Back in 2000.the Labour government had a vision of a network of Walk-In Centres [WiC]- and so more than 230 centres offering family doctor services were set up in England in the decade to 2010 to improve access to primary care for patients who found it hard to register with their local GP or were unable to get a speedy appointment at a time that suited them.
They used to be managed by Primary Care Trusts (PCTs), but since April 1 2013 this role falls to Clinical Commissioning Groups (CCGs).
NHS walk-in centres now offer fast and convenient access to healthcare advice and treatment for minor injuries and illnesses.
They help anyone whose modern, busy lifestyle, or practical circumstances and particular needs, make flexible and accessible services so important.
They offer patients MORE choice – they were NOT introduced to replace local GP or hospital services but complement existing local services.
Over the years, NHS Walk-in Centres have played a vital and successful role in enabling people to access care and relieving pressure on A&E.
The centres deliver primary care differently from the traditional way in which general practitioners (GPs) provide primary care services to patients who register with their practice. The Walk-In Centres allow patients to access care from a GP or a nurse with no need to register or to pre-book an appointment. The centres are open for longer hours than the typical GP practice, including after normal working hours and on weekends, and are situated in convenient locations, giving patients access to services outside regular office hours.
Walk-In Centres prove to be popular with the public. Attendances at many centres have exceeded expected levels, with around 7m attendances at type 3 A&E services (i.e WiCs, Urgent Care Centres and Minor Injury Units) in England, dealing with minor illnesses and injuries.
Yet Walk-in Centres across the contry are now being closed. To me it is a huge concern that a quarter of walk-in centres have been closed since 2010. Where they are well used and valued, they should be retained.
In many more localities where walk-in centres still operate, commissioners are reviewing contractual arrangements and are considering closing the centres or making changes to services or locations.
So what’s the current situation in Exeter?
We currently have 2 Walk-in Centres 1.2 miles apart – one in Sidwell Street and one at the Royal Devon & Exeter Hospital (RD&E), next to the Emergency Department.
These provide services in different ways.
At Sidwell Street, patients can turn up at the centre to use the service, which is led by nurses.
– Mon – Sat: 8am – 4pm; Sun: 10am – 4pm
– Sees approx 21,000 patients annually.
– Costs approx £800,000.
– Staffed by nurses, with access to the doctor at the RD&E WIC.
At the RD&E site, patients must all go via the Emergency Department and be triaged before accessing the Walk-In Centre [so in fact at RD&E, patients cannot just walk-in to that particular Walk-In Centre!]
– 7am – 11.30pm, 7 days per week.
– Sees approx 28,000 patients annually.
– Staffed by nurses, plus a doctor on some shifts.
– Costs approx £1.1million.
Back in June 2013, I attended one of a series of meetings organised by NEW Devon CCG to discuss various options for Exeter’s Walk-in Centres [and I wrote about the meeting for Exeter Daily, The Future of Exeter’s Walk-In Centres].
The PowerPoint slides and Q&A summarised by Dr Hamish Duncan can be downloaded from a link HERE.
NEW Devon CCG intend edto look at the areas that needed more research and planning to see if they could overcome the issues highlighted and put together a proposal for a valid, safe, sustainable WIC provision that provides excellent, high quality and affordable care to the people of Exeter and its surroundings.
Local MP, Ben Bradshaw has long been worried about the future of Sidwell Street WiC in particular, even to the extent of raising it at Prime Minister’s Questions on 05 November 2014.
Q5.  Mr Ben Bradshaw (Exeter) (Lab): People in Devon face being denied operations if they are overweight or smokers, as well as the loss of all fertility treatment, cataract operations restricted to just one eye, and the closure of Exeter’s very successful walk-in centre, all because of the unprecedented financial crisis facing my local NHS. Does the Prime Minister still think that his massive and costly reorganisation has been a success?
The Prime Minister: What we did by reducing the bureaucracy in the NHS is save £5 billion in this Parliament. That is why, nationally, there are over 8,000 more doctors and 2,500 more nurses. We have been able to do that only because there are 20,000 fewer administrators in the NHS. Those are the figures.
Mr Bradshaw indicated dissent
The Prime Minister: The right hon. Gentleman may shake his head, but those are the figures. His local clinical commissioning group is getting an £18 million cash increase in the next year, and it is going to get an additional £19 million through the Better Care fund, so locally there should be improvements in services rather than the picture he paints.
