Watchdog raises 'significant concerns' over level of GP cover at South Shields Urgent Care Hub

Healthwatch South Tyneside found the hub, at South Tyneside District Hospital, which commissioners had pledged would offer a 24/7 service, was without a GP more than a third of the time it was open during visits it made over a three week period in December and January.

The hub acts as a single front door to stream patients away from the emergency department in order to be seen by other clinicians, such as nurses or GPs.

During the first week of visits by Healthwatch the service was unavailable nearly half of the published opening times, which are 8am to 10pm seven days per week, and patients had to be sent to A&E which is open 24/7.

Most had been referred to the hub by the NHS 111 service – despite staff there having been notified there was no doctor available. Staff at the hub told Healthwatch they believed there were not enough staff to support the service.

Another major issue raised by staff was the layout of the building. With three ways into the centre, receptionists are unable to monitor patients’ whereabouts and are therefore unaware when a patient is with a doctor.

Staff also claimed some GPs felt unsafe working in the hub alone, away from the main A&E area, as the reception desk in the hub is no longer staffed.

In October 2014, prior to the relocation of the Jarrow Walk-In Centre, NHS South Tyneside Clinical Commissioning Group pledged the new urgent care hub would provide “universal access to a high quality urgent and emergency care service 24/7”.

The hub is managed by the Vocare Group, which says it provides “innovative, high quality healthcare services to patients and commissioners” with urgent care services to ten million UK patients via urgent care centres, GP out-of-hours services, integrated urgent care centres and the NHS 111 service.

Healthwatch visited the Urgent Care Hub between 10am and 12noon from December 11th to 15th, between 2pm and 4pm from January 8th to 12th, and between 8pm and 10pm from January 15th to 19th. Staff and volunteers spoke to 41 patients and members of staff.

Patients praised the hub staff’s dedication and “kind and helpful” manner despite the obvious staff shortages.

The Healthwatch report said: “Healthwatch South Tyneside is hugely disappointed for the people of South Tyneside in terms of the availability of the Urgent Care Hub.

“Staff reported that they considered the service was not adequately staffed. HWST has significant concerns in relation to the times when the service is ‘unavailable’. To reiterate this was 35% of the time over the period that HWST visited.

“HWST would like to know what steps South Tyneside CCG…is going to take to improve the availability of the service. HWST would like to know who is responsible for and how the service is audited for quality and safety; and would like to see a risk analysis undertaken in terms of when the service is unavailable.”

Sue Taylor, Chair of Healthwatch South Tyneside, added: “Our findings from visits to the Urgent Care Hub at South Tyneside District Hospital are of great concern.

“Far from the promises of a high quality 24/7 service, we found an urgent care hub which was frequently unavailable due to understaffing and in a state of confusion. Many patients were referred there from NHS 111 only to be told there was no doctor available so they would have to go to A&E.

“This is unacceptable and urgent action needs to be taken to address this.”

Healthwatch has written to NHS South Tyneside CCG and South Tyneside NHS Foundation Trust with a copy of the report asking how it intends to improve the service.

Responses from NHS South Tyneside CCG, South Tyneside NHS Foundation Trust and Vocare

Responding to the report, Matt Brown, director of operations for NHS South Tyneside CCG said: “We welcome the report from Healthwatch South Tyneside, it helpfully highlights issues that both the CCG and South Tyneside NHS Foundation Trust are aware of and are the subject of previous discussions via the Accident and Emergency Delivery Board.

“While clearly there have been challenges with GP cover in the urgent care hub provided by Vocare, appropriate clinical care has been provided by specialist nursing staff in the trust.

“We also note the positive comments made by patients using the urgent care hub in particular about the care and compassion of staff, clearly the service is used and valued and we are confident in the assurances from the trust that the issues around GP cover and changes to the fabric of the building in order to improve patient flow can be resolved and will improve upon the current patient experience.”

Commenting on behalf of South Tyneside NHS Foundation Trust, Dr Sean Fenwick, Director of Operations, added: “We welcome the feedback from Healthwatch about the urgent care hub service at South Tyneside District Hospital. Many of the issues identified are already being actively addressed as we look to improve the streaming of patients when they arrive with us.

“Plans to improve the physical layout of the urgent and emergency care entrance and reception area at the hospital will be complete later this year. These improvements will ensure patients are easily streamed into the right service and will also address GP concerns about working in isolation.

“I would like to firmly reassure patients and the public that despite the challenges faced in staffing the urgent care hub service with GPs, all patients who arrive in our care are always safely managed and receive timely and appropriate clinical care, depending on their needs.

“The urgent care hub is co-located with the hospital's emergency department and minor injuries service. As such, it is supported by our emergency nurse practitioners who work alongside the urgent care hub doctor for the majority of the time to support the streaming of patients, with our nursing staff also seeing and treating patients as appropriate.

“At no point has the urgent care hub service ‘closed’ or turned patients away. On those occasions where GPs have been unavailable, our nurse practitioners have ensured those patients needing medical review have received appropriate care.

“The challenges in staffing the urgent care hub service with GPs demonstrates the sheer scale of workforce issues facing the whole NHS and the lack of availability of GPs is certainly not uncommon in other parts of the region and the country.

“We are in dialogue with Vocare, who provide the GP service on our behalf, to discuss the issues around GP availability in line with our service contract and are also talking with our commissioners and other NHS partners, including NHS 111, to look at how we can together improve the flow of patients across the whole health economy to ensure people get the right care, in the right place, when they need it.”

Andy Gregory, Managing Director, Vocare, said: “As recently appointed Managing Director, I will be meeting the Trust and local providers to discuss the report further and to ensure we work in partnership to deliver seamless and accessible services to patients.

“Like all healthcare providers nationally, we work hard to deliver the best possible service despite the shortage of qualified clinicians in the UK.”