Agenda item

The Panel will receive an update from the B&NES, Swindon & Wiltshire Integrated Care Board (BSW ICB) on current issues.

The Director of Place, B&NES, BSW ICB addressed the Panel and highlighted the following areas from her update. A copy of the update will be attached to these minutes as an online appendix.

BSW ICB Prescriptions Ordering Direct – Proposals for the future

BSW ICB has developed a proposal for an organisational change to stop BSW ICB’s Prescriptions Ordering Direct (POD) in its current form and look at potential options for the future of repeat prescribing. We look forward to engaging with members on the proposal over the coming weeks.

Primary care is one of the most dynamic and innovative parts of the health service and ensuring our busy primary care system across BSW is supported and resourced fairly and equitably is an important focus for BSW ICB.

The context has also changed since POD was first launched in 2017. One of the ambitions set out in the national Delivery plan for recovering access to primary care is to enable patients in over 90% of practices to order repeat prescriptions using the NHS App by March 2024.

We have looked at scaling POD across the system, however it is clear that the levels of necessary financial support required would not be achievable. Other POD services have now closed or are in the process of closing across England for very similar reasons. 

We are now actively engaging with our staff ahead of a formal consultation on potential changes to POD. During this period, we would like to offer you and elected members with a role and interest in health services a meeting to discuss the proposal in more detail if helpful. Our engagement period will run up until 2^nd November inclusive.

After the engagement period and our consultation with staff, we will consider all comments received from our colleagues, yourselves and other stakeholders and will decide on the way forward. We will also feedback to you the outcome of the consultation and engagement process once we have gathered all the information we need. 

The BSW Primary and Community Care Delivery Plan (PCCDP)

The BSW ICB Board has approved a Primary and Community Care Delivery Plan (PCCDP) for BSW. The PCCDP builds on existing BSW strategies, including the BSW Together Integrated Care Strategy and Implementation Plan as well as national policy and guidance.

This delivery plan also incorporates feedback from over 40 stakeholders including primary care GPs, integrated care board (ICB) members, the clinical oversight group, and the integrated community-based care (ICBC) programme.

It sets out a number of priorities to deliver transformation for primary and community care and reflects the engagement work completed with service users, providers and wider stakeholders to identify initiatives and solutions to deliver our ambition.

Winter planning

As our health and care system continues to experience unrelenting demand challenges and operational pressures, we are continuing to work with our partners to deliver existing demand management and capacity improvement plans.

Operationally there continues to be significant joint working in the locality under our Home is Best programme of work which supports patients to remain at home, aims to reduce our reliance on bed-based care and improve patient outcomes and experience.

Working in partnership across health and social care, we are on track to deliver our plans to deliver against targets including reducing the number of the non-criteria to reside in our acutes - currently maintaining a position below our trajectory of 30, significantly reducing our number of discharge to assess beds by 40 per cent, we are currently at 31, exceeding our target of 36. 

We have also continued to increase our use of virtual wards- a flagship BSW scheme. A key focus for the coming months is on increasing referrals to the Virtual Ward step-up model through continuing to raise the profile of service. 

Community Investment Fund

Good progress has been made with our Community Investment Fund. BSW ICB has been working with five BaNES-based third sector organisations and has awarded grants to Southside Hardship Fund, Julian House, Citizens Advice Bureau, Age UK and West of England Rural Network.

These grants will help some of our most vulnerable communities with cost-of-living support, food and clothing and warm home grants. 

This is a key part of our strategy on health inequalities and a demonstrable example of how BSW ICB is working directly with our communities at a local level.

BSW VCSE sector partner Bath Mind opens new well-being accommodation for adults experiencing a mental health crisis

Local Voluntary, Community and Social Enterprise organisation Bath Mind has opened a non-medical house offering wellbeing accommodation for adults experiencing a mental health crisis.

Orchard House, located on the edge of Midsomer Norton, provides a step-up service for people living in the community who are experiencing difficulties with their mental health and need support to avoid hospital admission. It also provides a step-down service for those leaving an in-patient setting who would benefit from additional support before returning home.

