Over the last couple of weeks I have continued to have discussions with the Care Quality Commission (CQC) and have also visited the Hub again.
I will update on my ongoing conversations with both.
The CQC
The CQC’s job is “to make sure that health and social care services in England provide people with safe, effective, compassionate and high-quality care.” They do this by inspecting and monitoring the care that services provide.
To do this well, it’s important that people tell them about their experience of care. This is why I have been feeding in all of the concerns and experiences fed into me by local residents.
The CQC have the ability to demand improvements from a service and set a time frame in which to meet these improvements. They then have powers to take further action if this is needed and the improvements they have demanded have not been met.
The CQC have told me that they have been monitoring this situation for some time alongside the Clinical Commissioning Group (CCG). They have also said that they now have the ability to carry out an inspection on the Hub, now that the registration of the ‘Better Health Partnership’ has been registered with the CQC.
The CQC would welcome information from patients who use the service, especially those who have experienced poor care, or know that poor care is being provided. You can also tell them when you feel you have received good care. This can be provided to the CQC by patients by using the online experience form: https://www.cqc.org.uk/share-your-experience-finder or by calling the CQC National Customer Service Centre on 03000 616161 (which I have been told does not have extra charges).
The CQC acts completely independently of politicians. I therefore cannot compel them to take a particular course of action, however I will continue to feedback information regularly to them so that they can continue to monitor the situation and be fully informed in order to make any decisions on any necessary action.
The Better Health Partnership
I visited the hub again to meet with senior staff, look at the telephone data and speak to call handlers. I also asked for an update on the following:
Telephone waits: The hub have insisted that their telephone waiting times during peak hours have gone down, with hub staff including clinicians getting on the phone for the first part of the day. This is allowing for more calls to be cleared and is also allowing for patients to be triaged by clinicians. They have also taken on more call handlers which has provided an extra 100 hours call time.
The number of complaints which I have received regarding peak call times has gone down significantly. However I did report that I still received some reports of people being cut off, and people waiting for up to 30 minutes (mainly during off-peak times). They acknowledged that some of their longest wait times did still reflect a few calls waiting 30 minutes and said that this would have to come down. However last week exception I received a few complaints about long call waits. Having flagged this as an issue, I have been informed that there were a couple of days where senior staff were not in, so call wait times went up. I have made the point, and will be reiterating this again, that the call centre should be running efficiently all of the time. If senior staff are not at the hub, then there should be sufficient coverage to ensure the call centre does not see an increase in phone waits.
Appointment lists: I asked why the appointment list for April was still unavailable (at the time of my visit it was unavailable), especially as this is something we thought we had tackled (by removing the delay of releasing advanced appointments). They said that the decision by the previous manager to release dates by 1 or 2 months in advance had meant that all of the advanced routine appointments had been taken up immediately, which meant that by the time they got to that month, there was little to no flexibility in terms of appointments for those who needed more urgent appointments. The plan going forward is to release advanced appointments in stages, to ensure that this is done in a managed way in line with how other surgeries operate. This will mean that advanced appointments become available, but they aren’t all taken up immediately, therefore plenty of appointments will still be available for urgent appointments as well as some appointments which may be required with a week or two week wait.
This is specifically what the Hub have said to me on this:
“Patients seeking appointments at their general practice are a mix of people with urgent and less urgent needs. It is important that appointments are made available quickly to people who have become acutely unwell as well as people with longer term conditions who would like to book in advance. This therefore requires that the finite number of appointments we can provide be made available for booking with different advanced timing to give patients with differing needs equitable access. Some appointments will be opened for booking well in advance, some nearer the appointment time and some on the day of the appointment.
Previously all appointments were released 4-6 weeks in advance and we have found they were fully booked quickly after release, meaning few appointments remained available when the appointment day came round and patients with acute illness tried to access timely care.
In order to improve equity of access, a new rota of staged release is being implemented for appointments in April 2019 and subsequent months. The total number of appointments available will not change. The advanced appointment release for April 2019 is planned for w/c 18th March. When these advanced appointments are released some appointments will, however, be held back to release through April to meet the needs of people who become unwell during the month and need to be seen.
We recognise that patients may initially feel that fewer appointments are available to book in advance, but hope the release of more acute appointments throughout April will alleviate any concern and improve equity and access.”
From Monday (last), I have been told the 7 day, 14 day and same day appointment availability will start to come online and should therefore help with access.
Staff Recruitment Update: Every effort remains focused on recruiting more GPs to work in the local surgeries. Nationally, the NHS is undertaking its biggest recruitment drive in its history. Whilst we have seen more GPs & nurses recruited at GWH, we need more GPs to work in practise rather than as locums. The new Hub Manager (replacing Nigel Sweeney) is due to start next week, along with a new GP. Discussions are ongoing to bring an additional GP on board, as well as advertising nationally, as the Better Health Partnership is continuing its efforts to recruit more GPs across the 5 surgeries and this remains a top priority.
Prescription Ordering Service: The Hub now has more pharmacists to process and deliver prescriptions. The POD service is still run by the CCG but with more pharmacists in the hub, there is more speed in processing the prescriptions. GPs are also being able to sign off prescriptions electronically, which is speeding up the process and making sure that more prescriptions can be ready sooner.
I am aware that there are still concerns arising as a result of the appointment rota and we want to make sure that nobody gets cut off or has wait for 30 minutes on the phone. This is why I will continue to feedback and respond to all of the concerns & experiences I hear from local residents – both to the Hub and the CQC.
