Consultations and engagement

Community urgent care services – engagement

We want to make improvements to community urgent care services to improve patient experience and the quality of these services. 

Community urgent care services provide urgent same-day care and advice for people with urgent, but not life-threatening physical and mental health issues. They include our GP hubs, walk-in services and the GP out-of-hours service. 

Our case for change (July 2017) identified key issues that we need to address when we look at changes.  In March 2018, we wanted to test some of the ideas we are considering for a new model of care for community urgent care services. We wanted to explore these in more detail with groups of local people that we know a higher or more frequent users of these services to inform our planning. 

We commissioned the Healthwatch organisations in our three boroughs (Barking and Dagenham, Havering and Redbridge) to undertake engagement on:

  • Providing more bookable appointments when you have an urgent health care concern or need
  • NHS 111 (the free 24/7 telephone health advice service)
  • Making urgent care more accessible through digital channels (online booking, digital apps and resources)

Based on our data of current use of services and the feedback from our 2016 research study, we identified priority research groups as:

  • Parents of young children (especially those aged 0 to 5 Years)
  • Older people (those aged 60+)
  • Young adults (15 to 25/30)

Follow this link to a summary report. You can also read the borough-specific reports for Barking and DagenhamHavering and Redbridge.

Feedback from this engagement has informed the planning of options for a new model of care. We plan to undertake a public consultation during summer 2018.

Previous consultations and engagements

Spending NHS money wisely (1 & 2)

BHR CCGs face a significant financial challenge which means that we have to make some very difficult decisions about how best to spend our limited budget. This has become increasingly important as there is rising demand for local NHS services and we are seeing more patients with complex health issues than ever before.

During two public consultations (held from March to May and September to November 2017) we consulted on 48 proposals to change the way we spend local NHS money. These included proposals to stop funding:

  • Some over the counter medicines, such as anti-malarials, gluten-free products, sunscreens and probiotic supplements
  • A range of cosmetic procedures
  • Earwax removal (via aural micro suction)
  • Some injections for back pain
  • Osteopathy
  • Podiatry
  • Cataract surgery
  • Male and female sterilisation
  • IVF or reduce the number of cycles we offer
  • Weight loss surgery.

We consulted local residents and community groups about the 48 proposals, holding 12 public drop in sessions and delivering 49 presentations to local community groups. A document explaining the proposals was produced for both consultations, along with a survey. In total, over 1,420 survey responses and 26 letters/emails were received.

The governing bodies of BHR CCGs met in public following each consultation (on 29 June and 14 December 2017) and agreed to no longer fund certain treatments and procedures. Not all the proposals consulted on were agreed. Following recommendations, the governing bodies opted not to stop some cosmetic procedures. IVF will continue to be offered locally, but reduced to one cycle.

The changes came into effect from 10 July 2017 (SMW1) and 8 January 2018 (SMW2).

Follow these links to read the Spending NHS money wisely 1 and 2 – summary of decisions reached and for more information on the consultations.

What the NHS is doing nationally - medicines consultations 

From 21 July – 21 October 2017 NHS England, the organisation that leads the NHS, ran a public consultation on proposals to no longer routinely prescribe 18 ‘low value’ medicines that are available by a prescription only or over the counter. Follow this link to read BHR CCGs response to the consultation.

After reviewing the responses to its consultation, NHS England recommended that these 18 medicines should no longer be routinely prescribed. On 30 November 2017 NHS England’s Board approved the recommendations and has since issued national guidance to help CCGs when they decide which of these medicines to fund and prescribe locally. We are reviewing this guidance and how it might affect local prescribing.

During its consultation, NHS England also sought views on potentially restricting the routine prescribing of medicines that are available over the counter for the treatment of minor conditions or those which are best treated via self-care. The feedback received was broadly supportive and so it plans to consult on proposals related to a number of conditions and treatments in 2018. You can find more information at: www.engage.england.nhs.uk/consultation/items-routinely-prescribed

Note: Locally we have already consulted on some of these medicines and has decided not to fund them. Once the results of this national consultation are known, later in 2018, we will assess the new guidance and how it might affect its local prescribing.

Meadow Court

Between 4 August and 27 October 2017 Redbridge CCG consulted on proposed changes the way it pays for beds at Meadow Court, a dementia nursing home in Goodmayes, Redbridge which is run by Care UK.

