The Future of Exeter's Walk-In Centres

I recently took up an invitation from North, East & West Devon Clinical Commissioning Group (NEW Devon CCG) to attend a “Have Your Say” community engagement event to help them look at the way they/we use out 2 Walk-In Centres (WIC) in Exeter – one attached to the Accident & Emergency Department at RD&E, the other on Sidwell Street in the city centre.

They wanted to know about how to make sure that we have the right level of service, in the right place, at the right time. And probably at the right price (but we’ll come to that later).

Ben Bradshw MP has pledged his support for Exeter WICs, saying that they are very effective and showing an annual rise of 7% in patients. He is worried that all this great work is being put in danger because "GPs have never liked Walk-In Centres and want to close them down."

This is the situation elsewhere in the country and on BBC Radio Devon is quoted as saying:

“I hope NEW Devon CCG don’t make the same mistake as elsewhere and close Exeter’s Walk-In Centres"

This claim has been refuted by Dr David Jenner [Chair, Eastern Locality, NEW Devon CCG) on BBC Radio Devon  when he said

“Exeter GPs are grateful for Exeter’s Walk-In Centres as they deal with the city’s large working population”

Similar views were confirmed by Dr Rob Turner (Co-Chair, Eastern Locality Management Group, NEW Devon CCG)  at the meeting

Some useful facts and figures
RD&E Hospital – 01392 406304
Next to A&E, RD&E Hospital, Wonford, Exeter, EX2 5DW
Opening Hours; 07.00-22.00 each day.
Early to late 7 days a week, with peak after 17:00
See 28,000 patients a year at cost of £1.1m
Triaged via A&E Staffed by nurses with support from doctors on some shifts

City Centre – 01392 276892
31 Sidwell Street, Exeter, EX4 6NN
Opening Hours; Mon – Fri 07.30-18.00; Sat 08.30-18.00; Sun 10.00-16.00
Reflect working hours , with peak around noon
See 21,000 patients at cost of £800k
Staffed by nurses, some of whom are qualified to prescribe some drugs and medicines

Needs for the future?
RD&E A&E department is one of the very few that are currently meeting target waiting times of no more than 4 hours but the situation is fragile and thought to be “not sustainable without change.”

Who uses WIC and why?
I am very surprised that there is no data on this. Are the two Exeter WIC different? Hard to make good judgments on future if it is not known why patients make very specific choices over WIC. The meeting suggested four reasons:

1. Work in Exeter but live elsewhere, so unable to make appointment with their own GP to fit in with working life
2. Medical need arises during the day and too late for an appointment
3. Difficulties in making appointments with their own GP at suitable time
4. Infrequent relationship with GP

So far, so good, but something was troubling me. Why this consultation? And why now?

So why now?
Many WICs around the country have been closed, despite being extremely popular, because the demand was exceeding expectations and thus creating an unexpended financial burden.

The day following the event last week, Monitor concluded their own public consultation on the future of WICs.

Monitor considered that it was in the interests of patients to undertake a review into changes to arrangements relating to services provided by WIC in order to understand the impact of these changes on choice and competition.
Monitor hopes that the review will help the commissions - NHS England and CCGs - decide if they should be maintained, as NHS England has to decide whether to renew the deals, while local CCGs have to determine whether out-of-hours and non-registerd patient provision will continue.

And at the same time NHS England is running a review of Urgent and Emergency Services, and the public consultation phase runs until 11 August.

So why aren't NEW Devon CCG waiting until the results of these two important reviews published?

I'm guessing that it's tied up with some of the discussions to be held in the forthcoming Exeter Health Summits - that WIC provision is part of the re-commissioning process of services currently provided by North Devon NHS Trust  that has to go out to tender in December.

And why?
Budgetary pressures, no doubt?

But NEW Devon CCG didn't tell us how much they needed to save.

The cynic in me thinks that the RD&E WIC is "under consideration" because, if the CCG can save money by scaling back/closing the WIC, those patients that present will HAVE to be attended to by A&E - funded by NHS England. And that decision can be disguised by the fact that RD&E want to expand A&E.

I'm sorry to be so negative and pessimistic about the future of at least one of Exeter's two WICs.

I hope that NEW can do something to restore my optimism.

The next stage of consultation comes with the re-commissioning of Exeter’s community healthcare services, which includes Exeter’s WICs.

Exeter’s Health Summits will cover this on:
Wednesday 3 July 2013, 

Thursday 18 July 2013, 

Both meetings will be held at St Lukes College, Harts Lane, Exeter EX1 3RD

Due to the size of the venue there will be limited places and allocated on a first come basis
To reserve a place, contact: Helen Cox

More information on the Exeter Health Summits

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