Dave Smithson

I was recently contacted anonymously by a local resident who was concerned that the new medical facilities under construction in Halewood (Ravencourt) would not provide the same level of service or capacity to treat patients as the current GP practices do.

I have been assured that this is not the case and the following briefing has been provided to all councillors as a result of similar concerns being raised across Knowsley, I hope local residents find this useful.

Equitable Access to Primary Medical Care
Under the current NHS review, conducted by Health Minister Professor Lord Ara Darzi, each PCT area in England is required to commission a GP led health centre.

In Knowsley, we are not only doing this but also commissioning three brand new GP practices to provide out-of-hours (evening and weekend) health services and serve some of our most vulnerable patients during the day.

We wish to emphasise that contrary to some media coverage nationally, there is no question whatsoever of existing GP practices closing. This provision represents new capacity for Knowsley which is very much needed and is in addition to the successful recruitment of 20 new GPs to the borough in recent months. This is in direct response to extensive public engagement undertaken with local people, indicating a high degree of support.

What is Equitable Access to Primary Medical Care?

As part of the ongoing national NHS Review led by the Health Minister Professor Lord Ara Darzi, Knowsley Primary Care Trust is required to establish three new General Practices and a GP-led health centre to be commissioned by December 08.

This programme is commissioned by Knowsley PCT and supported by NHS North West (the regional Strategic Health Authority).

The practices will be commissioned through a tender process.

What is the aim of the programme?

The programme has been set up nationally to enable local NHS Primary Care Trusts that don’t have as many doctors as they need to attract new service providers to fill gaps in primary medical care provision within their area.

This can be through creating additional general practice capacity, increasing both GP provision and also other primary medical care clinical staff.

In Knowsley, the aim of the programme is to make sure that all Knowsley residents and patients have ‘equitable access’ to GP services.

What we mean by this is that everyone in Knowsley should get the primary medical care services that they need, regardless of their level of need and any other factors that affect their needs or their ability to use our NHS and related care and support services.

To do that, we need to understand and respond to the needs of local people who, for a variety of reasons, are not able to benefit from our traditional primary care services so that we take account of their particular needs in the way we provide services.

These reasons might simply be because they work shifts, so that they can’t get to the GP practice during normal hours.

Or it might be because they have family commitments that make it very difficult to get to existing services.

Or it might be because they are vulnerable and excluded because they have particular needs: for example, problems with alcohol misuse or with mental ill-health that make attending mainstream services difficult and require specialist understanding and support when they do use a service.

Why do we need this in Knowsley?

In Knowsley, there are currently 29 GP practices with almost 160,000 registered patients.

Within the last 18 months 20 new GPs have been recruited to work in these practices.

These GPs have increased capacity and capability of existing practices for their general patients. Our aim is to now focus upon meeting the needs of vulnerable and excluded groups, alongside providing additional access and capacity for all residents – promoting ‘equitable access’ to these services for all.

Whilst all Knowsley patients do already have the benefit of an out-of-hours medical service, which is commissioned by Knowsley Primary Care Trust from a local social enterprise called Urgent Care 24, this service is there to provide urgent medical help to local people who become ill unexpectedly through the night or at weekends and bank holidays when most other NHS services aren’t available. This service cannot, and should not try to, provide an ongoing service to vulnerable patients. Our new practices, however, will be able to cater for their regular health care needs and can also provide specialist support to those more vulnerable members of the community. They will also integrate with other Knowsley services, as is usual in our Knowsley way of working.

Significant engagement has taken place with local people over the last 18 months that helps us understand the needs of local people. We know we have many patients who are excluded from our mainstream services in Knowsley and we need to commission services to meet their needs. Local people with whom we have engaged are always supportive of this approach.

What services will the new practices provide?

The new practices will provide a mix of mainstream primary medical care services, plus a range of specialist services to meet the needs of particular vulnerable groups of patients.

The times the practices are available will overlap with current mainstream primary medical care services already provided at local GP practices.

The practices, which will be available from 8am until 10pm, with the last appointment being at 9.30pm, will assist vulnerable patients during daytime hours and will provide general primary medical care services in the evening.

This overlap with existing hours allows the new practices to undertake work with specific vulnerable sections of the population or those whose particular circumstances prevent them from gaining the best care from existing primary care.

Commissioning these new primary medical care practices to provide specific extended hours services for Knowsley patients will allow patients to book consultations through their existing practices, ensuring that from day one the new practices are providing the best possible service and are running at maximum efficiency and capacity.

The three practices will work alongside existing services to deliver a multi-faceted service, including a particular focus on effective referral through relevant health, social care, employment and housing services for the resident and registered populations of Knowsley who are at present vulnerable or at risk from experiencing social exclusion, or might do so at some point in the future.

The additional GP-led health centre will provide planned care as well as some urgent care.

What benefits will this bring to the patient?

The new practices will ensure that Knowsley patients have a choice to receive services either from a traditional GP practice where continuity and relationship are most important, or to use one of the new practices where opening times, convenience or the need for a particular specialist service are paramount.

Patients treated at the new practices will have the option to register with the site or remain with their current GP, since the new practices will be able, with the patient’s permission, to access the patient’s record.

The new practices will also be able to provide ‘in reach’ services to Nursing/Residential/Hostel/ based groups in order to provide preventative health services. It is also expected that the new practices will undertake preventative and risk detecting work within surgery consultations.

Where will these new services be based?

In order to implement this scheme it has been necessary to take into account the particular geography of Knowsley and equitable access for the whole population across the borough. Hence, it is planned to have two of the GP practices on a single site, one in Huyton and one in Kirkby, with the third on a split site in Whiston and Halewood. The GP-led provision will operate initially from existing premises within Kirkby on a temporary basis before a new GP-led health centre is developed.

Engagement with local people

We already have much information about the numbers of patients who need specialist support, as well as information about how some patients would like to be able to use GP and primary medical care services at times at which they are not currently available.

We have information from national and local engagement under a programme called ‘Fairness in Primary Care’ which happened in 2007 and led to our recruitment of the 20 new GPs.

We also have information from many sources locally about the needs of vulnerable groups.

In addition to this information, active engagement has taken place over recent weeks with vulnerable groups, including:

A Offenders on probation
B Drug and alcohol substance misusers
C People experiencing domestic violence in self-help or in supported residential accommodation
D Homeless men living in hostel accommodation
E People living in residential and nursing homes
F People on Drug Rehabilitation Requirement Orders

These views have been brought together with the other sources of information reports to help guide the development of the tender specification for our new practices and the services they will provide for local people.