A Threat to Urgent Care Services in the Borough of Croydon
A Publication by the Residents’ Associations in the South of the Borough
22 October 2015
Introduction and Background
For the past 18 months, representatives from the Residents Associations (RAs) of Hartley & District, Old Coulsdon, Coulsdon West, East Coulsdon, Kenley & District, Purley & Woodcote, Sanderstead and Riddlesdown have been in discussions with the Croydon Clinical Commissioning Group (CCG) regarding the provision of urgent care facilities within the Borough of Croydon and in particular regarding Purley Hospital. The RAs have had several meetings with the CCG, involved Croydon HealthWatch, local MP Chris Philp and have also written to Jeremy Hunt, MP; the Secretary of State for Health. However, following a reprocurement report issued by Croydon CCG on 1 September 2015, the RAs have now on 20 October 2015 written to all 16 Croydon CCG Governing Board members expressing grave concerns about this report; a summary of which is below.
Croydon CCG Decision in January 2016
In January 2016, the 16 members of the Croydon CCG Governing Body will be asked to make a decision on the future of urgent care provision in Croydon. This is a once in a generation opportunity to provide a comprehensive and effective urgent care system for Croydon. The Governing Body will be asked to make this decision on the basis of a CCCG reprocurement report dated 1 September 2015. This report gives 8 scenarios, which appear to polarise the decision between Walk-in Urgent Care provided at GP practices, or at Minor Injuries Units. The RAs believe there is another option, which is a combination of extended GP practices and a walk-in Urgent Care Centre at Purley Hospital. The Scenario 6a proposed by the RAs is supported by Chris Philp MP, GLA Member and Ward Councillor, Steve O’Connell and Ward Councillors; Tim Pollard, Lynne Hale, Badsha Quadir, Donald Speakman, Simon Brew, Chris Wright, James Thompson, Margaret Bird, Luke Clancy, Jeet Bains, Mario Creature, Steve Hollands, and Jan Buttinger.
Proposed Closures and Questions
The RAs were surprised at the lack of publicity regarding the Reprocurement Strategy Document released by the Croydon CCG on 1 September 2015. The potential implementation of the various scenarios in this document will fundamentally change the shape of urgent care services in Croydon and therefore the RAs feel that the various options under consideration deserve detailed scrutiny and a wider public debate.
The RAs have a number of questions regarding all of the scenarios being proposed. However, it is clear that only scenarios 5 and 6 are being given serious consideration by the executive of the CCG. Scenarios 5 & 6 will result in the closure of the existing Minor Injuries Units at Purley and at Parkway, New Addington and the Walk-In Centre at Edridge Road, Croydon. Croydon would then rely entirely on Croydon University Hospital and on extended GP services for the provision of urgent care services for the Borough’s 380,000 population.
Given that this is a fundamental change in service provision, the RAs are concerned that the Reprocurement Strategy document lacks sufficient detail on these scenarios, in particular:
· How many patients will each extended GP practice be able to treat per year, or per day?
· What will be the staffing requirements for walk-in services at an extended GP practice?
· Will the additional staff be exclusively for walk-in services, or will they supplement the staffing for the GP practice?
· Where will these extended GP practices be located?
· Who will oversee walk-in services at extended GPs, and will there be waiting time and quality of care, targets and monitoring?
· How will the services at these extended GP practices be advertised to the public, and who will pay for this publicity?
· How does the proposed budget of £340,000 per annum for 3 extended GP practices provide sufficient funds for these services? Appendix 3 to same document estimates that 6 extended GP practices would cost £1.7 million per annum; how do these figures reconcile?
The RAs believe that it would be irresponsible of the Governing body to approve either of these scenarios without having satisfactory answers to these questions.
· The lack of publicity regarding the various scenarios being considered is worrying.
· There has been no publication of the results of the consultation activities.
· The public forum held on 23 September 2015 was an ideal opportunity to discuss in detail the options being considered; but this was not done.
· There has been no indication as to how the consultation process has shaped the options under consideration.
