Agenda item

The Chairman noted that this item was a referral from the Health and Adult Social Care Scrutiny Committee, as the proposals had implications for the Amesbury Community Area.

The Chairman welcomed the following attendees from Wiltshire Medical Services:

• Michelle Reader - Director of Quality and Performance
• Dr Jamie Brosch – Medical Director
• Alun Jenkins – Director of Operations

Also welcomed was Tony Barron, Chairman of NHS Wiltshire.

At the Chairman’s invitation, Jamie gave a presentation detailing Wiltshire Medical Services’ (WMS’) proposals for the re-design of the Out of Hours medical service.

Jamie began by way of an apology, noting that WMS had been working to re-design the Out of Hours service for a while, but may have struggled to get the message across, despite trying to engage with staff and stakeholders.

WMS had run the Out of Hours service in the north half of the county since 2004, taking on the county-wide contract in 2010.  The service handled approximately 2000 requests a week, of which 50% were “closed” with advice over the telephone, 30% were seen at a Primary Care Centre (PCC), and 12% resulting in a home visit. 

One of the main challenges of providing the service was the relatively sparse and rural population within Wiltshire most areas of dense population around the edge of the county.  Due to the distance involved, Out of Hours home visits took much longer (up to six times) than consultations at a PCC. 

In addition, a detailed weekly analysis of activity and performance had identified a mismatch where 2/5 of the Out of Hours resources (i.e. visiting and PCC capacity) were based in the south of the county, while only 1/5 of the total activity took place in the south.  This resulted in vehicles being redeployed away from the area to meet demands elsewhere, exacerbating the issue of distance.

Another driving factor for change was the difficulty in recruiting and retaining nurse practitioners in the current structure due to the small teams.

A number of options had been developed and considered against key criteria, with Ease of Accessibility, Quality of Service, and Risk the highest weighted criteria.

The preferred option was to redesign the model of provision to match capacity with demand, and this included closing Amesbury as a clinical base, and redistributing the resource between Salisbury Foundation Hospital and Warminster Community Hospital.  This would see two clinicians based at Salisbury, with one designated as “mobile” for home visits, and another based at the hospital.  In was considered that this would give a better and more strategic service to the surrounding area than at present, where one clinician was based at Salisbury, and another in Amesbury, with both dealing with PCC appointments and home visits.

This proposal had been subject to a consultation with staff and stakeholders, with a visit from the Health and Adult Social Care Scrutiny Committee in February, and a briefing document circulated in April 2011.

The Chairman thanked Jamie for the presentation and invited questions and comments:

• Councillor John Noeken thanked Jamie for the presentation and for the attendance at the meeting, commenting that the detailed information on service demand would have been useful when the matter had been discussed at the Health and Adult Social Care Scrutiny Committee on 19 May. 

• Councillor Noeken also noted that a petition of 1300 names had been presented to WMS in opposition to the proposals, and the Mayor of Amesbury had raised concern over the proposals and the consultation. 

• An outstanding concern was regarding access to the re-designed service during the winter months, and especially in bad weather; there was a need to ensure that elderly residents could either get to the PCC or that the mobile Out of Hours Clinician could get to the patients at home.  This could be addressed with Wiltshire Council, as a number of 4-wheel-drive vehicles were available for emergencies in wintry weather conditions.

• Andy Rhind-Tutt, Mayor of Amesbury, raised a number of concerns, commenting that the Town Council had only heard about the proposals in 19 April.  He noted that Amesbury was a growing town, with the current population of 12,000 forecast to grow to 15,000 in the next five years.  In addition, 40% of the homes at the Archers Gate development was affordable housing and so would be occupied by people on low incomes.  It was unlikely that they would all have access to transport to travel to Salisbury during Out of Hours times, and so they would call 999 for medical emergencies, costing much more to the taxpayer.  Jamie commented that people were often able to find friends and neighbours to take them to surgeries when required,  In addition, although the primary criteria for prioritising home visits was the health of the patient, common sense was also applied, and WMS had a duty of care to those patients who could not travel.  In relation to the cost to emergency services, part of WMS’ performance monitoring was the impact on the ambulance service, and so this would be kept under review.

• Amesbury Town Council had also been made aware of allegations that Out of Hours Patients were being diverted to Salisbury, in order to generate figures that the Amesbury facility was not being used.  Jamie responded that this was not the case, although clearly the service was based on availability, and patients from Amesbury may have been sent to Salisbury if the Amesbury-based clinician was on home visits, and vice versa.

• Andy Rhind-Tutt also reported that a senior member of the Trust Board at Salisbury Foundation Hospital had privately expressed disappointment that the Trust Board had not been consulted as part of the process.  Tony Barron, Chairman  of NHS Wiltshire, responded that he was aware of this, and commented that the individual in question had identified himself and had rescinded the comments, having not been aware that the Chief Executive of Salisbury Foundation Hospital had been involved in the process of redesigning the Out of Hours proposals, and fully supported the proposed changes.

• Responding to a question regarding the impact on the Super Garrison, Jamie noted that the MOD had been consulted on the proposals and supported the new model.  Although the garrisons around Amesbury were forecast to grow in size, the garrison at Warminster was due to grow even faster, and so the additional resources would be needed at the Warminster Community Hospital.

• It was suggested that the Link scheme which currently operated in rural areas could be promoted in the Towns, to help residents without their own transport.

• In response to a query regarding the impact on care homes, Jamie commented that the proposed new model would improve the service to care homes, as the designated “mobile” Out of Hours clinician would provide a better service for housebound patients.

• Tony Barron added that the process of reviewing and refining the delivery of medical care across the county was an on-going process and that all factors, including the shifting population, were taken into account.  The new model would be kept under review and new services would be provided if and when they were required.

• Councillor John Noeken commented that he would write to WMS to clarify and summarise the points raised by the Area Board.

ACTION: Councillor John Noeken