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Author Topic: What is Behind the Closure of Jarrow Walk-Centre?  (Read 943 times)

roger

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What is Behind the Closure of Jarrow Walk-Centre?
« on: September 10, 2015, 08:42:06 am »

Fighting to Safeguard the Future of the NHS:

What is Behind the Closure of Jarrow Walk-Centre?
North East Workers's and Politics

As we publish, the people of South Tyneside, and Jarrow and Hebburn in particular, are waging a heroic battle to save their Walk-In Centre at Jarrow, Palmer Hospital from being closed down and moved to the District Hospital A&E in South Shields. The Save Jarrow Walk-In Centre Campaign has engaged hundreds of people from all walks of life in the borough. It has brought together trade unions and different political forces in one of the most broad campaigns seen in the borough in recent years.  In spite of this opposition the South Tyneside CCG is still determined to close the walk-centre in October and has ignored the just and reasoned arguments of residents in the borough.  The logical arguments that have seen a minor injuries, or a walk in centre in Jarrow since the NHS was founded are completely ignored.  Also, insultingly people who use the walk-in centre are blamed for the closure.  It doesn’t take much to read this message when the CCG says that the 27,000 patient attendances are completely unnecessary and these patients will “self care” and “disappear”. 

But besides the CCG and South Tyneside Health and Well Being Board who are closing the centre what is behind the closure of Jarrow Walk-In Centre?   For this we have to look at the whole direction that is being taken by the Government on the NHS.  Their Health Act in 2012 and the internal market created by the previous Labour government is the bridge on which this anti-social direction has been constructed.  In 2013, the Coalition government appointed Sir Bruce Keogh to review A&E services.   The result was a “five year forward view” which has as its real remit  closure, or downgrading of a large number of the present Accident and Emergency Services.  Presently A&E services are backed up by Intensive Care Units, Special Care baby units, and other vital services at the District Hospitals. Services which are all needed to run A&E emergency care. The new “Emergency Centres” will assess and initiate treatment for all patients (meaning both adults and children with physical and/or mental health needs) “and safely transfer them when necessary.”  Of course it is deliberately vague as to what back up services the District Hospitals will provide but it can be guessed that the aim is the closure of vital services at District hospitals already under pressure from loss of beds as their budgets are slashed. The way it is already being implemented is that Strategic Urgent Care Networks, of which the North East is one, will designate two types of emergency receiving hospital: Emergency Centres and Major (or Specialist) Emergency Centres.

So what about the CCGs Urgent Care Centre which will replace the walk-in centre in Jarrow at the District Hospital. Professor Jonathan Benger, National Clinical Director for Urgent Care for NHS England pointed out that “Urgent Care Centres will bridge this gap with Emergency Centres (now A&Es -ed). They will encompass all existing urgent care facilities which are not Emergency Departments such as Walk-in Centres, Minor Injuries Units and “Darzi” Centres.” ….  “And all Emergency Departments should have a co-located (our emphasis) Urgent Care Centre, wherever possible.”    So, this is the   “clinical decision” of the  CCG in closing the walk in centre in Jarrow which has nothing to do with the actual clinical need for the walk in centre to remain there. Instead of opening a new walk-in doctor facility at the District Hospital it is simply closing this vital and well placed walk-in centre at Palmer Hospital in Jarrow to create its Urgent Care Centre at the District Hospital.  This is the tick box “clinical decision” of the government’s “five year forward view”.   

However Professor Jonathan Benger says further on; “Part of the remit of Urgent Care Centres will be to ensure that smaller, more rural and remote communities have local high quality facilities. Stand-alone urgent care centres will be more common and important in remote and rural communities, and our aim is to strengthen the urgent care provision there.”   It would seem that remote areas of Sunderland, Gateshead, etc, can keep their walk-in centres (Urgent Care Centres), which is absolutely right but Jarrow and Hebburn cannot, even though the towns of Jarrow and Hebburn are as remote from South Shields as any other of these walk-in centres.

What is encouraging is that the fight to save Jarrow Walk-Centre has awoken the people of South Tyneside to the threat to their health service and the need to fight to safeguard its future.  The Save Jarrow Walk-In Centre Campaign is calling on everyone to sign its petition.  The fight is not over and the people of South Tyneside  are more and more getting involved in its activities.  Over the next few months and years this  movement must continue to lay the claims in defence of urgent care and  A&E services, as well as hospital beds and community services which are coming under unprecedented attack from constant reviews and cut-backs, fragmentation and privatisation. The claims of the people can only be won by strengthening their organised opposition and their unity with health workers and the whole community to fight to defend their services and to safeguard the future of the NHS.
« Last Edit: September 10, 2015, 08:47:51 am by roger »
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roger

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Re: What is Behind the Closure of Jarrow Walk-Centre?
« Reply #1 on: September 10, 2015, 08:44:58 am »

What is the South Tyneside and Gateshead 'Think Pharmacy First Common Ailments Scheme'?

South Tyneside Green Party

In light of recent discovery of the plans drawn up by the Clinical Commissioning Group (CCG) to close Jarrow Walk In Centre and its GP Practice I decided to investigate one of the alternative routes patients are expected to follow.  'Think Pharmacy First' is being launched all over the country.  In South Tyneside and Gateshead it is called 'Think Pharmacy First Common Ailments Scheme'.  Another scheme soon to be signposted in our pharmacies is the 'Transfer of Care' (TofC) scheme which will enable pharmacists to liase with a Medicines Use Review (MUR), a New Medicines Service (NMS) or public health interventions.  This is linked to PharmOutcomes and soon to be switched on.

