Meeting documents
Document: | 2003-01-08 SCRUTINY COMMITTEE LEISURE, SAFETY AND HEALTH |
PRESENT: Councillor Mrs Pearce (Chairman); Councillors Baldwin, Cadd, Chapple, Ghent, Lehmann, Mohammad, Searle, Sherwin (in place of Jones) and Mrs Smith. |
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APOLOGIES: Councillors Mrs Hannelly, Isham and Searle. |
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The Committee received evidence from a team representing the Vale of Aylesbury Primary Care Trust (PCT). The PCT team addressed the Committee, beginning with details of changes to the provision of health services over recent decades which had led to the creation of the PCT. In the early 1990s the Conservative Government had created the General Practitioner (GP) fund-holding project with the intention of connecting GPs' actions with consequences. The original project had given GPs control over approximately one third of their total budget. The project was later expanded to allow GPs to take control of 100% of their budget, which had led to the establishment of Primary Care Groups (PCGs). PCGs had since become PCTs. |
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The most recent Government proposal was for the establishment of Care Trusts (CTs), which would effectively merge PCTs and Social Services. The PCT team illustrated this policy trajectory for the Committee, emphasising that the fundamental rationale motivating such changes was the idea of engaging doctors, nurses, etc. with the management of health services. |
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The Vale of Aylesbury PCT (VAPCT) covered the area of the Aylesbury District plus Princes Risborough and Thame and was one of four PCTs in Buckinghamshire. VAPCT currently employed around 575 full time GPs, plus approximately an additional 3 associated staff per GP. The total budget of VAPCT was about £150m, although GP budgets were still held and allocated directly by Central Government. The majority of patients covered by VAPCT went to Stoke Mandeville for treatment, although it was common practice to utilise services at Wycombe General Hospital, John Radcliffe Hospital, Oxford and London Hospitals. |
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The aims of the PCT were:- |
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The PCT was managed by two distinct bodies:- |
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The PCT team concluded its presentation and debate ensued in relation to the issues already covered and wider issues within the context of this Scrutiny Review. |
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With further reference to the creation of CTs, the PCT team confirmed that so far only three or four of these had been established nationally, but that although this was the current trajectory of health service provision and that VAPCT had been in discussion with Social Services, such a decision was not due to be made within the foreseeable future. |
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Discussion turned to the current funding arrangements for the PCT and whether funding was allocated based on retrospective population figures or whether account was taken of potential population growth. Members expressed concern regarding the projected growth of the Aylesbury Vale population in the coming few years and a resulting possibility of a shortfall in not only funding for health services but also in the number of workers (including doctors) available to cope with the likely growth. The District Council was keen to identify any way it could help to reduce the impact of the growth on the health services. |
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The PCT team explained to the Committee that the existing formula for calculating PCT funding was complex. The formula was based on population, adjusted for certain indices (including population age, gender, etc.), but was always set retrospectively year-on-year using the previous years' population figures. VAPCT had established a Primary Care Capacity Planning Group to look specifically at areas such as projected population increases and the PCT, with its partners, would achieve its vision while also coping with changes. This was a multi-agency/multi-profession group and the Forward Plans Manager represented Aylesbury Vale District. Although this group was relatively new, it had already performed a stock take and had looked at Major Development Areas, death rates, investment in local staff and taking forward national frameworks. The Group had also focussed on the unprecedented problems experienced regarding recruitment of GP's, as well as the probability that a high proportion of existing staff would retire within the next 5 to10 years. Another workforce issue was the fact that Buckinghamshire had the lowest access to NHS dentists in England and that patient complaints had trebled in the past 3 months. The biggest problem that had been identified in increasing the number of dentists in Aylesbury Vale was the ability to find premises, which it was later noted was more the result of finding a landlord willing to lease a property for the necessary length of time, than planning constraints. Having considered the key issue of how best to provide health services for a growing population the Capacity Planning Group had begun to focus on a more integrated health service (i.e. a “one-stop-shopâ€Â). |
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The difficulty of funding based on retrospective population figures was noted and it was commented that with an unquestionable major influx of residents due in the coming years as a result of MDAs, the Government must be made aware of the need to have adequate infrastructure in place. This would necessitate firstly ensuring that the health service was performing well within the existing demands. |
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With regard to recruitment issues Members sought clarification of whether the difficulty in filling vacant GP posts was a local or national problem, how many vacancies currently existed, what initiatives were being undertaken in order to fill posts and how many GP lists were currently full in Aylesbury Town and in the Vale. In response, the PCT team informed the Committee that the NHS was never funded to the level it wished. GPs and staff were funded separately by Central Government and were not, to the knowledge of the PCT, cash limited. Unfortunately, with regard to the number of GPs in Aylesbury Vale, the Thames Valley (which included Bucks, Berks and Oxon) had been measured as having more than its quota of GPs per capita. This, it was stressed, was mainly the result of a higher number of GPs than was necessary practising in Oxfordshire. Overall, however, recruitment difficulties were a national problem that was caused by an increasing number of trained practitioners opting not to go into General Practice. |
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VAPTC had been proactive in attempting to resolve this issue and had, in particular, made a noticeable improvement in its provision of development opportunities. There had been only one vacancy for a GP in the Vale which had been problematic to overcome. The PCT was currently seeking to fill three and a half vacancies over four practices. Only one practice within the VAPCT area had a closed list, although some were struggling and one other list been temporarily closed. Allocations of new patients to a practice were aimed to be achieved within 48 hours. It was hoped that although bringing a major influx of new residents to the District, the MDA would also provide housing that would attract new Doctors, nurses, etc. into the District. |
