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REVIEW OF UNSCHEDULED CARE IN SOLIHULL by jianghongl

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									      REVIEW OF
 UNSCHEDULED CARE IN
      SOLIHULL




    Draft Report of the
 Healthier Communities &
Older People Scrutiny Board

        February, 2007
CONTENTS
Foreword by the Chairman of the Scrutiny Board

Scoping Document

Background Information and Rational

Desktop Research Discussed by Members

Findings of visits

Task and Finish Group Minute

Recommendations

Appendix 1: Presentation received from Badger Medical




                                                        2
                FOREWORD BY THE CHAIRMAN

                At its first meeting of the 2006/2007 Municipal Year the
                Healthier Communities and Older People Scrutiny Board
                resolved to undertake a detailed review of unscheduled care
                in Solihull.

                When considering unscheduled care the Board used the
                following definition:-

Unscheduled care is NHS care which cannot reasonably be foreseen or
planned in advance of contact with the relevant healthcare professional, or is
care which, unavoidably, is outside the core working period of local services.

The review sought to consider the following questions and make appropriate
recommendations:-

1.    How do Solihull citizens access unscheduled care?
2.    Why do Solihull citizens access unscheduled care?

In order to fully engage with this review members received the 24 Hour
Unscheduled Care Strategy from Solihull PCT and in small groups undertook
visits to the following providers of unscheduled care:-

     NHS Direct
     Solihull Hospital Accident and Emergency
     Out of Hours provider – Badger Medical

Two members of the Scrutiny Board also met with the Primary Care Trust
(PCT) PPI Forum.

Following on from our visits the Scrutiny Board agreed to set up a task and
finish group comprising of those members who visited the different out-of-
hours providers to formulate some draft recommendations to take back to the
Board for its agreement.

The Board now hopes that the recommendations we have agreed upon are
taken on board by our health partners and look forward to receiving
responses from them.

I would like to take this opportunity to thank all those officers both within
Solihull Council and from the providers of unscheduled care for their help and
enthusiasm in helping to ensure the completion of this review.

Councillor Honor M. Cox
Chairman of the Healthier Communities & Older People Scrutiny Board




                                                                                 3
SCOPING DOCUMENT




       SCOPING DOCUMENT FOR A REVIEW OF UNSCHEDULED CARE IN SOLIHULL




       How do Solihull citizens   Primary Care Trust (PCT) Care Pathway; National Health
 1
     access Unscheduled Care?         Service (NHS) activity data; epidemiological data



                                                         Accident
       Why do Solihull citizens   General      Out of                  NHS
 2                                                          &                     Clients
     access Unscheduled Care?     Practice     Hours                   Direct
                                                        Emergency


       What should be done
 3                                           Evidence synthesised by the Board
           differently?




                                                                                            4
                          POSSIBLE EVIDENCE AND ACTIVITY FOR SCRUTINY BOARD
Sessions               Contributors                      Setting                 Potential Evidence Generated    Q1   Q2   Q3
   1       PCT Director of System Reform,    Round table discussion of       Local and comparative
           PEC lead on out of hours          briefing papers.                epidemiological briefing on all
                                                                             areas as springboard for further
                                                                             question definition.
   2       Patient and Public Involvement    Round table discussion          How & Why clients access
           Forums of PCT, Heart of England                                   unscheduled care during day &
           Foundation Trust, & Solihull                                      out of hours. Expectations of
           &Birmingham Mental Health Trust                                   the NHS.
   3       NHS Direct                        Visit to the Call centre        Further understanding of role
                                                                             and function, especially their
                                                                             capacity & capability.
   4       Accident & Emergency              Visit to Solihull A&E           Their experience and concerns
           Department                                                        about trends. How do they
                                                                             manage to get people to see
                                                                             the right clinician, especially a
                                                                             primary Care clinician?
   5       Out of Hours care providers:      Visit to their centres          What do they see, how do they
           Solidoc & Badger Medical                                          fit into the pathway, how do
                                                                             they see and manage their
                                                                             contacts.
   6       Members synthesis of evidence     Facilitated round table
           and generation of                 discussion at the Civic Suite
           recommendations.




