Venue: Peel Room, Bury Town Hall, Knowsley Street, Bury BL9 0SW
Contact: Julie Gallagher
DECLARATIONS OF INTEREST
Members of Health Scrutiny Committee are asked to consider whether they have an interest in any of the matters on the agenda and if so, to formally declare that interest.
There were no declarations of interest made at the meeting.
Minutes of the meeting held on the 8th December are attached.
It was agreed:
That the minutes of the meeting held on 8th December 2016 be approved as a correct record.
The Committee resolved to re-arrange the agenda; representatives from the Clinical Commissioning Group would present their plans for consultation first. The Chair will then invite questions from the public present and then questions from Members of the Committee.
Representatives from Bury CCG will report at the meeting. Presentation is attached.
Dr Kiran Patel, Chair, Bury Clinical Commissioning Group and Stuart North, Chief Operating Officer, Bury Clinical Commissioning Group attended the meeting to update Members on the Consultation exercise currently being undertaken in relation to urgent care redesign. The presentation contained the following information:
Both nationally and locally it is recognised that the Urgent Care systems are under considerable pressure and is unsustatinable. In Bury it has been recognised that there is a need for better service planning and design to facilitate urgent care services. There is already local evidence of shift in urgent care trends as services continue to evolve.
• Self Care = Patient feels able to deal with condition
• Online Advice = Internet
• NHS111 = Free self care telephone number
• A&E = Accident and Emergency Department
• PWIC = Prestwich Walk – In Centre
• GP OOHs = BARDOC provider of full GP services evenings and weekends
• 999 = Emergency Telephone Number
• Pharmacist = Option for clinical advice
• Friend/Family = Patient options for advice
• BWIC = Bury Walk-In Centre
• GP EWHs = Access to GP appointments at local hubs evening and weekends
• EDS = Emergency Dental Service
· A&E in an emergency
· Self Care
· NHS 111 (transfer to Bury Clinical and non clinical hub. Triage to the right local service and advice/appointment booked)
As a result of the engagement process there has been the following changes to the original proposals:
•To develop the Primary Care integrated model of care with our local A&E departments at Fairfield General Hospital (FGH) and North Manchester General Hospital (NMGH)
•An acknowledgement of the importance placed on the local delivery of care
•A phased implementation of proposals reflective of opinions expressed during the engagement period. Proposals to be implemented in full by 1.10.17
PUBLIC QUESTION TIME
Questions are invited from members of the public present at the meeting on any matters for which this Committee is responsible.
Luise Fitzwalter raised a number of concerns with regards to the proposals which included; lack of detail, availability of the extended hours GP service for Ramsbottom residents, dual running of services including staffing issues, problems with recruitment to GP positions.
In response to these concerns, the CCG representatives reported that a wound care service had been introduced in six different locations including Ramsbottom.
Dr Patel reported that the GP extended hours service has not been as well utilised by patients in the Tottington and Ramsbottom areas. Every GP Practice within the CCG can now access the same IT system. The Virtual Clinical Hub has been operational for several weeks and this service will eventually be rolled out across Greater Manchester. Dr Patel reported that 75% of the patients who accessed the virtual hub have been triaged without the need to refer on to A&E.
Dr Patel reported that a primary aim of the urgent care redesign is to encourage and enable patients to self care. It is hoped a less fragmented service, as proposed, with entice GPs currently working as Locum doctors to work as permanent members of staff in more integrated multi-disciplinary teams.
The Chief Operating Officer reported that the CCG are in discussions with Pennine Care NHS Trust, the provider of the walk-in centre service, with a view to potentially extending the contract at the Town Centre venue.
Richard Coates, a member of the public raised concerns in respect of plans in Oxfordshire and elsewhere, for GPs to set up private companies to charge for primary care service that are no longer provided by the NHS, including urgent weekend and evening care and some minor surgery. Mr. Coates sought assurances from representatives of the CCG, that the closure of the urgent treatment centres will not be a step towards privatisation and charging for treatment.
Responding to these concerns, representatives from the CCG reported that Bury CCG does not intend to introduce payments for these primary care services. Statutory guidance dictates that certain services must be procured. Previous governments have encouraged competition from the private sector through the establishment of Independent Treatment Centres (2008/9) and the Any Qualified Provider Scheme. Dr Patel reported that he had spoken to the Local Medical Committee and they have confirmed that they have no plans to provide these schemes privately.
Dr Patel reported that the purpose of the urgent care redesign is to streamline the service and encourage patients to self care and not to privatise the service.
Paul Gerrard, a Member of the Public expressed concerns that the plans put too much emphasis on the 111 telephone triage service, a service that has been shown to be inadequate. He also raised concerns in respect of additional pressure on already over-stretched A&E departments as well as the decision making process.
With regards to the 111 telephone service, Dr. Patel reported that there had been some concerns raised in respect of the service and in particular the use of computer algorithms to ... view the full minutes text for item HSC.534
QUESTIONS FROM MEMBERS OF THE HEALTH SCRUTINY COMMITTEE
The Chair invited comments, questions from members of the committee and the following issues were raised:
Responding to a question in respect of a newspaper article suggesting the A&E department based at FGH may be downgraded; the Chief Operating Officer reported that there are no plans to downgrade A&E and FGH will continue to provide a high quality stroke service.
Members of the Committee discussed transport arrangements; the Chief Operating Officer reported that the CCG does not have decision making powers or jurisdiction in respect of how TfGM commission services, the CCG did not speak to Transport representatives when devising the proposals.
The Chief Operating Officer reported that 76,000 patients were seen in the walk-in centre in 2014/15; 67,000 in 2015/16 and a reduction of 6,500 in the first nine months of 2016/17.
In response to concerns raised, the Chief Operating Officer reported that NHS England has encouraged a national roll-out of the 111 programme to try and simplify the process for all patients irrespective of where they live in the country.
The Chief Operating Officer reported that the wound care services is already commissioned, the virtual clinical hubs will be rolled out following the decision of the CCG in respect of the urgent care redesign.
With regards to the role played by pharmacies, Dr Patel reported that they have a key role to play in providing advice and in encouraging patients to self care.
The Chief Operating Officer reported that he recognised that sometimes those suffering with mental health problems are not always able to access the most appropriate service. Pennine Care Foundation Trust do however provide the RAID service at A&E to help and support patients in distress.
With regards to an alternative proposal in respect of the Urgent Care Redesign; the Chief Operating Officer reported that if such a proposal is presented that the CCG have an obligation to consider it.
In response to confusion with regards to the commencement date of the consultation, the Chief Operating Officer reported that the consultation commenced on the 8th February 2017. Building on the already undertaken engagement exercise the consultation will include two public meetings and surveys will be available in GP surgeries, Libraries and Council buildings.
To clarify, the Chief Operating officer reported that at a CCG Board meeting an audience member proposed a vote of no confidence in the CCG Board, members of the public voted and the proposal was supported by members of the public present. The vote however has no constitutional basis. The Chief Operating Officer reported his concern that a representative from the Health and Wellbeing Board is appointed to sit on the CCG Board, but does not attend Board meetings.
The Chief Operating Officer reported that he welcomes the scrutiny of the urgent care redesign proposals and would want to see the same level of scrutiny from Committee members in all areas of the health and social care economy.
Responding to these comments, Councillor Kerrison acknowledged and accepted the need ... view the full minutes text for item HSC.535