After careful consideration it was decided by the CCG’s governing body on 30 November 2017 that those that live at Meadow Court can be safely and appropriately cared for in other homes, and that the contract with Care UK for Meadow Court nursing home does not offer value for money. For these reasons the governing body decided to end the CCG’s contract with Care UK for beds at Meadow Court. 

Procuring an NHS 111 service for North East London

BHR CCGs, together with other four CCGs in North East London opted to procure an enhanced NHS 111 service as part of our work to improve integrated urgent care across the area.

Between October and November 2016 an engagement was held with BHR residents to help design the future service and inform the procurement process. Face-to-face community engagement ran alongside an online survey, which was promoted through CCG channels and networks across Barking and Dagenham, Havering and Redbridge.

Key findings were:

  • Experience of using the current NHS 111 service for BHR is generally positive. Awareness needs to be improved, both of the service and what it offers
  • There is strong support for improving or enhancing callers’ access to clinicians and healthcare staff
  • Training and development for staff (111 advisors and any clinical staff) would help with communication with callers/ the public. Some participants questioned the number of questions each caller is asked and suggested simpler language could help
  • Better promotion of NHS 111 is needed to ensure the service is well recognised, understood and used appropriately.

Feedback from local people across all seven CCG areas involved in the procurement has helped to shape the service specification for an enhanced NHS 111 service.

 Follow this link to read the Summary of feedback from community engagement sessions document.

Improving urgent and emergency care

In March 2016, Barking and Dagenham, Havering and Redbridge CCGs, on behalf of the BHR Integrated Care Partnership, undertook the biggest piece of market research on urgent and emergency care ever carried out in our area. We talked to more than 4,000 people who live in Barking and Dagenham, Havering and Redbridge to understand how they make decisions about where to go when they need urgent and emergency care (UEC).

The research study was co-designed by our three local Healthwatch organisations and funded by the national Vanguard Programme.

Key findings include:

  • Local people are very aware of alternative services, but go to A&E due to confusion about choices
  • A&E is seen as a reliable, same-day service for urgent care needs and long waits are not a deterrent. People are prepared to wait as they believe they will be seen and treated – even though they understand it’s not always the appropriate place to go
  • People are more than twice as likely to use their GP than go to A&E
  • GPs are the most commonly used service (72%) followed by pharmacy/chemist (69%) – with A&E third most commonly used at 31%
  • Of those attending A&E
    • 39% sought no advice before attending A&E
    • 37% had seen their GP with the same issue
    • 26% had been to A&E before with same issue.
  • People tend to follow the professional healthcare advice they are given.

This research is already shaping our ambitious programme of change for UEC services in our area. We continue to listen to local people and take their feedback and experiences on board to help us transform UEC services across Barking and Dagenham, Havering and Redbridge.

 Follow this link to read the summary of the research report and supporting documents.

Community urgent care – patient, public and stakeholder engagement workshop

Following on from the UEC research study and engagement work in spring 2016, health and social care partners wanted to engage further with local people, clinicians and staff as we continued our work to develop a new model of care for urgent care services in our area.

More than 70 people from all three boroughs joined a workshop on October 7. It was an opportunity to explore the key themes that emerged from the work earlier in the year.

At the session, we agreed with participants to focus on two themes

  • Tackling the confusion around what local urgent care services are and how to best use them
  • Building trust and confidence in local services.

The report provides a summary of the points raised, focusing on key shared themes, as well as details of how we plan to address these.

Stroke rehabilitation services

We consulted patients about our plans to make stroke rehabilitation services more joined up with each other and focused on what individual people need, regardless of where people live. We ran a consultation between January - April 2016, holding a series of public drop in sessions and attending a range of community meetings. Three hundred and thirty responses to the consultation were received: 320 questionnaires and 10 letters/emails.

There was strong support for the preferred option: home-based services where possible and one stroke rehabilitation unit on the King George Hospital site. There was also strong support for establishing new home based services. The decision was made to implement the agreed changes.

Follow this link to read the report on the consultation.

 

Redbridge Compact

The Redbridge Compact is a joint agreement between voluntary groups and public bodies and exists to help the partners improve their relationship for mutual advantage and community gain.

Page last updated 01 June 2018