Agenda item

To receive a presentation from Betsi Cadwaladr University Health Board.

                                                                                                          10.10 a.m.

A report was distributed by BCUHB officials at the meeting on the GP Out of Hours (OOH) Service in the Board’s Central area, which covered the local authority areas of Conwy County Borough Council and Denbighshire County Council.  They advised that:-

·                     The GP Out of Hours Service had been identified under the Board’s Special Measures as an area which required improvement;

·                     For the Central Area the main OOH Service was operated out of the Ysbyty Glan Clwyd Site.  Since the opening of the new Accident and Emergency (A&E) Department at Ysbyty Glan Clwyd the OOH Services had been located next to the new A&E and consequently the same triage facility was used for both services.  This helped to ease pressure on A&E as those patients who did not require emergency intervention could be diverted to the OOH Service.  Welsh Ambulance Service Trust (WAST) paramedics were using a similar approach on the ambulances arriving at Ysbyty Glan Clwyd and therefore some patients who had arrived by ambulance were also being directed to the OOH Service;

·                     The OOH Service in the Central Area also undertook home visits when required.  The Central Area OOH Service recorded the third highest number of home visits in North Wales, after Gwynedd and Anglesey, this was due to the rural nature of the area.  In addition the Service did see some OOH patients at Ruthin Hospital, as it used that facility as an outpost for the service;

·                     The OOH Service based at Ysbyty Glan Clwyd was the most successful service in North Wales.  It had recruited 10 more GPs recently and had 100% coverage as a service. It was only slightly short of achieving maximum cover for bank holidays etc. Its achievement against national standards was virtually 100%;

·                     The only area in which it failed to achieve was the indicator relating to undertaking a home visit to those requiring one within 60 minutes – the rurality of area made this target a difficult one to achieve;

·                     The OOH Service had also invested in Advanced Nurse Practitioners, these members of staff could attend people at home to administer palliative care;

·                     Nurse practitioners’ hours had also increased;

·                     All shifts in the Central Area were covered by practice GPs who were paid a sessional rate.  Two shifts were operated:  6pm to 11pm, the time of highest demand – 2 or sometimes 3 doctors were available during this period.  The second shift operated overnight from 11pm onwards – 1 doctor and 2 nurse practitioners were available on this shift.

·                     Problems in the East Area in recruiting sufficient number of GPs to cover all shifts, was not due to a lack of interest but due to WG rules which do not permit GPs practising in England to also work in Wales.  This anomaly was now being rectified and this should in due course ease pressures in the East Area;

·                     The BCU Health Board was pleased with the OOH Service’s achievements to date, but was not complacent as it was aware that there were challenges ahead and a need to be more innovative to meet demand

Responding to members’ questions BCUHB officials confirmed:-

·                     There had been some problems with the phone lines to the GPs OOH service, however these had been resolved and a new telephone system with additional telephone lines had been installed.  This new system recorded the number of patients in the ‘call queue’ which enabled the Service to call on more staff to answer calls and triage the queries;

·                       That a total of 29 GPs had committed to provide services to the GP OOH Service for the Conwy and Denbighshire area.  No GP was obliged to provide cover, those who did so did it on a voluntary basis and provided varied amounts of cover dependent upon their personal commitments;

·                     As the new A&E Department in Ysbyty Glan Clwyd and the Conwy and Denbighshire OOH Service were co-located it facilitated a close working environment and enabled patients to be directed to the most appropriate service to meet their individual needs.  Welsh Ambulance Service Trust (WAST) staff operating the Paramedic Pathways model were also able to direct patients to either A&E or GP OOH service, whichever was the most appropriate, when they arrived at Ysbyty Glan Clwyd.  The co-location of both services therefore eased pressure on the A&E Department;

·                     Patients from the Dee Valley were usually directed to the A&E and GP OOH service at Ysbyty Maelor.  However, the WG ruling relating to GPs practising in England not being able to provide OOH services in Wales had caused problems in recruiting sufficient numbers of GPs to provide the OOH services in the East Area.  Whilst this ruling had recently been relaxed, and would help the situation in due course, in the interim some patients had been directed to the OOH in the Central Area and others to the service based in Dolgellau, which covered south Gwynedd.

At the conclusion of the discussion members commented that having GP surgeries open on a Saturday morning, as was being proposed in England, would help ease pressure on A&E departments and the GPs OOH service.  They acknowledged the challenges faced in the East Area due to WG rules and were pleased to understand that these rules were now going to be relaxed to permit GPs based in England to work on the OOH service in Wales.

At the conclusion of the discussion the Committee:-

RESOLVED – to receive the report and, whilst acknowledging the challenges in certain areas, to congratulate the Health Board on the improvements made to date, particularly the effective working practices with the Accident and Emergency Department at Ysbyty Glan Clwyd and encouraged the Board to secure continued improvement in this area.