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The possibility was raised of providing a bursary scheme to improve recruitment to the VAPCT area or provide similar assistance at the appropriate time in a GP's training. The PCT team responded that every effort was made to recruit along these lines and that vacancies had been filled in the past as a consequence of the PCT funding the training of the applicants, but that, as always, the ability of the PCT to do this was restricted by the availability of finance. It was indicated that there might soon be a new GP contract that might improve recruitment and retention. |
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Discussion moved briefly towards any specific needs or areas of deprivation within Aylesbury Vale and what the PCT priorities were in this respect. The Committee heard that the PCT had identified the areas of deprivation and were targeting services accordingly, but that local priorities and national priorities were not always complementary. Consequently, as well as not always having the funding required, PCTs often lacked the control over funding that they would like in order to address local priorities. |
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Reference was made to the budget deficit that the PCT had inherited and its likely impact on the future work of the PCT. The PCT team confirmed that this original budget deficit had been a cause for concern, but had, however, subsequently been dwarfed by more recent deficits (e.g. a prescribing deficit) which had created an even more restrictive set of circumstances. The outlook appeared serious, especially in view of some major government targets that PCTs were being asked to achieve. While acknowledging that the Government was investing a lot more money in the NHS in the next financial year, the PCT was careful to emphasise that, relative to the Health Service investment in Europe, investment in the NHS in the UK had been declining for 30 years. The PCT assured the Committee that the situation was now being addressed and that services were taking steps to reduce their deficits. |
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With reference to the ability of hospitals to cope with a potential population increase of 10,000 people between now and 2016, Members were informed that, based on the PCT's planning, the Private Finance Initiative (PFI) in Stoke Mandeville, due to be completed by 2005, in conjunction with other planned changes meant that AVPCT health services should cope with the known population increases. Other possibilities that were less definite could not be planned for at this time. |
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In response to further questioning, the PCT team explained that the Primary Care Capacity Planning Group had a large membership. As and when any expertise was required to assist with their work the Group invited representation from the particular service needed. So far as the PCT was concerned, there were a number of areas where the District Council could be of assistance, not least with planning and leasing/tenancy issues. While there were no firm plans about where health services should be best placed, any transport implications for patients being asked to travel out of the District would be thoroughly investigated (including consultation) before a final resolution was agreed. |
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The PCT team confirmed that there was no plan to cut services at the Buckingham Hospital. |
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The Director of Housing, Health and Leisure closed this part of the meeting by assuring the PCT that, although Members and Officers admittedly did not understand everything contained within and connected to this massive subject, they were keen to develop a comprehension of the background. Over the next month or two, the Committee would look further at what the PCT had said during the meeting as well as receiving evidence from other important witnesses. Only after that would Members be in a position to form recommendations regarding the best way forward. The Committee extended its thanks to the PCT for attending this meeting. |
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On reflecting the views and statements expressed by the PCT team, the Committee made the following initial observations and suggestions:- |
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Members were invited to submit any further questions for the PCT within the next seven days as their response would be sought to a number of issues highlighted subsequent to the conclusion of that part of the meeting. This would include seeking confirmation of any proposed changes to service provision at Buckingham Hospital, including the possibility of creating a “one-stop-shop†there. |
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The Committee requested that a GP be invited as a witness to give evidence at its next meeting, subject to confirmation that this would be appropriate. |
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RESOLVED – |
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That the evidence, observations and suggestions detailed above be incorporated into the final Stage Three report on the issue of the impact on local health facilities as a result of the planned growth of Aylesbury. |
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The Committee received a report detailing the current role, structure and programme of holiday activities for young people, the contribution that providing the programme made towards achieving the Authority's strategic objectives and the necessary process for undertaking this Scrutiny Review. The report highlighted some key issues that the Committee might consider examining as part of a scrutiny review, but also drew Members' attention to the fact that Leisure Services, including the provision of Holiday Activities for young people, was currently undergoing a Best Value Review, a Strategic Budget Review and Comprehensive Performance Assessment and that there would be resource implications in respect of these and any additional reviews. |
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Members noted the Appendices to the report, which assisted the Committee with its understanding of the range and extent of the programme of Holiday Activities for young people. As part of this review it was suggested that Members of this Committee my wish to attend and observe at least one of these activities during the February, 2003 half-term. |
Officers were asked why Green Bowls was absent from the programme of holiday activities since this had, in the past, been a popular option. It was suggested that the list of interviewees set out in the report be amended to include representatives of schools and/or after school clubs. Officers, bearing in mind the need to avoid duplication of the ongoing reviews of Leisure Services, agreed to seek written evidence from a representative of one of the two suggested for addition to the list of interviewees in Stage Two of the review. The Committee also requested that a number of specific following questions should be addressed and information included in the stage two exercise. |
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In response to questions concerning the Passport to Leisure (P2L) scheme, Members were informed that this was a matter separate to the provision of the holiday activities programme and involved a number of different issues. This scheme was new and the take up last year had been roughly 10%. The opinion was expressed by a Member that the discounts with the P2L were not enough to adequately assist families living on benefits. |
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RESOLVED – |
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RESOLVED – |
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That the Work programme be noted. |