Agenda item

The Committee reviewed the System Winter Plan at its September meeting so this is an opportunity to hear from system leads about what worked well and what lessons have been learnt to help inform the Winter Plan for this year.

Contributors:

Ms Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire Healthcare NHS Trust

Dr George Gavriel, Chair, Bucks GP Leadership Group

Mr Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust

Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing

Mr Craig Mcardle, Corporate Director, Adults & Health

Ms Sara Turnbull, Service Director, Adult Social Care (Operations)

Mr Mayank Patel, Chief Officer, Bucks Local Pharmaceutical Committee

The Chairman welcomed Dr George Gavriel, Chair, Bucks GP Leadership Group; Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust; Craig McArdle, Corporate Director, Adults & Health; Sara Turnbull, Service Director, Adult Social Care (Operations); Mayank Patel, Chief Officer, Bucks Local Pharmaceutical Committee, and Philippa Baker, Place Director, to the meeting.

During their presentation, the following key points were made:

·       As anticipated, the winter had been challenging, particularly due to additional pressures from industrial action. During the winter period, several initiatives were implemented to manage the high demand. Some schemes received national funding, such as the same-day emergency care approach. This allowed direct referrals from GP practices for certain conditions, bypassing the need for lengthy waits in the emergency department. HomeLink Healthcare services were piloted to facilitate the transition from hospital to home.

·       Bed capacity had been increased by 30 beds in the Olympic Lodge to help meet the increase in demand.  

·       A clinical assessment service had also been established, handling over 500 calls per week to alleviate pressures on primary care.

·       Efforts were made to keep patients at home to minimise hospital admissions whenever possible. Additional community beds were also set up in Amersham and Buckingham Community Hospital for step-down care.

·       50 virtual ward beds were established to help patients remain in their homes while receiving the necessary care. Numbers of patients who were medically optimised for discharge (patients that could be discharged but required ongoing medical optimisation) remained high both locally and nationally.

·       A 111 initiative had been established to direct patients to hubs instead of GPs. Patients were referred to appropriate pathways, such as urgent treatment centres or pharmacy out-of-hours services.  This initiative significantly reduced the pressure on GPs, with 70% of all 111 referrals being handled outside of GP practices.

The following points were noted during the Committee’s discussion:

·       Concerns were raised about the difficulty of getting timely GP appointments and how staffing was managed for ‘GPs at the front door’, while also supporting A&E and other units. It was acknowledged that using GPs in these positions could take away from primary care practices. To address this, shared roles between practices and services, as well as time-restricted positions for newly qualified GPs, were suggested to attract and retain more GPs in Buckinghamshire.

·       The importance of providing same-day urgent care in central locations like Wycombe and Aylesbury was emphasised to relieve pressure on GP practices, allowing them to focus on managing complex patients.

·       Members heard that Olympic Lodge was funded through external monies the previous year and the decision was made to keep it open until the 22^nd May.  It would reopen on the 1^st  October. The model used at Olympic Lodge had been independently evaluated and shown better outcomes for patients. The plan was to work with a small number of care homes to create a similar model in the community, aiming to establish a broader intermediate care offer in the system.

·       In terms of community beds, there were currently 56 beds split across different hospitals in Buckinghamshire. The aim was to retain these additional community beds.

·       A Member expressed concerns about the transfer of patients between in North Buckinghamshire and Milton Keynes Hospital. A similar issue was also identified in the South with Frimley Park Hospital. Efforts were made to improve communication and information sharing between primary care providers and hospital clinical leadership in both areas. Progress had been made in terms of accessing records, but better communication was still needed when transferring patients.  Milton Keynes Hospital was actively working to identify cross-border patients and make referrals to Buckinghamshire's community teams before discharge.

·       The Urgent Treatment Centre (UTC) at High Wycombe was still operational, serving approximately 100 patients per day. The distribution of patients attending A&E and UTCs was relatively even, with variations based on ambulance transport and proximity to different hospitals. Further data on this issue could be provided on request.

·       An urgent care improvement plan had been developed based on the winter plan to address the long waiting times and pressure on emergency departments, focusing on four key elements: attendance avoidance through clinical assessment and community pharmacies, expanding UTC hours at Stoke Mandeville Hospital, implementing an overnight unit and extending the consultant workforce.

·       A pilot programme involving multi-agency triage for discharged patients had been successful, prioritising safe and appropriate home discharges and reducing the number of people entering care homes.

·       Pharmacies were continuing to experience challenges. A Member commented that Independent pharmacies tended to provide a better service due to their flexibility in operations. During the winter months, there was a significant increase in demand for community pharmacy services, which was alleviated through individual pharmacies’ support. The Chairman suggested that the issues of pharmacies, particularly around communication, should be further explored outside the meeting.

·       A Member highlighted the importance of engaging with the public to help them understand the priorities. Mr Bhasin emphasised the need for a consistent approach across all partners, as the complexity and range of services made navigating them more difficult. The Council’s community boards could serve as a way of disseminating this information.

·       Virtual wards were currently utilised at a range of between 60 and 80 per cent, depending on factors such as turnaround time and staff leave. The goal was to double the number of virtual wards for the next winter, particularly supporting frailty, palliative care and respiratory cases.

·       The Home Independence Team, which was funded by the Council, had made positive progress in supporting a greater number of people during the winter. Although the team was now fully staffed, recruiting qualified social workers was still a significant challenge. However, a successful recruitment campaign had led to an expansion in the number of individuals being supported by the team, aligning with their desired direction for future growth.

·       A lack of funding had been a significant issue in delivering the winter plan. However, capital bids had been submitted for an additional ward, and recruitment efforts had doubled the consultant workforce. Collaborative work with system partners was needed to improve pathways and resource utilisation.

·       It was crucial to have the right services within the community to alleviate pressures on acute hospitals during the winter. This medium-term transformation effort required ongoing collaboration from all partners.

The Chairman thanked the presenters for their attendance and participation.