Meeting documents

Venue: Mezzanine Room 1, County Hall, Aylesbury. View directions

Contact: Liz Wheaton 

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No. Item


Apologies for Absence / Changes in Membership

Additional documents:


Apologies were received from Mr B Bendyshe-Brown, Mr C Etholen, Ms C Jones and Mrs A Cranmer.


Declarations of Interest

To disclose any Personal or Disclosable Pecuniary Interests

Additional documents:


There were no declarations of interest.


Minutes pdf icon PDF 219 KB

The minutes of the meeting held on Tuesday 29th January 2019 to be confirmed as a correct record.

Additional documents:


The minutes of the meeting held on Tuesday 29th January 2019 were agreed as a correct record.


Public Questions

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:


There are no public questions for this meeting.

Additional documents:


There were no public questions.


The Chairman reported that Bucks Healthcare Trust had responded to the remaining part of Mr Russell’s question and this had been sent to him.


Chairman's update

For the Chairman to update the Committee on recent scrutiny related activities and events attended since the last meeting.

Additional documents:


The Chairman updated the Committee on the work of the task and finish group undertaking pre-decision scrutiny on the residential short breaks (respite) proposal.


Committee Update

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.

Additional documents:


Ms T Jervis, Chief Executive, Healthwatch Bucks updated the Committee on their key areas of work, including the following.


·         The second "Getting Bucks involved" working group took place in February.

·         The main priorities for Healthwatch Bucks were mental health, adult social care transformation and the development of primary and community care.

·         A recent piece of work had just been completed around reablement where patients were interviewed to find out what they thought of the service – the feedback was generally positive.


The NHS Long Term Plan pdf icon PDF 1 MB


In January, the NHS long term plan was published.  This 10 year plan sets out the ambition for the NHS during this period.  Key areas of focus are prevention, population health, improving clinical outcomes and reducing health inequalities.  This item is for Committee Members to receive an overview of the plan and to hear how the key areas will be delivered locally.



David Williams, Director of Strategy and Business Development, Buckinghamshire Healthcare NHS Trust



Presentation attached


Intended outcome:

For Members to be reassured that the key areas of focus outlined in the NHS long term plan will be delivered locally over the coming years.

Additional documents:


The Chairman welcomed Mr D Williams, Director of Strategy, Bucks Healthcare NHS Trust.  Mr Williams took Members through the presentation and made the following main points.


·         The NHS long-term plan, published in January, mirrored the priorities already identified in Buckinghamshire.  The Plan was in response to a 3.4% uplift in NHS funding signalled by the Government.

·         As Buckinghamshire was one of the first Integrated Care Systems (ICS), its focus was already on integrated services between health and social care and working closely as a system.

·         The main task over the next six months would be to develop a plan to implement change and partners within the ICS would be working together to produce a plan by the Autumn.

·         £2.3 billion of the NHS funding had been ring-fenced for improving access to mental health services across the country.

·         60% of people living in Bucks would die from cancer or cardiovascular disease so early diagnosis was a priority.  The target to be seen and treated for cancer was 62 days – in Buckinghamshire Healthcare Trust in January, 85.2% of patients are seen within the target compared to 76.2% nationally. 

·         The stroke unit at Wycombe Hospital was nationally recognised as an ‘A Grade’ unit.  A new therapy, which would improve outcomes for a proportion of stroke patients, had been introduced in conjunction with Oxford University.

·         A second Cath Lab had opened recently in Wycombe to provide more support for cardiac patients.

·         The maternity services were well regarded, particularly in terms of continuity of care.

·         There was a focus on urgent care.  Around 30,000 patients were seen in the Wycombe Urgent Treatment Centre each year as well as the A&E services at Stoke Mandeville Hospital.  A GP streaming service had been introduced at Stoke Mandeville Hospital and this service was seeing around 50 patients a day.

·         A capital investment of £5 million had been allocated to A&E services and these changes would improve the environment for patients.

·         Reducing child obesity, smoking during pregnancy and health inequalities remain priorities.

·         The joint IT strategy was having an impact and had received significant investment to deliver more projects to improve connections with patients to the service over the coming months.

·         Within the Hospital Trust there was a 17% vacancy rate for nurses and a 5% medical vacancy rate.

·         It was hoped that the 2019 spending review would provide more funding for public health and social care in line with the aspirations in the Plan.

·         In response to a question about how priorities were set, Mr Williams explained that there was a national template for delivering services but the local needs of the population were the starting point.  The Integrated Care System (ICS) had developed a delivery plan for Buckinghamshire.

·         A Member referred to the section in the plan which outlined 4 models of funding and asked which model Buckinghamshire would adopt.  Mr Williams explained that it would be the responsibility of the ICS to discuss and agree the most appropriate funding model but he  ...  view the full minutes text for item 7.


Primary Care Networks pdf icon PDF 1 MB


As well as the NHS long term plan, the new GP contract has been published which is a 5 year framework to support the long term plan. The GP contract highlights the development of Primary Care Networks (PCN).  PCNs enable the provision of proactive, accessible, co-ordinated and more integrated primary and community care.


Representatives from Buckinghamshire GPs will present the local plans for PCNs.



Dr P Macdonald

Dr M Thornton



Presentation attached


Intended outcome:

For Committee Members to gain a greater understanding of how PCNs will work across Buckinghamshire and how this new approach will deliver better outcomes for patients.

Additional documents:


The Chairman welcomed Dr P Macdonald, Chair of FedBucks and Dr M Thornton, Clinical Director of FedBucks.


The following main points were made during the presentation and the discussion.


·         The GP Federation provides an opportunity for practices to work together to build community models of care and to work at scale.

·         The five year plan would help practices with their planning and provide stability.

