Agenda item

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

Laura Ambler, Director of Place for Bath and North East Somerset, BSW ICB addressed the Panel and sought to highlight four areas from the update report. A copy of the update report will be attached as an online appendix to these minutes.

Primary Care Access Recovery Plan (PCARP)

There are currently 221,645 patients registered with a GP Practice in BaNES (June 2024). The range of Practice Registered list sizes vary from 26,000 (Heart of Bath) to 5,258 (Westfield). There are six Primary Care Networks (PCNs) in BaNES covering between 69,709 (Three Valleys) to 26,000 (Heart of Bath).

The Primary Care Access Recovery Plan (PCARP) forms part of the Operational Planning guidance and supports the Fuller Stocktake vision focussing on the first element of streamlining access to care and advice. The national ambitions for the PCARP are:

• To make it easier for patients to contact their practice and;
• For patients’ requests to be managed on the same day, whether that is an urgent appointment, a non-urgent appointment within 2 weeks or signposting to another service.

BSW has made good progress with the delivery of PCARP in BaNES, as well as Swindon and Wiltshire during the first year of the programme and is in a good position regionally.

Second year of PCARP: as a prerequisite of delivering the ambitions of the Fuller report, securing the foundation of good, equitable and consistent primary care access and resilience needs to remain an ongoing area of focus for the ICB as PCARP enters its second year.

British Medical Association (BMA) GP Collective Action

The BMA is currently balloting GPs on taking collective action in England. This ballot process will last until 29 July. GP members who run their surgeries will vote on whether to support the BMA’s call for collective action. The decision to launch the ballot came after the BMA formally entered a dispute with NHS England following the member referendum on the 2024/25 GMS contract changes in March.

Collective action is not the same as strike action, but it could see GPs prioritising the focus of their work. While discussions are ongoing, nothing is fixed, and all plans being explored are subject to change.

The BMA will seek to direct action from 1st August 2024.

Partnership in Neurodiversity in Schools (PINS)

BSW ICB is working in partnership with our local authorities and parent carer forums to pilot the provision of support to primary schools to help them meet the needs of their neurodivergent children.

This is a needs-led approach without the need for a diagnosis. By supporting primary school-age children and helping schools to identify and support their needs, these tools can be carried through into senior school and adulthood.

Assessing and meeting the needs of children with Special Educational Needs and Disability (SEND) in mainstream schools is the foundation for improving outcomes, parental confidence and delivering the financially sustainable SEND system, as envisaged in the SEND and Alternative Provision (AP) Improvement Plan.

The PINS project is testing a new model for supporting good outcomes in mainstream schools for Neurodiverse students and strengthening parent, carer and school partnerships. The project will focus on strengthening knowledge, skills and improving environments to better meet the needs of neurodiverse children. Through a focus on supportive learning environments and well- equipped schools, we can improve the outcomes for this group of children.

Sulis Elective Orthopaedic Centre

Planning permission has now been granted by BaNES Council for the Royal United Hospitals (RUH) Bath NHS Foundation Trust (RUH) to build a new wing at Sulis Hospital, a fully operational independent hospital owned by the RUH that treats both NHS and private patients.

Situated at Sulis Hospital in Peasedown St John, just outside of Bath, the new Sulis Elective Orthopaedic Centre (SEOC) will act as an NHS elective surgery hub; it will serve NHS patients from across the South West, helping to tackle the region's backlog of elective, non-emergency surgery.

It will mean an additional 3,750 non-emergency, orthopaedic operations can be carried out for NHS patients at the hospital each year.

Surgery at the site will be protected from disruption and cancellations caused by surges in emergency hospital admissions because Sulis does not have an emergency department. This means that the SEOC will enhance the resilience of services in the future.

A breaking ground event is scheduled to take place on Wednesday 24th July.

Kevin Burnett referred to the figures listed within the update for the Primary Care Access Recovery Plan and asked how many other authorities they were being compared to.

Laura Ambler replied that the figures were a comparison to other authorities across the South West of England.

Kevin Burnett asked if the app referred to was the NHS App that was released first of all during the Covid pandemic, what was seen as its role now and how are the public being encouraged to use it.

Laura Ambler replied that it was the same NHS App and that there was a drive to increase registrations to enable people to manage their own health records in a pro-active way.

Kevin Burnett asked if she was able to elaborate on the prospective records access enabled and the one care navigator course.

Laura Ambler replied that being digitally enabled and to have the ability to share records appropriately was critical to achieving integrated seamless care. She added that the role of the care navigator is to attempt to direct people to the most appropriate service.

Kevin Burnett asked if the ICB had any impact on the GP Collective Action.

Laura Ambler replied that this was an ongoing national discussion and that the role of the ICB is to have a watching brief and to understand what it will mean for local areas once a decision is made.

Kevin Burnett referred to the Partnership in Neurodiversity in Schools (PINS) and asked how many schools had signed up so far, how does this work fit in with the Council’s new SEND and AP Advisory Service and what happens when any support required has been identified.

Laura Ambler replied that it was recognised that there has been an increase in the demand profile for children presenting with neurodiversity needs. She said that this was due to having a better understanding of such conditions and being able to identify them.

