Minutes:
The Committee received Dr M. Shapley (Clinical Chair) and Dr D. Hughes (Clinical Accountable Officer) to discuss the role of the North Staffordshire Clinical Commissioning Group (CCG). The Chair emphasised that the Committee would like to see closer links with the CCG and to work together rather than focusing on financial aspects. Newcastle Borough Council had their own initiatives, but were very keen to see preventative measures.
In April 2011 the CCG was delegated an authority and would be designated an authority in April 2013. The upcoming months were very important and there would be public meetings of the board. The CCG was poised to get through 2013 well, with 80% of services commissioning and were also in a good position as they had come from a single Primary Care Trust (PCT), and had retained good staff and skills. The PCT had 158 full time staff; the CCG had 38 and was much smaller. This had been mitigated to some extent by PCT staff working in the commissioning support unit, e.g. in HR. The CCG aimed to be lean and nimble, but there was quite a challenge ahead. The Doctors felt the CCG was significantly leaner and working very hard.
Members questioned what services were being commissioned by the CCG as a commissioning body. The system had changed dramatically in 2012, with the Director of Public Health having accountability and the CCG taking responsibility for meeting targets. The CCG did not commission areas coming under general practice, such as sexual health, but were able to purchase some aspects of preventative care and could commission certain services if required. However, the primary accountability was with Public Health. With regard to community services provided by the hospital, Members felt an understanding of the health requirements of North Staffordshire was needed. Through the Joint Strategic Needs Assessment, there was a good idea of what was happening in different areas and this would influence what services it was felt needed to be commissioned.
The responsibility for walk-in centres was questioned by Members. As the NHS had changed dramatically, Members felt a road map of how the NHS worked was required. The CCG had inherited the walk-in centres and it was advised that there was an on-going review. The Staffordshire and Stoke on Trent Partnership NHS Trust (SSOTP) were responsible for the Haywood walk-in centre, which was an important centre and worked well with A and E. Some walk-in centres were the responsibility of the CCG, and there were CCG staff employed at the Haywood centre. This was not considered positively by Members. Members noted that the purpose of the walk-in centres was to see patients who would have otherwise gone to A and E, and had personally experienced visiting Morston House and not being able to see a doctor as it was necessary to be registered at the centre. A few years ago an appointment could be obtained within one hour, but it appeared that the centre was now operating more like a GP surgery. The CCG had no control over this and it had been inherited from the NHS Commissioning Board, which had commissioned the service.
Members questioned if the Doctors envisaged there being any problems from April. They also noted that the public may ask which body was delivering what service and ask what the CCG would be giving to patients. It was acknowledged that there had been a problem for many years with discharge information. For around eighteen months there had been a communication group between Stoke-on-Trent and the CCG, which discussed such areas as electronic discharge of patients and making improvements through this. The Doctors felt this was a useful group and were aware of the problem. The changes which were taking place would give patients and the public a greater voice and Members felt that what was being set up by the CCG would be an improvement, but that this needed to be communicated to the public. It was advised that patients would be members of the CCG, there would be a partnership with the public and there was also the Patient Congress. Members felt the changes were a big opportunity, but were concerned about how they would be communicated to the public and questioned how information from the Patient Congress was communicated back to the public. The CCG worked very closely with communications and there was a flow of information. It was questioned whether there were difficulties in getting a wide range of people to participate in patient groups, e.g. a cross section of different age groups. This was acknowledged as a problem that the CCG were trying to address, as people did not want to give up their time.
The CCG covered both Staffordshire Moorlands and Newcastle, as per the old primary care trust, but worked closely with Stoke e.g. with joint executive committees. Members felt that the predominant problem was there were too many people going to hospital when they did not need to. Some of the problems were caused by the flow of patients through the hospital and the Doctors considered that there could be admission avoidance as they did not think patients wanted to go to hospital if they could be cared for at home. The contract for the West Midlands Ambulance Service was held by the CCG and it was necessary to make sure that ambulances were not taking people to hospital who did not need specialist care. There were tools available, such as a flow and capacity hub, to identify services that were not necessarily for A and E and replace the transport to the hospital. There would also be advanced long term condition management. The CCG had a responsibility to promote quality and GPs were managing the patients going to A and E. Members felt that one reason for high patient numbers could be that the UHNS was more easily accessible by public transport than other hospitals, and people would go there for that reason meaning walk-in centres such as the Haywood were not utilised to their full potential.
The buildings and contents of GP surgeries would not be transferred to the CCG and Members questioned how they could be sure they would remain open. This aspect was currently in development and the NHS Commissioning Board had a duty to ensure they would remain. It was questioned that if there was an increase in usage of a surgery and more doctors were required, how this would be proved. This would be taken back to the NHS Commissioning Board. It was a very important issue and the model of care was to keep patients as close to home as possible. There was a district nursing review and it would be necessary to ensure that there was community infrastructure going forward.
Members asked if GP practices could have extended opening hours to help prevent the public from going to A and E. It was the responsibility of GPs to work with CCGs to reduce the pressures on A and E and it would be wrong for the CCG to dictate to GPs. There was however a national contract with specified hours and it would be sensible to be flexible. There would also be a new GP out of hours service in April and a new 111 number was to be introduced to replace NHS Direct. The Doctors also noted that when the new UHNS A and E opened there was an increase in patient figures, which could reflect people going there to see the new department.
It was questioned how local authorities could assist more. The Executive Director, Operational Services advised that whilst for example the Borough Council had a statutory responsibility with regard to community safety, Staffordshire County Council held statutory responsibility for public health. Public health underpinned so many of the things that the Borough Council did, but the Council did not have the statutory responsibility for it. What the Council could do was to include any awareness campaigns in the Borough newspaper, The Reporter. There were other initiatives within the Council and the Chair considered that the Council needed to work more closely with health agencies. There was also the Let’s Work Together initiative, which had been initiated by the Fire Service. Let’s Work Together would see the agencies who go into the public’s homes looking for problems aside from the service they were providing. Members felt that health agencies could also be involved in the initiative, but understood that they were not yet on board. Members would like to see Council Officers and members of the CCG sit down and discuss where they could work together. The Doctors advised that clinical directors and associates would have a role in engagement and concurred that it made absolute sense for the Council and the CCG to work together where they could. The CCG were not unwilling to engage and urged the Committee to inform them when things were not working.
Members questioned what the CCG point of view was with regard to Health and Well Being Boards providing assistance to them. Everything was very new, but there were clear links with the CCG and Health and Well Being Board. The Joint Strategic Needs Assessment and the Health and Well Being Strategy would give an idea of what was required and it would be necessary to learn how to bring all the different strands together. There were real challenges facing the CCG and they would have to do things differently, which might not be popular with the public and the Doctors felt that Member support would help with this. Members felt education was important and conveying information to the public about GP practices, walk-in centres etc.
The Chair emphasised that the Committee were not being critical of the CCG, but were being their critical friend and the more the Council and the CCG worked together the better. The Doctors concurred that it had been a good exercise for them to attend the meeting. The Chair considered that it would be helpful if the CCG could attend a future Full Council meeting to talk to Councillors about the public health changes and explain the structure of the NHS.
The Chair thanked the Doctors for their attendance at the meeting.
RESOLVED: (a) That the information be received.
(b) That the CCG attend a future Full Council meeting to discuss the changes in public health and explain the structure of the NHS.