Proposed changes to NHS urgent care services in Dartford, Gravesham and Swanley

Our public consultation about the future location of a new Urgent Treatment Centre, for urgent care,  ran from 12 August to 4 November 2019.

By urgent care, we mean care to treat illnesses and injuries that are not life threatening but require an urgent clinical assessment or treatment on the same day.

The CCG proposes to create a new Urgent Treatment Centre  (UTC) at either Gravesham Community Hospital or Darent Valley Hospital by autumn 2020.

Both proposed options will bring together the existing urgent care services provided by the Minor Injuries Unit at Gravesham Community Hospital and the White Horse Walk-in Centre at Fleet Health Campus under one roof.  This will make it easier for you to know where to go if you or your family need medical help urgently.

The local arrangements for urgent care services do not currently offer the full range of services that Urgent Treatment Centres nationwide are required to provide by autumn 2020.

Here you can read more about the two proposed options for change and find out what happens next.

Our proposed options for change

Our first proposal is to create an Urgent Treatment Centre by relocating services at the White Horse Walk-in to join the Minor Injuries Unit at Gravesham Community Hospital.

The Urgent Treatment Centre would be open 12 hours a day, from 8am to 8pm, every day including bank holidays.  Some patients will have had an appointment made for them by the ambulance service, NHS 111 or another clinician.  Others will wait for their turn to be seen.

Patients would be treated by GPs, nurses, paramedics or other healthcare staff. Patients would be transferred to the A&E department at Darent Valley Hospital or to another service if necessary.

 

Our second proposal is to relocate both the Minor injuries Unit at Gravesham Community Hospital and the services at the White Horse Walk-in to create an Urgent Treatment Centre alongside the existing A&E department at Darent Valley hospital.

The Urgent Treatment Centre would be open for a minimum of 12 hours a day. These hours may be extended. On arrival, patients will be assessed by a doctor or nurse and those who need it will be referred to the A&E department. Other patients will be seen and treated by GPs, nurses, paramedics, mental health specialists or pharmacists depending on their medical needs. Some patients will have had an appointment made for them by the ambulance service, NHS 111 or other clinician. Others will wait for their turn to be seen.

 

 

Giving your views

The consultation has now closed. Thank you to all who:

  • responded to our survey
  • invited us to speak at your group or club
  • attended one of our public events
  • made your views known in other ways

We will provide further information on the feedback we received in due course.

Consultation documents

Here you can find documents giving you background information about the proposal to create a new Urgent Treatment Centre, including how we developed our proposals and various impact assessments.

Consultation documents

Download a PDF version of the full consultation document, with the survey included at the back, here

Consultation document large print

Urgent Care Pre Consultation Business Case

 

Appendices:

Appendix A – DGS UTC Travel Modelling – Mapping

Appendix B: Annual Report and Accounts 2018/19

Appendix C: Urgent and Emergency Care – The Case for Change and Proposed Clinical Model of Care and associated appendices. These have been listed individually for ease of access.

Appendix C: Listening Events

Appendix C: Community Impact Assessment

Appendix C: Whole systems event feedback

Appendix C: Clinical model case for change

Appendix C: GP Engagement feedback

 

Appendix D: Draft Urgent Treatment Centre Service Specification

Appendix E: Digital Delivery Plan

Appendix F: The Urgent Care Review Journey

 

Appendix G – What do we know about the way patients use our current walk-in urgent care services

Appendix H: Feedback from Neighbouring CCGs/Chairs of Overview Scrutiny Committees

Appendix I: Communications and Engagement Plan 2019

Appendix J: Public consultation document

Appendix K: HealthWatch Scrutiny of Integrated Urgent Care Report

Appendix L: Clinical Peer Appraisal

Appendix M: DVH Clinical Audit of A&E Activity Streamable to a co-located UTC

 

Appendix N: Minutes of NHS England Assurance Meetings. These have been listed separately for ease of access.

Appendix N: Impact Assessments: (Quality Impact Assessment)

Appendix N: Impact Assessments (Data Protection)

Appendix N: Impact Assessments (Equality Impact Assessment)

 

Appendix O: Minutes of NHS England Assurance Meetings. These have been listed separately for ease of access.

Appendix O: NHSE Stage 1 Checkpoint meeting.letter

Appendix O: NHSE Stage 2 Checkpoint meeting actions

Appendix O: Minutes of NHS England Assurance Meetings (Stage 1 Meetings Actions)

Appendix O: Minutes of NHSE Assurance Meetings ( Pre-Stage 2 Checkpoint Meeting)

Appendix O: NHSE & I Scheme Assurance 

Appendix P: Modelling Assumptions

Appendix Q – Summary tables of the sensitivity modelling scenarios

Publicity

Consultation postcard

Consultation poster

Public Consultation Event Poster

What will we do with your comments?

