Agenda item

The Health & Adult Social Care Select Committee agreed to set up an Inquiry into the development of primary care networks in Buckinghamshire in September 2021.

A small group of councillors volunteered to participate in the Inquiry. Evidence gathering meetings, with a number of stakeholders, took place between January 2022 to June 2022. The Inquiry Group was chaired by Cllr Jane MacBean and comprised of Cllrs Phil Gomm, Carol Heap, Howard Mordue, Alan Turner and Julia Wassell. Following the evidence gathering meetings, the Inquiry Group then met to discuss and agree its key findings and recommendations, which were presented in the report found at Appendix 1.

As the focus of this Inquiry was on the development of primary care networks, the majority of recommendations were aimed at the Integrated Care Board, Integrated Care Partnership and Place-based Partnership. Representatives from the Integrated Care Board have been asked to respond to the recommendations relevant to them. Cabinet was asked to consider the recommendations of the Select Committee which were aimed at the Council.

RESOLVED

1)      That the Select Committee and Inquiry Group, as well as the supporting officers, be thanked for their work and subsequent recommendations.

2)      That Cabinet’s responses to the Inquiry and recommendations, as set out and circulated to Members, be AGREED.

Note: a complete breakdown of the scrutiny recommendations and Cabinet’s responses can be found here.

The Health & Adult Social Care Select Committee agreed to set up an Inquiry into the development of primary care networks in Buckinghamshire in September 2021.

A small group of councillors volunteered to participate in the Inquiry. Evidence gathering meetings, with a number of stakeholders, took place between January 2022 to June 2022. Following the evidence gathering meetings, the Inquiry Group then met to discuss and agree its key findings and recommendations, which were presented in the report found at Appendix 1.

As the focus of this Inquiry was on the development of primary care networks, the majority of recommendations were aimed at the Integrated Care Board, Integrated Care Partnership and Place-based Partnership. Representatives from the Integrated Care Board have been asked to respond to the recommendations relevant to them. Cabinet was asked to consider the recommendations of the Select Committee which were aimed at the Council.

The Chairman of the Health and Adult Social Care Select Committee made the following points in presenting the Committee’s report:-

• In July 2019, as part of the NHS Long-Term Plan, around 7,000 general practices across England came together to form more than 1,250 Primary Care Networks. In Buckinghamshire there were 13 PCNs. 
• The regulations around PCNs have been incorporated into the contract that each GP practice had with the NHS through NHS England.
• To support PCNs, the Additional Roles Reimbursement Scheme (ARRS) provided funding for 20,000 additional roles to create bespoke multi-disciplinary teams, including pharmacists, physiotherapists, paramedics, mental health practitioners and social prescribing support workers.
• NHS England also introduced a statutory requirement for every surgery to set up a Patient Participation Group to allow patients to work with their surgeries to enhance and improve the service they offer.
• Since 2019, the HASC Select Committee had, over the past few years received presentations on PCN development.  It was fair to say that the PCNs were developing at very different rates and their success in recruiting to the additional roles and reorganising was varied.
• The Inquiry was set up to look at the different working practices of 13 PCN’s and Patient Participation Groups to understand the key challenges they faced. In addition, the Inquiry Group wanted to collate examples of good practice and discuss areas of improvement with key partners.
• Evidence gathering took place between January and June of this year and the Chairman thanked all those who gave up their valuable time to talk to the Committee. In particular, the Chairman thanked the Inquiry Group for their hard work, which comprised of Cllrs Phil Gomm, Carol Heap, Howard Mordue, Alan Turner and Julia Wassell. She also thanked Liz Wheaton who supported the Group from the Scrutiny Team.
• The report contained 17 areas of recommendation based on what the Committee heard during the evidence gathering.  The majority of the recommendations were aimed at health partners.
• In July, clinical commissioning groups were abolished and Integrated Care Systems became legal entities.  The Integrated Care Board, Integrated Care Partnership and Place-based Partnerships have been formed and the Committee hoped that the findings and recommendations in the report would ensure that the delivery of successful Primary Care Networks was a priority and appropriate resources were allocated to help deliver this.
• Philippa Baker, the newly appointed Place-based Director, attended the Select Committee meeting when the inquiry report was discussed and has worked with the Head of PCN Delivery and Development in responding to the recommendations.  14 of the recommendations were for external partners and 3 related to Council services; two for the Cabinet Member for Health and Wellbeing and one for the Cabinet Member for Communities.

