Agenda and minutes

The Chairman welcomed everyone to the meeting. Apologies were received from Mr L Wood and Mr D Williams (Mr D Leveson attended in place of Mr D Williams).  The Chairman advised that Ms Zoe McIntosh, the new Chief Executive Officer, Healthwatch Bucks, had replaced Mr Miguel Souto on the Committee. The Chairman thanked Mr Souto for his contribution and stated she was looking forward to working with Ms McIntosh.

Mr A Turner declared an interest as he was a trustee of an independent adult day care provider charity.

To confirm the minutes of the meeting held on Thursday 10^th September 2020.

The minutes of the last meeting were reviewed; the Chairman advised that the responses to the additional questions on the Mental Health topic and Primary Care Network item were being prepared and letters would be circulated to the partners; if any additional questions were raised they would be added to future meeting minutes.

Ms P Birchley referred to item 6, point 14, which stated “A 24/7 mental health helpline had been established to divert the pressure from 111 and A&E. Whilst this offering had been established quickly, it was deemed unsustainable so the Trust was working with commissioners to find a solution.”  Ms Birchley asked whether a solution had been found.  Julia Wassell reported that the mental health helpline was advertised as being available 24 hours a day, seven days a week, and should be used as the main point of contact.  The Chairman acknowledged J Wassell’s comment and stated she would contact the Oxford Health NHS Foundation Trust for formal confirmation.

ACTION:  The Chairman

Ms Birchley highlighted that the sentence on page 9, “It was acknowledged that there would be an unprecedented demand on flu jabs this year. As yet, there were no real plans on how to resource this and deliver it in a Covid safe way”; had been superseded by other comments later in the minutes.  The Chairman explained that the point reflected what was said at that point in the meeting. The Chairman added that she had attended the last Health and Wellbeing Board meeting and raised questions on the winter plan; follow up work would be carried out on flu vaccinations and the winter plan.

RESOLVED:  The minutes of the meeting held on 10 September 2020 were AGREED as an accurate record.

No public questions have been submitted for this meeting.

There were no public questions submitted for this meeting.   However, an email had been received past the submission deadline; the Chairman advised that a response had been sent to the member of the public advising them to watch the meeting and if the resident still had outstanding questions after the meeting today, the Chairman encouraged the resident to put them forward in time for the January meeting. 

For the Chairman to update Members on health and adult social care scrutiny related activities since the last meeting.

The Chairman updated Committee Members on the following issues:

A response had been provided on Buckinghamshire Healthcare NHS Trust’s Annual Quality Account 2019/20; the Chairman thanked the committee members involved and stated she was looking forward to seeing the quality account published.

On 20^th August 2020, Unity Health launched a public consultation on the proposed closure of New Chapel Surgery in Long Crendon.  Members will hear from representatives from Unity Health, the Clinical Commissioning Group and a local action group.

The consultation ends on 23^rd November 2020.

Presenters:

Ms L Munro-Faure, Managing Partner, Unity Health

Dr S Logan, Clinical Partner, Unity Health

Dr A Furlonger, Clinical Partner, Unity Health

Ms J Newman, Head of Primary Care, Clinical Commissioning Group

Ms F Cayley, Chairman of the Local Action Group

Ms F Momen, Member of the Local Action Group

Papers:

Consultation briefing issued by Unity Health on 20^th August 2020

Future of Primary Care Services in Long Crendon (Paper prepared by Unity Health)

The Chairman advised that on 20 August 2020, the Clinical Commissioning Group (CCG) Comms team had circulated an email on behalf of Unity Health (the health providers of five GP surgeries in Buckinghamshire and Oxfordshire) to key stakeholders with a consultation paper for patients on the proposed closure of New Chapel Surgery in Long Crendon.  The public consultation would finish on 23 November 2020 and there was a Primary Care Commissioning Committee meeting on 3 December 2020 where it was proposed that the potential closure would be discussed. 

The Chairman welcomed Ms L Munro-Faure, Managing Partner, Unity Health; Dr S Logan, Clinical Partner, Unity Health and Dr A Furlonger, Clinical Partner, Unity Health.

Dr Furlonger explained that Unity Health served 22,000 patients across five sites and was a training practice, training future GPs.  Unity Health had formed in Oct 2017 through the merger of Trinity Health and Wellington House practices.  Wellington House had covered Princes Risborough and Chinnor; Trinity Health had covered Long Crendon, Brill and Thame.  The Long Crendon practice served 3,490 patients of which 2,350 lived in Long Crendon and the remainder travelled from the surrounding villages.  The existing premises in Long Crendon were unfit for purpose; it was an old chapel which was inadequate in terms of space and the clinical rooms did not meet modern regulations.  Training for GPs and healthcare professionals had ceased in this site due to lack of space.  It was a dispensary practice but was on the road with no parking, drop off or safe disabled access.  There were drainage problems at the site and there was no outside space to expand further; also the age of the building did not lend itself to modification.  Other options had been explored and a number of redevelopment/new premises applications had been submitted which had not been successful in obtaining approval for the funding of a new site.  It had also been a struggle to recruit and retain GPs and other healthcare professionals as they were reluctant to work in isolation in the old building.  After a great deal of consideration, Unity Health had started the consultation process about the possible closure  Unity Health prepared a paper for the Select Committee in which it put forward 4 options. The paper made clear this was not a formal options appraisal but a presentation of the position to date.  The preferred option was option four (Register all patients with Brill surgery but continue to provide some services from another facility in Long Crendon to address some of the patient concerns identified through the consultation process and the difficulties in accessing services in rural communities).  Unity Health had held discussions with a village action group and the CCG and proposed continued provision of services from new premises which could be a collaboration in a community building using land provided to the parish council by the developer for this purpose as part of the Section 106 money.