                                                                                                                       5
MEMBERS OF THE HEALTHIER COMMUNITIES AND OLDER PEOPLE
SCRUTINY BOARD

Councillor Honor Cox (Chairman);
Councillor Alan Nash (Vice-Chairman);
Councillor Irene Chamberlain (until 10 October 2006)
Councillor Stuart Davis;
Councillor Barbara Harber (from 10 October 2006)
Councillor Ken Hawkins;
Councillor Dr Peter Lea;
Councillor Jim Ryan;
Councillor Simon Slater;
Councillor Mrs Kate Wild

Mrs Delia Zeuthen – non-voting co-opted member representing the Birmingham
Heartlands and Solihull Hospitals Public and Patient Involvement Forum

MEMBERS OF THE UNSCHEDULED CARE TASK AND FINISH GROUP

Councillor Honor Cox (Chairman)
Councillor Irene Chamberlain
Councillor Ken Hawkins
Councillor Dr Peter Lea




                                                                             7
BACKGROUND INFORMATION AND RATIONAL

Unscheduled care is a provision that everyone at some point during his or her
lifetime is likely to access. It is therefore, an area of great importance to residents of
Solihull. After a recent visit to NHS Direct members of the Board thought it would be
a worthwhile exercise to talk to the main players in unscheduled care, consider any
good practice they employ and to finally make recommendations based on its
findings.

Until 2004 out of hours treatment1 was the responsibility of GPs. Given that GPs had
to provide cover for care twenty-four hours per day, seven days per week this meant
that they were often expected to work both during the daytime and the evening.
Under new regulations GPs were given the option to opt out of offering out of hours
care in order to ensure their own work life balance.

Since then, if GPs decided to opt out, out-of-hours care then became the
responsibility of the Primary Care Trust (PCT) to ensure care provision was met. In
order to ensure their responsibility was met many PCTs contracted out of hours
providers to supply this service.

At the beginning of this Review there were two main providers of out-of-hours care in
Solihull these were Solidoc which was based at Solihull Hospital and Badger Medical
which covered parts of the north of Solihull and whose headquarters are based in the
centre of Birmingham. During August 2006 however the PCT re-tendered the out-of-
hours care contract and Badger Medical was appointed as the sole provider of this
service for Solihull also taking the provisions at Solihull Hospital that were previously
run by Solidoc. Due to this change we felt it was even more important to look at the
out-of-hours provision available to residents of Solihull.




1
 The out of hours period is considered to be 6:30pm to 8:00am, Monday to Friday or at any times on
Saturdays, Sundays and Bank Holidays.


                                                                                                     8
DESKTOP RESEARCH CONSIDERED BY MEMBERS

The following documents were circulated to members as background and desktop
research:-

Report of the Health Services Management Centre, University of Birmingham “24
Hour Unscheduled Care Strategy, Solihull PCT”

NHS Direct Service Prospectus 2006/07

Department of Health 24:7 access to primary care

Department of Health, “Raising Standards for Patients. New Partnerships in Out-of-
Hours Care”, October 2000

Department of Health, “National Quality Requirements in the Delivery of Out-of-
Hours Services”, October 2004




                                                                                     9
Meeting with Hazel Nelson – 31 August 2006

Present: Councillor Honor Cox (Chairman)
         Adam Hadley (Scrutiny Officer)

Under the re-tendering exercise the PCT had agreed that Badger Medical would be
the sole provider of out-of-hours care in Solihull. Under the new arrangements
doctors would either have an answer phone system that would give patients the
number to contact Badger directly or as some surgeries have, a call divert system
that would transfer patients directly to the Badger call centre. In order that patients
know about the new arrangements the PCT in connection with Badger would be
undertaking a major publicity drive from 1 October 2006. The new arrangements fit
within a piece of work the Solihull Care Trust ‘s Professional Executive Committee
(PEC) undertook with Natpac (a university for health care) whereby patients were
interviewed about what they wanted from an out-of-hours service and agreed that
they wanted to only make one phone call to receive advice.

Solidoc currently runs a service at Solihull Hospital in order for patients who need
out-of-hours care to receive appropriate provision at the hospital without having to
attend the accident and emergency department. The reason for this is that very
often accident and emergency has not been used correctly and takes resources
away from those patients that really need this service. Badger, as well as agreeing
to keep this resource, has also indicated that it could operate a similar unit at the Lift
Building at Crabtree.