She added that there was an increase in the number of Autism only profiles coming forward.

She stated that 40 schools had signed up to take part and that when they did so they completed a self-assessment checklist to identify what potential areas of support would be needed.

The Director of Education & Safeguarding added that the SEND / AP Advice Service will be operational from September and that part of its role will be to signpost people / schools to the work of the PINS project.

Kevin Burnett asked if there was a limit to the number of schools that could take part in the PINS project.

Laura Ambler replied that this pilot version has stated that it wants to have a minimum of 40 schools involved and could possibly roll out further in the future. She added that 12 schools within B&NES had signed up to the project.

Kevin Burnett asked what happens once a school has completed the self-assessment and identified that certain areas of support are required.

Laura Ambler replied that this is when they will begin to receive the targeted support from the health and care specialists. She added that this is a nationally funded project with a direct amount awarded to the BSW footprint.

Councillor Joanna Wright asked how members of public can make complaints and challenge the behaviours of their GP surgeries if they are not happy.

Laura Ambler that this would normally begin with the Patient Advisory Liaison Service (PALS) and said that individual practices should also have their own complaints process to follow and that these should be available online to view.

Councillor Wright commented that she welcomed the reply as it was important to allow the public to feel able to make complaints should such issues arise. She added that she would welcome further information on how the process works and said that easier avenues to access should be made available.

Laura Ambler replied that she would take the matter away for further consideration and provide the Panel with a response at a future meeting.

Councillor Wright referred to the PINS project and said that she was aware of a letter from the Palladium Academy Trust that says the funding available will not match the spending required and that unfunded SEND provision will have to cease due to financial difficulties. She said that this highlighted the extreme pressure that some schools are working under.

Councillor May said that he was aware of this issue and had held a discussion with the Director of Education & Safeguarding regarding it. He added that funding is received through the Dedicated Schools Grant and that if a Trust feels that it is not adequate enough they must raise that directly with the DfE.

The Chair said that she felt that schools were being asked to do more with less resources and hoped that the new Government would address this.

Councillor Wright asked for the Panel’s comments around the pressure on schools to be fed back as part of the PINS project. She also queried how many schools had decided to not take part in the project due to the pressure they feel that they are under already.

Laura Ambler replied that she would relay these comments as part of the evaluation of the project.

Kevin Burnett stated that it was his view that the funding given to schools was dire. He also said that he would welcome Ofsted playing more of a role in feeding back comments to the DfE following any reviews carried out with the Local Authority, especially with regard to funding. He added that he appreciated the work that the PINS project was trying to address.

Councillor Dave Harding referred to the Primary Care Access Recovery Plan and asked if further information could be received, to include figures in relation to B&NES rather than just the ICB and GP practices by deprivation quintiles as this could possibly identify any issues regarding access to IT.

He said that he would like to see the numbers over the past five years, and then ongoing, as part of this plan of fully trained GP’s, new doctors and health professionals funded through the ARSS Programme to have a better understanding of the capacity levels.

Laura Ambler said that she would welcome those specific questions via email and then would supply a response.

Councillor Harding agreed to do so.

Councillor Lesley Mansell commented that she would appreciate the update reports being circulated earlier than they currently are to enable more time for Panel members to read them. She asked if the more isolated communities, such as boat dwellers, would be able to access the Dental Van.

Laura Ambler replied that they don’t yet know what provision will be possible through the Dental Van and were being mindful of the groups that could benefit from it.

Councillor Mansell added that she had received feedback from residents within her ward that were worried about providing information electronically and using the NHS App.

Laura Ambler replied that she understood the concerns but stated that the NHS App was secure and was a way of enabling people to access their own records / data. She added that arrangements can be made so that a helper or carer could access them if required.

Councillor Mansell commented that PINS was seen as a positive way forward, but asked how that would relate to people who may need some form of diagnosis before receiving a service, giving Housing as an example. She asked what training and information would be provided as part of the project.

Laura Ambler agreed that it should be seen as a positive initiative that can provide support without the need for a complete diagnosis. She said that understood the challenges for those people that require a diagnosis to access a particular service. She added that through this pilot there would be shared learning opportunities for many members of staff.

Councillor Ruth Malloy asked how children that are in need of urgent dental care will be identified.

Laura Ambler replied that there is a Public Health programme that is looking at the oral health care of children. She added that it will also be recorded how many children present for emergency dental care, such as extractions at our acute hospitals.

Councillor Mansell asked how many of the 12 B&NES schools involved in the PINS project were in Radstock.

Laura Ambler replied that she would find out and reply in due course to the Panel.

Kevin Burnett asked if it was felt that there is now a better understanding of areas surrounding neurodiversity.

Laura Ambler replied that she believed that more people were now aware of these types of conditions and that it was now more about being able to identify the needs of individuals. She added that there is a Programme Board that has a schedule of work and she would be happy to supply an update to a future meeting.

The Chair asked if within the digital records area of work, there were any plans to be able to expand it across the whole country to allow for dual registration for groups of people, such as students.

Laura Ambler replied that there was a way to go on this matter and that both the ICB and NHS England were looking at this.

The Chair, on behalf of the Panel, thanked Laura Ambler for the update.