Meeting documents

Apologies for absence were received from Mr S Adams and Mrs P Birchley.  The Committee noted that Mrs A Davies was permanently replacing Mrs M Baldwin for this Meeting.

To declare any personal and prejudicial interests

There were no declarations of interest.

of the meeting held on 13 April 2007 to be confirmed as a correct record

The Minutes of the Meeting held on 13 April 2007 were agreed as a correct record.

The Strategy for Buckinghamshire

The overarching theme of this month’s meeting focuses on Community Services.

The newly appointed Director of System Reform at Buckinghamshire Primary Care Trust (PCT) will set the scene to support the strategy outlined in the White Paper ‘Our Health, Our Care, Our Say’ that focuses on the need for an increased  number of health care services based in accessible community settings. Within this context, he will provide a broad strategic outline of the PCT’s plans for Buckinghamshire that will start the process to deliver this vision.

Richard Mills Director of System Reform

Buckinghamshire PCT

Richard Mills, Director of System Reform, Buckinghamshire PCT, gave an informative presentation on the PCT’s plans to provide an increased number of health care services based in accessible community settings.  A copy of the slides was circulated with the agenda papers.

After the presentation the following points were made through questions asked:-

Community Hospitals

• Members were delighted that an early commitment had been made to secure the future for the existing five community hospitals in Buckingham, Chalfont and Gerrards Cross, Marlow, Thame and the Waterside Unit.
• A Member referred to A&E Department in Buckingham Hospital, which had short waiting times and prevented people attending Milton Keynes Hospital. He commented that this hospital was crucial to residents north of Aylesbury, particularly bearing in mind the increase in housing growth expected in the near future. Linda Sharkey reported that this Hospital was very successful and that a proper analysis of trends would be made to define what services should be provided at the Hospital to give maximum benefit to the local population.
• Members noted that there had been a press release telling people that the community hospitals were not going to be closed but felt that this needed to have wider coverage, as they had not been aware of the press release. Members agreed to let Richard Mills have any ideas on the best way to give reassurance to the public for example one Member suggested using the Getting Closer to Communities Cluster Groups.

Chesham Healthzone

• Concern was expressed about the delivery of the Chesham Healthzone as the present two GP surgeries in that area were becoming very cramped. The PCT were currently looking at the quickest way of delivering this Service and joining up with a partner who had a good range of experience in building these Schemes. The existing plans had been drawn up two years ago and outline planning permission had been obtained. Full planning permission was now required. A timeline for the Project was being drafted and it was agreed that this would be circulated to the Committee once it had been finalised.

Action Richard Mills

Health Care Staff

• A Member queried the importance of school nurses who could pick up health problems in young people at an early stage e.g eating disorders. There was now a shortage of school nurses. Richard Mills commented that as part of the Community Strategy they were planning to review the work of health care staff to ensure the most effective use of their skills. It was important to look at the bigger picture of health care and prevention and also influencing the children and the parents to lead a healthier lifestyle.

Provision of Services

• In relation to rural areas, there should be more emphasis on services rather than planning them around buildings. There were some real issues about rural deprivation and services need to be planned in an imaginative way with more partnership working.
• Richard Mills explained that this whole Strategy was about reversing the trend away  ...  view the full minutes text for item 4.

The Chairman of the GP Collaborative, United Commissioning, based in Aylesbury Vale, will outline the principles underpinning  Practice Based Commissioning. The committee will hear how GPs will work together and alongside NHS trusts and local partners to identify patients’ needs, agree priorities and plan service delivery in the local community.

Dr Johnny Marshall Chairman United Commissioning

Dr Johnny Marshall, Chair of United Commissioning gave a presentation on the principles underpinning Practice Based Commissioning and how GPs were working alongside NHS Trusts and local partners to identify patients’ needs and to agree priorities and to plan service delivery in the local community. A copy of the slides was circulated with the agenda papers.

