At times, the NHS seems almost hell-bent on breaking things that work. The introduction of the 111 out of hours call service more than two years ago was chaotic. Shropdoc had to step back in to rescue the service in our county. Only today, the press is reporting that out-of-hours services in Norfolk and Wisbech are in chaos and risk patient safety. In contrast, Shropdoc is consistently rated as being among the 25% best out of hours providers in the UK.
Despite having one of the best services going, our local Clinical Commissioning Groups have decided to put the Shropdoc contract out to tender . Tracey Huffer, Shropshire Councillor for Ludlow East, gives her reaction:
“This could be a disaster in the making. Shropdoc is run by local GPs who have an intimate knowledge of the area. They know its geography and patients. They know how awkward it can be for people to access medical facilities at the Royal Shrewsbury Hospital. They know it is very difficult to get to the Princess Royal at Telford from places like Ludlow. That is why Shropdoc runs a first class service that is among the best in the country.
The feedback I receive about Shropdoc from patients when working as a nurse is really positive. I can’t see why we need to replace something that is working so well. And remember, when the NHS last tried to replace Shropdoc with 111 in May 2013, the whole project had to be abandoned at the very last minute because the 111 providers could not cope.
The Clinical Commissioning Groups should abandon this plan immediately. They should concentrate their efforts on getting Future Fit right and stop interfering with the parts of the system that work really well in this county.”
The details of what is happening to Shropdoc are explained in a letter from its chairman Dr Russell Muirhead. I reproduce the letter in full below. It also gives details of how to object.
The deadline for comments is 22 January.
ALERT – potential loss of Shropdoc as the local OOH provider
You may or may not be aware but Shropshire County and Telford & Wrekin CCG’s are asking for comments from clinicians (as well as the public and other stakeholders) about their plans to re-commission the 111 service and to tender Shropdoc at the same time. A letter to this effect was sent to all practices on the 5th January which hopefully you will have seen.
Whilst the 111 service is a nationally mandated service which should make access for patients easier and simpler, an aspiration which Shropdoc supports, what happens beyond that initial call is critical to the service that a patient in your practice might receive. The CCG can mandate all calls to be triaged by 111 and have the patients sent straight to 999, A&E or an appointment; or the CCG can mandate calls which require clinical input to be sent to Shropdoc, where over 60% speak to a clinician and have their consultation completed over the phone.
Shropdoc has provided OOH’s services on this patch for the last 20 years, as well as many other services including the Care Coordination service, physiotherapy triage and dedicated helplines for oncology and LTC patients. The organisation is highly regarded by patients and is recognised nationally for its quality.
One key element has been the continuing support of local GP’s and nurses; we have not suffered as severely as some other providers around the country with regard to recruitment and retention, in no small part because our organisation is run by you for the benefit of your patients.
A well run 111 and OOH’s service is key to reducing inappropriate demand on day time general practice. There is a very real risk that any new provider would not enjoy the support which Shropdoc does and any resultant reduction in service provision and quality could have a significant deleterious effect on patient care and General Practice workload in the daytime period.
We would therefore urge you to respond to the CCGs request for comments and experiences of the current services – firstname.lastname@example.org or email@example.com and complete the online survey http://tinyurl.com/111-outofhours-engage-survey . The closing date is 22nd January 2016.
Shropdoc is registered, and therefore licensed to provide services, by the Care Quality Commission (Provider ID:1-199795171). For more information, visit www.cqc.org.uk
You may wish to consider the following points when formulating your response:
- Shropdoc is a GP Co-operative which retains the commitment to OOH’s from a large number of local GP’s.
- Shropdoc and primary care works well together in an integrated fashion – clinical handover, margins, flagging, CCC, PLT cover, daytime triage etc.
- Shropdoc can integrate with the 111 service without being subjected to a tender process.
- Tendering will cost a significant amount of money to both the CCG and to Shropdoc and will delay change on the ground by 12 months.
- NHS pathways are risk averse; A&E and 999 referral rates will increase and hospital admission rates are very likely to increase.
- Loss of local GP commitment – in other areas where the local GP provider has lost the contract the majority of local GP’s leave the service.
- The sustained input from high quality locally based GP’s in the triage /telephone consultation will be lost.
- There is no national must do that says the Shropdoc number must be shut down.
- A priority must be the integration of daytime and OOH’s urgent care including MIUS, WIC’s, UCC’s and OOH’s locally which cannot be done easily once OOH services have been tendered separately.
- Shropdoc currently sends 2% of its triaged calls to 999, 111 sends between 11 and 13%.
Shropdoc is your organisation, working for you. The CCG is an organisation clinically led by you, GP’s have the ability to decide what should be done. Please make your views known to both the CCG and the GP board members.
Dr Russell Muirhead