I recently met 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. I want to update constituents following this discussion.
My vision for the future of the three standalone minor injury unit sites is to transform them into either Rapid Access Centres or Urgent Care Centres given the slightly different needs for each site. 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.
Below I have outlined my rational for this conclusion.
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, as the recent public meetings demonstrated, but it is unlikely to deliver significant savings for the CCG. Minor Injury Unit patients will go to A&E or their local GPs, both of which already face high demand.
The CCG told me that they do not believe the existing Minor Injury Units 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. I asked them for the data on this. 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.
At the recent public meetings the CCG put forward a range of options in relation to the Minor Injury Units, but in essence I believe it boils down to three options.
Keep the Minor Injury Units 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 Minor Injury Units to a small number of local GP surgeries for them to expand and offer the services currently offered by the Minor Injury Units. This was the option supported in the internal paper leaked to me by a whistleblower. This model currently exists at Sawston, where the GP surgery offers minor injury treatment and other services such as physio. However, this surgery is just 6.4 miles from Addenbrookes. I am against option 2.
During the meeting it was clear that the CCG has not ruled this out. I set out a series of concerns with this approach.
• Not all local GPs wish to expand – such as those nearing retirement. Many cannot expand on their existing sites due to space constraints for their building. Highways issues or limited parking also restrict this expansion.
• 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 our area like many rural areas is more difficult than South Cambridgeshire. Our healthcare needs are more than South Cambridgeshire, where life expectancy is higher. Unlike South Cambridgeshire and Peterborough GPs we do not have a major hospital a short distance away.
• Existing GP surgeries are already facing increased patient demand and would struggle to absorb significant expansion, whilst also treating existing capacity.
Closing the Minor Injury Units to expand a small number of GP surgeries would be a mistake and I do not believe it would have public support.
My vision, which I put forward as a constructive solution to address the CCG’s efficiency concerns, is to make 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 surgeries to predict but more predictable if covering a larger patient population. This emulates lessons learnt from the Peterborough hospital pilot where GP provision was put alongside A&E to more effectively direct patients to the right services.
• Re-locate and consolidate other health services which are often located in a wide range of premises. For example out-of-hours provision, children services, sexual health, mental health support, addiction treatment, even council services like housing advice. Some services are already on these sites or nearby but there is significant scope for further consolidation. 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.
• 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.
• 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 Minor Injury Units 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.
The CCG need to make best use of their funds and reduce the proportion of their budget being spent in acute hospitals, which is currently very high, so that more can be spent on the other healthcare needs they fund. Making Doddington, Wisbech and Ely into Rapid Access or Urgent Care Centres and consolidating other services on to these sites would enable them to do so. Clearly as part of such discussions the capital costs for these sites will need to be worked out, but this would equally apply to any expansion of existing GP surgeries to absorb additional activity and where there will be less benefits for patients. This would also require local services to join up and share their resources and work together to deliver a greater range of sustainable local services for local people. All services will need to work together to make this vision a reality.
The CCG have agreed to look in more detail at my proposal for Rapid Access Centres or Urgent Care Centres on the existing MIU sites, which they said had merit, and I will update again once I hear their response. In the meantime I am continuing to analyse the wide range of data I have requested from the CCG, particularly relating to the how the budget is being spent in the rest of the county and assumptions made on population growth.
In relation to the recent public meetings in both Doddington and Wisbech, I was concerned with the number of people who were unable to get in due to venues not being big enough. After raising these concerns, the CCG have agreed to hold further public meetings on the following dates:
Thursday 8 September, March Community Centre, March, 6.30-8.00pm
Tuesday 20 September, Queen Mary Centre, Wisbech, 6.30-8.00pm
Wednesday 21 September, Chatteris Parish Church, Chatteris, 6.30-8.00pm
Tuesday 27 September, The Maltings, Ely, 6.30-8.00pm
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.