Agenda item
Clinical Commissioning Group Update
The Select Committee will receive an update from the Clinical Commissioning Group (CCG) on current issues.
Minutes:
Dr Ian Orpen addressed the Select Committee, a summary of the update is set out below.
A&E performance
We did not see a reduction in demand and pressure on services over the summer and our performance against the A&E waiting time target (95% of attendees to be seen within four hours) dropped to 79.3% in August. However indicative figures for September show that performance has improved and currently stands at 87%.
Local performance and progress against the locally agreed A&E Improvement Plan continues to be overseen by regular tripartite meetings of the Royal United Hospitals (RUH), CCGs, NHS England and NHS Improvement.
Sustainability and Transformation Plan (STP)
The B&NES, Swindon and Wiltshire (BSW) footprint is developing plans to be submitted to NHS England on 21 October 2016 setting out how a transformation in health and care outcomes within the footprint will be achieved and sustained.
In collaboration with Wiltshire CCG, we held an engagement event for over 80 voluntary and charitable organisations and independent providers on 13 September 2016 in Devizes. The event was an opportunity for delegates to hear more and feedback about emerging priorities. A report from the event will be published on our website at the start of October. Further engagement is planned for after the submission of the plans on 21 October 2016.
Re-procurement of NHS 111 and GP out-of-hours services
The NHS111 and GP out-of-hours services in B&NES are to be reviewed and re-procured across the wider STP footprint. Commissioners from the three localities are working together to develop a new, more joined-up model of care for these two key urgent care services that will also include provision for a ‘clinical hub’ to provide timely, accessible and specialist advice to patients and health professionals. The new contract will begin in April/May 2018.
Planning guidance for 2017/19 published
NHS England and NHS Improvement have published their planning guidance for the health service. For the first time the CCG will have to develop plans to cover a two, instead of a one year period from April 2017 to March 2019 and submit plans by this Christmas.
The new guidance marks a shift from planning at an organisation-level to a system-wide approach that is aligned to local Sustainability and Transformation Plans. For the first time there is also a move towards adopting system-wide control totals alongside individual organisational control targets to enable health leaders to plan beyond their organisational boundaries and strengthen collaboration with other local health and care organisations for the benefit of the local population.
There are also plans to boost funding to improve and increase the capacity in General Practice and to allow an additional £6 per head of population to improve access to General Practice by April 2019. The CCG will need to set out in its two year plan how it will support and transform General Practice and expand opening hours to include evenings and weekends.
Strengthening Financial Performance & Accountability in 2016/17
On 21 July 2016 NHS England and NHS Improvement published “Strengthening Financial Performance & Accountability in 2016/17” which sets out a series of actions designed to support the NHS to achieve financial sustainability and improve operational performance.
The CCG’s control total for 2016/17 is a surplus of £2.3m – 1% of our allocated funding from NHS England. We recognised at our planning stage a high degree of risk to achieving this and as the year progresses much of this risk is materialising. We are monitoring the situation closely and are developing plans to offset the increasing cost pressures.
Interim Accountable Officer Support to Wiltshire CCG
Tracey Cox had agreed to take on the additional responsibility of interim Accountable Officer at Wiltshire CCG from 26 September 2016 following the departure of Simon Truelove who has held the role of Accountable Officer on an interim basis since Deborah Fielding left earlier in the year. Both CCGs share many of the same priorities and challenges across B&NES and Wiltshire and Tracey’s interim role will enable us to pool our insight and share expertise. To support this arrangement Wiltshire CCG will be employing an interim Chief Operating Officer.
Councillor Bryan Organ said that he was very impressed by the 111 service. He asked if GP’s had any influence on Pharmacy Services.
Dr Orpen replied that directly they did not as this service is commissioned by NHS England.
Councillor Paul May asked for assurance that Tracey Cox would have adequate support for her new interim role.
Dr Orpen replied that plans are in place to support Tracey and that the crossover of the two roles should provide benefits to both parties.
Referring to the Planning Guidance 2017/19 Councillor Paul May asked what was meant by the term ‘system-wide control’.
Dr Orpen replied that this referred to the financial target that was to be met by the end of the year.
The Director for Integrated Health & Care Commissioning added that it was an overall pot of money from the CCG, RUH and the Council which should be looked at as a single resource.
Councillor Lin Patterson commented that she felt that recent decisions were leading to a decimation of our health provision. She asked what level of budget deficit was projected.
Dr Orpen replied that it was modest, but to do nothing it would become substantial over the coming 4 to 5 years. He said that the proposals should be seen as alternative ways to invest funding rather than cuts. He added that difficult choices would be required to be made.
Councillor Eleanor Jackson commented on how difficult it was for local residents to access physiotherapy / rehabilitation. She asked if the pressure within the A&E department was due to bed blocking.
Dr Orpen replied that as part of Your Care, Your Way the intention was to allow the areas such as physiotherapy to work more effectively. He added that there was an A&E Delivery Board looking at finding solutions to the lack of available beds.
Councillor Eleanor Jackson asked if there were any figures available to show whether advice given at pharmacies saved time on GP appointments.
Dr Orpen replied that he did not know if data was available regarding this.
Councillor Eleanor Jackson asked if following the closure of some beds at Hillview Lodge were there enough beds available for mental health patients.
The Director for Integrated Health & Care Commissioning replied that the same amount of provision was available as alternative beds are being purchased. However, these are outside of Bath and North East Somerset, which is not ideal. The planned reprovision of Hillview Lodge is planned to address this.
Councillor Geoff Ward questioned whether it was possible to provide a gold plated service within such a complex system.
Dr Orpen replied that public expectations have changed greatly over the years. He added that the system was complex but it was one that they have to work within.
Councillor Paul May commented that the NHS was a credit to the staff within it and said that B&NES was fortunate to have Dr Orpen and his team.
The Chair thanked Dr Orpen for his update on behalf of the Select Committee.