The Chair asked how and who agreed the six priorities of the BSW Primary and Community Care Delivery Plan.

The Director of Place, B&NES, BSW ICB replied that they were agreed through the engagement work on the Integrated Care Strategy and included liaising with stakeholders across the system, including acute, primary and community care.

She added that the transformation priorities were as expected and that they were seen as part of the golden thread that comes through the Integrated Care Strategy. She said that there was also significant joined up working between the Integrated Care Alliance and the Health & Wellbeing Board.

The Chair asked if there was any political involvement in this process.

The Director of Place, B&NES, BSW ICB replied that there was through the work of the Health & Wellbeing Board and the Integrated Care Partnership.

Kevin Burnett referred to a question from a previous meeting and asked if the Panel could be updated on how the service at the Royal United Hospital Urgent Treatment Centre was progressing following their amendments to it which began on September 4th 2023.

The Director of Place, B&NES, BSW ICB replied that the Urgent Treatment Centre was going well and that no adverse patient impacts had been identified. She added that it would be reviewed after three months.

Kevin Burnett asked if the changes had resulted in any savings on resources.

The Director of Place, B&NES, BSW ICB replied that it has enabled this part of the service to be more efficient, in terms of what resources we put where and when and that it has enabled patients to access care how and when they need it.

Kevin Burnett asked if there was any available update on the Health Infrastructure Plan 2.

The Director of Place, B&NES, BSW ICB apologised for not having an answer on this matter yet and would seek to source an update in due course.

Kevin Burnett asked for confirmation that the BSW ICB have a SEND representative and asked what their role was and how they liaised with other agencies.

The Director of Place, B&NES, BSW ICB replied that Gill May, Chief Nurse has that role and that there are SEND Board representatives in each locality. She added that she is the executive lead for Learning Disabilities & Autism and will attend the Children & Young Persons Programme Board where discussions regarding SEND take place.

Kevin Burnett commented that at a previous meeting it was suggested that officers from the Council meet with the ICB to discuss identification of Young Carers.

He asked if a clear message could be given as to how and when people were expected to contact Prevention / Early Intervention services.

The Director of Place, B&NES, BSW ICB replied that this was partly the driver behind the Primary Care & Community Delivery Plan and the need to have the right access in place. She added that the Community Wellbeing Hub was a flagship for this area and has a role within this work area. She said that she would relay these comments to colleagues in Primary Care within the ICB.

Councillor Liz Hardman referred to the issue of dental services and stated that many local dentists were no longer able to provide a service under the NHS because they were not paid enough. She asked the ICB to explore with the Government whether the pay for B&NES NHS dentists can be improved and whether the changes would see an improvement in services for residents. She added that she welcomed the focus on the areas of greatest need and inequality of access.

The Director of Place, B&NES, BSW ICB replied that there were some structure issues that need to be resolved and that they would seek to report back as soon as possible. She added the intention of the changes is to improve access to services.

Councillor Joanna Wright suggested that the Council write directly to all local NHS dentists and ask them how many patients they have removed from their NHS lists over the past three years.

The Chair suggested that Dental Services forms a report at a future meeting of the Panel.

Councillor Liz Hardman commented that she would also welcome a future report on Pharmacies to the Panel. She asked why Prescriptions Ordering Direct was being stopped in its current form.

The Director of Place, B&NES, BSW ICB replied that it was a service that does not need to be provided and that it was only being used by one practice within B&NES. She added that arrangements have been adapted internally for those practices that do not use POD.

Councillor Hardman asked for clarification on the reductions being made with regard to Discharge to Assess.

The Director of Place, B&NES, BSW ICB replied that this was linked to their Home is Best programme and to support people to be in their own homes for as long as possible and reduce the reliance on bedded care. She stated that they had a target of 36 beds in use and had managed to reduce this to 31 which was a great achievement.

The Chair suggested that the Chair of the ICB could be invited to a future meeting of the Panel.

The Chair thanked the Director of Place, B&NES, BSW ICB for the update on behalf of the Panel.