· What are the plans for further engagement with the local community and stakeholders?
· It was clear in the meeting with the CCG executive team on 18 March 2015 that the favoured scenario would be based on GP practices. This was before the consultation was undertaken.
The RAs are not opposed in principle to incorporating extended GP practices into an urgent care system for the Borough; with the proviso that satisfactory answers are forthcoming to the questions listed above. However, the RAs believe that a Borough the size of Croydon needs more than extended GPs and the Croydon University Hospital urgent care facility, if the system is to meet the demands of the 380,000 population. The RAs have researched and detailed an alternative scenario. This scenario combines elements of Scenarios 4 and 6 to create a more comprehensive solution, and within budget. The RAs are referring to this as Scenario 6A.
The RAs Proposed Scenario 6A
On analysis of the 8 model scenarios presented in the reprocurement strategy document, and their associated costings, the RAs have proposed an additional scenario, which is a combination of scenarios 4 and 6; i.e. combining extended GP practices with an Urgent Care Centre at Purley. This is referred to as Scenario 6A:
· One 24/7 urgent care centre (UCC) based at the front of A&E fitting the national specification as part of the national review.
· One GP out Of Hours service co-located with UCC fitting the national specification as part of the national review.
· One further 12hour/7day UCC at Purley, fitting the national specification as part of the national review.
· 3 GP extended 8am-8pm, 7 day centres with enhanced minor injuries capacity. 3 GP centres will cover Croydon borough. GPs in Croydon will be obliged under the new contract to provide a level of GP cover to the centres supported by investment to support the minor injury cover.
In accordance with NHS common practice, the Purley UCC would treat adults and children of all ages presenting with:
· sprains and strains
· broken bones
· wound infections
· minor burns and scalds
· minor head injuries
· insect and animal bites
· minor eye injuries
· injuries to the back, shoulder and chest
The unit should be staffed by specialist trauma nurse(s) and a GP.
Benefits of Scenario 6A
This scenario would allow for the provision of 3 extended GP practices, 8am -8pm, 7 day centres, with enhanced minor injuries capacity to provide wider coverage in the Croydon borough area, as detailed in scenario 6 of the strategy document.
The combination of scenarios 4 and 6 has significant advantages:
· Provision of local urgent care services to meet the needs of the 105,770 residents in Purley and surrounding wards – Waddon, Croham, Sanderstead, Kenley, Coulsdon East & Coulsdon West.
· Provision to meet the estimated 4% - 5% population growth in Purley and surrounding wards over the next 5 years.
· A significant increase in urgent care capacity within the Croydon Borough to:
1. provide greater resilience in the system to meet seasonal demand variations and unforeseen circumstances, and,
2. relieve ongoing pressure at CUH Urgent Care Centre.
· A more geographically dispersed range of urgent care and minor injuries treatment options within the borough.
· Significant estimated cost savings of £550,999 per annum, representing a reduction of 8.1% on current budgeted expenditure.
Why Purley Hospital?
Purley Hospital was redeveloped with £11m of public money in 2012/13 to provide improved outpatient facilities and an Urgent Care Centre for the local population. The redevelopment was conceived with the intention of providing a walk-in urgent care facility, and hence the site is already suitable:
· There is already an x-ray facility on site.
· There is the space available to house the facility.
· Purley Hospital is well served by public transport, with several bus routes and a train station nearby.
· Purley Hospital is easily accessed by road, with a car park on site and an additional pay-and-display facility within 100 metres.
· It has the facility to receive ambulances.
Purley Hospital is in the district centre of Purley with a local population of approximately 105,770 residents in the surrounding wards. It would address the difficulties faced by residents in the south of the borough in attending Croydon University Hospital, either by public transport or by car. It would provide the urgent care services needed in the south of the borough, which is otherwise devoid of urgent care facilities.
