Agenda item
Clinical Commissioning Group Update
The Panel will receive an update from the Clinical Commissioning Group (CCG) on current issues.
Minutes:
Dr Ian Orpen addressed the Select Committee on a number of issues, a summary is set out below.
Urgent Care Pressures
He informed them that 2015 continues to be a challenging year for the health and social care community in terms of delivering against the national target for A&E waiting times. On-going poor performance below target is attributable to a range of factors including an increase in the average length of stay of patients for all CCGs, higher delayed transfers of care above planned numbers at key points in the quarter and poor patient flow within the Royal United Hospitals Foundation Trust (RUH) when the numbers of admissions and discharges are not in balance.
He stated that the CCG and RUH are currently showing as an outlier with year to date performance of 91.2%. He added that it should be recognised that no other prominent country in the world reaches a figure of 90%.
He explained that he chairs the B&NES System Resilience Group, which oversees operational performance of the urgent care system and includes partners across the local health and social care system including the RUH, the Council, Sirona, the South West Ambulance Service, NHS 111 and neighbouring CCGs. The structure and format of this group is being reviewed and the CCG is ensuring an on-going focus on the agreed actions sets out within the 4-hour recovery plan.
Joint Primary Care Co-commissioning
He explained that from the 1st of April 2015, the CCG has taken greater responsibility and involvement in the design and commissioning (buying) of primary care services, in a joint commissioning arrangement with NHS England. The new arrangement will support our local plans to improve primary care services in Bath and North East Somerset. This joint approach between our CCG and NHS England is referred to as the ‘co-commissioning of primary care’ and we will now begin meeting regularly in a joint committee, in public, to consider and take decisions on local services together.
CCG Annual Report 2014-15 and Operational Plan
He encouraged the Select Committee to view both the Annual Report and Operational Plan that were available online.
National Updates
He informed them that in June 2015 announcements were made to review and change some key national targets to ensure they make sense for patients and are operationally well designed:
· 18 week referral to treatment time (RTT) measures:- The NHS Constitution sets out that patients should wait no longer than 18 weeks from GP referral to treatment. Targets will be changed and rationalised to one measure that tracks the experience of every patient waiting as the main measure. This ‘incomplete’ RTT standard measures every patient on the waiting list, not just those treated in a particular month (currently measured as ‘admitted’ and ‘non-admitted’ standards).
Development of Local Estates Strategies
He explained that all CCGs received a communication on 22 June 2015 regarding the development of local estates strategies for each area by December 2015 linked to the development of local responses to the NHS England’s Five Year Forward View. This plan has a vision of care delivery shifted to integrated, community based services and the estates strategies seek to ensure NHS land and building are used effectively to support this transition.
The letter indicates that support to CCGs will be provided from NHS Property Services (NHS PS) and Community Health Partnerships (CHP) to provide strategic estates advice to assist commissioners.
The Chair asked for clarification in terms of cancer patients that there is a shorter referral time than 18 weeks.
Dr Orpen replied that the timescales are indeed shorter and added that survival rates locally are high.
Councillor Tim Ball asked for reassurance on the matter of GP surgery funding. He said that a figure of £113,000 had been removed from the surgeries that serve Twerton & Southdown.
Dr Orpen replied that historically GP contracts were administered in two ways - a General Medical Services contract and a Personal Medical Services contract. He added that from around the year 2000 all 27 local practices moved to a Personal Medical Services contract and that allocation of funding was dependent on the services provided.
He said that the CCG and NHS would discuss how to redistribute the funding and that areas of real need would be assessed appropriately.
Councillor Tim Ball asked if the Carr Hill formula would be used to distribute funding.
Dr Orpen replied that this was a national formula and that practices could state their case for further funding.
Councillor Eleanor Jackson said that in her opinion her local practise was short of two GPs and asked what could be done.
Dr Orpen replied that the Government has pledged to recruit 5,000 more GPs by the end of this Parliament.
Councillor Eleanor Jackson asked how practises could obtain more modern facilities and better disabled access.
Dr Orpen replied that national funding was available to bid for through the Primary Care Estates. He added that through the Your Care Your Way project the CCG and Council were looking to provide services and facilities in a different way.
Councillor Paul May asked if GPs were on site at the Minor Injury Unit of the RUH.
Dr Orpen replied that the Urgent Care Centre on site at the RUH was a 24/7 GP / Nurse led facility. He added that it was linked to Paulton Hospital.
Councillor Geoff Ward asked what current actions were being taken to address poor patient flow.
Dr Orpen replied by saying that if you took an example of an 85 year old patient being admitted for pneumonia there are a lot of potential care factors that need to be taken into account and that it can be complicated to access all appropriate services. He added that recently some wards had been closed for planned development. He said that the RUH Improvement Board were monitoring this matter.
Councillor Tim Ball said that he had been made aware that a nurse had worked between 7.00am – 6.00pm on Tuesday 28th July with no break. He stated that this concerned him and asked for it to be looked into on behalf of the Select Committee.
Dr Orpen replied that the CCG do take these matters seriously and would make enquiries.
The Chair thanked him for his update on behalf of the Select Committee.