Agenda and minutes

None declared.

The minutes are attached.

RESOLVED:-

that the minutes of the previous meeting held on 24 July 2013 be approved as an accurate record of the meeting, subject to the following amendment:-

-       Page 1, under ‘Also present’, add ‘Councillor Hirani (Lead Member for Adults and Health).

Brent Clinical Commissioning Group: commissioning intentions

In reply to queries from Members, Rob Larkman (Chief Officer, Brent, Ealing, Harrow and Hillingdon Clinical Commissioning Groups) confirmed that a list of consultees for cardiology and ophthalmology procurements and a copy of the Brent Clinical Commissioning Group (CCG) investment study had been provided to the Committee.

Two reports are included under this item, the first being the NHS England report outlining the general services provided by GPs under different contract types and summarising the contractual arrangements with GPs in Brent and the differing levels of access available at different practices across Brent.  The second report outlines the aims of the former ACE programme undertaken in 2010/11, by the PCT, designed to improve GP access.

A number of appendices are attached to the reports and there are also two supplementary agenda packs containing other appendices. 

Julie Sands (Deputy Head of Primary Care, North West London NHS, NHS England) introduced the first report on access to primary medical services in Brent.  She informed the Committee that the national GP patient survey 2012-2013 had been analysed to identify what areas were in need of improvement.  In Brent’s case, there had been a considerable variation in GP practices across the borough in relation to patient access, both in terms of practice opening times and in how patients rated access. This was an issue that was mirrored across England and was of some concern.  Julie Sands advised that the national Assurance Framework, developed by NHS England, bought together a range of demographic and performance issues about practices, including reported patient satisfaction on accessing GP services, and this information would be used to identify and manages practices where there were concerns about the level of service provided.  NHS England would carry out an investigation into the underlying reasons for any concerns or dissatisfaction with a particular practice and depending on the circumstances of each case, the course of action to address this may involve encouraging best practice with other high performing practices in the locality, taking remedial action or in more serious situations or where the problems had continued in the longer term, using contractual levers such as breach notices and control sanctions. 

Referring to the Standard General Medical Services Contract in the second supplementary agenda, Julie Sands advised that this was nationally prescribed.  However, there was no specific criteria in respect of access provision.  Members noted that there was a range of different kinds of contracts that the provider may have with the NHS, however every effort was made to encourage practices to offer enhanced services, although this was optional.  Members noted the types of contract and the services offered by each practice in Brent as set out in the first supplementary agenda.

Jo Ohlson (Chief Operating Officer, Brent CCG) then presented the second report on supporting practice improvement and primary care development that detailed the outcome of the Access Choice and Experience (ACE) programme and the work of Brent CCG since April 2012.  An update on the outcome of patient satisfaction rates was also included, comparing results with 2009/2010, 2010/2011 and 2012/2013 respectively.  It was noted that the biggest improvement in Brent was satisfaction in being able to get through to a practice by phone.  Jo Ohlson advised that there had also been some improvement in being able to obtain an appointment reasonably quickly.  However, in respect of satisfaction with the opening hours of GP practices, this had seen a slight reduction and this mirrored the trend nationally. 

With regard to Brent CCG support to improving care, the following strategies had been developed to underpin this:-

·         Supporting development and implementation of practice improvement plans

·         Investing in additional primary care capacity

·         Transforming primary care as part of developing out of hospital services

Jo Ohlson explained that Brent CCG worked with practices to ensure that they were fully compliant with  ...  view the full minutes text for item 4.

The covering and main report are both attached.

With the agreement of the Chair, Irwin Van Colle (Chair, Kingsbury Patient Participation Group) addressed the committee.  Irwin Van Colle began by stating that overall the Equalities, Diversity and Engagement (EDEN) Committee was a highly successful organisation and that in Kingsbury, most of the GP practices sent delegates to the Patient Participation Group meetings.  Members heard that Brent CCG were in consultation with the EDEN Committee over constitutional matters, and whilst there had been some agreement, such as in complaints, differences of opinion remained in respect of commissioning.  In particular, the EDEN Committee was against any proposals for their abolition as apparently had been suggested by the CCG on 25 September 2013 and there were competing views as to how consultation should be undertaken.   EDEN Committee members also felt that the CCG was sometimes simply informing them of their intentions rather than consulting fully with them.  Irwin Van Colle advised that the EDEN Committee was requesting than an open, borough-wide conference involving the CCG, the council, the EDEN Committee and patient participation groups be undertaken on extending public and patient engagement and the committee was asked to help facilitate the creation of this conference.

