- Meeting of Health and Adult Social Care Select Committee, Friday 7th February 2020 9.45 am (Item 6.)
In July 2019, Primary Care Networks (PCNs) were launched in Buckinghamshire and nationwide which heralded a new kind of collaboration between groups of GP practices and other community based health and care service, with the aim of benefitting both patients and surgeries.
Across the country many GP practices are coping with unprecedented pressures, due to increased workload, increased demand, an aging workforce and a shortage of GPs. At the same time, many patients today have illnesses that are treated in hospital when care provided in the community would have better outcomes. Community services such as general practice, social care, mental health and voluntary community groups will need to work together to achieve these better outcomes. The formation of PCNs seeks to address both these issues.
Buckinghamshire has 12 PCNs, covering the population of the entire county and involving all 50 of its practices.
Ms L Smith, Interim Director Primary Care and Transformation
Dr A Bates, Westongrove Primary Care Network
Lin Hazell, Cabinet Member for Health & Wellbeing
Ms G Quinton, Executive Director, Communities, Health and Adult Social Care, Buckinghamshire County Council
Ms K Jackson, Service Director (Integrated Care), Buckinghamshire County Council
Ms J Hoare, Managing Director, Bucks Integrated Care Partnership
Power point presentation
The Chairman welcomed Ms L Smith, Interim Director, Primary Care and Transformation, Dr R Sawhney, Clinical Director for Health Inequalities, Lin Hazell, Cabinet Member for Health & Wellbeing, Ms G Quinton, Executive Director, Communities, Health & Adult Social Care, Ms K Jackson, Service Director (Integrated Care) and Ms J Hoare, Managing Director, Bucks Integrated Care Partnership.
During the presentation and discussion, the following key points were made.
· The health and care needs of the population were increasing and becoming more complex.
· The system was financially challenged and efficiencies had to be made.
· NHSE had clearly articulated its ambitions and implementation expectations in the Long-term Plan.
· Primary Care Networks were mandated and money had been earmarked for community investment.
· The Buckinghamshire Care Model centred around a pro-active community based care model designed around local population health and care needs which through integration would break down the historic barriers between primary, community and secondary care.
· Some of the main features of the model included:
o Those "at risk" patients would be identified early and pro-actively managed with non-medical interventions and care;
o Patients with complex comorbidity would be managed by a single community based multi-disciplinary team lead by a complex care manager;
o Patients would be supported to live independently at home but not isolated;
o Patients would tell their story once;
o Patients would be pro-actively pulled out of the Hospital setting back to their home once medically fit.
· There were three main areas of work – Prevention and Pro-active Care, Responsive Care and Long-term care. A number of enablers, including Digital, Workforce, Capital & Estates and Communications & Engagement ran through all the areas of work.
· There were 12 Primary Care Networks (PCNs) across Buckinghamshire of which 5 had been chosen to be part of a national project around health population management. In time, PCNs would consist of general practices working together with a range of local providers across primary care, community services, social care and the voluntary sector.
· There was a high expectation on PCNs to deliver services and a number of key roles had already been recruited by some PCNs, including social prescribers and pharmacists.
· A Member expressed concern about the ability to recruit to the new roles created by the PCNs. Ms Smith acknowledged that it was a challenge but the investment had been made and a number of roles needed to be filled during 2020/21. A number of hybrid roles had been created and a workforce passport had been developed to enable more flexible working across the system.
· Work was underway to align PCNs with the new Community Boards and there would be a series of workshops to start fostering relationships between the key stakeholders.
· The need to undertake community engagement at "Place" was acknowledged and it was agreed that this would be important over the coming months.
· A number of objectives had been set to strengthen community integration to help tackle inequalities, including identifying and treating those with hypertension who were BME and/or live in quintile 5, mental health activities and reducing the prevalence of smoking, particularly in GP practices in deprivation quintiles 4 & 5.
· In recognition of the importance of integration and collaboration to ensure successful delivery of community change, a Member asked who had overall oversight of this to make sure it happened and that outcomes were monitored and reviewed. Ms Smith explained that Dr Thornton and Ms Quinton were responsible for delivering rapid community change at Place. Ms Quinton explained that it was a partnership approach and progress was being made, although the pace of integration was acknowledged as not being fast enough. The complexity of integrating services was recognised.
· Following a discussion around the use of social prescribing by GPs, Dr Sawhney provided an example of how it works in her GP surgery but acknowledged that social prescribing needed to be embedded across the Primary Care Network.
· A Member commented that the voluntary sector was missing from the slide entitled "The Integration Dynamic" which highlighted the strength of working together to deliver the community model. Ms Smith responded by saying that the voluntary care services and patient engagement ran through the whole model but acknowledged it needed to be represented in the diagram.
· In response to a question about home adaptations and monitoring the quality of this service, Ms Quinton explained that the Disabled Disability Grant, part of the Better Care Fund money, would sit within Ms Quinto’s portfolio in the new council. She went on to say that a review of accessibility of this service would be undertaken and value for money and quality of service delivery would also form part of the review.
· Ms Smith agreed to send further information on the primary care training hubs and where this training was taking place as a Member asked whether it was being delivered at Wycombe or Uxbridge.
Action: Ms Smith
· In response to a question about Community Boards and how health and social care would be embedded within communities, Ms Smith explained that the starting point would be to have a local directory of services with a single front door. She went on to say that this approach had been developed in other authorities and mentioned the Frome model of care. Ms Quinton added that Tier 1 of the Adult Social Care Transformation Programme had delivered the Community Asset Plan which mapped local services and activities. This tool would also help to address social isolation, particularly in rural areas.
· A Member expressed concern about the breadth of issues that the Community Boards were being asked to review, from local infrastructure to transport issues.
· A Member commented that there needed to be more grass-roots projects and cited mental health as an example, where more out-reach work needed to be done.
· A Member commented that the increased demand in A&E patients was partly due to people not understanding when to visit A&E rather than accessing other services, such as the pharmacist or the MIIU.
· The inconsistency in the quality of Patient Participation Groups was acknowledged and a Member felt more investment should be given to ensuring these groups all provided the same level of service.
· A Member felt that, from a voluntary organisation point of view, the Council’s current commissioning system was very complicated and a more proportional approach to commissioning would be beneficial.
The Chairman thanked the presenters and concluded that training and education of health and social care professionals and addressing health inequalities might want to be reviewed by the Committee in the new council.