Chesterfield Royal Hospital bosses call for health care shake-up - as NHS faces unprecedented pressure across the country

The NHS is under increasing pressure, with record waiting lists, extended ambulance delays and rocketing flu patient numbers. Nine in 10 NHS hospitals are dangerously busy in England, latest figures show.

Just days before the end of 2022 the Royal announced two critical incidents as the services were overwhelmed by the unprecedented number of patients.

As of January 1, 96% of the hospital’s 546 beds across adult and paediatric general and acute wards at Chesterfield Royal Hospital NHS Foundation Trust were occupied, including all of the 16 critical care beds .

Chief Executive at the Royal Chesterfield Hospital Dr Hal Spencer said: “We had high pressure on our emergency department and inpatient wards and beds. We stood down some of the outpatient clinics and routine appointments to free up the doctors and nurses to help to work in the emergency department and on the wards. We kept the hospital safe and continued with emergency work and cancer treatment.

“We've got some really fantastic staff at Chesterfield Royal Hospital, and I'm really proud to be working with them. Over the last two weeks, they have been working very hard and really went above and beyond.

“However, standing down our non-urgent activity is a short-term measure. In the medium term, we need to do things differently as a system. Chesterfield Royal Hospital has unique links with primary care – through our Royal Primary Care division - and that has great potential to help going forward. If patients could receive the help they need in general practice and in the community, they wouldn't need to come to the hospital.”

Royal Chesterfield Hospital has been working on its links with primary care since 2015 when Royal Chesterfield Hospital stepped in as a caretaker for a large practice, which got itself into real difficulty. It acted as a caretaker before eventually taking over the contract at the request of NHS England.

Dr Peter Scriven, Divisional Director of Royal Primary Care, said: “If CRH hadn't stepped in, there would have been a primary care catastrophe in Chesterfield. The board took a big bold step at the time and what they did wasn't without risk. But they really made a massive difference to the stability of primary care.”

What started as one contract, has grown over time as more GP practices have joined Royal Primary Care. Now it comprises six sites in Chesterfield – Grangewood, Inkersall, Staveley, Ashgate, Holme Hall and Whittington as well as two in Clay Cross – Clay Cross and Grassmoor and one in Heanor – Brooklyn and provides primary care services for around 44 000 patients, offering over 11k appointments per month.

Dr Peter Scriven said: “That's quite unusual because usually the contract for primary care is held by a GP partnership. The advantage of being part of the CRH family is that hospitals have a really high standard of governance and accountability for business operations. It means our doctors can be doctors and our nurses can be nurses instead of trying to manage a business.

“There's a few hospitals that have bits of primary care, but we're much more closely linked. I don't know of any other hospital in the UK that has primary care in quite the same way that Chesterfield does.”

The close links between Chesterfield Royal Hospital and primary care has allowed more flexibility during the critical incident, helping to manage the patients better.

Dr Hal Spencer said: “Current situation is difficult not only in Chesterfield but across the UK. Primary care doesn’t get any special advantages but because we are a bigger organisation, there's a little bit more flexibility to move doctors, nurses and the administrative staff around different practices within RPC in order to keep our services going.”

Dr Peter Scriven added: “The number of GPs has declined over the last decade and continues to slide quite steeply. That’s why we need to innovate and Royal Primary Care is right at the point. We've got a brilliant team and a wide range of health specialists including Practice Nursing Team, Specialist Mental Health Practitioners, Advanced Nurse Practitioners, GPs and in house pharmacists who can do medication reviews. They are all fabulous.”

“But there's a lot that the general public can do to help. The very important message to the patients for 2023 is to use the services wisely. We can all play a part in helping the NHS get through a challenging time, by being sensible with what services we use. GPs are experienced doctors with a very different skill set to hospital doctors and identifying who needs to go up to the hospital and who doesn’t is crucial.”

Working on developing more links between the hospital and other local care providers is one of the main aims Royal Chesterfield Hospital has for 2023.

Dr Hal Spencer said: “ We need to make sure that the patient who needs help is getting the care they need in a timely way and at the right place. Lots of that depends on breaking down the barriers between primary and secondary care.

“It is a priority for the coming year to be working more closely with the whole joined-up Derbyshire care system -social care, neighboring hospitals, Derbyshire community health service and primary care. We’re not isolated organisations will because we're all working together for the same themes and aims.”