When the consultation closed on 4 November 2019, all the comments and feedback we  have received will be collated and analysed by an independent organisation and this analysis will inform the Decision-Making Business Case (DMBC).

A final set of proposals, which will include the consultation feedback, the DMBC and the feedback and findings from the various internal committees, will be considered by the CCG Governing Body and a final decision is expected in early 2020.

The public consultation feedback report and final report to the Governing Body will be published on the CCG website.

The story so far

NHS Dartford, Gravesham and Swanley Clinical Commissioning Group (CCG) has been engaging for some time with local people about the creation of an Urgent Treatment Centre (UTC) in Dartford, Gravesham and Swanley.

 

This infographic shows how are have engaged local people and stakeholders so far.

What do the proposed changes mean for you?

  • You will be able to receive treatment for minor injuries (such as suspected broken bones) and minor illnesses (such as infections) in one place
  • You will be able to have x-rays, blood tests and similar services on site to help diagnose illness and improve treatment offered
  • You will be able to book an appointment for the new Urgent Treatment Centre via NHS 111 or, you can turn up and wait to be seen
  • There will no longer be a Walk-in Centre at Fleet Health Campus in Northfleet but there are plans for more community and GP services to be available from that site
  • The new Urgent Treatment Centre will be led by GPs working with other health professionals as a team including Advanced Nurse Practitioners, Emergency Nurse Practitioners, Paramedics and Mental Health Practitioners, as well as Out of Hours Doctors
  • It is expected that new and existing staff will be employed in the new Urgent Treatment Centre
  • Option one – if Gravesham Community Hospital is selected for the new UTC, the existing Minor Injuries Unit will be expanded to include services for minor ailments transferred from the White Horse Walk-in Centre
  • Option two – if Gravesham Community Hospital is not selected as the site for the Urgent Treatment Centre, it could become a super GP practice and health and wellbeing hub offering more outpatient clinics and community services
  • Option one – if Darent Valley Hospital is not selected as the site for the new UTC, it will still have A&E and GP Out of Hours services.
  • The new UTC will offer the same services as other Urgent Treatment Centres in England and will comply with the NHS England 27 standards for best practice.

Events

We wanted to receive the views of as many people as possible  on the proposals to help us decide the best option for everyone in Dartford, Gravesham and Swanley.

During the public consultation period, which ran from 12 August to 4 November, we organised a series of events where members of the public were able to find out more about the proposals and have their voice heard.

Three public events

Three public consultation events were held across the CCG area to give local people the chance to discuss and give their feedback on the proposed two options.

They were held on:

Wednesday 16 October at Clocktower Pavilion, St Mary’s Road, Swanley BR8 7BU.

Monday 28 October at Princes Suite, Princes Park Stadium, Darenth Road, Dartford DA1 1RT

Wednesday 30 October at Kent Room, Gravesham Civic Centre, Windmill Street, Gravesend DA12 1AU.

 

Roadshows:

Below are details of our pop-up roadshows where we went out and about in the community to talk to people face to face:

August Urgent Care Roadshows

September Urgent Care Roadshows

October Urgent Care Roadshows

 

You can also sign up for our Health Network to receive up to date news and events.

TfL Consultation: our response

Response by NHS Dartford, Gravesham and Swanley (DGS) Clinical Commissioning Group (CCG) to proposed TFL changes to Busses 428 and 492

About us

NHS Dartford, Gravesham and Swanley (DGS) Clinical Commissioning Group (CCG) is one of eight CCGs in Kent and Medway. We commission health care services on behalf of approx. 270,000 people.  The area within the CCG’s responsibility covers 100 square miles from Gravesend to Dartford, Swanley and West Kingsdown to New Ash Green, Meopham, Cobham and Higham.

Our response

We are concerned that the proposed TFL changes to busses 428 and 492 will severely restrict access to NHS healthcare services for a significant proportion of the local population the CCG serves.

Darent Valley Hospital (DVH) which is on the current Bus 428 route to and from Blue Water shopping centre is the only acute hospital for the local DGS population of around 270,000 served by the CCG. Darent Valley Hospital has also been identified as one of three hospitals that will house a Hyper-acute Specialist Stroke Unit transforming care and outcomes for local people unfortunate to suffer a stroke. Furthermore, the hospital is one of the proposed site options (under consultation) for an Urgent Treatment Centre for local people in DGS.  The lack of a direct route to/from Bluewater shopping centre is also likely to have a negative impact on friends and families of patients on admission at Darent Valley Hospital wishing to visit loved ones and provide the support  which can be vital to the recovery of patients.

Data available to the CCG indicates that 70% of people attending Darent Valley in 2018/19 came from Dartford Gravesham and Swanley; and that some parts of the local population are reliant on public transport because they have less access to a car. Some of the groups that we have identified would be most affected by restrictions to public transport are – families with young children, people with disabilities, elderly residents and others from the socio-economically deprived areas of the county.

