Primary Urgent Care Services Consultation - Review

Consultation review: Urgent Primary Care

May 2018

 

Context

In October-December 2017, Oldham CCG undertook a major consultation relating to proposed changes to Urgent Primary Care provision in the borough.  A decision was made at the Governing Body meeting in January 2018 which reflected the views expressed during the consultation. At the time of writing, work is ongoing to operationalise the proposals.

What we did

An Urgent Primary Care Oversight Group (UPCOG) was established to oversee the consultation. This was chaired by the CCG’s Vice Chair/ Lay Member for Patient and Public Involvement.

UPCOG met before during and after consultation to provide assurance that the consultation was both effective and compliant with the relevant legislation, guidance and case law.

A prospectus was published to explain the issues, set out the case for change, share the learning from the pre-consultation period, set out the CCG’s proposals and an alternative proposal and explain how local people can take part.

The approach mixed a need to have a meaningful number and sufficiently representative sample of participants overall (and from each Cluster as well as outside Oldham), to give anybody who wished the opportunity to take part and to specifically target groups who were identified as potentially being disadvantaged by the proposals as a result of the Equality Impact Assessment undertaken.

This multi-methodology approach also ensure a mix of qualitative and quantitative inputs, enabling the CCG to understand in more people why people think the way they do about urgent primary care.

The consultation featured 3 strands of work:

  • The main face-to-face survey undertaken on the CCG’s behalf by Membership Engagement Services. 2,542 residents were surveyed across the 5 clusters and also in 3 out of area locations (Mossley, Milnrow and Middleton) to capture the views of non-Oldham residents/registered patients who may use Oldham’s Urgent Care services. A variety of locations were used, including the Royal Oldham Hospital and the Integrated Care Centre.
  • The same survey undertaken online by the CCG using Survey Monkey. This resulted in a further 80 responses and more detailed/lengthy comments from the consultees. 
  • 17 community groups were spoken with during the consultation process, seeking the views of protected characteristic groups who were identified as potentially being disadvantaged by the proposals as a result of the Equality Impact Assessment undertaken.

What worked well?

  • Having a formal oversight group worked well to ensure there was a link during the work to the Governing Body, the right questions were asked to assure the robustness of the methodology and that there was sufficient clinical leadership of the consultation work. Patients were brought onto the group at the options appraisal stage.
  • The main methodology – street based surveying was effective in terms of the overall sample size and representativeness of Oldham geographically and ethnically. It mitigated against the risk of participants ‘self selecting’ and us only hearing from a limited range of people.
  • The prospectus document was well received. It was accessible without ‘dumbing down’ the quite complex issues involved. The use of (real) clinicians as our voices in the document worked well.
  • The work with community groups was generally very well received. The approach of going out to existing meetings and events rather than inviting people to separate events worked well – people were comfortable to speak their minds on their own territory and amongst friends.
  • Pre-consultation work to explain the case for change and the rationale behind the proposals with local leaders and opinion formers was time well spent. This led to us being able to undertake the consultation without misunderstandings or local campaigns as has happened with similar proposals elsewhere.

What could be improved?

  • Ideally we would have been able to involve members of the public in developing the proposals more at a much earlier stage of the work. We would then have involved these people in developing the narratives and consultation methodologies, and potentially in the oversight of the work.
  • The main problem with street surveying was the cost, which would be prohibitive if we were to use it as a regular methodology for engagement. It is a tactical which needs to be used sparingly.
  • We could have made more use of clinical leaders to front the proposals, including attending more of the face to face sessions. Where we did use GPs, practice nurses etc. to explain the proposals and lead discussions with the public, this was extremely well received.

Recommendations

  • Thought should be given making the UPCOG group a formalised standing committee as a sub-committee of Governing Body to assure the ongoing public involvement of the CCG and report to the Governing Body. This committee would have patient representation and further thought would need to be given about how these people would be selected and supported – possibly with the involvement of Healthwatch Oldham.
  • Thought should be given to how we can make use of patient activists or community champions to canvass the views of their communities to ensure we can gather views at scale in a sustainable manner.
  • The Engagement function needs to be better linked into the commissioning team to identify at the earliest possible stage when ideas or themes are starting to coalesce into becoming a programme of work. This would enable us to support the work by bringing in patient voices earlier.
  • We need to identify engagement sessions earlier to make it easier to get these into the diaries of clinical leaders.