Think Pharmacy First!  What does it mean to patients?  This is a Common Ailments Scheme for minor ailments only, which was launched in April.  Instead of making an appointment to see our GP we are being asked to first, seek advice from a pharmacist, thus, reducing pressure on struggling GP practices, A and E units and Walk In Centres.  They will be able to give a free prescription for a range of minor ailments.  They will have access to Summary Care Records, (SCR) soon to be renamed 'Partial GP Records'. These contain sensitive personal information about gender, name, age, DOB, ethnicity, post code and key clinical information, including patient medication, known allergies and any adverse reactions to meds.  They will not have access to full medical records.   Clinicians will have a card which will be protected by a passcode and they will be responsible for its use by others in their team.  The system will be able to mark every time it is used and what it has been used for and by whom (although it is possible to trick the system).  GPs already use these cards to access our medical records.  When this scheme is fully operational in the autumn, patient permission must be given for  the Pharmacist to view the records, except where a patient is at risk of harm and unable to give permission.  Then there is a way of over-riding protocols ‘in the patient’s best interest’.  In the near future everyone with a card will be able to access sensitive information.  Most people who work for the NHS have a limited access and are privy to restricted viewing.   

This is a further step in the movement towards a totally paperless records system by 2018 where all clinicians, doctors, nurses, pharmacists, dentists, etc., will be able to access a central database.  Although The 'Proof of Concept' report addressed the question of protocols and passwords required for clinicians to access this system I am unaware of any similar requisite for patient use.  Is it possible to abuse such a system?  Although there are protocols and passwords for clinicians to access this system I am unaware of any system of passwords or proof of identity to be offered by the patient who wishes to use this.  Is it possible for an identity thief to use it?  The 'Proof of Concept' report did not address this question.

Before they can take part in the scheme the pharmacist must complete a training program. They are also responsible for the in-house training of members of their team to be able to undertake a consultation with a patient. The team includes Pharmacy Technician, Dispensing Assistant or Pharmacy assistant. As part of this training questions have to be asked about training involving safeguarding vulnerable people and dealing with physical and mental problems.   All staff involved in the delivery of the scheme must be trained and complete 'Every Contact is a Health Improvement Contact' and have training on relevant paperwork and protocols, which can be in house.  The South Tyneside Pioneer 'Scene Setting' and 'Skills Session' training may be completed within the first year of service.  A consultation form will be completed as a patient is given advice  and/or treatment and/or onward signposting to alternative Health Care professionals. (I'm not sure yet of how the new TofC scheme fits in here!)  Any products supplied must be entered on the 'Patient Medical Record' (Kept for 5 years) and the interaction recorded on PharmOutcomes.  A PharmOutcomes Dataset must be fully completed for all patients.  This includes Patient Details, Consultation Record, Supply Details, Accessibility and Person Conducting Consultation. Then aggregate data from PharmOutcomes must be transmitted to the Commissioner on a monthly basis.  This seems to be contradictory as first it is recommended that 'Scene Setting' and 'Skills Session' must be completed in order to provide the service.  Then it is recommended that these be completed within the first year.  Does this mean that untrained people will be undertaking consultations?

After speaking to seven pharmacies in Jarrow I learnt that the system was not quite as joined-up as it could be.  Opening hours vary from five days to seven days,  with a single pharmacists on site all day who often only manages a 10 minute break to 'grab' some lunch, I wonder how feasible it is to expect this person to carry out in-house training of assistants and carry out consultations with patients.   If a patient comes to harm due to something a Pharmacist does or does not do then they become liable.  It is not clear if an assistant makes an error of judgement who is liable.    Free prescriptions are only available if entitled and are on the list and do not apply to prescription only medicine or repeat prescriptions.  Patients are not to be shown the list of available medications in case it is abused.  This quote from a 'Think Pharmacy First' leaflet suggests that an adult accompanying a child must also be eligible for free prescriptions.

"To receive free medicines for a child on the Think Pharmacy First scheme, the parent or guardian must also be eligible for free prescriptions."

The chairman of the Local Pharmaceutical Committee (LPC) Mr David Carter, in his blog, describes the new service as 'a service where the public can access a vast range of medicines for an increasing range of conditions "quickly and conveniently" from community pharmacy instead of accessing other more expensive services (GP, Walk in Centres or Accident & Emergency departments).'

To comment on this I have to disagree with the term 'vast list'.  There are ten ailments and approximately fifty different medicines. Most of them are paracetamol, ibuprofen and creams.   Most people who attend a Walk In Centre do so because they can not see their own GP.   They are often sent there by receptionists or 111 services.  I understand that the Walk In Centre in Jarrow was initialised five years ago as a trial remedy for poor access to GPs .  It has been a  great success.  The Health Minister, Jeremy Hunt, would be proud of it!  It aspires to everything he subscribes to.  The walk in centre and the GP practice are open seven days a week from 8am to 8pm.   Why close it?  Even Mr Hambleton (Chairman of CCG) said that it was not due to a money saving venture.

I realise that at present this is a minor ailments scheme (MAS) and at face value the medications involved seem fairly innocuous.   However, having sensitive information about individuals accessible in a retail setting is not desirable for obvious reasons.  Could errors be made regarding pain killers?  How up to date are the SCRs going to be? Could this be extended in the future to other medications?  Would a Pharmacist have to stand helplessly by as a person dies of anaphylaxis? Would medical records be open to alteration?  There are those in the profession discussing whether patients can add or remove details from their records.  Would the Medical Record still be deemed evidence in a legal battle if it had been changed?  There are lots of questions which need addressing.  The biggest question for me is whether this will help GP practices to cope with their load.  Will it compensate for the loss of Jarrow Walk In Centre?  I don't think it will.   NHS Choice!  Whose choice are we discussing?  Not the choice of the Patients!

Lesley Kay Hanson

South Tyneside Green Party
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