Agenda item

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

Lucy Baker, BSW ICB addressed the Panel and said she was happy to take questions on the update report that had been provided. A copy of the report will be attached as an online appendix to these minutes.

Councillor Michelle O’Doherty wished to share a recent experience of attending the A&E department at the RUH. She explained that initially she had taken her son to Paulton Minor Injuries Unit only to find out that there was no X-ray service available on that day. They then returned to the RUH and had a 7 hour wait before being seen. She said that whilst there she noticed at least 15 ambulances waiting outside the A&E.

She asked what services were in place for patients that don’t need to attend A&E and what is being done to address the backlog of ambulances waiting to deliver their patients.

Lucy Baker replied that a huge amount of work is being done to try to address the issue of ambulance backlog at A&E and that over the past 4-6 weeks the waiting time had reduced.

She said that a review of what services can be provided at the Minor Injuries Units was ongoing and that it does have provision of an X-ray service, but might not have been possible on this occasion due to staffing levels.

She advised that a separate Urgent Treatment Centre is available through contacting the 111 service to book an appointment.

She explained that discussions relating to forming a plan for future provision were due to begin next week with colleagues from Primary Care, Clinicians from A&E and the Urgent Treatment Centre and Community Clinicians.

Councillor O’Doherty said that she had called 111 and the option of the Urgent Treatment Centre at the RUH was not mentioned, they were advised to go to Paulton. She questioned whether having it on the RUH site was the most appropriate location as people would almost naturally go to A&E instead.

Lucy Baker replied that it has been acknowledged that more could be done to make the public aware of the Urgent Treatment Centre. She said that when contact is made through 111 the operator can access a directory of services, of which the Urgent Treatment Centre is one of them, and this now has a separate flow to those patients trying to access A&E. She said that updates on progress can be provided to the Panel.

Councillor Lesley Mansell asked if the Panel could be informed of who was in contention to being awarded the Community Health contract and what form of public consultation will take place.

Lucy Baker replied that as a live procurement process was ongoing, she was unable to provide any further comment.

Councillor Paul Crossley asked if a reply in principle regarding consultation could be given.

Lucy Baker said that in principle they would work with the public on this matter at some stage. She added that more information could be shared when allowed and this might be in July / August. She added that feedback on community provision is gathered on a regular basis.

The Director of Adult Social Care added that it was hoped that a preferred bidder would be identified by September and at that point the Panel could potentially review the process, but she stated that it is a procurement by the ICB, not the Council.

Councillor Mansell asked if feedback would be in the form of a survey or through an in-person Q&A session.

Lucy Baker replied that her comment regarding feedback was not in relation to the procurement, but in terms of the current provision, how they have discussions with friends, family and individual patients and also via questionnaires.

Councillor Mansell asked if an update could be given on how our local hospitals are working together to share ideas on service transformation and provision.

Lucy Baker replied that within B&NES, Swindon & Wiltshire there is the Acute Hospital Alliance (RUH Bath, Great Western Hospital Swindon and Salisbury Foundation Trust) who work together as a group on matters from clinical pathways to back-office savings.

Councillor Liz Hardman referred to subject of GP surgeries and how difficult it is for people to get an appointment. She said that she was proud of the Paulton Minor Injuries Unit, but acknowledged that some services are not always available. She asked if the Panel could be updated on how this situation is planned to improve.

Lucy Baker replied that work is ongoing regarding access to Primary Care and that she would be prepared to bring something further back to the Panel at a future meeting. She added that part of that work was around the triage of patients when they contact their GP as in some cases it would be more beneficial for them to see a pharmacist or a Mental Health professional rather than a GP.

Councillor Hardman suggested whether a code could be given to patients who are asked by their GP to contact them within a few days if symptoms still persist rather than starting from the beginning of the process again.

Lucy Baker replied that she was aware that some practices do use text messaging and other forms of technology to communicate directly with their GP, but she was conscious that not all patients would be digitally able. She proposed whether a GP lead could attend a future meeting to give a more direct account.