The system which operates at Solihull Hospital is called the ‘Divert system’. This is
where a patient attends accident and emergency out of hours and under a strict
criteria system does not need the services of accident and emergency and so
instead are diverted to Solidoc, and from now on, Badger. Note: this system only
operates from 6.30pm – midnight.

Bagder have also agreed to meet each of the recommendations contained within the
Carson Report a summary of which has already been circulated to members.

Badger are also in the process of introducing a computer system for palliative care
whereby any care that is undertaken during the day by the district nurse is placed on
to the computer system so that Badger are fully up to date as to what the patient has
received in terms of health care should they be required out of hours. There is also
an agreement that any one receiving palliative care will be seen by a Badger doctor
within 45 minutes. Badger will also have a link with the Marie Curie Hospice and any
call from them will be treated as a Grade 1 call.

Solidoc staff have been offered employment with Badger should they wish to accept
it.

Solihull Hospital have also recently implemented a 24 hour district nurse room so
that those patients who don’t require home care can receive their care at the hospital
and that more patients can be seen by the nurses.




                                                                                        10
With regard to NHS Direct as a provider for health care advice at any time there are
future staffing issues for this and a number of call centres have been closed down
and patients cannot guarantee being transferred to their local call centre (Solihull’s
local call centre is located at Brierley Hill in Dudley).

Hazel Nelson’s main recommendation to the review is that the Board endorse her
recommendation that the divert system be run 24 hours per day at Solihull Hospital
so that accident and emergency can focus on accident and emergency and not
illnesses that could be dealt with by a Badger doctor.

As an aside and as part of any future recommendations made on this review
members may wish to endorse the decision taken some years ago to keep the
accident and emergency department at Solihull Hospital open 24 hours per day.




                                                                                     11
VISIT TO NHS DIRECT

Present: Councillors Cox and Dr Lea.
         Adam Hadley (Scrutiny Officer)

     NHS Direct started in 2000
     The site at Brierley Hill covers the central West Midlands region
     Calls to NHS Direct can flow all over the country if the local call centre is busy
      so as to cut the waiting times of callers
     The normal waiting time for callers was 60 seconds and this target was
      achieved in 87-90% of calls
     When a call is received the caller hears a recorded message informing them
      about the calls being recorded and if no one is free to take the call they are
      then placed in a queue.
     The call centres have more people working at weekends and bank holidays
     NHS Direct had developed and changed over the years. The original pilot
      was one where there were lots of local call centres with four different types of
      technology. This has now changed to one software system and less call
      centres that are all linked up to allow calls to flow where they can be
      answered more swiftly
     Each year there is between a 2% and 4% growth in calls which is similar to
      the percentage increase in the number of people using accident and
      emergency departments
     NHS Direct hasn’t advertised in three years
     The online service has reduced costs
     The online system has proved popular with those people wanting further
      anonymity but it does require users to answer a series of questions and if the
      answers indicate a potential problem they are then asked to call NHS Direct
     The service is no longer in partnership with out of hours providers but are still
      technically linked so as to ensure a joined up service for patients
     Calls can be passed electronically to 999 or the ambulance service directly
     Calls are initially answered by “Health Advisors” who receive four weeks of
      training. Nurses in the call centres receive six weeks of training so as to
      educate them about dealing with patients whom they cannot see or touch
     The prioritisation system has been rewritten and developed in the UK
     Upon receiving a call the advisor would look for any emergency (which should
      be a 999 call) and if a call is identified as such it is transferred straight to the
      ambulance service
     The second is priority one which is a caller that needs to be spoken to
      immediately by a nurse: the example given was if a caller was suicidal. These
      callers are kept on the line and transferred to a nurse.
     Priority 2 callers are called back within an hour and priority three callers are
      called back within three hours.
     Health Advisors have a protocol of yes or no questions whereas nurses don’t
      have to be as prescriptive
     There are sometimes issues when a caller doesn’t want to release relevant
      information