·       Progress in implementing the recommendations would be monitored by the Select Committee at 6 months and again at 12 months, although one of the recommendations was around preparing an annual report for the HASC on the performance of PCNs, including resourcing, staffing and outcomes.

• The HASC Select Committee would also be inviting all those who were responsible for overseeing the delivery of the recommendations to a Select Committee meeting in April.

The Leader thanked the Chairman for an excellent report and commented on the different stages of development of PCN’s referring to table 1 in the report. He emphasised the importance of Patient Participation Groups in understanding the experience of customers to PCN services.

During discussion the following points were made:-

·       In response to a question about how external partners were going to highlight this to their patients, the Chairman reported that nationally there was a lot of reorganisation being undertaken in terms of integrated care systems and place based partnerships. The local partnership was still in its infancy but with the newly appointed Place-based Director this should develop at pace. The Chairman had been concerned at the development of PCN’s over previous years and also that Patient Participation Groups were a statutory requirement of every GP practice but some still had not had any Group meetings or they were meeting but not being as effective as they should be. The pandemic had been an incredible strain on GP surgeries but there had been a lot of good work to transition into new ways of working and there was a lot of funding to recruit to these new roles and GP surgeries should group together in their PCN’s to take advantage of this funding. Funding was decided year on year which did not give GP surgeries enough continuity which needed to be addressed. Buckinghamshire was a very diverse county with large rural areas and densely populated urban areas and the PCN’s were very different in nature. There were some examples of best practice and health partners should encourage the sharing of information across Buckinghamshire e.g. technology and expertise. The NHS should provide further support. There were also a number of professionals at GP surgeries that could help patients other than GPs and this needed to be communicated more widely. Other GP surgeries needed to recruit more non-GP service professionals.

·       The Leader commented that it must be difficult for residents to understand the reorganisation changes locally and how it impacted on them. The Chairman reported that explaining acronyms was key including understanding the new complex structure. From 1 July 2022, the new BOB Integrated Care Board (ICB) gained the commissioning responsibilities of the area’s three Clinical Commissioning Groups (CCGs – which dissolved on 30 June), together with some current national functions, including pharmacy, optometry and dentistry. The BOB Integrated Care Partnership (ICP) – whose statutory members were the ICB and the five upper tier local authorities – would develop an overall strategy by the end of 2022 which would set out how to improve health and care outcomes for the local population. The new system should bring economies of scale, new ways of working and centres of excellence but it could have implications for how far residents needed to travel to access services. The Chairman reported that an informal meeting had been held with partners including the five authorities to look at the emerging picture and to scrutinise new services to ensure that there were good outcomes for residents.

The Cabinet Member for Health and Wellbeing responded saying that the report was excellent and forensic in nature. With the implementation of the Health and Care Act earlier this year the NHS had undergone significant change and it was important to look at how these changes had been delivered on the ground. The Inquiry had provided great scrutiny into one of the most fundamental building blocks of NHS services locally. The recommendations provided a focus for NHS commissioners in the ICS system to ensure that all residents should be able to expect the same quality services from primary care. It was important to highlight the need for an active and engaged network of Patient Participation Groups. Two of the recommendations related to adult social care and although the portfolio area would not be taking the approach proposed by the Committee for reasons of practicality and capacity, there was agreement about the importance of having effective and close working relationships with PCN’s.

In relation to Recommendation 13 and a named social worker, Adult Social Care have restructured their operational teams into four geographical areas of the County aligning them more with PCN’s and providing direct telephone numbers and email addresses to make sure issues were picked up in a timely manner. Service Managers would be making contact with PCN’s regularly over the next few months to make sure this was working effectively.

In relation to recommendation 14 multi-disciplinary meetings were taking place when necessary to help individual patients and clients which was the most efficient use of time.  There was also a process for more complex cases which could be requested by partners. The Cabinet Member reported that she was looking forward to the development of the place-based partnership and the opportunities this would bring  for even more integrated working at a neighbourhood level in Buckinghamshire.

In terms of recommendation 15 which related to the Cabinet Member for Communities it was important to build relationships with Community Boards and PCN’s and Public Participation Groups to tackle inequalities. Opportunity Bucks would provide support to 10 wards in Buckinghamshire targeted at the specific needs of the community.

RESOLVED

1)      That the Select Committee and Inquiry Group, as well as the supporting officers, be thanked for their work and subsequent recommendations.

2)      That Cabinet’s responses to the Inquiry and recommendations, as set out and circulated to Members, be AGREED.

Note: a complete breakdown of the scrutiny recommendations and Cabinet’s responses can be found here.