Councillor Paul May commented that the Local Plan process was currently ongoing which could see a further 10,000 – 16,000 homes within B&NES and wanted to raise the potential impact this would have on local GPs. He said that he had already raised the matter with the ICB.

Councillor Ruth Malloy referred to an incident that she had been made aware of where a member of the public had requested a home visit from their GP and was told that this would not be possible, so they had to call for an ambulance.

She asked if it was known whether this occurs on a regular basis.

Lucy Baker replied that home visits by GPs is quite a historical model of care and that now, nationally and locally, there is a system used called the Virtual Ward which allows for hospital level care to be delivered at home.

She added that either a Doctor, Paramedic or an Enhanced Care Practitioner Nurse would carry out an assessment at home and would also be able to administer oxygen and intravenous medication whilst being monitored by the Virtual Ward.

Councillor Mansell asked if the issue of repeat prescriptions could be included in any future update report as she was aware that some members of the public were finding themselves going round in circles to obtain their medication.

Lucy Baker replied that the direction of travel on this matter is to use the NHS app to request repeat prescriptions. She acknowledged that there could be more work to do to make the public aware of this process and to support them with their access to health care.

Councillor Wright referred to a recent matter involving a family member where following surgery they were asked to attend their local doctor for follow up care. She explained that they were then actually told that they needed to be treated in Paulton despite the person in question not being able to travel that distance due to the surgery carried out.

She stated that this was not a reasonable service to expect and that all parties should know and be aware of what information has been given to a patient relating to their ongoing care.

Lucy Baker replied that any patient having had either emergency or elective surgery should be given a Patient Initiated Follow Up (PIFU) that does not require them to go through their GP for access to care after a surgical procedure.

She added that case studies are used regularly for learning within the NHS and that as part of a future report she would enquire as to how they are used within Primary Care.

Kevin Burnett asked at what point in the triage service does the level of knowledge or skill reach the level of a doctor, acknowledging that there needs to be a degree of experience to be able to ask the right questions.

Lucy Baker replied that within the Primary Access report they would seek to include information on examples of what GPs are doing locally in terms of providing a triage service.

Kevin Burnett asked if medical services within the RUH were still working under  a rating of ‘Requires Improvement’.

Lucy Baker replied that she would respond separately on that issue to the Panel in due course.

Kevin Burnett said that despite receiving a written answer he was still not clear on the roles and responsibilities of the ICB SEND Representative and whether their role involved connecting services or seeking additional resources. He commented that there was also an ongoing DfE Change Programme relating to SEND and asked if the ICB was involved in that in terms of B&NES.

Lucy Baker replied that it was the Chief Nurse who has that role within the ICB and she would ask if further information on the role could be shared with the Panel. She added that she would also pursue a response regarding the DfE Change Programme.

She said that a lot of work regarding the SEND agenda was ongoing locally, including the Partnerships for Inclusion of Neurodiversity in Schools (PINS) which was working with 40 schools across the BSW footprint.

Kevin Burnett asked if any further comment could be given regarding pharmacies and their current capacity levels.

Lucy Baker replied that until recently the ICB did not have pharmacies within their area of responsibility, it had been under NHS England. She added that a Pharmacy Strategy was in the process of being developed and could provide an update to a future meeting.

Councillor Paul Crossley commented that he regularly uses the NHS app and encouraged those who can to download and use it.

The Chair commented that the number of students within B&NES has increased to around 25,000 and that this must also add to the pressure on GP services locally.

Lucy Baker replied that she had recently met with the GP lead at the University of Bath practice, and they are doing some particular work with students who have an autism diagnosis and access to medication. She added that with regard to overall capacity concerning student numbers she would provide an answer to the Panel outside of the meeting.

The Chair asked if the Police were involved in the work the ICB does regarding Mental Health issues.

Lucy Baker replied that they are and that they work closely and collaboratively with both Police Forces within the BSW footprint. She added that there is an ongoing national piece of work relating to the role of the police when attending a mental health incident.

The Chair, on behalf of the Panel, thanked Lucy for the update report and attending the meeting.