                                                                                       12
   Some call handlers are placed on plain English courses so the caller can
    understand them; handlers are also put on a simulation exercise to ensure
    that trainers can understand what they are saying
   A translation service is available should callers require it
   The translation service is considered better than asking a family member to
    undertake translation
   Calls can be transferred to an out of hours provider if the need requires it
   Self care advice can be given, if appropriate, so that callers can look after
    themselves in the home
   5-7% of calls are classified at 999 calls
   12% of calls are classified as accident and emergency calls
   25% of calls are classified as GP urgent calls
   The rest of the calls are considered routine GP calls and they are advised to
    wait until they can see their own GP
   Between midnight and 7 am NHS Direct takes approximately 200 calls
   Between 6pm and midnight NHS Direct takes approximately 2000 calls
   There is a large percentage of calls taken relating to domestic violence during
    Friday and Saturday nights
   All staff are trained in domestic violence and child protection issues
   Referrals can and are made to social services
   NHS Direct will begin to move into using SMS text messaging for advice
   The two sites in the West Midlands employ 250 staff and 50 employees are at
    each call centre at any one time
   The organisation as a whole employs 5000 people, 1200 of whom are
    registered nurses (this is the same as a general sized hospital)
   Nurses are employed as “Sister Grade” (Grade F) which is an attractive offer
    when there are not very many positions of this grade in the wider NHS
   Call centre workers are paid more than their counterparts in other call centres
    due to the level of training they receive
   There is a complete turn over of staff every 3 years
   40% of nurses get promoted after working for NHS Direct
   5% of nurses retire after working for NHS Direct
   There is a 30-40% turnover of call centre staff which is in line with the call
    centre industry norm
   There has been no need for nurse recruitment at this site in over a year and
    they have had to turn nurses away
   The complaint rate is less than 0.04% and each complaint is investigated and
    responded to individually
   Any calls that lead to a death are investigated in order to see whether there
    was anything more could have been done
   They are currently undertaking an organisational review in order for them to
    become closer as an organisation
   They are aware that as technology develops, so does the service they offer
   There is between a 97 and 98% satisfaction rate so it is unlikely that the
    service would change if the Government did, especially since the service
    developed from a pilot called “888” which came from a Conservative think
    tank




                                                                                 13
   Education in the wider public is needed so that the service is utilised
    appropriately
   In light of the recent tendering exercise undertaken by the PCT with regards to
    out of hours care, staff have not been lost but absorbed into other areas
   If a power cut or other emergency rendered a call centre inoperable the calls
    would be taken up by other call centres
   8 small centres are closing but they will be consolidated into the larger call
    centres as part of the organisational review




                                                                                14
VISIT TO THE ACCIDENT AND EMERGENCY DEPARTMENT AT SOLIHULL
HOSPITAL

Members Present:
Councillor Chamberlain
Councillor Dr Lea

Officers Present:
Dr Mitam Barooah – Chief Consultant (Heart of England Foundation Trust)
Joseph Bright – Minute Taker
Jane Elwell – Lead Nurse for Emergency Nurse Practitioners (ENP) (Heart of
England Foundation Trust)
Sylvia Hughes - Primary Care Advanced Nurse Practitioner (Care Trust)
Jane Reed – Head of Adult Services (Care Trust)

Members were shown the patient pathway for Accident and Emergency Services,
from initial diagnosis to treatment to discharge. The hospital staff explained the range
of conditions treated in A & E from suspected broken bones to suspected heart
attacks.

Following the tour of A & E Services, members conducted a question and answer
session with the hospital staff. They questioned how soon the staff aimed to respond
to patients once they had entered accident and emergency services. The Lead
Nurse for ENP confirmed that the staff aimed to assess patients within 20 minutes of
visiting A & E Services. She also explained the procedures in place for nurses to
distinguish minor injuries from serious cases to ensure patients with serious
conditions received medical help as soon as possible. It was also highlighted that the
national target for patients entering A & E services to receive treatment and
discharge was four hours, something Solihull Hospital adhered to.

The hospital staff made reference to cases where patients entered A & E Services
and turned violent, especially on Friday and Saturday nights. The Leader of ENP
services noted the procedure in place for this, whereby the nursing staff contacted
the police. It was also emphasised that the hospital was currently looking at
expanding security services within the hospital, as it only employed one security
guard at that time.

