CCG backs downgrade of 'temporarily closed' A&E

A paper will go to the Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group’s board next week, proposing the permanent downgrade of Weston Area Health Trust’s A&E department.

The CCG will be asked to back closing the A&E at Weston General Hospital overnight and moving some emergency and complex surgery and critical care to larger hospital trusts in Taunton and Bristol. 

The CCG described the model as a “consultant and GP-led A&E”. The A&E would remain open between 8am and 10pm. Overnight, there would be a “strengthened GP out-of-hours” service that could refer directly to the hospital, but patients could not walk in.

The hospital’s intensive care unit would be downgraded to a high dependency unit, with no “more serious and complex emergency” care undertaken overnight. In addition, a “small number of complex emergency surgery cases” would also move to Bristol or Taunton.

Both the trust and the CCG have already expressed support for the option, but there will be a period of public consultation before any changes are enacted.

However, the proposal is already opposed by some of the trust’s consultants. A statement from a group Our NHS Our Concern, which includes some current trust consultants and a former director of nursing, said it was “disappointed and concerned” by the CCG proposal. It called on the CCG to first consider an “innovative” alternative model proposed by trust consultants that would retain a 24/7 consultant-led A&E department, with increased specialist support and ambulatory care. 

”The downgrading of emergency departments in small district general hospitals has the potential to lead to a further downgrade of high-level clinical services such as intensive care and high dependency. This further impacts of patient safety at this hospital if this vital function is also downgraded as a result of any emergency department closure.”

The trust’s A&E has been closed “temporarily” overnight since June 2017. This followed the Care Quality Commission rating the service “inadequate” and noting the hospital often had to keep patients in corridors that were “not a safe environment for emergency care and treatment”.

Since then, patients have had to travel to Bristol or Taunton if they need care overnight and for some complex procedures at any time of the day. However, the option now proposed would further reduce the complex surgery performed at the hospital and the hours in which it would be performed.

The A&E’s downgrade would include an increase in community services and routine electives offered at the hospital, including new frailty services, non-complex procedures, and mental health services.

The option picked is one of five the CCG had considered, including reopening the A&E overnight and replacing it with a GP-led urgent treatment centre. 

The CCG said 92 per cent of the people who used Weston General Hospital before the temporary A&E closure would continue to do so. It was not able to confirm whether the trust’s A&E would still be deemed a type-one A&E under the proposal.

A type-one A&E has 24/7 consultant presence, and the unit will not be open 24 hours. The CCG has said there would be a consultant presence during the day.

Local MP John Penrose, who is married to NHS Improvement chair Dido Harding, welcomed the proposal. He characterised it as a “long-awaited and hard-fought return of 24/7 urgent and emergency care to our hospital” although he acknowledged it would be “delivered differently”.

The CCG has explicitly said the A&E will not return to full 24-hour services under its proposal and patients will need a GP referral to access urgent services at the hospital after-hours. Mr Penrose has previously called for the overnight re-opening of Weston’s A&E, stating it was “essential” that it was only temporary and that the trust had “promised” him it would re-open.

CCG medical director Martin Jones said: “The preferred option we are putting forward has been shaped by doctors, health and care professionals and the public. It will allow us to deliver 24-hour urgent and emergency care in the most effective way, with a boosted out-of-hours service and greater opportunity for GPs to admit patients directly onto wards overnight.”

Trust medical director Peter Collins said: “These proposals, developed by clinicians, would allow us to continue to deliver the care people need most often at Weston General. The vast majority of current services and treatments would continue to be provided at the hospital at the times of day they are most in demand.”

The move comes after commissioners approved a downgrade of the A&E at Princess Royal Hospital in Telford, turning it into an urgent care centre.

The story was updated on 31 January to include comments by Our NHS Our Concern.