Barnsley Rapid Access Clinic Service Review (updated 18 November) 

We have recently reviewed the way in which a local service, known as the Rapid Access Clinic, is provided within the community and a key part of this work is for us to gain feedback from patients, staff and clinicians of their experiences of accessing, using and referring into the service, as well as views and comments on our proposals for the future of the service.

What is the Rapid Access Clinic and who is it for?

The Rapid Access Clinic is provided at The Cudworth Centre, Barnsley, by South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) and consists of a number of services for mainly frail, elderly adults.

The aim of the Rapid Access Clinic is to enable adults living within Barnsley to be seen by a consultant in elderly medicine for tests and treatment. Patients are seen to diagnose a new illness or for support with a long term condition.

Patients are referred to attend the Rapid Access Clinic by a GP, a Community Nurse, a hospital consultant or another healthcare professional.

You may have been referred to the clinic because: 

• You have a long term medical condition(s) i.e. a condition without a cure. Examples of long term conditions are diabetes, asthma, stroke, coronary heart disease, high blood pressure and heart failure; or
• You have experienced a history of falls or be at a high risk of falls; or
• You are at a high risk of fracture to your bones; or
• You have osteoporosis which is a condition that weakens bones and makes them more likely to break; or
• You have experienced a minor TIA (transient ischaemic attack) often referred to as a ‘mini-stroke’.

Why did we set out review this service?

Demand for NHS services and an increasing older population is putting pressure on existing frontline community services and as a CCG, we need to establish whether this service provides the best value for the Barnsley Pound and achieves the outcomes for local people that it sets out to.

What did we find out?

The clinic does not provide a 'one stop shop' which means that although, a number of patients can access some simpler tests at the clinic within a couple of days of being referred, other patients may need to go to hospital at a later date for further tests.

As part of our review into the service, we found that some patients are also being referred directly to hospital without accessing the clinic first – the hospital can offer the patients additional tests.

We also found that there is an overlap between the services offered by the clinic and other existing services that are already delivered and can be accessed via other routes. 

(Further information is also provided in relation to what we found out as part of the review via the introduction to the online survey which can be accessed below)

What is our proposal?

We are proposing to stop all activity and services offered at the Rapid Access Clinic. This means that the contract to provide the clinic would be ended and services would no longer be provided at The Cudworth Centre.

As the Rapid Access Clinic does not see patients on a continuous or long term basis, we anticipate a minimal impact on patients currently using the service. In the future patients will still be able to access the same level and treatment and care as previously offered, however this care would be delivered by alternative local teams:

• Patients with a Suspected TIA can be seen at Barnsley hospital for diagnosis and support as part of an integrated TIA pathway. Patients who would have previously been referred to the Rapid Access Clinic would be referred to another service provided by the hospital and SWYPFT as part of the integrated pathways.
• Patients with a history or at risk of falling can be seen by the Specialist Community Falls Service for assessments, support and advice or by the Elderly Care Department at Barnsley Hospital (see below). Patients who would have previously been referred to the Rapid Access Clinic would be seen in the community or at hospital. 
• Patients who have osteoporosis or who are at high risk of fracture to their bones can be seen by the Elderly Care Department at Barnsley Hospital. This service has 5 full time Consultants working in Geriatric Medicine and can provide a comprehensive assessment for those experiencing problems including: frailty, falls, fractures, bone fragility and stroke.
• Patients with Long Term Conditions can be seen by specialist services established for long term conditions, for example, BREATHE for patients with COPD and the Diabetes service.

Benefits of stopping the service provided at Cudworth would avoid duplication with other services providing similar support and would mean a better use of the Barnsley Pound.

Engagement Process 

We have invited views and feedback via two dedicated surveys; one for patients who have used the service and members of the public and the other survey aimed at professionals and referrers who refer patients into the service.  We have worked with the service to write to and gain views and feedback from patients who have used the services within the last six months and we have also been visiting clinics to talk to current patients and gain their views in relation to our proposal and to help shape decision making and next steps.   

The closing date for feedback via the above surveys was 12th September. We have now collated and analysed all of the feedback received and detailed what people have told us in this summary feedback report. 

As well as being available to access the report here, we have also provided copies of this via post or email to those people who provided us with a copy of their contact details at the end of the survey.

This information has been fed back to the Clinical Commissioning Group (CCG) Governing Body to aid their decision making process and next steps regarding the provision of this service locally. 

Outcome of the review 

We have compiled a 'You said, Our response' report which explains how feedback from patients, carers and clinicians has been used to inform decision making for future plans for Rapid Access Clinic Services.   We have also provided copies of this via post or email to those people who provided us with a copy of their contact details at the end of the survey.

The engagement exercise, alongside the discussions with and additional information received from the provider has fed into the future of the service.

Following discussion and deliberation, the CCG has taken the decision to ultimately decommission the Rapid Access Clinic held at Cudworth. The decision was approved by the CCG Governing Body at their meeting held in public on 8 November 2018 and the contract to provide the service will terminate on 31 March 2019.

Thank you again for taking the time to share your views with us

Further information

If you require any further information in relation to this work, please call us on 01226 433738 or e-mail us at barnccg.comms@nhs.net using the subject header – Rapid Access Clinic Service Review.

Thank you for taking the time to provide us with your feedback, it is appreciated.