Agenda item

To receive a verbal report with details of the GP Out of Hours Service.

10.15 a.m. – 11.00 a.m.

The Chair welcomed Betsi Cadwaladr University Health Board (BCUHB) representative Sefton Brennan, Divisional Lead (Central), North Wales GP Out of Hours (OOH) Service, to the meeting.

Mr Brennan gave detailed statistical information which included:

·       The fact that during January 2017 99.4% and February 2017 99.1% of the GP OOH Service staffing hours had been filled, with only 1 shift unfilled in January and 2 in February.  These were unfilled due to staff sickness;

·       Historically, during the preceding 12 months, apart from during the holiday period the staff hours filled had been in the high 90% region;

·       The Service now had 43 GPs that worked for it, compared to 29 in June 2015.  Whilst a couple of the GPs who provided OOH service cover were not aligned to a specific GP practice, all of the GPs regularly worked within the Health Board’s area;

·       The Central Division GP OOH Service on average dealt with circa 3,600 patients a month.  However, during December 2016 the Service dealt with its highest number of patients in one single month for 4 years;

·       Despite the Service only being available for 70% of the time that hospital Emergency Departments (ED) were available, it dealt with more patients than ED.  Across North Wales the GP OOH Services deal with approximately 10,000 patients per month;

·       One area on which the Service was underperforming was on the completion of documentation within the expected timescale, particularly in cases where no intervention action was required.  Nevertheless the Central Division’s GP OOH Service performance was consistent with the all-Wales average performance;

·       A GP now worked within ED between 10am and 6pm Monday to Friday with a view to ease pressure on the Department and release them to deal with actual emergencies.  This approach was felt to be beneficial as each individual patient’s situation required some type of attention or intervention, the GP in ED could assess the patient’s condition to determine whether it merited emergency hospital admission or another course of action.  It also reassured the patient by the fact that they were being seen and treated by a medical professional;

·       Referral rates from the GP OOH to District General Hospitals (DGHs) was circa 5%, which meant that 95% of patients seen by the GP OOH Service did not require to be admitted to a hospital as an emergency admission;

The Service was constantly striving to improve its services to patients and attempting to deliver a more holistic and seamless health service experience for the patient.  The Service was working in conjunction with other health service providers and voluntary organisations e.g. EDs, DGHs, Pharmacists, the Welsh Ambulance Services Trust (WAST) and the Marie Curie Nursing Service.  Mr Brennan provided examples of such work, for example working to improve triage nursing call back times to reassure patients and deter unnecessary visits to EDs and working with patients to help them choose the correct pathway to meet their health and social well-being needs, as approximately 9% of the GP OOH Service workload were referrals from EDs or WAST.  In addition the GP OOH Service had restarted working with the District Nursing Service, there was currently 1 District Nurse working within the GP OOH Service 24 hours a day.

The Wales Audit Office (WAO) had recently undertaken an audit of all GP OOH Services in Wales.  Initial feedback from the audit was favourable, indicating that the service provided in the North Wales Central Division, which covered Conwy and Denbighshire, was one of the strongest in Wales and one which demonstrated good practices.  A recent satisfaction survey in the Division had indicated that 90% of patients were of the view that the service they received had been either excellent or good (70% rating it excellent and 20% rating it as good). The only negative comments related to a lack of a children’s waiting area in the GP OOH Department and that not all prescribed drugs were available on site, which necessitated the patient to collect them from an external pharmacist.

Responding to members’ questions the Divisional Lead advised that:

·       A change in Welsh Government (WG) regulations in 2010 had made it a requirement for all Health Boards to provide a GP OOH Service themselves rather than contract the work out to external providers.  In the BCUHB area the GP OOH Service was one service across the region, delivered in three separate divisions;

·       All patients, be they children or adults, were prioritised via a triage system.  The initial call would be to a trained call handler who would use an algorithm to determine the patient’s requirements and refer it to a practitioner who would then call back within 20 minutes with a proposed course of action.  This method provided a safety net for all callers;

·       The majority of calls received reported symptoms such as respiratory problems, vomiting and diarrhoea, back pain, abdominal pain, forgetting to order repeat prescriptions etc.;

·       Despite the fact that the Service had dealt with in excess of 5,000 patients during December the percentage of those callers referred to ED had remained static at 5%;

·       The usage figures for the Service had been increasing and the Health Board was working closely with GP surgeries in relation to the availability of GP appointments;

·       Despite the fact that the GP OOH Service did not have access to patients’ full medical records and had to depend on the information provided by the patient regarding their medical history, the number of complaints lodged against the Service were very low;

·       The NHS Direct telephone line was a helpline which existed to give the public advice and guidance, it could not prescribe medication or determine a course of action.

At the conclusion of the discussion the Committee thanked the Divisional Lead for attending and updating members on the Service, and it was:

RESOLVED that a further progress report be provided to elected members in due course, possibly in conjunction with the Welsh Ambulance Services Trust (WAST)