Agenda item

To consider the information provided by NHS Kent and Medway on the arrangements for phlebotomy services in Deal.

The Chairman welcomed Natalie Davis, Chief of Staff NHS Kent and Medway and Sukh Singh, Director of Primary Care NHS Kent and Medway.

 

It was stated that the previous 25 hour per week phlebotomy contract at Deal Hospital had been surrendered to the Integrated Care Board (ICB). The investment in GP’s as replacements was intended to widen access through providing more hours of operation. However, after listening to the community it was now proposed to reintroduce the phlebotomy service at Deal Hospital for 25 hours of operation for key priority groups. This would be subject to a procurement exercise, as required by law, on the basis of a one year plus one contract. The service provided at Deal Hospital would be kept under review and if changes were required following this, they would be looked at further.

 

Q1. The independent review stated that the local survey undertaken by the Deal Blood Test Action Group contained numerous biased questions. Why, therefore has it been taken on board when considering this new service.

 

Members were advised that the report was based on more than the responses to the questionnaire as it also included information gathered from other sources. It was stated that the responses to questions would still be helpful, even if the independent review concluded the questions themselves were biased.

 

Q2. The independent report showed increased uptake of appointments at GP practices on cessation of the hospital clinic, with a subsequent (I assume) increase in staffing levels. Has the ICB liaised with practices as to how these staff can be redeployed should GP blood test appointments fall?

 

Members were advised that GPs had increased staffing and that they had been notified in writing that activity would be monitored for any unexpected variation. However, practices were ultimately responsible for their staff and how they used them. The Deal Community Phlebotomy Service responded specifically to those patient groups who had been unable to access a blood test locally. This service and the service provided by practices were seeking to coexist, but the impact on general practice and other providers would be reviewed as part of the evaluation.

 

Q3. The earlier proposed Deal pilot was to use Buckland hospital EKHUFT staff. Is this to be the case this time and if so, what will be the consequence for the phlebotomy service at BHD.

 

The procurement process would determine the provider for this service but there were no plans to change in phlebotomy service at Buckland hospital.

 

Q4. Communication was deemed to be key going forward. Can we be assured that the changes, particularly the patient criteria list, are clearly communicated to the Deal population in a timely manner.

 

Members were advised that this would be done. 

 

Q5. How does the ICB plan to monitor and report back to DDC regarding the quality of this new service?

 

Members were advised that the ICB would be happy to engage with Members in respect of this.

 

Q6. What does SBAR stand for?

 

It was stated that SBAR stood for Situation, Background, Assessment, and Recommendation. It was a widely used report structure and communication tool to ensure consistent communication with the headline paragraphs under each title.

 

Q7. About the independent survey, by BHNC … can we see a copy of the questions used in the survey that was sent to surgeries? How many people replied to their survey? What type of survey was it, paper? Online? Verbal? How much did the survey cost? What was the need for holding another survey because the action group survey went to almost every household in Deal, Walmer & several neighbouring villages, (over 10,000 people), in paper format and online.

 

Patient surveys were conducted by all four practices asking patients to score their experience of the blood testing service “in house” at the surgeries. Responses were recorded in different ways (paper, online & verbal) and a total of 154 patients responded.

 

The raw survey results were shared with Bexley Health Neighbourhood Care to inform their independent review.

 

Q8. The use of trained receptionists, trained that is for 2 days only for blood taking, is that safe? What about patients who bruise easily? Other medical problems? (I note that patients with known difficult venipuncture can go to the hospital). I suspect that not all categories of situations are covered. Surely, at the GP’s discretion for high need patients defined by the GP?

 

The ICB supported the training and development of staff. Phlebotomists were specialists and valid partners in the healthcare team.

 

Q9. How to get an early morning appointment? As some surgeries don’t start til 8:30 am, others later. Some patients need to get to work after a test. Many workers living in Deal travel elsewhere to work. The hospital will open at 8am. Surely patients like this should be able to go to the hospital?

 

The previous service offered at Deal hospital had clear opening hours (07:30 to 13:00) accessible only by appointment as it was staffed by one part-time phlebotomist (25 hours per week). While this provided for early morning appointments it was unable to meet all patients' needs. While the ICB would like to be able to meet all the needs of patients it was acknowledged that this was not always possible. The ICB wanted to work with the whole population to provide the best service it could to as many people as possible.

 

The feedback received from the GP phlebotomy service has been positive and for many patients represented an improvement over the previous arrangements. The GP service when considered with the new Deal Hospital service would represent a significant improvement in capacity.

 

Members while welcoming the proposed restoration of phlebotomy services at Deal Hospital urged the ICB to reflect further on widening access to the Deal Hospital service.

 

Q10.  Why not have the hospital service open to all who want to go there, and record why they go there, and assess the use and need at the end of the year? It is convenient to use the GP service for some, but others not, for a variety of reasons.

 

The ICB believed that this would likely destabilise the general practice service to the extent that the services from general practice would need to close as they would not be sustainable. The Deal Hospital phlebotomy service was funded by the ICB and would stretch limited resources. The ICB was working on a way to support delivery of a safe service for all venues.

 

Q11. How will you judge the effectiveness of this Deal outpatient service at the end of the year? What are the review criteria you will judge by?

 

The criteria will include, but not be limited to:

 

•       Patient satisfaction survey

•       Total number of people attending (with a minimum set to make it viable)

•       Number of ‘urgent’ blood tests

•       Number of did not attend (DNA)

•       Ages

•       Postcode

•       Waiting times

•       Referral source

•       Segmentation of those attending by criteria the service is focused on

•       Impact on general practice and other healthcare providers.

 

The review would cover GP provided phlebotomy services as well as Deal Hospital.

 

Q12. I believe there is a consultation about the local ICB, and a possible restructuring. Can you tell us what is being planned? And who will be responsible for this particular phlebotomy service in future?

 

There was an internal restructure which would result in fewer ICB staff in post. However, there were no changes proposed to the duties of the ICB.

 

It was moved by Councillor C A Vinson, duly seconded by Councillor D R Friend, and

 

RESOLVED:  (a)   That the Overview and Scrutiny Committee requests a copy of the evaluation report when published.

 

                        (b)   That consideration be given in the tender for phlebotomy services at Deal Hospital to the following:

 

(i)            Providing the service from 7.30am onwards at Deal Hospital.

 

(ii)           To express concern that the service at Deal Hospital will only be open to a restricted number of groups and not be open to all.