Agenda item

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

Tracey Cox 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

NHS England and NHS Improvement brought together local health and care leaders at a Discharge Summit last month to review some of the current issues and challenges.  Following this, a key action for the RUH and wider community partners is to adopt a system-wide approach to the delivery of Home First.  This initiative identifies patients who can be discharged early to be safely cared for by therapy staff in their own homes and assessed for their ongoing care needs.

All CCGs and NHS acute trusts received a letter on 9 March 2017 from Simon Stevens, Chief Executive of NHS England, and Jim Mackey, Chief Executive of NHS Improvement, setting out a series of actions to get A&E performance back on track. 

These include:

• Every hospital has a front door streaming model by October 2017 under which GPs and nurses will assess patients to reduce pressure on A&E

·  Rollout of weekend and evening GP appointments to 50% of the population by March 2018 rising to 100% by March 2019

• An increase in the number of callers to NHS111 who receive a clinical assessment

Delegated Commissioning

The CCG’s application to take over responsibility for the commissioning of primary care services from NHS England has been approved.  This new responsibility takes effect from 1 April 2017.

The successful transition to delegated commissioning will rely on continued close working between the CCG and NHS England.

Financial Position

The CCG has regularly reported the rising pressure on its budget caused by the increasing demand for health and care services. We have made considerable efforts over the last twelve months to reduce our expenditure and whilst we anticipate that we will achieve a balanced financial position by the end of the 2016/17 financial year, we will not be able to deliver the required 1% surplus of £2.3m as required by NHS England. 

This will impact on our financial allocation for 2017/18 and financial pressures are set to continue into future years.  If we do not make further efficiency savings the funding gap is projected to be £10m in 2017/18, £15m in 2018/19 and rise to a total deficit of £21m in 2019/20.

We are developing a plan to deliver the significant savings required, balancing this with our determination to minimise the adverse impact on patients. The success of this plan will require greater levels of partnership working with local health and care organisations and our GP members.  We will also work with our wider stakeholders and patients to identify how we can commission services appropriately to continue providing high quality health services for our local population.

Sustainability and Transformation Plan

Before the end of March, NHS England is expected to announce the next steps for STPs and how some STP areas will be supported to accelerate towards accountable care systems. An accountable care system takes accountability for the delivery of all care and care outcomes for a given population, for a defined period of time, under a contractual arrangement with a strategic commissioner.  In doing so it designs and delivers services to best meet the needs of its population and improve health and wellbeing outcomes.  In light of the national direction of travel we are giving some thought to how we might evolve local models of care in B&NES in the future into an accountable care system,  building upon current arrangements.

Maternity Services Review

The RUH has begun a review of maternity services, seeking the views of women, families, staff, commissioners and the voluntary sector to understand what matters most to patients. The RUH wants to understand what families want from maternity services and what drives the choices they are making in relation to their care and decision-making around where to have their baby. They also need to understand what women feel is good about the current service provision and what they would like to see improved.

The Budget – Implications for Health & Social Care

The recent Budget included a number of announcements that will impact health and social care:

• An extra £2bn in funding for social care across the next three years, with £1bn available in the next year to allow Local Authorities to act now to commission new care packages

• The government will produce a Green Paper to be published in the autumn setting out the options for the future funding of social care

• £325m investment in a small number of STPs which are ready ahead of schedule, to allow the plans to proceed

• Further investment where necessary for other STPs, with a further announcement in the Autumn Budget around a multi-year capital investment programme for the implementation of STPs across England

• £100m investment to place more GPs in accident and emergency departments for next winter to support the establishment of front door streaming (as described in Section 1).

Councillor Tim Ball asked in terms of A&E performance were the people kept waiting over four hours actual emergencies.

Tracey Cox replied all patients are triaged on clinical property and that the figure was a crude statistic to be judged upon. She added that a front door streaming model would assess the appropriateness of where patients should be attending.

James Scott added that the average for a patient to be seen in February was 8 minutes and to receive treatment was 42 minutes. He said that the department was well staffed and was the best performing in the South West.

Councillor Tim Ball commented that he had concerns over the rollout of weekend and evening GP appointments and queried how many GPs were retiring or leaving because of this.

Tracey Cox replied that it was not about all practices being open and that plans were still being developed. She said that additional capacity could also be found in GP Hubs.

Councillor Tim Ball said in regard to Delegated Commissioning that he would not want to see progressive GPs have their work curtailed.

Tracey Cox replied that this work would not force GPs to change their direction of travel and that it would support practices to be sustainable.

Councillor Geoff Ward asked how much did the CCG contribute to the NHS England Action Plan.

James Scott replied that they attended an Emergency Care Conference where the Plan was discussed at an STP level. He said that one of the key elements being pursued was the Urgent Care Centre at the RUH which is run by local GPs in a similar model that has been successful in Luton and Blackpool.

Councillor Paul May said that the quality of service within A&E was paramount. He added that he supported the GP commissioning work and that specialisms should be looked for within specific practices.

The Chair thanked Tracey Cox for the update on behalf of the Select Committee.