Agenda item

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

a)    Integrated Primary Care Access Service

b)    Proposed Changes to the Mental Health Crisis Teams Across Solent NHS and Southern Health for PSEH

Items for Monitoring

a)      Integrated Primary Care Access Service

Representatives from the Fareham and Gosport and South Eastern Hampshire CCGs and Southern Hampshire Primary Care Alliance provided an overview of the partnership and service delivery.

Members heard regarding integrated care and the changes introduced and proposed next steps.  Previously, a complex range of services were offered that resulted in duplication and competition, as well as difficulties staffing that led to cancelled appointments.  Multiple sites were running with operational challenges and some services were also used more than others at various times.

In 2017, the government introduced new funding for GP extended access to run every day, including after hours and weekends.  New integrated primary care access service combines GP extended access service for out of hours, home visits, and urgent appointments.  A pilot reflected that users were prepared to travel and preferred a service that was flexible and not confusing to use with various locations and hours.

Upon the completion of contracts in June and in considering the services together alongside public engagement, the CCG decided to commission a single simplified service offering urgent or routine appointments during the day and home visits after-hours.  The GP Alliance was the only interested provider and awarded the contract.

Service hubs offer longer hours of care with a wider and enhanced range of health care professionals and easier access for users.  The improved IT system allows providers to access patient records after-hours including notes, results, ordering tests and referrals, increasing consistency and safety in patient care.  Continued home visits for those unable to travel and for mental crisis patients is through private provision of services.  The location and set-up of the hubs with GPs supporting nurses and NPs eliminates lone practitioner safety issues. 

There was not a great deal of time to mobilize these services but with stakeholder engagement, the changes were implemented in June.  Whitehill and Bordon was an area at issue and have asked the alliance to reintroduce the service for the hours that it was previously available.  Areas of difficulty and access will continue to be monitored and addressed.

In response to questions, Members heard:

·         Service in Whitehill and Bordon will be reinstated from 1^st August 2019 and had received positive responses in general.

·         Lots of work is being done around sharing information about the service and accessing it via 111 to help users know where to go when GP surgeries are closed to reduce the immense pressure on A&E.

·         More work will be done with local communities and especially the elderly, vulnerable, and those whose conditions may worsen with time.

·         The consolidated service will allow for consistency, strategic planning and fitting in with the NHS long term plan and alignment, with a secure place in the integrated care model going forwards.

·         Community engagement, lone provider risks, and practicalities of running services are all considered, but operating from privately owned sites has further resource implications and growth limitations.

·         This service is available to all patients offering routine appointments in both the service areas and more appointment slots to ease pressure.

·         Ongoing work being done to ensure that if someone calls in, they will be offered appointments with their own practitioner as receptionists can look simultaneously into both services.

·         These services will be available across Hampshire.

·         While there was concern about the Fareham and Gosport opening times, the Portchester location will be available and further changes considered based on cancellations, user feedback, transport issues, and evaluations

·         Metrics of usage will be measured and considered.

RESOLVED:

That the Committee:

a. Noted the update and current challenges as well as any recorded

issues addressed and/or resolved

b. Noted the proposed change is in the interest of the service

users affected

c. Requested a further update for November 2019

The Chairman called for a 10-minute recess. 

b)    Proposed Changes to the Mental Health Crisis Teams Across Solent NHS and Southern Health for PSEH.

This item was taken second, out of order, after Item 7b at the Chairman’s discretion.

A representative of Southern Health NHS Foundation Trust presented on the change in approach to improving the delivery of mental health services by bringing together two NHS mental health trusts in partnership starting December 2017.  Preparation work and consideration of records and clinical pathways used by service users and interventions provided against them guided 150 hours of workshops with a variety of stakeholders to create access points for people with mental health problems.

The crisis element of mental health provisions is a priority and the crisis resolution team in Solent and acute mental health services at Southern Health will form a single provision across south east and Solent for timely service for crisis assessments and enhanced alternatives.  Crisis teams will provide specific assessments as a gateway to other services that may include hospital or home treatment elements. The aspiration remains, eliminating postcode lottery with a key aim to have more users and carers access services, as well as more support and development for providers and staff.

Currently, both Solent and Southern Health are co-located and providing out-of-hours crisis.  Operating separately leads to limited staffing but collaboration enables better catering for users since implementation in late May.  A final stage of legal framework remains and progress will lead to single line management for crisis services and a single management mind.  Referrals, as in other areas of the county, will be via 111 (with mental health nurses available) and is the vehicle for self-referral.

The next steps include considering daytime provisions and a single base for Portsmouth (in addition to two Southern Health bases, Havant and Fareham) for better access and timely response within the area.  Enhancing provisions across the single team will better serve the areas.  Older persons’ provision will be a needs-led service for getting the specific interventions they require rather than based on age alone. 

In response to questions, Members heard:

• Police are an important collaborator with capacity constraints and crisis response teams will ease their pressure with their expertise in needs assessment and provision of home treatment.
• It can be challenging for people in a confused mental state to self-refer and know the information about where and how to do so.
• Communication strategy around how to publicize the 111 service is key to both self-referral, as well as referrals from carers and loved ones.
• The primary driver is to provide access to services before someone reaches the point where they are unwell and needing crisis help.

• There are wider issues of the lack of trained psychologists providing adequate counselling in terms of community mental health provision.
• Workshops and group programmes are often not enough for those needing intensive support and this remains an ongoing goal across the county.
• The operating standard is laid out in fidelity documents (3^rd iteration) addressing response times as metrics to be measured against.
• Transformation funding has been requested from the NHS to assist with the provision of a 24-hour service.
• While the 111 service does have a script for physical medical care and attention, callers in a crisis will be put through to experienced mental health nurses.
• Mental health nurses have been able to use their expertise and informal engagement to divert patients from A&E and receive better response to their mental health needs with a fairly positive response.
• Phase 1 is expected be complete in September and Phase 2 launching afterwards.
• Mental health does feature significantly in the NHS long term plan for developing a model of public mental health in the community.

Members noted their appreciation of the importance of robust strong community mental health teams, especially with limited resources for care in the community.  The committee was broadly supportive of the proposal and believed it will help some in crisis mode, but that it was vital to concentrate on the bigger picture and understand why people are getting into these situations in the first place.  Long waiting times for therapy or treatment could leave a large window of time that could lead to a crisis and an equal amount of effort ought to be put into crisis prevention.  Members noted that more resources are needed for these critical underfunded services.

RESOLVED:

That the Committee:

a. Noted the update on the phased implementation starting from summer 2019.

b. Requested a further progress update for the November 2019 meeting.