Discussion with officers from Havering Clinical Commissioning Group and the service provider on issues concerning the Harold Wood walk-in clinic.
Minutes:
The CCG Chief Operating Officer explained that the contract for the walk-in centre (formerly polyclinic) covered the walk-in service, wound care and phlebotomy. The contract had started with the former Havering Primary Care Trust but some parts of the contract including for the walk-in centre were now with the CCG. The primary care part of the contract was held by NHS England. Responsibility for the contract could not be changed until the contract expired in December 2015.
Wound care such as stitches removal could be provided at the walk-in centre or at some GP surgeries. Officers accepted that this was confusing for people and so wished to develop a cluster model to ensure treatment closer to people’s homes.
The clinic was open 8 am to 8 pm seven days a week and 52% of Havering patients attended during the morning. Officers explained that patients presenting in the evening would be redirected if it was felt that they could not complete their treatment by 8 pm. Of 2,620 patients seen at the walk-in clinic after 6 pm in the last two weeks, only 90 had been redirected elsewhere. A decision to redirect would always be made a clinical member of a staff.
It was confirmed that there was a doctor on duty for walk-in patients throughout the centre’s opening hours i.e. from 8 am to 8 pm. Most patients presenting with injuries would however be seen by a Nurse Practitioner while those presenting with illnesses would be seen by a GP. This was because Nurse Practitioners were A&E trained although an A&E GP also worked at the walk-in clinic for five sessions a week. The Nurse Practitioners at the walk-in clinic were A&E-trained and were able to prescribe.
There was a defined waiting area for the GP practice and the rest of the waiting was allocated to the walk-in centre. If patients needed a referral for tests etc they would, after being examined, be referred back to their own GP for this. Patients presenting in a serious condition would be stabilised as far as possible (an IV drip could be inserted if needed) and then referred to A&E if necessary. There were agreed pathways between the walk-in clinic and Queen’s Hospital A&E. It was accepted that the Harold Wood centre saw more patients needing to go to A&E than other walk-in clinics elsewhere.
Officers accepted that reported cases of walk-in centre staff refusing to remove stitches should not have taken place. It was thought this may be related to difficulties in people obtaining GP appointments. This service was available at the clinic and such reports could be followed up. The CCG would also look at the clarity of information re stitches removal that was given to patients at Queen’s Hospital. Post-op clinics (booked by appointment) were run at the walk-in clinic by nurses.
A representative of the Patient Participation Group fort the walk-in centre felt that the centre offered a very good service. Officers confirmed that the waiting time at the walk-in clinic was normally two hours and at 6.30 pm that evening there had been 22 patients waiting to be seen. Children or people presenting with urgent conditions would always be seen even if they arrived a few minutes before the closing time. The CCG was also looking at extending urgent care generally in Havering next year with for example some GPs opening later at night. It was also noted the Patient Participation Group would shortly allow patients to submit comments on the walk-in centre via e-mail.
Officers agreed to implement a suggestion that the name of the doctor and nurse on duty be put on a display board at the walk-in centre entrance. The CCG Chief Operating Officer would bring to a future meeting of the Committee the outcome of work on why patients presented at the centre as more ill compared to other similar walk-in centres. It was accepted that there were issues around access to GPs and this had led to a bid for funding from the Challenge Fund. Members felt that services should be made more widely known to the public. The ‘Don’t Go To A&E’ campaign had been effective but this had led to an increase in people attending the walk-in clinic.
The Committee NOTED the update and AGREED to arrange a visit to the walk-in centre.