working patients and from an infection control perspective.  However, Members raised a number of queries and concerns about the roll-out of digital services.  Reference was made to practical experience of attempting to make contact electronically or by phone, and comment was made that older patients who, while acknowledging the risks, might prefer personal face to face consultations and would need assurance that the digital system was safe.  Accessibility issues were also raised, including for those who might not have access to IT or be confident in its use and for the BAME community and other hard to reach groups.  In response, it was noted that any approach proved to be ‘good’ would be rolled out at pace and that there was now a better mix of digital and face to face offers. It was further noted that, in addition to the digital offer at the Hub, services over the phone were also available through a patient’s own GP surgery.  Issues arising with BAME and hard to reach groups had been recognised during the pandemic and work was being undertaken through the Cabinet Member for Covid issues and the Chair of the CCG Governing Body on messaging around the system.  It was recognised that language issues did apply to some communities and Members’ concerns regarding translation facilities would be responded to.  A request was made for the Committee Chair to be included in consideration of communications issues.

A Member commented that the health service had for some time been unable to encourage people not to attend EDs unnecessarily and suggested this may have been down to an inability to explain how the system worked. In response it was suggested that Oldham’s system might have been overcomplicated and the intention was to develop a simpler system for accessing health care.  Part of this process was to understand why and when people accessed either their GP or the hospital, for example, as it was known that if a patient failed to make contact with a surgery after three calls they were more likely to attend hospital, work was being undertaken on telephony and operating procedures. 

With regard to GP access, queries were made as to the seeking of patient feedback and of any actions the CCG could take against GP surgeries requiring attention.  In response it was reported that the CCG had enforced regulatory actions and that while three surgeries were rated as ‘requiring improvement’, most were rated ‘good’.  The CCG wanted to see thriving GP surgeries but needed to be aware of patients views and expectations.  Noting the ratings for GP surgeries, a Member expressed a concern that not all surgeries were holding Patient Participation Group meetings.  An undertaking was given to follow up this concern.   

RESOLVED – that the work undertaken to date with regard to the Integrated Care Centre, and the development of the Covid Assessment Centre and the Oldham Clinical Digital Hub, be noted, along with the intentions for further developments and the involvement of the public.