Meeting documents

RESOLVED

That Mr B Roberts be elected as Chairman of the Health and Adult Social Care Select Committee for the ensuing year.

RESOLVED

That Ms A Cranmer be appointed as Vice Chairman of the Health and Adult Social Care Select Committee for the ensuing year.

The Chairman welcomed the following new members to the Committee:

• Ms A Cranmer
• Ms I Darby
• Mr G Williams
• Mr N Hussain

Apologies had been received from:

• Ms W Matthews
• Ms L Clarke OBE
• Ms C Jones

·         Ms M Aston

·         Mrs I Darby

There were no declarations of interest.

To confirm the minutes of the meeting held on Tuesday 24^th April as a correct record.

This is an opportunity for members of the public to put a question or raise an issue of concern, related to health.   Where possible, the relevant organisation to which the question/issue is directed will be present to give a verbal response.  Members of the public will be invited to speak for up to four minutes on their issue.  A maximum of 30 minutes is set aside for the Public Questions slot in total (including responses and any Committee discussion). This may be extended with the Chairman’s discretion. 

For full guidance on Public Questions, including how to register a request to speak during this slot, please follow this link:

http://www.buckscc.gov.uk/about-your-council/scrutiny/getting-involved/

There were no public questions for this meeting.

Purpose:

This item was adjourned at the April meeting and the Committee agreed that it would continue to evaluate the community hubs as part of the Trust’s vision for developing care closer to home.

Attendees:

Mr N Macdonald, Chief Executive, Bucks Healthcare Trust

Ms C Morrice, Chief Nurse, Bucks Healthcare Trust

Dr M Thornton, GP Partner, Unity Health and Clinical Lead, FedBucks

Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Group

Papers:

Report attached – unchanged since the April meeting

Power point presentation attached – unchanged since the April meeting

Intended outcomes:

For Members to evaluate the community hubs pilot and to consider the future plans put forward by Bucks Healthcare Trust.

The Chairman welcomed Mr N Macdonald, Chief Executive, Bucks Healthcare Trust (BHT); Ms C Morrice, Chief Nurse, BHT; Dr M Thornton, GP Partner, Unity Health and Clinical Lead, FedBucks and Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Group.

The Chairman explained that this item had been adjourned at the last meeting and was being re-visited for further questions.

In response to a query regarding the number of patients using the hubs in Thame and Marlow, and the impact on the budget and current staffing levels, if the hubs were run at full capacity; the following points were made:

·         If the geographical boundaries were constrained there would be between 30,000 – 40,000 people in the Marlow area.

·         The majority of patients came from the locality of the hub.

·         Opportunities existed to make better use of the peaks and troughs of demand.

·         The next step was to offer a greater breadth of services.

·         The referrers needed to be aware of which services were provided and when they were available.

·         The "no boundary" approach would continue as it had been found that patients were prepared to travel for the right treatment.

A member of the Committee asked how patients were identified as being members of the community who would benefit by availing themselves of the community hub services and how they could be encouraged to attend the clinics.  The following points were noted:

·         Data needed to be obtained from the GP surgeries in order to identify those individuals who would benefit from being invited to attend the community hub before the GP made the referral.

·         A number of pilots had been studied and it was acknowledged it was an emerging area, making it difficult to know where to invest resources to achieve maximum benefit.

·         Individuals at high risk needed to be identified by predictive modelling through integrated work with health and social care colleagues.  The individuals would attend the hub to trial some of the services and the outcome would be measured by monitoring population health management data to see if the level of admissions reduced or at least stabilised.

·         The challenge would be to know whether the intervention had prevented admission to hospital.

·         Ms Morrice had carried out work with the community services to find out the five areas which mattered to the community. 

·         The KPIs were continually evolving and the service was being shaped to fit the local community and "one size did not fit all".

A concern was raised over the level of feedback from staff as it was felt they were instrumental to the plans.  It was acknowledged that:

·         The changes had just as much impact on staff as on patients.

·         There may be anxiety amongst some staff and this was being managed by having conversations with staff in order to help shape the future service.

·         Staff were being informed and involved in the design of the service.

·         The hubs could be an attractive option to encourage talent into Buckinghamshire.

·         The community teams had been looking at  ...  view the full minutes text for item 7.

Purpose:

This item will provide the Committee with an overview of the current GP provision in Bucks, including the challenges and opportunities in advance of a more in-depth look at this issue later in the year.

Attendees:

Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Group

Ms H Delaitre, Associate Director of Primary Care

Papers:

Power point presentation attached

Intended outcomes:

For Members to gain a greater understanding of current GP provision across the County.

