Agenda item

CCG Review of Same Day Healthcare

The Committee will receive a verbal update from Katie Summers, NHS Berkshire West CCG on the review of same day healthcare and associated issues.


The Committee received a verbal update from Katie Summers, Berkshire West Vaccination Lead and Director of Place Partnerships, Andy Ciecierski, North & West Reading Locality Clinical Lead and Sanjay Desai, Interim Director of Primary Care, from NHS Berkshire West CCG, on the review of the Reading Walk in Centre, data and information on the vaccination status and GP appointments.

Andy Ciecierski informed the Committee that the Reading Walk in Centre had opened in August 2009 and was commissioned to provide 38,000 appointments per annum.  However, prior to COVID the figures visiting the centre had been lower than 38,000 and the future of the centre had been under consideration due to the lower capacity.  During COVID the Walk-in service had been suspended, following national guidance for a Triage First model of providing Primary Care.  During the continuing pandemic discussions and plans regarding changes to the centre had been put on hold.  It was noted that the surgery at the centre was now working as a normal doctor’s surgery with an increasing number of registered patients. This had risen steadily from 0 in January 2009, 8200 in January 2018, 9600 in January 2019, 10,300 in January 2020, 10,180 in January 2021 and 11,053 in January 2022.  It was noted that there had been an increase in list sizes across central practices in Reading due to increased residential housing and this was expected to further increase in the future.

The appropriate name of the centre was also being considered due to the central location of the practice. Due to organisational changes and pandemic pressures on staff time and workload a decision had been taken to extend the timeframe for making a final decision on the future need for walk-in services in Reading and then to complete the necessary procurement of the GP practice service.  The current APMS contract has therefore been extended to March 2023.  A public consultation would be required to consider the walk-in element of the centre and consideration would also need to be given to how primary care would be undertaken in the future.  This could continue to include triage phone calls, online consultations, chat systems and video conferences for patients as during the pandemic. Andy Ciecierski noted that some patients preferred phone consultations due to the convenience and lack of travel requirements. Further discussions would be undertaken regarding the walk-in centre and if this was needed going forward, in line with the future of primary care.


Katie Summers thanked the Council for their support with contacting members of the public during the Vaccination Canvassing exercise.  It was noted that 1,189 households had been visited during the exercise from 29 June 2021 to 9 July 2021. Following these, 263 patients had been identified as no longer at the address and had been cleansed from GP lists.  It was also noted that 53.1% of households did not respond or answer.


Possible reasons for the differences between GP and Office for National Statistics (ONS) populations were:


  • Over-counting in GP practice registers (e.g. ghost patients – students)
  • Under-counting in population estimates (e.g. associated with census completion/incorrect estimation of internal migration)
  • Different definitions of who counted as ‘resident’ in the country 


The CCG and the Council had identified notable differences especially for men who were in the age groups who were not invited for screening programmes e.g. Leighton Park university area of 25–29 year-olds, possibly ex-students who had moved on, and Kennet Island, 35-39 year-olds as a transient location with social housing. 


Following an internal review, the CCG had undertaken actions with GP practices.  These had been to check if their registers were more up to date than ONS data and how many patients had not wanted to take up the vaccine appointment.  It was reported that most GP practices were contacting people six to seven times and logged non responses which were then reported to the CCG.


A review of individual practices in Berkshire West with regard to list size had identified that data reported between August 2018 to August 2021 across Berkshire West showed an increase of 7% in registers. The CCG Primary Care Team had contacted all the practices identified in the report, as well as the practices where households were registered who had been visited by the canvassing team, to verify lists and to provide assurance that their list maintenance processes follow those defined within the GP contract and FP69 procedures. The outcome of this review had not yet been completed.  Many practices had reported that in addition to the regular list maintenance reviews there had been clean ups after the COVID vaccination invites had been sent out.


Regarding the list cleansing exercise for male patients aged 18-44, Berkshire West CCG would be undertaking immigrant checks as part of an extended programme of list maintenance, together with a list clean of four practices in Reading which had seen above average growth in male patients aged 18 – 44 registered. The CCG were redeploying CCG staff to Reading practices with high immigrant uptake, to support the registration and COVID vaccination record. 


The CCG were also investigating the possibility of commissioning GP practices to undertake audits and were engaging with Primary Care Support England (PCSE) to run a bespoke audit to support list cleaning. It was noted that the initial costs from PCSE were high and NHS England had been requested to support funding as the current costs were not feasible.


Regarding GP appointments, it was noted that currently the CCG held 45 contracts with GP practices.  Initially a GP ‘call-back’ was offered and a ten to fifteen-minute appointment phone call was provided as necessary.  It was suggested that for working patients this provided an improvement on having to take time off from work to visit a surgery.  Time slots could be accommodated to support patients and appointments offered when they were available. The triage model was currently under review until the guidance from NHS England on the future model was released.


In response to the presentation the following points were noted:


  • Issues regarding accessing same day appointments were because primary care services were stretched.  Staff had not been increased to support the work being required by GP practices.


  • A further report and input into the walk-in centre review were requested by the Committee.  If available, further information was requested to be brought to the next meeting for consideration and for the members to feedback and represent the views of the people of Reading.


  • It was suggested that, even though the figure of 38,000 walk in appointments had not been met, the 30,000 that did use the centre was a considerable demand for the service and needed serious consideration ahead of any permanent closure.


  • Concern was raised regarding the wording around immigrant checks and it was suggested that the terminology meant migrant and transient patients.  However, clarity of the terminology would be confirmed.


  • KPIs were not used by GPs to consider the effectiveness of phone triage for patients during the pandemic.  GPs were able to build a picture of patient health record using records and to evaluate the needs of the patient using that information. It was suggested that appointments did not have to be face-to-face.  However, it was recognised that this could be a challenge for some patients.


  • In the future there should be an element of choice with regard to face-to-face or virtual appointments.


  • Katie Summers suggested that Reading Advice Network be contacted to provide support for individuals with accessing the digital-first, hybrid model and becoming more digitally literate. It was suggested to link the Reading digital support programme with health services to support people in areas of need.


  • In response to problems with accessing appointments at 8am, it was noted that most practices were open from early in the morning to late in the evening.  Patients could call anytime during the day and should receive a call back urgently if required. It was understood that some practices had difficulty with the number of patients requiring an urgent on-the-day appointment and different practices ran different models.  It was suggested to survey practices to see the models used and discuss at patient participation groups to consider issues.


It was suggested that an additional meeting could take place ahead of the next formal meeting to discuss and scrutinise issues.


Resolved –


(1)         That a report regarding the review of the Reading Walk-in Centre be submitted to the next meeting, for the Committee to be consulted on the future of the centre;

(2)     That information clarifying the definition of the word immigrant be circulated to the Committee;

(3)     That an additional informal meeting be arranged to consider issues regarding the Walk-in Centre and GP appointments.