After the presentation the following points were made through questions asked:-

• A Member expressed concern about the location of some GP surgeries. She gave an example of an area in High Wycombe where there were a number of surgeries very close to each other, but there was a large residential area up a large hill, which did not have a GP surgery. Therefore access to a surgery for elderly residents was particularly difficult. In response to this it was noted that it was difficult getting a balance between providing quality services and local access. Dr Johnny Marshall reported that one of the mechanisms used by United Commissioning was a Peer Review, which should redefine standards of care. Richard Mills commented that there might be ways the PCT could help in this area. The Chairman suggested it would be helpful for the PCT to review the map of GP surgeries in the area.

Action: Richard Mills

• Concern was expressed about providing rehabilitation services at home. Dr Johnny Marshall referred to international evidence that the quality of care at home was the same as in an acute setting where highly trained professionals were provided. Linda Sharkey informed Members that she would be happy to talk at a future meeting on the integrated care model for rehabilitation. She referred to stroke patients as an example.

Action: Linda Sharkey

• A Member referred to the Haddenham Health Centre and how that could be better used, particularly for accident and emergency work out of normal working hours. Dr Johnny Marshall reported that they had been discussing how to avoid using A&E at hospitals but this required careful consideration of having the right resources (especially equipment, and skills) to provide these in the local community and how this was managed. In relation to consultants coming out to Health Centres, consultants needed to be able to deal with patients effectively and safely with all the facilities they required. This needed to be considered in relation to the reconfiguration of services and which services were best provided locally. Some consultants were in favour of delivering services more locally, but these consultants tended to be specialists in those areas, which were more suited to local services. Good partnership working was the true test.
• There was pressure to provide larger surgeries but this needed to be balanced out against patient choice.

The Chairman thanked Dr Johnny Marshall for attending the meeting and for his excellent presentation.

In response to the staff consultation paper released in August 2006, the Director of Provider Services for Buckinghamshire PCT will provide the Committee with an update on the range of PCT Provider Services and current staffing levels. Concerns regarding potential cuts to services in the context of the current financial constraints will be addressed.

Katie Donlevy Director Provider Services PCT

Vicky Aldred, Head of Provider Services Development, PCT provided the Committee with an update on the range of PCT Provider Services and current staffing levels. A copy of the slides was circulated with the agenda papers.

After the presentation the following points were made through questions asked:-

• The reduction in whole time equivalent staff from April 2006 to March 2007 was 115. A Member asked how many of those staff were administrative. It was agreed that this information would be sent to Members.

Action: Vicky Aldred

• It could be argued that the PCT was currently under resourced in management terms as good management is vital to the delivery of high quality clinical services.
• Out of county services meant tertiary referrals that were not provided within Buckinghamshire.
• In relation to the reduction in after hours nursing care it was noted that this was being reworked to target appropriate skills to meet current demands. A blanket service had been provided before but this was not equitable across the PCT. Further details on this area would be provided to Members.

Action: Vicky Aldred

• Concern was expressed that one GP surgery was not providing patients with information about carer groups and Vicky Aldred agreed to look into this issue.

Action: Vicky Aldred

The Chairman thanked Vicky Aldred for attending the meeting.

The Forum Support Officer will update the committee on key patient issues arising from the forum’s current work programmes.

The Committee noted the update and summary of the work of the PPIF for each of the NHS Trusts. In addition to the report Members noted that an assessment was being undertaken on patient transport services and voluntary drivers. The Committee needed to consider how they wanted to be involved in this issue.

An opportunity to update the Committee on relevant information and report on any meetings of external organisations attended since the last meeting of the Committee.  This is particularly pertinent to members who act in a liaison capacity with NHS Boards and for District Representatives.

The Committee noted the following information:-

• The Strategic Health Authority was hosting an event called ‘Maternity Matters’ on 5 June 2007.
• Mrs P Bacon gave a report on the meeting of the Oxfordshire and Buckinghamshire Mental Health Trust Board meeting. A copy of the notes of the meeting would be circulated to Members.
• Sir J Horsbrugh-Porter gave a report on a meeting he had attended - Primary Care Trust Meeting on 8 April 2007.
• The future of Wexham Park Hospital was being addressed over the next few months and would need to be looked at by the Committee.
• The Policy Officer referred to an Awareness Day with regard to Eating Disorders, which had been instigated by the Review undertaken by the Committee.

1 June 2007 – 10am

The date and time of the next meeting is 10.00am on Friday 1 June 2007.