Locations of current urgent care facilities in and around Croydon. Taken from NHS Choices:
Residents in the South of Croydon Borough have an older age profile than Croydon as a whole, and many rely on public transport for accessing local services. Attending Croydon University Hospital (CUH) by public transport is impractical for many, and in some areas requires the use of 3 different buses. An Urgent Care Centre at Purley would provide accessible local facilities to address this problem.
Is There Demand to Support An Urgent Care Centre at Purley?
Firstly it should be noted that currently 50,000 patients per year access Purley MIU, Parkway MIU and Edridge Rd Walk-in centre. The scenario of just 3 extended GP practices would not be able to cope with this number of displaced patients.
After Purley Hospital was redeveloped in 2012/13, there was a failure to sufficiently publicise the new Urgent Care Centre, even to the extent that it took significant pressure from the RAs just to get a sign erected in the hospital grounds. Feedback from residents suggests that up to 80% of the local population were unaware of the walk–in urgent care facilities at the unit. Despite this lack of publicity, attendance numbers were increasing, and rose by 56% in the year preceding the downgrading of the unit in May 2014.
The 105,770 local population in Purley and surrounding Croydon Borough Wards is estimated to increase by 4% - 5% over the next 5 years. Towns/Cities with a similar size population to Purley and surrounding wards include Bath, Gillingham, Maidstone, Lincoln. All of these towns have stand-alone Accident and Emergency Centres.
Current data shows that for the year 2014/15; 2,224 residents from Purley and surrounding Wards attended urgent care facilities outside Croydon Borough, in East Surrey, (Redhill, Caterham and Epsom), primarily because it is easier to get to than CUH. This is costly in re-charges for the Croydon CCG and reduces utilisation efficiency of the Croydon urgent care estate. Many of these patients would use Purley Hospital if an Urgent Care Centre was provided. For the year 2014/15, 6,008 residents from Purley and surrounding wards attended CUH Urgent Care Centre. This does not included attendees to CUH Accident & Emergency dept.
The above attendances are additional to the existing 8,000 p.a. attendances at Purley MIU. Combining these attendances gives a potential demand for urgent care services in Purley of approximately 16,200 attendances per annum.
Additionally, Purley would be the centre of choice for many of the 36,000 patients who currently attend Edridge Road Walk-In Centre. This is likely to create an additional demand of approximately 8,000 attendances per year. These figures are entirely consistent with the 105,770 population in Purley and surrounding wards which represents over a quarter of the Croydon Borough population, of 380,000. It should be obvious to see that a population of this size needs local and comprehensive urgent care facilities. Therefore, a properly publicised and equipped Urgent Care Centre at Purley could have about 24,000 attendances per year which would make it sufficiently utilised to be viable and cost-effective.
The RAs believe there would be significant cost savings achieved by adopting this scenario.
The Borough Wide Perspective
Croydon University Hospital Urgent Care Centre has consistently failed to meet its targets in terms of standards of care and waiting times. The unit is under significant pressure which will only increase as the Croydon population grows. The redevelopment of Croydon A&E is to be welcomed, but this will also increase pressure on the site during the redevelopment process.
Under scenarios 5 and 6, Croydon University Hospital would stand alone as the only urgent care centre for the whole of the 380,000 population of Croydon Borough. The additional extended GP practices would have limited capacity and limited capability.
The provision of an Urgent Care Centre at Purley has a number of benefits for the Borough:
· A significant increase in borough wide urgent care capacity, to meet existing and future demand.
· Greater resilience within the Croydon System Resilience Group to meet seasonal fluctuations and unforeseen circumstances.
· Relieving pressure on Croydon University Hospital helping CUH achieve its targets and improve standards of care.
· For non Type 1 injuries, ambulances could be redirected to Purley thus reducing ambulance transit times and relieving pressure on the London Ambulance Service.
Within the NHS Five Year Plan, services should be provided close to local populations; and as much as possible, be drawn away from acute hospitals. This is an approach already adopted by many other CCGs. Scenario 6A provides an opportunity to relieve pressure on Croydon University Hospital and to provide services close to the local population in the south of the borough.