Turn patients away from A&E and charge for missed GP appointments - NHS suggestions from Peterborough and Cambridgeshire residents

The Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) - which commissions health services in the county - says its Big Conversation survey reached more people than ever.

Thursday, 6th February 2020, 5:00 am

The results suggest support for turning people away from A&E if the health issue is not an emergency, limiting prescriptions to medicines that cannot be readily bought over the counter and setting health improvement targets prior to being operated on.

But a CCG report on the findings also said “at the public meetings and in survey responses we heard that some people did not like the binary nature of the questions and found them difficult to answer as they wanted more options, or to give a nuanced response”.

Although the CCG is keen for the Big Conversation not to be seen as a consultation – a formal consultation forms part of the legal process to make policy changes, which is not the case here – the body praised the survey’s reach in comparison with past efforts to gather public feedback, noting it received about three times the number of responses as the next largest consultation undertaken.

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The CCG said the background to carrying out the survey is it is “facing an unprecedented financial challenge in 2019/20 and beyond”.

The survey ran from September 27 to December 20 and “was designed to help the CCG better understand what matters most to the local community, as well as asking for ideas from the community and clinicians that could help us to make savings in the future”.

Director of external affairs and policy at the CCG, Jessica Bawden, told the CCG’s governing body on Wednesday that the reach of the consultation was “better than we have done before”.

Lay member of the board, David Finlay, pointed out there are around a million people in the Cambridgeshire and Peterborough CCG area and asked how representative the 6,000 are of the wider area. Mrs Bawden replied that she could not say.

Chairman of the CCG’s governing body, Dr Gary Howsam, said he was “delighted” with the response and said the results would be one reference point among many to influence decisions going forward.

The CCG says the county spends “£5.3 million on medications each year that could be bought over the counter rather than via a prescription. Often these medicines are cheaper to buy over the counter than it is to pay for a prescription”.

A total of 93 per cent of respondents said “we should only prescribe items that cannot be readily purchased over the counter to enable the money to be spent on other healthcare services,” when asked to choose between that and: “We should continue to prescribe anything people need and reduce other healthcare services.”

Dr Howsam said: “I don’t think I was surprised by the answer, but I was surprised by the magnitude of people supporting that position.”

Part of the feedback summarised in the CCG’s report said: “People were mostly supportive of GPs not prescribing medicines that could easily and cheaply be bought over the counter in most pharmacies.

“However, people felt that there should still be exceptions to this at the GP’s discretion. If the GP felt that the patient would not buy the medicine and the condition or illness would deteriorate then they should still prescribe that medicine.”

And 88 per cent of respondents were in favour of turning people away from A&E if the health issue was not deemed to be a genuine emergency.

Only 12 per cent said “you should always be seen at A&E if you go there and you shouldn’t be turned away”.

The CCG’s report said: “There was generally consensus on this issue in the comments we received and at the public meetings. People told us that we should turn people away from A&E if they shouldn’t be there. A&E should only see those that are urgent.”

A large number of respondents, 77 per cent, agreed that they should set their own targets to improve their health, such as stopping smoking, drinking less alcohol and losing weight before having planned operations.

However, 23 per cent said they should be able to access whatever service they need even if they don’t make lifestyle changes.

And 79 per cent of people were in favour of using technology such as phone appointments or live chats to access medical advice quicker, rather than wait for a face-to-face appointment.

“We always assume that people value that one-to-one, face-to-face transaction, whereas actually if we can use technology so that we can scale up the way we distribute information to people I think that’s really valuable,” Dr Howsam said.

Asked on how to deal with the issue of missed appointments, which costs on average £120 a time, 73 per cent of people said “the NHS should get tougher on people who frequently miss appointments, unless they are vulnerable or have exceptional reasons for doing so”.

And 25 per cent of people said “the NHS should get better at reminding people to attend, using automatic reminder systems wherever possible”, while three per cent said “these things happen and the NHS should be flexible enough to manage this”.

The CCG report said: “Some people suggested that the NHS should charge a small standard fee for every appointment – suggestions between £10 – £30. This money is then refunded if you attend the appointment.

“People also felt there should be standard charges across the whole system for any missed appointment that cannot be proven to have valid reason for being missed. Other suggested a three strikes system, on the third missed appointment you are charged for all previous appointments.

“Lots of people wanted a system introduced where you had to log a bank card or credit card with the NHS in order to receive services. Then it would be easy to charge people for missed appointments or misuse of the service.

“Other people suggested the NHS develop a billing type system that lets a patient know how much their treatment would have cost if they had to pay for it. People would then start to value the service they receive from the NHS instead of taking it for granted.

“People were keen to point out that there should always be exemptions for people on low incomes.”

The CCG said the responses also highlighted “mental health services were seen as a key issue that needed addressing”.

“People had a lot to tell us about GP services,” the CCG report said, with a lot of focus on the issue of availability.

Ben Hatton, Local Democracy Reporting Service