An update on changes to community phlebotomy services, including recent revisions to the arrangements in the Cirencester area.
Mary Hutton, (Accountable Officer for Gloucestershire NHS CCG/Lead Officer for One Gloucestershire Integrated Care System ICS), referred members to the report on Community Phlebotomy Services.
In response to the public representation made by Mr Marco Taylor at the September committee meeting, (and to the public representation made by Mr Taylor at this meeting), the committee received an update on community phlebotomy (blood testing) services. The purpose of the update was to brief members on the rationale for making changes to community phlebotomy services in Gloucestershire, including recent revisions to the service arrangements in the Cirencester area.
Referencing a review of service provision in 2019, (involving consultation with GP’s across the county), followed by updates to the committee in March, July and September 2020, members were advised that, prior to the recent changes, community phlebotomy services had been provided in a range of settings/locations across the county, including ‘drop in’ hospital clinics and at GP practices. Blood tests can be requested by a range of clinicians, including GPs and by hospitals based clinical teams.
Before the changes, some patients had been able to access local phlebotomy services at local GP practices, whilst other patients had to travel to a hospital setting to receive a blood test. High levels of demand within hospital settings had resulted in long waiting times for many patients. On occasions, services had to close earlier than scheduled in order to manage the high volume of patients requiring tests, with some patients having to revisit the hospital at a later date.
To address the situation, the CCG had endeavoured to make improvements to the provision of phlebotomy services with the aim of ensuring all patients had timely access to a safe and high quality community service at a location as near to their home as possible and, in doing so, providing a consistent service across the county.
Following changes introduced over the summer, blood tests generated by a GP or Practice Nurse continued to be provided by primary care services, whilst blood tests generated as part of a hospital outpatient appointment was now the responsibility of the hospital managing the patients care.
The CCG had funded all 73 Gloucestershire GP Practices to start the provision of phlebotomy services for patients requiring ‘primary care requested’ blood tests from 1 July 2020 (1 August 2020 in Cirencester). Acknowledging specific issues affecting the Cirencester area, additional temporary arrangements had been put in place, (to be supplemented by additional permanent arrangements from 2 December 2020).
A consequence of the changes had been a notable increase in CCG spending on community phlebotomy services. Furthermore, in response to the Covid-19 emergency and the need for social distancing requirements, some appointments were taking longer than anticipated.
Members were advised that, prior to the changes, the total demand for providing phlebotomy services at the Gloucestershire Royal, Cheltenham General and Cirencester Hospitals, had often been so great, the resources available for providing the services had been significantly overstretched.
GP practices now had their own in-house phlebotomy capacity from which to manage community phlebotomy needs, allowing hospital based phlebotomy services at Gloucestershire Royal and Cheltenham General Hospitals the ability to better manage outpatient secondary care phlebotomy demand successfully. A reduction in the footfall at each site allowed the county’s Acute hospitals to provide a COVID-secure service, a factor which might not have been possible prior to the changes.
For patients accessing GP requested blood tests at local GP practices, there was no change. The only change was that the GP practices were now remunerated for providing blood testing services. For patients who had previously been required to use hospital ‘drop in’ phlebotomy clinics for GP requested blood tests, it was hoped the move to the new service model, (provided by GP practices), would help reduce travel and waiting times, and avoid hospital car parking charges.
In addition to the changes to community phlebotomy services, separate, additional changes had been made to the secondary care phlebotomy services provided at the Cirencester Community Hospital. New arrangements allowed patients to book secondary care blood tests at the hospital if required by a consultant. It was acknowledged that these changes had resulted in some patients having to travel further for secondary care requested phlebotomy appointments where GP practices had been unable to accommodate urgent requests. Whilst some GP practices had adapted to the changes more quickly than others, this had not been the case in all areas. With the added impact of the Covid emergency on recruitment issues and supply issues creating a significant backlog, the service provision in the Cirencester area had taken longer to set up than in other areas.
In response to concerns about accessing services in the Cirencester area, the Hospitals NHS Foundation Trust had quickly reinstated a bookable Monday morning phlebotomy clinic at the Cirencester Community Hospital for patients needing blood tests as part of consultant outpatient care. This service had been extended to providing two bookable morning clinics a week from 12 October 2020.
From 2 November 2020, the Gloucestershire Health and Care NHS Foundation Trust had assumed overall responsibility for providing phlebotomy services at Cirencester Hospital, allowing patients aged 16 and over, where their consultant required them to have a blood test, to access the service three days per week (Monday, Tuesday and Friday). It was hoped this service would be expended to five days a week from December 2020.
To manage resources effectively and to ensure safe social distancing measures, this service now offered a bookable (virtual) service for patients to make appointments via a dedicated booking line (0300 421 6215) on each weekday between 9am and 3pm.
Due to Covid-19 arrangements, there had been a significant increase in the demand for blood tests within primary care, including blood tests for oncology patients and patients with long term conditions, (not covered by the CCG GP funding). This rapid increase in demand had seriously impacted on the phlebotomy service capacity within primary care.. Acknowledging members concerns, it was confirmed that work was underway with partners from the Integrated Care System (ICS) to develop a more sustainable and countywide approach to delivering phlebotomy services.
The NHS CCG was confident that, overall, phlebotomy services across the county would benefit from the changes and provide a better experience to patients.
In response to the briefing, several members remained resolute in their concerns about phlebotomy services, particularly in the Cirencester area. One member emphasised the challenges of accessing services at Gloucester and Cheltenham hospitals when having travel from a rural location. Another member suggested that the changes had been completely un-satisfactory and needed to be reviewed. One concern was the need for reliable evidence, with a request to include performance indicators and data to support the narrative in update reports. The request was noted.
Questioning the use of government funding to fund GP’s, members also questioned the timing of the changes, (during the pandemic), and whether the funding could have been put to better use. A key issue raised by several members was the lack of consultation on the changes. Other members stated they had not experienced any issues in the services provided by GP practices and enquired why Cirencester had been so affected. One member commended the efficiency of the service from personal experience.
Responding to the comments, Dr Andy Seymour, (Clinical Chair at CCG/ISC), reiterated the impact of the pandemic on service provision and the challenges presented in recruiting experienced staff to support the changes to phlebotomy services. He confirmed that the changes would continue to be monitored and that a full review would be undertaken after the Covid-19 emergency.
Mary Hutton reported a reduction in the number of complaints about phlebotomy services across the county, (with the exception of the Cirencester area), and was confident this would continue going forward. To unpick the changes at this stage would be detrimental.
Commending the robustness of the discussion and acknowledging the strength of concern from some members of the committee and from members of the public from the Cirencester area, it was agreed that the committee would receive further updates on the changes to phlebotomy services in 2021. Action by – NHS GCCG