The Darent Valley hospital has particular challenges that make public transport an essential service for access to the healthcare provision available onsite: The current parking issues at DVH and road congestion mean that many staff and patients rely on the direct bus route from Blue water to get to the hospital having parked their cars at the shopping centre.

We would ask TFL to re-consider its proposed changes to the 428 and 492 bus routes to enable the population served by both our organisations to access the vital NHS health care they need and deserve. Many thanks in advance for your consideration.

Kind regards

Ian Ayres – Managing Director, Dartford Gravesham & Swanley, Swale, Medway and West Kent CCGs

Dr Sarah Macdermott – Clinical Chair, Dartford Gravesham & Swanley CCG

Background

TFL (Transport for London) is running a Public Consultation for 8 weeks until Tuesday 10 September. The proposed changes to the affected bus routes are outlined below. These changes are intended to take effect from January 2020 (subject to the outcome of the consultation).

Proposed changes

Route 428:

  • would no longer run between Crayford and Bluewater (so it would no longer serve DVH)
  • would run between Erith and Crayford on its existing routing
  • customers to / from DVH would need to change buses at Crayford to and from route 96 which would continue to serve DVH

Route 492:

  • would no longer run between Dartford town centre and Bluewater (it currently runs via London Road, Stone, not serving DVH)
  • would run between Sidcup and Dartford town centre on its existing routing

Frequently asked questions and answers

Q:  Haven’t you already asked local people about changes to urgent care? Why are we being asked again?

A:  The CCG has been engaging with local people about urgent care services for a few years because we want to make sure that local NHS services are shaped by local people’s views. However we are now formally consulting on two definite options for the location of an Urgent Treatment Centre namely:

  • To create an Urgent Treatment Centre at Gravesham Community Hospital by moving services from the current Fleet Health Campus in Northfleet (White Horse Walk-in Centre) to join the Minor Injuries Unit at Gravesham Community Hospital. OR
  • To create an Urgent Treatment Centre at Darent Valley Hospital by moving services from the current Minor Injuries Unit at Gravesham Community Hospital and the Fleet Health Campus in Northfleet (White Horse Walk-in Centre) to Darent Valley Hospital

A: Has the CCG has already made up its mind?

A:  No, the CCG has not made up its mind. We have two options for the location of a future Urgent Treatment Centre. Each has different advantages and disadvantages for different groups of local people. We want to hear from as many people as possible to understand how these two options will impact on them. The public consultation is not a referendum or a vote but it is an opportunity for local people to tell the CCG about the important issues the CCG should consider when making its decision.   

Q:  Will the Whitehorse Walk-in Centre be closing?

No, the Whitehorse Walk-in Centre will not be closing. It will continue to offer GP services on site but it will no longer offer Walk-in NHS treatment services from that site. However, there are plans for more outpatient clinics and community services to be offered from that site.

Q: Will these proposals affect the A&E/ Emergency Department at Darent Valley Hospital?

A:  If Darent Valley Hospital is not selected as the site for the new Urgent Treatment Centre, the A&E/ Emergency Department will continue to operate in its current format from the existing site.

Q: What will happen to Gravesham Community Hospital if the Urgent Treatment Centre is sited at Darent Valley Hospital? Will it have to close?

A: If Gravesham Community Hospital is not selected as the site for the new Urgent Treatment Centre, it will continue to offer all the NHS services it currently does except the Minor Injuries Unit. In addition, it could become a health and wellbeing hub offering more outpatient clinics, community and GP services

Q: Why can’t the Urgent Treatment Centre be sited at the Fleet Healthcare Campus, where the Walk-In Centre is?

A: Urgent Treatment Centres have to conform to national standards such as diagnostics and x-ray.  The Fleet Healthcare Campus (White horse Walk-in Centre) does not currently have the appropriate capacity for these facilities and will require major capital investment to accommodate them. 

Q: Why do we need an Urgent Treatment Centre?  The existing services work well as they are

A: Current Urgent Care services offer different treatments (minor injuries separated from minor illness) in different venues with different specialist staff during different opening hours. We want to simplify access to urgent care services by bringing advice and treatment for minor illness and minor injury under one roof and making NHS 111 the single point of access for urgent care services. This is in line with national policy to make it easier for people to understand what services are available to them.

Q: Parking at the current Walk-in Centre at the White Horse is free. Is it therefore fair to relocate it to Darent Valley Hospital or Gravesham Community Hospital, where you’ll have to pay parking fees?

A:  Urgent care services are being co-located in line with national strategy/mandate.  Urgent Treatment Centres will allow for all minor illness and injuries to be treated within a single service supported by necessary diagnostics. 

Parking is one of the issues that has been raised during the consultation and has been noted for consideration during the decision making process.