Councillors and committees

Agenda item

Update on preparations for the winter demand

Fergus Keegan, Director of Quality, Kingston & Richmond CCGs will update the panel on plans for this winter


Fergus Keegan, Director of Quality and Engagement at Kingston and Richmond CCGs gave a detailed presentation on the preparations for winter. 


This year’s winter plan builds on work of last year and is aligned with the DH, PHE and NHSE’s third national integrated “stay well this winter” campaign.  The presentation gave information on relevant statistics, the focus for Stay Well this Winter, the local communications plan, primary care access and the role of the A&E Delivery Board which is chaired by Ann Radmore.


The national campaign brief is “to ensure that people who are most at-risk of preventable emergency admission to hospital are aware of and, where possible, are motivated to take actions that may avoid admission this winter”.  The campaign seeks to educate at-risk groups about the actions they can take to stay healthy (C2DE adults aged 65+, people with long term conditions and carers and to improve the update of flu vaccine.


Key statistics in the past year:


·         Emergency admissions via A&E at Kingston Hospital – increased by 12.2%

·         Ambulance journeys (KCCG patients) - increased by 3.7%

·         A&E attendances (all) at Kingston) Hospital - increased by 0.55%

·         A&E attendances (KCCG patients – increased by 1.1%


·         RBK Delayed Transfers of Care – reduced by 63% comparing Sept 17 with Sept 16


·         Flu immunisation 65+ for KCCG (Sept 16 to Jan 17) 66.1% and for year to date 61.4%

·         People registered with Kingston GPs – 209,409 – increased by 2.4% (includes small numbers of people from outside Kingston)

·         GP appointments over past year – 811,522

·         Extended Primary care hub appointments April – Sept 17 – 14,942

·         (this increases GP appointment capacity by 3.6% over a year)


In terms of overall A&E attendances:


·         Total A&E attendances at Kingston Hospital (Oct 16 – Sept 17)   117,198

·         65% (65,202) patients from other CCGs

·         44% (51,996) patients from KCCG


·         22,805 KCCG patients (30%) attended another A&E


Fergus Keegan stated that Kingston has not seen the same level of growth in A&E attendances compared with other hospitals but a higher proportion of over 85s need to stay in hospital and they have greater health needs. Kingston Hospital has a clinical decision unit which provides a safe area for people who need to stay longer than 4 hours.  This enables more time for observations and prevents people being sent home in the middle of the night.


Partnership working in Kingston and notably RBK’s adult social care team have enabled 63% reduction in delayed transfers of care compared to previous 12 months and Kingston is the 2nd best in London.


Flu vaccinations for Kingston’s NHS staff now stands at 71% (at 6 December 2017).  This is an improvement on last year and has exceeded the target. 


Fergus Keegan drew attention to the additional capacity that has been provided in primary care particularly at the primary care hubs.  All together an additional 58K appointments are being provide plus a further 23K - 24K community nursing appointments.  For every A&E attendance there are 11 appointments elsewhere.  People attending A&E inappropriately are redirected to other services eg their GP, pharmacy or one of the GP hubs.


In relation to the communications plan there are small changes compared to last year’s.  Local promotional material is being linked to the national campaign and the aim is to encourage 1M people across the country to use local pharmacies rather than A&E.  Fergus Keegan emphasised that the aim is not about preventing emergency treatment but encouraging people to use it appropriately and to take steps to keep well, keep warm, take up flu vaccination, ensure stocks of food and encourage people to keep an eye on elderly neighbours.  


There are three stages to the communications plan, firstly (October) to raise awareness of flu vaccination, secondly (January/February) to continue to raise awareness of flu, encourage people to use pharmacies for advice especially about long term conditions and to use the 111 service, and thirdly (February to March) targeting parents of children under 5 to stock up on medications such as Calpol.


London is one of three regional areas selected to deliver a 111 awareness campaign.


Communication platforms include film clips for websites, social media, posters and leaflets, stakeholder communications and communications in GP practices.


Kingston and Richmond have extended primary care services to provide GP and nurse appointments 8am to 8pm seven days a week.  In Kingston these are located at Kingston Health Centre, Surbiton Health Centre and the Merritt Health Centre in Chessington (Richmond’s are at Teddington Memorial Hospital and Essex House in Barnes). The Kingston services are currently operating at 70% capacity and at weekends between 30-40%.


Walk-in centres are available at Teddington Memorial Hospital and Queen Mary Hospital, Roehampton avoiding attendance at A&E.


There has been good planning for this winter and a programme of work has been developed by the A&E Delivery Board with improvements made on last year.  A focus is to better manage the peaks as effectively as possible. It is anticipated that this will be a tough winter and it will be challenging especially for the over 85 group of patients.  


In response to a question Fergus Keegan confirmed that more work is needed to address people who are regarded as frequent users of the A&E service. 


A question was asked about the new GP app service.  This is available for people who work in London Zones 1 to 3 and this is a paid for service rather than being free to the patient under the NHS.  Whilst it is advertised as offering the opportunity of being able to speak to a NHS GP, this service is an adjunct to the GP’s NHS role. 


Dr Phil Moore added that concerns about this service had been raised at the Primary Care Committee and he was aware that many representations are being made but not by KCCG.  


Dr D’Souza asked for further details about Kingston Hospital’s Clinical Decision Unit.  Fergus Keegan explained that the national 4 hour target is appropriate for most but there are occasions where a hospital may need more time to diagnose, or determine the next step for treatment.  The CDU provides beds and single sex and is under the supervision of the A&E team.


Mr Robb (in the gallery) suggested that the Merritt Centre was not open as long as the other two and would it be possible to extend this to 8am to 8pm.  Fergus Keegan pointed to the need to ensure affordability and added that weekend services are underused especially on Sunday (only 30-40% capacity) and the services is provided by just a small pool of GPs to provide. 


Agreed that:


The information provided is noted.