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

In July over 94 per cent of patients were seen in A&E within the four hour target wait.  However in August this dropped to 90.6 per cent and unverified figures for September indicate a further decline.  Working with the Royal United Hospitals Bath NHS Foundation Trust (RUH), Virgin Care, the South Western Ambulance Service NHS Foundation Trust and many other providers we are beginning our preparations for winter to ensure we can maintain patient safety and performance over the coming months.

GP Survey Results Summer 2017

GPs in Bath and North East Somerset have once again come top of a nationwide patient survey for patient experience.

The July GP Patient Survey showed that 93 per cent of the almost three thousand B&NES residents who took part in the survey in January 2017 rated their experience at their GP surgery as ‘good’. This compares with a national average of 85 per cent.

The continued positive results that B&NES GPs achieve in this survey despite the exceptional pressures on their time and services is testament to GPs commitment to the quality of patient care.

Urgent Care Centre

At the start of August 2017 we appointed the RUH and B&NES Enhanced Medical Services to run the Bath-based Urgent Care Centre after a rigorous procurement process.

The partnership will take over responsibility of the centre from May 2018, and will work closely with B&NES Doctors Urgent Care – which currently runs the service – to ensure a smooth transition.

Helping patients get fit for surgery

From next month we are making changes to the fitness programme we currently provide for patients needing hip or knee surgery. Over 40 percent of participants see such an improvement they no longer require surgery. From October the programme will be extended by up to three months to include weight management support for those with a body mass index (BMI) of 30 or more and smoking cessation advice for smokers. 

One of the ways to improve health and wellbeing is to increase the number of people accessing smoking cessation and weight management services, and evidence suggests that the point of referral to surgery is an opportune moment to encourage people to uptake referrals to these services.

Evidence also suggests that patients who smoke and/or are obese are at higher risk of surgical complications when compared to those who don’t smoke and are a healthy weight.

We plan to roll the scheme out to other surgical procedures next year following consultation with the public about our plans which begins at the start of October.

NHS England consultation on prescriptions for medicines of low value

NHS England has launched a formal consultation on new national guidelines which state that 18 treatments – including homeopathy, travel vaccines and herbal treatments (which together cost UK taxpayers £141 million a year) should no longer be routinely prescribed by GPs. 

The consultation also seeks views on the prescribing of products for minor self-limiting conditions which are readily available over the counter, at supermarkets and other retailers, often at a lower price than the cost to the NHS.  The products include cough mixture and cold treatments, eye drops, laxatives and sun cream lotions.

The consultation closes on 21 October and once the feedback has been analysed we can expect to receive newguidance to inform our decisions about changes to our local prescribing policies.

Following consultation locally in B&NES in 2016, we have already made some changes to our prescribing policies for gluten-free foods for patients with coeliac disease and two types of over-the-counter products – antihistamines and painkillers where they are used to treat minor, short-term ailments. 

Information about the consultation is available via our website www.banesccg.nhs.uk .

Councillor Bryan Organ asked if the number of GP and hospital appointments not being kept was an issue within B&NES.

Dr Orpen replied that it is an issue that is monitored and is addressed if it occurs from regular sources. He said that all but one local surgery has an automated phone system to enable members of the public to cancel appointments.

Councillor Lizzie Gladwyn said that it was good to see the merged pathway for Urgent Care. With regard to patients being fit for surgery she asked if it was taken into account for those who, through their current condition cannot lose weight.

Dr Orpen replied that hospitals were conscious of the need to not disadvantage people that require surgery. He added that through a public survey 70% of respondents recognised the need to do more to help themselves prior to surgery.

Councillor Lizzie Gladwyn asked if the pressure on the A&E department in August and September was due to specific holiday injuries or people returning from holiday with injuries.

Dr Orpen replied that if anything actual numbers of patients were down and that the delays were due to less staff being on site due to the time of year.

Councillor Tim Ball said that he agreed with the approach taken on the matter of being fit for surgery. He added that he recognised the need to withdraw certain types of prescription, he commented though that he had noticed that there had been in some cases a 50% rise in the cost of some gluten-free foods in supermarkets following the withdrawal of those for coeliac patients in 2016.

Dr Orpen replied that he had met with the Coeliac Society prior to that decision being made to discuss alternatives that patients could choose.

Councillor Tim Ball addressed Dr Orpen and Councillor Vic Pritchard in their role as Co-Chair of the Health & Wellbeing Board. He said that a formal complaint had been submitted as the apologies of himself and Councillor Jackson were not being recorded in their role as official observers to the Board.

Councillor Eleanor Jackson said that she attended the Board whenever she could and that it was only through recent ill health that she was unable to be present. She said that she found it insulting to be treated in this manner and also could not understand why they were not allowed to be involved in any Development Days.

Dr Orpen replied that the Development Days were about the effectiveness of the Board and although he understood their role as observers they were not members of the Board.

Councillor Vic Pritchard said that he could see a reason for recording their attendance but as they were not members of the Board he was not sure of the need to record their apologies.

The Chair said that the matter should be discussed further outside of the Select Committee by Dr Orpen, Councillor Pritchard and the Director Integrated Health & Care Commissioning.

Dr Orpen said that there was no intention to offend both Councillors and that he hoped a solution could be found.

Councillor Eleanor Jackson asked if a review of patient prescription medication took place as standard every year. She also invited Dr Orpen to one of her weekend surgeries to meet local members of the public and discuss problems.

Dr Orpen replied that GP’s do perform such a review to see if a patient still requires the medication or if their circumstances have changed. He added though what they cannot do is address patients directly on their previous usage.

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