Agenda item
B&NES, SWINDON & WILTSHIRE INTEGRATED CARE BOARD (BSW ICB) UPDATE
The Panel will receive an update from the B&NES, Swindon & Wiltshire Integrated Care Board (BSW ICB) on current issues.
Minutes:
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.
£40.5m NHS funding boost to improve care for individuals with a learning disability and autistic people in the South West
People living with autism and learning disabilities across B&NES are set to benefit from a £40m NHS investment to improve acute mental health care in the South West.
Twenty new mental health hospital beds across the South West will help bring an end to long-distance placements, making life better both for individuals who need hospital treatment, and for their families, friends, and carers.
Two new 10-bed units, in Bristol and Devon, will be designed specifically to care for individuals with a learning disability or autistic people who would benefit from treatment in a hospital and whose needs cannot be met in a mainstream mental health hospital, even with reasonable adjustments.
The new facility has been designed with input from service users, people with a lived experience, and their families and carers and will provide the kind of specialist therapeutic mental health care which cannot be provided at home or in another mainstream hospital.
Orchard House
Orchard House is our new community crisis house based in Midsomer Norton that provides step-up and step-down support for people with mental health needs. The facility, which is provided by Bath Mind, provides accommodation 365 days a year, 24 hours a day for four people at any one time.
Orchard House includes dedicated quiet and therapy space for individuals to support their recovery and reduce preventable hospital attendances and admissions as well as expediting discharge back to the community with jointly agreed safety support plans and community engagement programmes.
Royal United Hospital performs the first HIFU non-invasive prostate cancer treatment in the South West
The Royal United Hospitals Bath NHS Foundation Trust (RUH) has successfully treated two prostate cancer patients with an innovative high-intensity focused ultrasound (HIFU) treatment, the first time this therapy has been carried out in the region.
The new HIFU unit at RUH Bath, with equipment funded by Prost8 and the UK Focused Ultrasound Foundation, integrates advanced image-guided capabilities and ultrasound energy to precisely target the prostate without any incisions or radiation, therefore sparing nearby healthy structures.
Kevin Burnett referred to the new NHS funding and asked if this would in any way fill the void for the closure of Homeward, the previous temporary community hospital ward.
The Director of Place, B&NES, BSW ICB replied that their Winter Plan is in place and although Homeward was originally within that plan, the Virtual Wards will more than compensate for its closure. She added that the Community Wellbeing Hub also has a role in discharge planning and access to other services. She explained that a focus remains on reducing the reliance on bedded care.
Kevin Burnett asked if there was just a single point of contact for the Community Wellbeing Hub and a guide of when and who to contact.
The Director of Place, B&NES, BSW ICB replied that there was just one single contact number for the Hub. She said that GP’s were able to make referrals into it and that there was also a unit within the Atrium of the RUH to offer advice.
Councillor Liz Hardman commented that she was aware that the BSW ICB currently has a deficit of £31m with proposed savings planned for a further £93m. She asked how this financial position would impact on services.
The Director of Place, B&NES, BSW ICB replied that the majority of, if not all, ICBs were facing similar pressures and need to obtain a balanced financial position. She added that she could not state at this stage the direct impacts of these proposals and would update the Panel when possible.
Councillor Hardman asked if any comment could be given on the issue of whether the ICBs in general have agreed to a single bank rate, when this action would be taken, what impact it will have on workers / residents and if the savings that are hoped by this action can be achieved.
The Director of Place, B&NES, BSW ICB replied that she would need to take that question away and reply in due course.
The Chair commented that she was surprised by the level of debt a relatively new body, such as the BSW ICB, was facing.
The Director of Place, B&NES, BSW ICB replied that the deficit, to a degree, was historic and that they are taking steps to have a balanced financial plan in place moving forward.
Councillor Eleanor Jackson asked how best to get information out into the community regarding the Falls Clinic and the work that it does to try to prevent these incidents from occurring.
The Director of Place, B&NES, BSW ICB replied that there is a referrals team based within the RUH that works closely with the Community Wellbeing Hub. She added that they also have a programme of work named Integrated Neighbourhoods that will look at how provision such as this can be based more within communities to aid with prevention and avoidance.
Councillor Joanna Wright commented that suitable connections need to be put in place and that as much as possible people need to be approached when they are in the right settings.
Victoria Stanley, Programme Lead, BSW Community Pharmacy, Optometry and Dentistry addressed the Panel and gave a presentation on the subject of B&NES Community Pharmacy. A copy of the presentation will be added as an online appendix to these minutes and a summary is set out below.
Community Pharmacy in BSW
· 145 Contractors
· 2 x Local Pharmaceutical Committees
o Community Pharmacy Avon
o Community Pharmacy Swindon & Wiltshire
· On an average day dispense 50,000 items in BSW
· Nearly 3000 walk in consultations seeking minor illness and their own medicines (20 per day per pharmacy)
Provision of Community Pharmacy
· Like GPs, community pharmacists are independent contractors, but they are also part of the NHS family. Every day about 1.6 million people visit a pharmacy in England.
· Community pharmacies are situated in high street locations, in neighbourhood centres, in supermarkets and in the heart of the most deprived communities. Some are open long hours when other health care professionals are unavailable. There are several different types and sizes of community pharmacies, ranging from the large chains with shops on every High Street or in edge of town supermarkets, to small individually owned pharmacies in small communities, in the suburbs and often in deprived areas or rural settings.
Community Pharmacy – Types and Hours
Types of pharmacy
· 40 hours Community Pharmacy
· 100 hours Community Pharmacy (not now an option to enter the market)
· Distance Selling Pharmacy
Hours of provision
· 40 hrs (100hrs) are Core Hours: only changed by NHSE consent, but decisions can be appealed.