I love the way Hansard puts it – Mr Bradshaw indicated dissent!
[Express & Echo Exeter MP Ben Bradshaw questions move to ‘close’ NHS walk-in centre 08 November 2014]
The Sidwell Street Walk-In Centre in particular has faced difficulties since that CCG meeting – in March 2014, it saw its opening hours reduced by around 20% a week due to staffing issues, including vacancies and the difficulty in recruiting to a service that is under review [Express and Echo: Future of Exeter’s walk-in centre dealt another blow, 29 April 2015].
Now it looks as though, the cash-strapped NEW Devon CCG have come (or very close to coming) to a decision on the future of Sidwell Street WiC.
The meeting of Eastern Locality Board held on 27 May 2015 [Download from link HERE] discussed urgent care in the community, along with in-patient care where delivery will require reconfiguration of community services.
The CCG proposed to set up nurse led urgent care centres in Exmouth, Exeter, Tiverton and Honiton with consistent opening hours offering a wider range of care, and a Minor Injury Service in Okehampton and to commissioning minor injury services from GP surgeries where it makes sense to do so to ensure appropriate access.
The urgent care tender is presently underway and the final model has not yet been decided and is pending further national guidance on urgent care centres and provider proposals.
The hope is that such a Devon-wide service will be a consistent, more responsive service where the overall urgent care systems are better integrated to meet the needs of the whole population.
But that still makes me fearful of the future of Sidwell Street WiC – and I seems I’m not alone. Other local people think it’s essential for the community and have used 38 Degrees to set up a petition to save it.
“We the undersigned believe that the Sidwell Street Walk-in Centre is an essential and well-located NHS facility in the centre of our city. We demand the Clinical Commissioning Group to keep it open”
There is a paragraph on why people think this is important:
The NHS Walk-in Centre in Sidwell Street, Exeter is centrally located, which makes it very accessible to everyone living in Exeter. It is open from 8AM to 4PM every day (10AM-4PM Sundays) and is available to everyone in the community, whether or not registered with a GP – on a drop-in basis. This means there are many users, including young people to whom it provides a unique point of access to NHS healthcare services, without which they would have none. It also takes pressure off already stretched A&E. We want the CCG to commit to keeping this service open for the future.
And the Express & Echo have highlighted the campaign: Campaigners fight to save Exeter’s NHS walk-in centre [08 June 2015].
Running alongside the local concern about Exeter’s WiCs, there has been some consternation at national level, with NHS regulator Monitor carrying out a review of Walk-In Centres in 2013/14.
Monitor said the closure of 53 popular clinics could “leave vulnerable people unable to access GP care” and “will put more pressure on A&E” [see Further Reading below for the full details].
Monitor said some GP practices were referring patients from their own list to walk-in centres because they were unable to provide them with a speedy appointment. “This suggests some practices are using the centres to meet the needs of some patients for whom they are paid to provide primary care, rather than responding to what these patients want.”
Monitor said there may be perceived conflicts of interest if a clinical commissioning group (CCG) – a clinician-run organisation that purchases care for its local area – opts to close a walk-in centre then uses the funds to buy services from CCG member GP practices.
Although some commissioners claimed there had been no increase in demand for GP services and no complaints when a local walk-in centre had been closed, Monitor said there had been no formal post-closure evaluation to assess the impact on patients.
And the situation is futher complicated because of the Review of Urgent and Emergency Care commissioned in 2013 by Sir Bruce Keogh – in June 2013, a set of Emerging Principles was published. These seem to ignore the convenience of current Walk-In Centres.
The latest update [August 2014] seems to require getting the NHS 111 service up and running properly before turning it’s focus on a delivery model for urgent and emergency service.
Monitor Walk-In Centre Review: Preliminary Report (November 2013) Publication code: IRREP 23/13
Monitor Walk-In Centre Review: Responses to our Preliminary Report (February 2014) Publication code: IRRES 01/14
Monitor Walk-In Centre Review: Final Report and Recommendations (February 2014) Publication code: IRRES 02/14
Monitor Advice and Recommendations for Commissioners: Deciding the future of Walk-In Centres (February 2014) Publication code: IRRES 03/14
Healthwatch Devon Exeter Walk-In Centres (November 2014)
NEW Devon Clinic Commissioning Group Response to Survey by Healthwatch Devon – Exeter Walk in Centres (November 2014)