The hospital staff were asked whether there were any issues that could affect the
provision of A & E services at Solihull. The Lead Nurse for ENP services explained
that there was a significant volume of experienced nurses who would be reaching
retirement age and this could potentially create a vacuum in staff. She explained that
this issue was a national problem, where there was a lack of experienced, qualified
nurses to replace retiring staff in A & E services. It was also highlighted that the
nurses currently in A & E covered many shortages on the basis of goodwill.

Staff also noted that there was currently insufficient capacity for intermediate care. It
was explained that while there were provisions in place to support patients with
minor injuries, as well as procedures to support patients who entered A & E with
serious conditions, there was a need for greater rehabilitation services to support



                                                                                       15
patients requiring intermediate care. The hospital staff explained that this would
require more intermediate care beds plus greater support for residents at home.

Upon a second visit to the accident and emergency department the Chairman
received further information regarding the role of the Advanced Nurse Practitioner in
the Minor Injuries Unit (MIU) and the Medical Admissions Unit (MAU).

The main role of this post is to :

    Prevent unnecessary hospital admissions;
    Provide evidence and information for future service development;
    Strategically assist in the planning and development of community services to
     support this role

The majority of referrals are being generated by the MAU as the MIU patients
predominantly tend to have significantly less need for support services on discharge.
However, there is scope for further development of the role in areas such as back
pain and falls prevention and developing links with the ambulance service.

There is a substantive group of patients attending between the hours of 9am and
5pm who do not require a hospital bed, whose needs are such that they cannot be
managed at home but could be managed in a nurse led facility elsewhere. These
are mainly frail elderly people who require daily bloods and sepsis screening and/or
supervision as their clinical condition has the potential to deteriorate in the initial 24-
48 hours.




                                                                                          16
VISIT TO BADGER MEDICAL (Out of hours provider for parts of the North of
Solihull)

(Birmingham And District General Practitioner Emergency Rooms Group)

Members Present:
Councillor Hawkins
Councillor Dr Lea

Officers Present:
Jane Edwards – Nurse Consultant, Badger Medical
Adam Hadley – Scrutiny Officer, SMBC
Terry Peate – General Manager, Badger Medical

The presentation delivered to members is attached as Appendix 1.

   Members were informed that Badger use case streaming and it is only one call
    directly through to Badger rather than several calls.
   Complaints are reduced by speeding up the process with which a caller can
    speak to a doctor.
   The receptionist only takes demographic details and decides whether the issue is
    life threatening.
   The most experienced clinicians are used to make decisions and prioritise cases
    (when A&E did this waiting times were reduced).
   Consultations can be made at various locations meaning everyone in the
    organisation can help each other out during busy periods.
   It may be possible in the future for doctors to work from home and whilst this isn’t
    necessarily ideal during normal time, in the event of something like pandemic flu
    it could be a both useful and necessary
   Only nurses who are advanced practitioners can give advice
   An experienced doctor will review the cases for case streaming, the receptionist
    will then call back and relay the information and the patient will be given a choice
    of which centre they want to attend.
   Each time of arrival is recorded so as to ensure accurate data on waiting times.
   Any injuries are referred to accident and emergency. Dental needs outside the
    scope of the contract are referred to an out of hours dentist.
   There is no walk in centre at Solihull Hospital
   Members were reminded that patients shouldn’t turn to accident and emergency
    for non accidents and emergencies since this costs the PCT money
   This is part of the reason for the “Divert System” which operates at Solihull
    accident and emergency department
   Having Badger at Solihull Hospital has eased pressure on Heartlands Hospital.
   On a general note members were informed that some people do not have their
    own GP
   It is not viable to run Badger through the night at Solihull Hospital.
   Home visits are run only on medical need and not social need.




                                                                                      17
   One area of questioning was over getting prescriptions at night. Members were
    informed that hospitals now keep some drugs on site and that Solihull Care Trust
    had requested that Badger supply the full course of tablets if a prescription is
    issued at night. This would then be paid for by the Care Trust, not the hospital.
   The Care Trust may wish to consider a day time service so that people are not
    going to A&E when they don’t have to .




