Over the past two years there have been ongoing conversations with staff, partners and the wider community about how we can develop and improve the health care provision at Penrith Urgent Treatment Centre.
Overnight, demand for the walk in service is extremely low, and there is a need to expand the services available during the day to ensure it benefits more patients in Penrith and the surrounding area.
Working with partners and community representatives a proposal has been developed to change the way healthcare treatment is accessed overnight in Penrith. The walk in service would remain in place until 8pm after which there would be an appointment system accessed through 111 (delivered by Cumbria Health On Call).
- allow us to redeploy staff to expand services available during the day, when demand is outstripping capacity for IV antibiotics for example.
- Enable an expansion of x-ray provision to reduce the need to transfer patients to CIC or WCH
- Increase the opportunities to divert patients to Penrith UTC as an alternative.
- Ensure that clinical decision makers are available in the unit at all times which will minimise waiting times and maximise safety.
- Ensure that the intermittent overnight changes that occur due to staffing challenges are eliminated and a permanent arrangement for accessing services is in place.
We want to understand what people feel about these proposals and to develop them further using feedback.
To do this we’re asking the local community in particular to complete a short survey; the responses will be used to inform and develop the plans.
The survey will be open for four weeks from the week beginning 12th July until the week of the 9th August.
The Penrith UTC is a Type 3 Urgent Treatment Centre delivered from the Penrith Hospital site. It is one of the components of the North Cumbria Urgent Care services available to patients.
Urgent Care services are essential services for the management of urgent health care needs and can be accessed by the public directly. The UTC in Penrith fulfills the criteria for a Type 3 unit managing both injury and illness.
The unit is the base for the CHOC Out Of Hours (OOH) GP service during their hours of operation and the CHOC clinicians form part of the Clinical Decision Making team in the OOH period.
The UTC is open 24 hours per day and 7 days per week.
The service is GP and Nurse Practitioner led with a dedicated team of nurses to provide treatments to patients.
The service is delivered from a converted ward area in the hospital with a reception/ waiting area, 4 single consulting/ treatment rooms and two 4 bedded areas that are also used for seeing and treating patients.
The service manages minor illness, minor injury and refers patients with conditions that require further treatment to Cumberland Infrmary in Carlisle after assessment and immediately necessary treatment.
There are x-ray facilities available 08.30am to 4.30pm weekdays on site located in the main hospital building just across the car park.
NWAS bring patients to the unit if they are suitable as described in our agreed pathways.
111 have the unit in their directory of service and advice for patients to attend.
GP surgeries refer patients to the unit with minor injuries where x-ray or treatment may be necessary.
CHOC use the UTC as their base and invite patients to be seen in the unit OOH by appointment.
Clinical Decision Makers:
Monday to Sunday: Nurse Practitioner 8am-8.30pm (Independent clinical decision maker)
Monday to Friday: GP employed by NCIC 10am-6.30pm
Monday to Sunday: CHOC service based at the UTC 6.30pm-8am
Monday to Friday: 1 doctor covering UTC and visits 6.30pm-8am
Saturday and Sunday: Treatment Centre doctor 8am-6.30pm seeing CHOC invited patients and walk in patients in UTC. 6.30pm 2 doctors both responsible for CHOC base visits, home visits and UTC to 11 pm, 1 doctor after who is responsible for home visits CHOC invited patients and UTC attenders.
Day time: 1 x band 6, 1 x band 5 start 07.15, 1 x band 3 HCA 09.30-20.00
Evening: 1 x band 6, 1 x band 5pm until 9.30pm
Night: 1 x band 6, 1 x band 5 from 9pm-7.30am
The data for 2017-2018 and 2018-2019 shows there are normally around 15,500 attendances at the unit per year. (Data for 2020 is not comparable due to the servcies changes brought on by COVID-19 pandemic)
Ihe image below shows that the demand is extremely low overnight with an average of 3 walk in attendances between 10pm and 8am.
Between 8am and 10pm attendances are much higher with an average of 46.
The unit is a component in a wider system of urgent care and the current service model has not been changed for many years, the unit needs to fulfil a role in the wider system and a review is an opportunity to look for added value to patients in Eden and the wider North Cumbria System. This falls into the remit of the Urgent Assessment and Admissions Pathways group, a subgroup of the Urgent Care Programme Board.
Nurse staffing has become a challenge in recent years and this has meant intermittent overnight closures when insufficient staff are available to keep the unit open. Nurse recruitment is challenging and unlikely to change.
Nurse and Clinician time is valuable and we need to maximise the value by ensuring their time is used effectively. Activity in the unit overnight is low and there are concerns about the value delivered for the whole population.
Healthcare provision and the needs of the population have changed since the service was set up as it is now with changes to expectations and treatment options, the services we deliver need to evolve with those changes.
The Trust aims to provide a high quality, clinically appropriate service that maximises the skills and time of the available workforce, is sustainable and meets the need of the population in Eden and contributes to the delivery of urgent care to the wider system.
The unit is important to the Eden area and we recognise that any change was best made by working in conjunction with the patients and public locally.
A collaborative engagement approach was taken in Autumn 2019 meeting with stakeholders including staff and local health and care representatives to review the staffing challenges and look for potential solutions.
Several suggestions were actions including:
- Explore the use of paramedics overnight – this proved unachievable
- Review vacancies and recruit for permanent rather than temporary positions – this happened and there was some recruitment which has helped the service in the last 15 months
This was followed up with an event involving some community leaders and NCIC governors at Penrith Methodist Hall on January 20 2020 and the challenges were discussed at the East Cumbria Community Forum on March 6 2020.
The engagement works was led by Dr Craig Melrose from NCIC and supported by the NCIC and CCG Engagement teams.
There have also been conversations with the leader of Penrith Town Council, the local MP, the county council's helath scrutiny committee and local GPs.
The meetings involved an open discussion about what was valuable to the community, the challenges of staffing the service overnight for a very small number of walk-ins, alternative ways the service could be offered and how the released resources could be used to the benefit of the community ie, offering Intra Venous transfusion sessions more locally to reduce travel for local patients.
Among the group there was an appreciation of the opportunities to broaden services from the savings made, providing patients could still access OOH CHOC service via 111.
Covid-19 put a halt to further meetings with the community and the health system focused on responding to the pandemic.
This has recently been picked back up again and we are keen to widen the scope of the engagement and have developed the survey to do this.