Ms J Newman, Head of Primary  ...  view the full minutes text for item 6.

Covid-19 has fundamentally changed the way we provide health and social care in Buckinghamshire.  The Buckinghamshire ICP agreed to undertake a comprehensive programme of public engagement about the changes we have made and discuss some the changes we are considering in order to reset health and social care services for the future.

The engagement programme has been developed around the following 4 themes – reducing health inequalities, community services, keeping people safe and non face-to-face services.

The programme and survey launched on 24^th August 2020 and the survey closed on 19^th October 2020.  Further engagement work is planned in November.  A fuller discussion on the outcomes of this work will be discussed at the January meeting.

Presenters:

Mr D Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust

Papers:

Cover report

Report which went to the Health & Wellbeing Board, July 2020

The Chairman welcomed Mr D Leveson, Deputy Director of Strategy, Buckinghamshire Healthcare NHS Trust (BHT).  Mr Leveson explained that he and Mr D Williams had been leading on the engagement process during which an online survey had been held from 24 August to 19 October 2020.  There were four themes in the survey; reducing health inequalities, community services, keeping people safe and digital appointments.  Phase 2 of the engagement process was underway and would run during November and December; a social research company had been employed to run 12 in-depth focus groups and 20 in-depth one-to-one interviews to target hard to reach groups e.g. carers, young people, those living in deprived areas and the Black, Asian and Minority Ethnic (BAME) community; these would be completed by the end of 2020. 

Approximately 2,800 responses had been received; the average age of respondent was 61 and the majority were white with over 70% being white women.  Initial analysis had shown that there were over 20,000 pieces of free text to be coded and themed. 

Mr Leveson highlighted a few key points from the survey data:

• More than 50% of respondents felt they were healthy or very healthy.
• Of those who responded saying they were not healthy; a number were receptive to making lifestyle changes, particularly in obesity.
• 80% of respondents had had a phone or video appointment in the last three years and were generally satisfied with the appointment.  The majority were happy to continue with a digital appointment in the future but the number declined with increased age. The biggest concern over online consultations was when people needed a physical examination; it needed to be clear that a face to face appointment would be available when required.
• When asked about planned care e.g. ophthalmology, and what was most important to people, the following points were made:

Ø  Receiving a diagnosis and being treated as quickly as possible.

Ø  Being treated locally; people were willing to travel if being seen at a centre of excellence resulted in quicker treatment but it was important to consider the frequency of need and the age of the person. 

• People were generally receptive of dialling 111 or visiting a pharmacy but there was a slight reticence over clinical credibility; particularly by those with a long term condition or older people.
• Community services – the response rate for those with experience of a community hospital bed was low; however, there could be detail in the free text.  When asked about rehabilitation and recovery and whether they would prefer to recover at home or in a hospital bed; it depended on the circumstance; the security of a hospital bed was appealing for older people.

During the discussion, Members asked the following questions:

• The Chairman queried the timing of this piece of work as people were accessing services differently during the pandemic.  Mr Leveson stated that the use of digital appointments and NHS 111 had been planned before the pandemic but Covid-19 had accelerated the changes.  The pandemic  ...  view the full minutes text for item 7.

The Committee will hear from representatives from the Clinical Commissioning Group, the Local Pharmaceutical Committee and a local pharmacist.

Presenters:

Ms J Butterworth,

Mr M Patel, Chief Officer, Local Pharmaceutical Committee

Mr K Patel, Local Pharmacist

Papers:

Medicines Optimisation Governance paper (prepared by the CCG)

Report from the Local Pharmaceutical Committee

The Chairman welcomed Ms J Butterworth, Buckinghamshire CCG; Mr M Patel, Chief Officer, Local Pharmaceutical Committee (LPC) and Mr K Patel, Local Pharmacist and owner of a number of local pharmacists.

The Chairman declared an interest in having known Mr Kalpesh Patel for several years as he was the Chairman of the local Rotary group and an owner of numerous pharmacies.

Ms Butterworth, Associate Director for Medicines Optimisation, advised that the report had provided a brief overview of where the pharmacy workforce sat in the system and stressed that they were all working together more closely than ever under a single governance structure.