                                                                                   18
DISCUSSIONS WITH THE SOLIHULL PCT PPI FORUM

In attendance: Cllr H Cox, SMBC
               Cllr I Chamberlain, SMBC

                Ken Norton, Chairman, PCT PPI Forum
                Jean King, Forum Member
                Bryan Smart, Forum Member
                Patricia Handslip, Forum Support Manager

                Roy Eaton, Senior Scrutiny Officer, SMBC

Out of hours provision

PPI will be trying to establish that the services to be provided by Badger Medical will
be what are expected by the contract.

Reference was made to several telephone numbers promoted in the area for use out
of hours. This was a source of confusion to the general public. Not everyone present
was aware of the promotional literature that was being referred to.

Mr Norton commented that one of the key issues to be established is whether the
services to be provided by Badger will result in a qualified medical practitioner
visiting a patient’s home when necessary. This situation may be exacerbated in that
Badger may be using doctors from outside the area (the majority of Solidoc GPs
were from Solihull), which could involve some lengthy journeys. He about the rumour
that there could be a limited number of Solihull GPs that will work for Badger. A
comment was made that a patient will only get a home visit if the situation is life
threatening; otherwise there is an expectation that the patient will visit the Solihull
Hospital site. Mr Norton questioned whether the provision would always be from the
Solihull site or would the public be expected to travel to Whittall Street in
Birmingham.

Mr Norton continued that the general public needed to be educated as to how best to
access health care particularly with the increased use of triage treatment of
categorising patients.




                                                                                     19
Divert system at A & E department, Solihull

Cllr Cox commented that the problem is that many members of the public will go to
the A & E department instead of visiting their own GP. This situation is exacerbated
that at some surgeries it takes days to get an appointment to see a doctor. A
comment was made that the geography in the A & E department was wrong in that
whilst there is a separate reception for the “Divert” scheme the patient is first met by
the A & E reception desk, which in some cases could be counter-productive.

The Divert system undoubtedly reduces A & E income but, without it, the additional
numbers of patients that would have to be processed by A & E would put too great a
pressure on that department.

A general comment was made about A & E in that there is anecdotal evidence of
patients being made to wait for 4 hours in ambulances outside the department. If a
patient calls an ambulance in response to an emergency situation, the ambulance
will take the patient to Heartlands, not Solihull, except in the case of a heart attack in
which case the patient would be fast tracked through Solihull Hospital. The comment
was made that the waiting time at Heartlands A & E was significantly longer than at
Solihull.

NHS Direct

PPI Members confirmed that they had yet to visit the NHS Direct facility. The
anecdotal evidence suggested that the service was not up to scratch. The
Councillors advised that some of them had recently visited the facility. The
presentation received, the answers given to questions and from what they observed
left them with the impression that it was an efficient operation.

Councillor Cox said that they had been told that the call operatives received intensive
training and by using a script of basic questions they were able to assess whether
the caller needed to be put through to a doctor or a nurse dependant upon the
severity of the illness.

Mr Norton commented that a number of PCTs had withdrawn from their contracts
with NHS Direct. Why should this be?




                                                                                        20
UNSCHEDULED CARE TASK AND FINISH GROUP MINUTE

RECOMMENDATIONS OF THE REVIEW OF UNSCHEDULED CARE

Members received copies of the notes from each of the visits undertaken during the
course of the Review. They discussed their visit to the Accident and Emergency (A &
E) Services at Solihull Hospital. Members highlighted the fact that the A & E staff had
raised the issue of security, noting a lack of provisions in place for when problems
arose. The staff explained that they had a direct line to the police for when security
issues arose; however, they felt the lack of other provision could create issues,
especially on Friday and Saturday nights, when some patients arrived at the A & E
services after drinking alcohol.

Members also noted that a number of patients visited the A and E Services for
convenience, rather than for genuine emergencies and they expressed concern that
there was a lack of General Practitioners (GPs) present to address this issue. They
also emphasised that some patients may have resorted to A & E Services as GPs
often no longer held surgeries on a Saturday or after the working day in the
evenings. Members questioned whether Solihull Hospital, in collaboration with other
service providers, should undertake educative programmes to ensure patients used
the A & E services correctly.

