Extended access in primary care – Autumn 2017
NHS England committed an additional £500 million by 2020/21 to fund additional access to GP services. This includes routine appointments for evenings and weekends to meet the needs of the local patient population. We used a number of approaches to reach people including Community Voices, social media and a paper and online survey.
The CCG received 506 responses from North Kirklees and found that most people were supportive of the idea of providing appointments early morning, late evening and weekends. They could see the benefits this would bring, especially for those people that work full-time. For routine appointments, the most popular times were Monday to Friday 6.30pm to 8.00pm, Saturday 8.00am – 8.00pm and Sunday 8.00am to 1.00pm. People also told us that for urgent appointments they were more likely to be willing to travel further and be seen by someone other than their own GP.
The feedback from the engagement was used to develop the service specification for the Extended Access Service and to support the way in which we communicate the changes to local people. The contents of the service specification reflected what our patients feel is important. This included the key themes around the necessity to have:
- A central location
- Disabled Access
- Good car parking facilities
- Public transport access by bus and train
- Access to a pharmacy nearby
- Communications campaign to raise awareness of the evening and weekend appointments and how to book them
Health care in care homes – Autumn 2017
We looked at how we can improve the health services that older people receive in care homes. Two surveys were designed; one for GP practices and one for care home residents, staff, relatives / carers, and the wider public. An animation was developed by Healthwatch to help explain the ideas being presented. The video can be accessed here
To ensure we gained views from both staff of care homes and the residents and their families, Healthwatch Kirklees staff visited 12 care homes to support the completion of surveys. They also raised awareness of the survey via social media advertising.
We received 230 completed public surveys. And 25 completed surveys, from 14 practices (there are 27 practices in North Kirklees). There was overwhelming support for the proposal to introduce regular health and wellbeing reviews. There were mixed views on the use of telehealth, whilst they could see the potential benefits there was some concern as to how it would work.
Care home staff were supportive of the proposal of one GP practice to one care home. They felt it would improve the care they received by having a familiar face and continuity of care. For some residents, losing a known GP was reported as a negative to this approach.
Overall the engagement feedback supported the CCG proposals and provided reassurance around the model which will be used when procuring this new service. However, the comments received have allowed us to refine and improve our approach in respect of a number of elements. The mixed views relating to the use of telehealth means that we now plan to provide GPs and care home staff with access to/sight of the clinical record to support them in decision-making when using this tool.
Weekly visits to the care home will be a key part of the new service and we have further developed the way in which practices will be aligned to homes to improve equitable access, consistency of care, working relationships, and communication between practices and care homes.
Health optimisation – Spring 2017
It had been agreed by NHS North Kirklees and Greater Huddersfield Clinical Commissioning Groups (CCGs) to scope the introduction of a health optimisation programme that would include new criteria asking patients with a BMI over 30 to lose weight and smokers to quit before undergoing non-urgent elective surgery. To support this work we recruited 13 Community Voices representatives to have conversations within their communities.. In addition to the work undertaken by the Community Voices, a task and finish group was established to support the scoping of the health optimisation non-elective surgery pathway. The members of this group included five lay representatives from a range of voluntary and community organisations.
The CCGs received responses from 584 people and most were supportive of encouraging people to give up smoking or lose weight prior to a routine operation. Although it was felt that these decisions should be made by the consultant on a case by case basis and that people should be provided with realistic weight loss goals. Views on how much time people should be given to achieve these goals ranged from two weeks to 12 months. For smoking this ranged from six weeks to six months.
Some questioned why this should be restricted to people who smoke or have a high BMI, and suggested that it should be extended to include people who drink alcohol or take drugs.
Initially the CCGs agreed to develop a programme asking people to lose weight/quit smoking before their surgery. However, after further engagement, particularly with clinicians and elected representatives, the decision was taken not to progress with the original programme but instead to:
- Review/amend clinical policies to make sure they are in line with NICE guidance in respect of smoking and weight loss
- Ensure that GPs and hospital doctors talk to patients about the risks of smoking and being overweight
- Improve CCG signposting of healthy living information and local support services
- CCG to produce its own guidance leaflets for patients and use key national campaigns during the year to highlight healthy living e.g. Stoptober and Change4Life
Wheelchair services engagement – Spring 2017
The current provider in partnership with NHS North Kirklees, Greater Huddersfield and Calderdale CCGs and Healthwatch engaged with service users. This was as a direct result of a number of issues raised by service users, carers and families. We wrote to all services users who had used the service in the last two years and circulated a survey to key stakeholders and publicised through Healthwatch.
For children and young people, carers and families and service users whose needs change over time, timely access, good information and communication were the most reported improvements required. For people who had used the service less frequently the service received more positive feedback.
From the 287 responses people told us that there were a number of improvements needed to ensure the current service meets the needs of all service users.
The CCGs are using the findings from the engagement to further inform a new service specification. This specification will be developed with clinicians and key stakeholders. The current provider has already identified areas of improvement from the report, including improving communications and information. We will also be talking to people further about the development of a service specification in spring 2018.