·         Part of the new GP contract involved enhanced services and developing Primary Care Networks (PCNs) which were a vehicle for bolting on an integrated team and a place based care service.

·         PCNs would provide additional resilience and support for GPs and provided an opportunity for practices to work together and develop a new community model of care.  This would result in better outcomes for the patients.

·         The Networks would be made-up of around 30-50,000 population size although some networks can be larger than this and there had to be a connection geographically. 

·         One of the key advantages of the new PCNs was around additional support for the workforce. The Government had a target of recruiting 5,000 new GPs which had been very difficult to achieve.

·         There were five different areas:

o   Pharmacists;

o   Social prescribers;

o   Physician Associates;

o   Physiotherapists;

o   Community paramedics.

·         The new workforce would be rolled out across the PCN over the next 3 years.

·         The new contract included indemnity packages for GPs.

·         There were also new service specifications within the contract which focussed on the following areas:

o   Medication reviews, bringing pharmacists into the network means that more advanced medication reviews can take place which would be of particular importance in care homes;

o   Care Homes – more general practice in this setting;

o   Anticipatory care – preventing people from admittance to Hospital;

o   More personalised care for patients with specific needs;

o   Early cancer diagnosis – earlier access to diagnostic services to detect stage 1 and 2;

o   Tackling inequalities – additional funds to tackle this.

·         Would like strong patient engagement in this and there was a need to involve the voluntary sector.

·         A priority would be to look at the local population and redesign the services to meet the local needs.

·         Quality and service improvement managers would be appointed to look at what currently works and build on this.

·         In general, a positive move for GPs and better care for patients would be provided.  Opportunity to develop as time goes on as it was a 2-5 year project.

·         In Somerset, a model had been developed which resulted in a reduction of 30% in Hospital admissions.  This was due to finding problems across the whole population, better outcomes for patients, identifying problems earlier and intervening earlier to find solutions.

·         PCNs would use "Community connectors" – people in the community who are the eyes and ears and connect people with the system.

·         Single digital record will help to see the patient story.

·         In response to a question about the role and scope of the Physician Associates, Dr Thornton explained that they  ...  view the full minutes text for item 8.


Adult Social Care Transformation - Tier 1 pdf icon PDF 592 KB


At its meeting in July 2018, Members received a presentation on the progress being made in the Adult Social Care Transformation Plan which comprises three tiers of delivery.  Tier 1 focusses on "Living Independently" and has a number of work streams, including a new front door and developing a model of prevention.  This item will provide Members with progress on delivering the tier 1 projects.



Lin Hazell, Cabinet Member for Health & Wellbeing

Ms G Quinton, Executive Director, Communities, Health & Adult Social Care

Dr J O’Grady, Director of Public Health, (Tier 1 sponsor)

Ms R Carley, PMO Manager, Adult Social Care

Mr T Chettle, Head of Access, Adult Social Care

Mr L Lopes, Transformation Project Officer, Adult Social Care



Presentation attached


Intended outcome:

For Members to be reassured that the projects within tier 1 of the transformation plan are on track to be delivered on time and will be looking for evidence that this will lead to better outcomes for clients.  Members will also seek reassurance that the plans will be delivered within the planned savings.

Additional documents:


The Chairman welcomed Dr J O’Grady, Director of Public Health and Mr T Chettle, Head of Access, Adult Social Care.  This item looked at Tier 1 of the ASC Transformation Programme.


During their presentation, the following main points were made.


·         The overall aim was for people to remain happy, healthy and independent at home for as long as possible.

·         A shared approach to prevention had been developed which had been co-designed with partners and looked at the broader determinants of health.

·         Social isolation had been identified and agreed as a priority by all partners across the whole system.  All partners had been offered an opportunity to work with Public Health to help build the plan for tackling this issue.  The Integrated Care System had signed up to the shared model.

·         One of the main areas of work for this tier was around redesigning the digital front door to provide guidance, signposting and self-assessment and self-referral for Adult Social Care clients.

·         Extensive training for staff in the strength based approach had taken place and this would continue over the coming months.  More people were having their problems resolved at the front door.

·         A prototype for the community mapping project had been developed. The service had received national funding for discovery work which looks at what will work for the user.  A company had just been appointed to redesign the digital offer, including further development of the community map.  This project was due for completion by the end of September.

·         Street Association pilots had been set-up which focus on working with communities to help them build resilience and strength.

·         Social Care were working in partnership with communities, voluntary sector and other key stakeholders to co-design the community map.

·         The ambition would be to have a similar product to the Family Information Service website which brings all services and information together.  Work was currently underway with partners to create a single point of access.

·         This year, less packages of care had been commissioned which resulted in savings in tier 1.  Services were being provided differently in a more appropriate way for the client.

·         A Member suggested measuring the quality of the new service by the number of compliments and complaints.

·         Concerns were raised in relation to a lack of communication and engagement between service users and the service area.  The Chairman agreed to look into this outside of the meeting.


Action: Chairman


·         In response to a question about the use of community hubs, Mr Chettle explained that the community hubs were part of a wider County Council strategy and Adult Social Care were asked to contribute to the development of hubs, as part of the pilot.


The Chairman thanked the presenters and the Committee agreed that this item should be brought to a future meeting to review and monitor its progress.


Committee Work Programme pdf icon PDF 48 KB

There will be a private Committee work programming session at the end of this meeting to discuss and agree items for forthcoming meetings.



Work programme attached


Additional documents:


Members noted the work programme.


Date and Time of Next Meeting

The next meeting will take place on Tuesday 25th June 2019 at 10am in Mezz Room 1, County Hall, Aylesbury.

Additional documents:


The next meeting will take place on Tuesday 25th June 2019 at 10am in Mezz Room 1, County Hall, Aylesbury.