Members also discussed their visit to the Badger Medical Centre. They noted the
Centre had improved their telephone exchange service with the introduction of a new
software system. Members also highlighted that, under the previous system SoliDoc,
Nurses exclusively responded to queries. They welcomed that under the new Badger
system Doctors also received calls in order to provide advice and issue treatment.
Members raised the issue of the availability of drugs during out-of-opening hours,
explaining that there used to be an all night chemist in Birmingham which had
closed. They noted that Badger Medical had a stock of drugs in place in cases of
emergencies at night, but they expressed concern as to whether this was sufficient.

Members then discussed their visit to NHS Direct. They noted that whilst the service
had a good system in place, they expressed concern that NHS Direct were
attempting to provide an educative service for patients which should be conducted
during the day-time/working hours. Members also expressed concern at the expense
of the system, noting that it currently cost £33 per contact.

Members stated that it would be beneficial to review the performance of the Badger
Medical Centre and NHS Direct during the next twelve months. They agreed that the
performance of Badger and NHS Direct be monitored throughout the next year by
the Care Trust and that an annual report detailing this be received by the Healthier
Communities and Older People Scrutiny Board. Members also suggested that
Badger Medical and NHS Direct should not attempt to publicise its services by
including leaflets within local newspapers since it was felt that residents did not look
at leaflets received in newspapers. Instead the contact numbers for Badger and NHS
Direct should be circulated separately to every home within the Borough.




                                                                                     21
Members then considered the recommendations they would like to include in the
final report of the Review of Unscheduled Care. Firstly, members noted that they
were impressed with the quality of the services offered by the out-of-hours providers.
General comments made by the Group included:-

   There is a need to educate people so that they used the correct service at the
    appropriate time.
   If patients are unable to gain an appointment quickly with their GP they are more
    likely to use Accident and Emergency as an alternative service.

With regard to the Divert System in operation at Solihull Hospital members felt that a
recommendation to extend this service to 24 hours a day should only be made if the
Medical Committee felt this would be an appropriate move.




                                                                                    22
RECOMMENDATIONS

The Healthier Communities and Older People Scrutiny Board asks that the relevant
Health Bodies implement the following recommendations:-

     Recommendation                                         Responsibility
    1. That an educative programme is developed             Solihull Care Trust in
        ensuring that people use unscheduled care           collaboration with its health
        provision correctly.                                service partners.

    2.   That the accident and emergency department         Heart of England Foundation
         at Solihull Hospital be encouraged to consider     Trust
         increased security for its staff

    3.   That GPs be encouraged to share relevant           Solihull Care Trust/Badger
         information with unscheduled care providers on     Medical/ NHS Direct
         those people receiving palliative care so that
         their needs can be met faster.

    4.   That Solihull Hospital be encouraged to run the    Heart of England Foundation
         Divert System 24 hours a day.                      Trust

    5.   That the contact number for Badger Medical         Badger Medical
         and NHS Direct be individually circulated to
         every home in the Borough and not by placing
         a ‘flyer’ in a local newspaper.

    6.   That the performance of Badger Medical and         Solihull Care Trust/Badger
         NHS Direct be monitored throughout the             Medical/ NHS Direct
         ensuing year by the Care Trust and that an
         annual report be received by the statutory
         Health Scrutiny Board at Solihull Council
         detailing the performance throughout the
         previous year.

    7.   That the Care Trust looks at ways of ensuring      Solihull Care Trust
         that an all night pharmacist is available in the
         Borough

    8. That Badger Medical be asked to ensure that          Badger Medical
        doctors visiting Solihull residents are not
        having to travel long distances and in doing so
        increasing waiting times.




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Recommendation                                        Responsibility
9. That as part of its commissioning role the         Solihull Care Trust
   Solihull Care Trust ensure that General
   Practitioners offer an evening and/or Saturday
   service for those residents who work during the
   day time (so that they do not need to attend the
   Accident and Emergency Department as a
   result of having no GP available)

10. That those NHS bodies to which the                All of the above
    recommendations relate be asked to send a
    response to the Scrutiny Board within 28 days
    (under the requirement detailed within The
    Local Authority [Overview & Scrutiny
    Committee Health Scrutiny Functions]
    Regulations 2002)




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Appendix 1: Presentation received from Badger Medical




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