Agenda item

The Select Committee will receive an update from the Clinical Commissioning Group (CCG) on current issues.

Dr Ian Orpen addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

A&E performance

The CCG saw increased demand and pressure on services over the summer and performance against the A&E waiting time target (95 per cent of attendees to be seen within four hours) dropped to 79.3 per cent in August 2016.  However, performance for October 2016 improved to 91.5 per cent.

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.  The newly constituted A&E Delivery Board is focusing on responding to the five nationally mandated actions to support on-going recovery of performance.

CCG Improvement and Assessment Framework

Our assurance ratings for quarter two of 2016/17 are:

Better Health – Good  

Better Care – Requires Improvement

Sustainability – Requires Improvement 

Leadership – Requires Improvement

NHS England acknowledged a lot of good work has been undertaken around leadership and there are many positive examples of the good work the CCG is carrying out.  However, due to concerns around our performance within ‘Sustainability’ and ‘Better Care’, we are also assessed as requires improvement under ‘Leadership’. 

Prescribing changes consultation

On 24 November, the CCG launched a four week period of public engagement on proposed changes to our prescribing policy. The CCG has been reviewing treatments that are shown to be less clinically effective, provide insufficient health benefits and those that do not represent good value for money. As a result, there are two proposed changes to the local prescribing policy:

·  To stop prescriptions of gluten-free products for people with coeliac disease

·  To stop prescriptions for two groups of over-the-counter medicines – painkillers and antihistamines – when they are used for short-term, minor ailments such as mild hayfever, headache, coughs and colds.

Operational Plan

Our draft Operational Plan for 2017-19 has been submitted to NHS England. The final version is due on Friday 23 December. For the first time, plans are required over a two-year period and must support the delivery of the Sustainability and Transformation Plan for B&NES, Swindon and Wiltshire.

NHS England is also providing new funding to improve access and increase capacity in general practice by April 2019.  Our Operational Plan includes a section on how we will support and transform general practice to offer extended opening hours across evenings and weekends.

Delegated Commissioning

Our 26 member practices are voting to decide if the CCG should take on delegated commissioning of primary care from NHS England. We have been working under joint commissioning arrangements in 2016-17 but delegated commissioning would give the CCG greater control over our future and help us to align our plans across community and acute services.

Swindon and Wiltshire CCGs are also expected to move to delegated commissioning so we have agreed that Wiltshire CCG will host a shared team to deliver the new primary care responsibilities.

Online booking at GP practices

GP practices are now able to offer their patients access to all online services; booking and cancelling appointments, ordering repeat prescriptions and viewing their medical records. 

NHS England has set a target for practices to have a minimum of ten per cent of their patients registered for online services by 31 March 2017.  In B&NES, 81 per cent of all GP practices (21 out of 26 practices) have already achieved ten percent.  This is encouraging progress and the CCG continues to work with practices to promote the benefits to patients of registering for online services.

Councillor Paul May asked if GP’s would be involved in the procurement of out-of-hours services.

Dr Orpen replied that they would be involved in the process and said that the workforce around the out-of-hours service has changed and it was about finding the model that works.

Councillor Paul May asked if Delegated Commissioning would provide GP’s with more work.

Dr Orpen replied that some concerns have been raised and that the vote had not concluded yet. He added that some conflicts of interest would need to be managed, but that it had the potential to shape the way Primary Care works.

Councillor Eleanor Jackson asked if Delegated Commissioning would give advantages in bulk buying.

Dr Orpen replied that it was more about the mechanics of the process.

Councillor Eleanor Jackson asked why the NHS111 system was being re-procured as she felt it was working well in her opinion.

Dr Orpen replied that it was due to be re-procured and that this was an opportunity to align it with the out-of-hours service. He added that NHS111 has improved, but that there were still some issues, particularly the number of calls being passed to A&E.

Councillor Eleanor Jackson asked if a purpose built GP practice was to be built in Radstock and if it was dependant on sharing the facility with the library.

Tracey Cox, CCG Chief Officer replied that due diligence was ongoing and that the site may have some co-dependants.

Councillor Tim Ball asked if the re-procurement of the CAMHS service would include children on the autistic spectrum and if evaluators from that sector would be involved in the process.

The Director of Integrated Health & Care Commissioning replied that ADHD would be included within the service and that robust arrangements are in place to involve service users and carers in the process.

Councillor Lin Patterson asked if the Council and the CCG make national Government aware of our financial difficulties.

Dr Orpen replied that NHS Clinical Commissioners represent us on this matter, but it is clear that no extra funding is available.

Councillor Paul May commented that there are never enough resources and that the CCG has to deliver the plans that Government sets out.

The Cabinet Member for Adult Social Care & Health commented that the LGA continues to lobby ministers on this subject and that he would transfer Councillor Patterson’s concerns to them at a meeting next week.

Councillor Bryan Organ commented that it was good to see that a significant portion of time had been set aside for the procurement of Urgent Care services.

Dr Orpen replied that due to the potential geographical nature of the solution it was right to take this amount of time.

The Chair thanked Dr Orpen for his update on behalf of the Select Committee.