· 100 hrs contractors are able to reduce to 72 hours – giving 5 weeks' notice.
· Supplementary Hours: pharmacy can change - giving 5 weeks' notice.
Essential Services (required)
· Dispensing: provision of medicines and appliances, giving advice to patients on use. This includes electronic repeat dispensing, which reduces practice workload.
· Discharge Medicines Service: support patients with changes to medicines following a hospital stay and reduces risk of readmission.
· Disposal of Unwanted Medicines: receive and safely dispose of unwanted medicines, supported by the clinical waste service.
· Healthy Living Pharmacies: pro-active support to patients, promoting behaviour change and improving health and wellbeing, supporting reduction in health inequalities.
· Public Health Campaigns: participate in 6 nationally defined health campaigns – display/distribute leaflets i.e., ‘help us to help you’.
Advanced Services (nationally offered, optional provision)
· Community Pharmacist Consultation Service (CPCS): 111 / GP/UEC referral to the pharmacist for minor illness or an urgent supply of repeat medication. In BSW in 2022/2023 GPs sent 21,500 referrals to pharmacy and NHS111 sent 12,500 referrals
· Influenza: 18yrs and over at risk, as defined in the Green Book, offering extended hours and flexibility of access. Significant increase in use during CoViD.
· Pharmacy Contraception Service: Tier 1- on-going management of routine oral contraception which was initiated in general practice or sexual health clinic. Tier 2 will enable initiation of oral contraception.
· New Medicines Service: support people with long-term conditions to use new medicines effectively and enable self-management.
· Smoking Cessation Service: referred on hospital discharge for smoking cessation advice and support.
Locally Commissioned Services
· Local Authorities and Health Partners commission sexual health services, needle and syringe exchange services, smoking cessation services, supervised methadone consumption from some pharmacies.
· (ICB) Specialist Medicines Service: hold an agreed stock, largely focused on medicines for end-of-life care.
· (ICB) Patient Group Directions for Minor Illness
Community Pharmacy Quality Scheme
· Part of the Community Pharmacy Contractual Framework
· Year 5 Scheme 2023/24 (Launched 1st June 2023)
· One gateway criterion New Medicines Service (NMS) - Minimum of 15 between 1/4/23 – 31/12/23
· Three domains
o Medicines Safety & Optimisation:
§ re-audit and implement learning on reducing harm from anticoagulants
§ palliative and EOL Care
o Respiratory
§ inhaler technique checks
§ personalised asthma plans
§ safer prescribing of bronchodilators
o Prevention
§ antimicrobial stewardship
§ advice on safe disposal of unwanted medicines.
Market Entry
· Pharmaceutical Needs Assessment: Local Authority led
· Pharmaceutical Services Regulations Committee (PSRC)
o Current or Future Need
o Unforeseen Benefit
o Relocation with No Significant Change
o Consolidation
o Distance Selling
o Rurality Review
o Dispensing Practice
· NHS Resolution: appeals process
Expanding Community Pharmacy Services
· Community Pharmacy has been seen as an essential part of primary care offering patients easy access to health services in the heart of their communities. Over 80% of patients live within a 20-minute walk of their pharmacy who give expert clinical advice.
· Building on the success of the existing services outlined in the Community Pharmacy Contractual Framework (CPCF) delivered by Community Pharmacy - this plan wants to expand the range of services offered making better use of the clinical skills in community pharmacy, making them the first port of call for patients for many minor illnesses.
Current Provision in B&NES
· Total Community Pharmacists: 35
· Total 40-hour Contracts: 34
· Total 100-hour Contracts: 1* (*Recently changed to 72-hour contract)
Workforce Challenges
Vacancy rates
· Pharmacists 25% (second highest in the country)
· Pharmacy technicians 28%
· Accuracy checkers 46%
Councillor Alex Beaumont asked if he could be informed which pharmacy in Keynsham was the Community Pharmacy and how is its status advertised.
Victoria Stanley replied that they were working with Healthwatch to see what can be done in terms of informing the public more about this provision. She added that she would reply following the meeting with regard to the siting of the Community Pharmacy in Keynsham.
Councillor Paul Crossley asked what processes are followed for giving advice to young people regarding sexual health.
The Associate Director for Public Health replied that they can be given emergency contraception and that safeguarding is monitored through the Sexual Health Board.
Councillor Crossley said that he would like the Panel to consider adding the subject of Modern Slavery to its workplan as he said that recent figures show that there are around 125,000 within the UK.
Councillor Joanna Wright said that she would welcome all Councillors being advised of a list of the Community Pharmacies so that they are aware of the ones that exist within their Wards.
Councillor Liz Hardman asked how the pharmacies were chosen to become Community Pharmacies.
Victoria Stanley replied that this process is led through the work of the Pharmaceutical Needs Assessment.
The Associate Director for Public Health replied that the results of the Assessment are published on the Council’s website every three years.
Councillor Eleanor Jackson commented that the pharmacies in Radstock & Westfield were both excellent and asked if Highways / Parking Services could be approached to see whether staff could be given a pass (or passes) that would enable them to use the nearby car parks for a longer period of time and for the pharmacy to be open for longer.
The Chair said that she would be interested to see the demographics of the users of the Community Pharmacies, in particular the number of students.
Helen Wilkinson replied that they could seek to provide that information when they return to a future meeting to provide the Panel with an update.
The Chair, on behalf of the Panel, thanked all the officers for the update and the presentation.
The Panel RESOLVED to note the information that had been provided.