The Chairman welcomed Ms L Patten, Accountable Officer, Bucks Clinical Commissioning Group and Ms H Delaitre, Associate Director of Primary Care to the meeting.

The Chairman advised that the item would be coming back to the Committee in September for a fuller discussion.  Ms Delaitre ran through the presentation and highlighted the following points:

• Primary care consisted of GPs, dentists, opticians and community pharmacies.
• There were 3 types of GP contract; the General Medical Services (GMS); Personal Services Medical (PMS); Alternative Provider Medical Services (APMS).
• The contract holders were small independent businesses and were monitored on their service delivery of the contract.
• There were 51 general practices serving 528,000 patients from 72 buildings.
• Primary Care Commissioning Committee meetings were held in public.
• GPs received a core services payment and could opt in or out of providing certain services.
• There would be a growing pressure of housing growth in the next 15-20 years and the CCG was liaising with the District Councils with reference to the impact on primary care
• Population demographics – there was an ageing population and an increase in the prevalence of long term conditions.
• Fewer GPs were choosing primary care as a profession.
• Work was being carried out to encourage GPs to work in Buckinghamshire.
• Most GP surgeries were full; support was needed for the GP practices. 
• Primary Care was part of the Buckinghamshire One Public Estate initiative and the Integrated Care System (ICS).

In response to questions the following points were discussed.

• The GPs would be encouraged to work together to share opportunities and best practice and support the emerging community model.
• The problem of persuading some GPs to move out of their existing accommodation and into new rented accommodation in order to create modern facility was acknowledged but it was the GP’s decision as an independent business. 
• People needed to be directed to the right place via 111 to avoid unnecessary visits to the A&E departments.
• It was confirmed that GPs did not gain financially for referring fewer patients but evidence suggested that GPs should refer a patient to see a specialist only when all other options had been explored first.
• The GPs funding allocation was weighted for deprived populations and areas with an older population. 
• The community hubs would take into consideration the forthcoming demographic changes. 
• The future strategy would be to co-locate GP practices with other services wherever possible.
• The commissioners were responsible for making sure the correct level of services was available to the patients.
• It was likely there would be a move to appointments being available from 8.00 am to 8.00 pm.
• Bookable appointments between 8am and 8pm weekdays would be available for all patients in Buckinghamshire by the end of 2018.
• It was acknowledged that there was a challenge with GP appointment availability.
• The definition of a GP cluster was more than one GP practice working together. 
• It had been an incentive for GPs to work together in clusters with 30,000-50,000 registered patients as there was value in close  ...  view the full minutes text for item 8.

Purpose:

The Health & Adult Social Care Select Committee carried out a review of the Hospital Discharge process and made recommendations to help improve the process across the whole health and social care system.  The final report went to the Council’s Cabinet in April 2017 and this item is an update on the progress of the recommendations at 12 months.

Attendees:

Lin Hazell, Cabinet Member for Health & Wellbeing, Bucks County Council

Ms K Jackson, Director of Operations, Bucks County Council

Ms N Fox, Chief Operating Officer, Bucks Healthcare Trust

Ms D Richards, Director of Commissioning and Delivery, Clinical Commissioning Group

Papers:

Recommendation progress table attached (12 month update)

Intended outcomes:

For Members to discuss the progress on the recommendations and to delegate the assigning of the RAG status to the Chairman of the Committee.

The Chairman welcomed Lin Hazell, Cabinet Member for Health & Wellbeing, BCC; Ms K Jackson, Director of Operations, BCC; Ms N Fox, Chief Operating Officer, BHT and Ms C Morrice, Chief Nurse, BHT

The Committee heard about the progress with the recommendations made in the Inquiry report and the following main points were made.

• Community nurses had now been linked to the Hospital wards.
• Pharmacists were now part of the Discharge team.
• Paramedics were working in A&E which was proving to be successful.
• There was a drive to build on the reablement services which the CQC had recently rated as "Good".
• Healthwatch Bucks were thanked for their hospital pharmacy project and commended for their work around improving the processes and patient experience which followed on as part of the Inquiry.

RESOLVED:  The Committee agreed to delegate the assigning of the RAG status to the Chairman.

The Chairman did not have any updates to report.

None to report.

Purpose:

For Committee Members to note the work programme and discuss future items.

Papers:

Work programme attached

The Committee noted the work programme.

The next meeting is due to take place on Tuesday 24^th July at 10am in Mezz Room 1, County Hall, Aylesbury.

Tuesday 24 July 2018 at 10.00 a.m.