During the discussion, Members asked the following questions:

• The Chairman highlighted that report referred to additional roles being recruited to support the Primary Care Networks (PCNs) and asked how recruitment was going and what would happen to the funding if the posts were not filled. Ms Butterworth explained that the approval for use of the funding had been delayed due to the pandemic but the process had been accelerated and funding would be taken from this year and next year’s pot.  The number of clinical pharmacists and technicians increased each year.  Recruitment was still going ahead.  Funding was for a mid-point between a junior and senior post but if a senior pharmacist was needed the PCNs needed to provide additional funding which was an issue for some PCNs. Last year there had been anunderspend and this had been utilised creatively; it had also been used to fund a PCN lead pharmacist two days a week to provide support to pharmacies.
• A member of the committee asked what the take up was for electronic repeat prescriptions and how were the people being handled who were not computer literate.  Ms Butterworth did not know the exact figure but thought it was approximately 15%.  Ms Butterworth explained that patients could not be put on an Electronic Repeat Dispensing (ERD) service unless their medication was stable and there were a large number of patients waiting for monitoring results which had been delayed by Covid-19.  For those patients who could not be put on ERD they relied on patient access to make things easier using technology but surgeries were trying to move away from prescriptions being posted through the letter box.  However, there was a difference between electronic prescriptions, which was very high, and ERD where six to 12 months’ worth of prescriptions were loaded onto the spine at one time and then the community pharmacies could pull them down as appropriate. 
• A member of the committee stated he was conscious of the crucial role of staff in the pharmacies during the pandemic and asked if they had received all the support they needed i.e. had the insurance issue of preventing deployment staff on an emergency basis been resolved?  Pharmacists were not paid for the delivery of prescriptions – could the gap be plugged?  Pharmacists had to source their own Personal Protective Equipment (PPE) – could this be funded?  Ms Butterworth confirmed  ...  view the full minutes text for item 8.

Details on this item to follow.

Mr N Graham, Service Director, Legal and Democratic Services, stated that there was a statutory requirement to set up a Joint Health Scrutiny Committee for the five authorities in the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS).  The draft Terms of Reference (TofR) were attached to the report.  Work had been carried out on defining the work of the scrutiny committee; Mr Graham emphasised that there was no wish to take away the scrutiny arrangements of each authority but there were certain things the ICS had been carrying out at a strategic level which it would be helpful for all authorities affected to come together and work on.  The existing local scrutiny committees had the power to refer decisions to the Secretary of State and this would also apply to the Joint Health Scrutiny Committee.  The size of the committee was still under discussion.  The draft TofR set out the practical arrangements and would need to be ratified by Full Council.  The next Full Council meeting was on 9 December 2020 and it was proposed that if the Select Committee agreed to the content of the draft TofR, that delegated power be given to the Chairman for final sign-off.  If the content was significantly changed the draft TofR would be brought back to the Select Committee and ratified at a future Full Council meeting.

The Chairman thanked Mr Graham and Ms Wheaton for their work on the setting up of the Buckinghamshire, Oxfordshire and West Berkshire Integrated Care System - joint health scrutiny committee. 

RESOLVED: 

• Members of the Health and Adult Social Care Select Committee DISCUSSED the progress made to date in setting up a joint health scrutiny committee for the BOB ICS which will aid continued negotiations.
• Members APPROVED the draft terms of reference and AGREED to delegate the final sign-off of the terms of reference for the joint health scrutiny committee to the Chairman of the Health & Adult Social Care Select Committee. 

Members APPROVED that the final terms of reference will be discussed and ratified at Full Council.

The Committee will discuss the work programme and agree the items for the next meeting.

Presenters:

All Committee Members

Papers:

Work Programme attached

Committee Members discussed the draft work programme and agreed the following items for the January meeting:

• Hospital discharge to assess Buckinghamshire Integrated Care Partnership (ICP)
• The Winter Plan and an assessment of Covid-19.

Access to GP surgeries during the second lockdown.

Each year the Director of Public Health produces an annual report on the health of their population.  In light of the creation of the new Buckinghamshire Council and its 16 Community Boards, this year’s report focuses on the overall health and wellbeing of Buckinghamshire’s population. It serves as a baseline against which progress in improving the health and wellbeing of our population can be measured.  It highlights the many opportunities that the new unitary council and members have to improve the health of our residents through the council’s actions on community engagement and leadership, transport, planning, the environment, the economy, education and other services.  The aim is to support a strategic approach in the new council and partners to address the health of our population.

Committee Members are asked to note the Director for Public Health’s Annual Report.

Papers:

Cover report

Director for Public Health Annual report

It was agreed that an email would be circulated requesting comments on the Director of Public Health Annual Report (DPHAR) which would be fed back to the Director of Public Health and Councillor Gareth Williams, Cabinet Member for Communities and Public Health.

ACTION:  L Wheaton to circulate and email requesting feedback on the DPHAR

The next meeting is due to take place on Thursday 7^th January 2021 at 10am.

Thursday 7 January 2021 at 10am.