Agenda item

Purpose: To present an overview of demand in urgent and unscheduled out-of-hours calls. Consider response and issues arising.

Ben Blease, Divisional Director Adult Community Health Services, Berkshire Healthcare NHS Foundation Trust presented the report on urgent and unscheduled primary care provided during the out-of-hours period in West Berkshire (Agenda Item 6).

Ben Blease first gave an overview of the Berkshire West Out Of Hours Primary Care Service, WestCall. She advised the Committee of the hours of operation, the locations and the services provided. Ms Blease then explained how they delivered the service including virtual triage (by phone), face to face and point of care testing. She spoke about how the diagnostic tests were beneficial for patients as it could mean avoiding admissions into hospital. Ms Blease noted the key role WestCall played in the Berkshire West system particularly in avoiding hospital admissions, supporting community beds, care home visits and supporting with flu jabs. They also worked with ambulance services, mental health services and social care.

Ms Blease moved on to explain WestCall activity in the Berkshire West system. In the Newbury area last year they saw 15420 patients which was 13% of all patients registered in West Berkshire. This was slightly higher than other areas of Berkshire West and was a large increase in demand from the previous year. Ms Blease advised that they did not have waiting lists as they had to see all patients by 8am. However, patients were prioritised by 111 and some patients might have faced delays when demand and complexity exceeded capacity.

Ms Blease advised that challenges were made worse when their patient management system (Adastra) was shut down for a number of weeks due to a cyber attack in August. This meant that paper records were needed and they could not access patient data. This caused huge delays. The digital outage also meant they could not communicate with patients as easily and so they received some complaints.

A further challenge to WestCall was staffing. Finding clinicians to work nights and weekends was difficult. They had sessional staff who expected higher rates of pay for working additional hours. In addition to the 16% increase in demand there was increased numbers of two hour wait referrals. Additionally the government no longer supported training packages for advanced practitioner training. A further concern was that 22% of referrals in the last year were closed with no other treatment required than self-care. That was a large number of patients that came through to the service when alternatives were more suitable than the urgent care service. Ms Blease gave an overview of the most common reasons for referral to 111 and WestCall. The main reason was needing updated medication for patients who had not been able to get a prescription from their practice. Other reasons were requesting advice for ill-defined signs and symptoms, often parents worried about children, and also for cystitis and viral infections. Ms Blease noted that education of the public was needed.

Ms Blease moved on to give an overview of how WestCall were breaking down access barriers to patients. As they had increased virtual triage, they had focussed on good translation and interpretation services. WestCall were the go to medical service for migrants in the West Berkshire area. For example they would see migrants when housed in hotels initially. They also saw over 100 unregistered patients every week. Often these were homeless people or people from Gypsy, Traveller or Roma communities. They also had over the border patients or patients visiting West Berkshire. Ms Blease then gave an overview of feedback from patients. She noted usually it was that they had been kindly treated, staff were professional and patients got what they needed. Often the waiting time was the main complaint but that would have been higher if they waited in an Emergency Department and so often more education was needed.

Ms Blease then gave an overview of their winter plans. They were working with the Urgent Care Board to direct patients to the most appropriate outcome for their referral. Adastra had been fixed and was being used. They were working with system partners to encourage consideration around pilots – they would often lose sessional doctors when there were new pilot services. Finally they were working with Oxfordshire and Buckinghamshire to organise mutual aid with staffing for evenings and weekends.

Councillor Moore asked how easy it was for WestCall to access patient records. Ms Blease advised that the South Central Ambulance Service and 111 did not have access to patient records and so they had to ask for patient history. This was then asked again when Adastra was down as GP patient data was difficult to get hold of. Information between organisations was not shared easily and this was particularly highlighted when Adastra went down. Ben advised those organisations were working on this.

Councillor Macro noted that one month to resolve the Adastra outage was a very long time and asked whether WestCall were thinking of an alternative. Ms Blease advised that it was the longest outage ever in the NHS. They worked hard to stand up another system but explained it was a very specialised system that needed to transfer live patient data quickly. Other systems had too many restrictions such as not allowing unregistered patients. Adastra was the one piece of software available that met their requirements at that time.

Councillor Linden asked whether the triage process had worked to free up the most experienced staff to treat the most complex cases. Ms Blease explained that when the flow of referrals came in they were split into two lists. One for the most urgent cases to be seen by doctors and the other for less urgent and more routine cases for pharmacists, advance nurse practitioners and paramedics.

Councillor Linden asked what West Berkshire Council could do to help WestCall. Ms Blease said that they needed to find a way to educate patients especially in winter. Particularly around not calling 111 for ear aches and head colds. Regarding prescriptions, patients still did not get them in time and that remained their biggest referral in to WestCall. Public Health messaging could help with that. Councillor Linden noted that Public Health was at West Berkshire Council and that Paul Coe, Service Director for Adult Social Care, was in the meeting and suggested some work together. He noted that it was complicated for elderly people, often on multiple medications and so people would forget. It was agreed that Paul Coe would link Steve Welch, the new Service Director for Communities and Wellbeing, with Ms Blease.

The Chairman asked for further information around staff numbers in the service. Ms Blease confirmed that they employed 60 - 80 people but noted that some had very small contracts such as 8 hours once a month. It was a very complex way of employing people. WestCall was about the size of a larger than average GP practice.

RESOLVED that the report be noted.