With the agreement of the Chair, Julia Kirk (Co-Founder, CMH Rheumatology Patient’s Support Group) addressed the committee.  Julia Kirk stated that she was a rheumatology patient at CMH and attended the hospital every two months.  Members heard that the Support Group was dismayed that Brent CCG had not consulted anyone before issuing a decommissioning notice on 28 March 2013 to North West London Hospitals Trust (NWLHT) confirming that musculoskeletal (MSK) services including rheumatology would cease on 1 October 2013.  Upon the Support Group hearing of this in August 2013, Julia Kirk stated that she had sent a letter of complaint to Brent CCG detailing the lack of consultation and indicating that they wished the CMH rheumatology clinic and other services to continue at the Trust.  Brent CCG had responded by stating that a consultation was not required and as a result, she had sent a complaint to the Health Ombudsman at stage two of the complaints procedure.  She was aware that at least 50 other Support Group members had submitted their complaints to Brent and Harrow CCGs respectively.  Julia Kirk outlined the details of the complaints as set out in her written statement and requested that Brent CCG withdraw the decommissioning notice on 28 March 2013, stop the tendering process, request active dialogue between Brent CCG, NWLHT and patients to help design services based on patient needs and ensure that future services continue to operate at CMH and Northwick Park Hospital (NPH).

The Chair then invited Sarah Mansuralli to introduce the report.  Sarah Mansuralli advised that Brent CCG’s intention to commission new pathways for outpatient specialities stemmed from the Commissioning Strategy Plan for 2009-2014.  CCG’s key intentions included commissioning of services to improve the health and wellbeing of its patients, secure sustainable care to receive up to date, high quality, cost effective care and ensure these  ...  view the full minutes text for item 5.

This report provided by Brent CCG gives a short update on plans for improving the courier service used for the pathology samples, which it says is now the only outstanding item from the Root Cause Analysis.

Ian Winstanley (Assistant Chief Operating Officer, Brent Clinical Commissioning Group) introduced the report that provided an update with regard to the investigation into the serious incident involving the pathology service.  This report focused on the aspect of the investigation concerning the pathology courier service, which although not directly associated with problems described in the root cause analysis, it had appeared that transportation and delivery times played a role in the variation of potassium levels.  This is because they added to the instability of the samples due to fluctuation in temperature during storage at the GP practice or, and possibly in addition, during transportation in the laboratory both in summer and winter.  Ian Winstanley advised that the task and finish group analysing this issue had concluded that the courier company should create best practice for storage of sample guidelines for GP practices.  In addition, the courier company was requested to pilot a hub and spoke process where bikes collect from practices and travel a significantly shorter distance to a hub where samples would be transferred to a temperature controlled van to take the samples to the laboratory.   It was intended that these measures be in place by the third week of October 2013 and initial findings would be reported to the CCG and a future meeting of the Health Partnerships Overview and Scrutiny Committee.

During members’ discussion, confirmation on whether the pathology service provider was accredited yet.  It was also enquired whether it was feasible for the bikes themselves to have temperature controlled storage.

In reply, Ian Winstanley advised that Clinical Pathology Accreditation (CPA) had changed the criteria for accreditation.  However, the service provider had remained in constant contract with the CPA and had applied for accreditation under the new criteria and this was awaited.  Jon Stewart advised that both NPH and CMH dealt with samples in the same way as any other hospital.  He advised that as far as he was aware, there were no pathology courier services that transported samples using bikes with temperature controlled storage because of the difficulties in overcoming the impracticalities involved.  Ian Winstanley added that it was not yet known precisely how changes to temperature affected results and GP practice storage arrangements were also being looked at.

At the last meeting of the committee in July 2013, members requested an update on the actions undertaken following the serious incident at Central Middlesex Hospital Urgent Care Centre in 2012. The update is attached.

Members noted the update report on the Central Middlesex Hospital Urgent Care Centre serious incident.

The work programme is attached.

Members had before them the work programme 2013-14 for their consideration.  The Chair sought clarification as to whether an update on the wave two commissioning could be provided at the next meeting and what lessons had been learnt in respect of consultation since wave one.  In reply, Sarah Mansuralli advised that the service specification would not be ready for consultation until April 2014, however details of the planned consultation and an update could be provided before then.  She stated that a number of lessons had been learnt following the wave one consultation and there would be stronger focus on patient and public engagement.  The timescale of the consultation would also be sufficient in length in order to gather all the necessary information.

The Chair requested that the independent provider appointed to organise the consultation be invited to the next meeting of the committee to provide details of their consultation programme and to respond to members’ questions.  The Chair also requested a paper on how hospitals and GP practices were planning to cope with the problems associated with winter, including the additional demand on services and how many GP practices were using Accident and Emergency and Urgent Care Centre units.  In respect of shaping a healthier future, the Chair requested an update on progress particularly in relation to CMH.  The Chair also requested that the current diabetes services and future commissioning item include details of all the services, including community services, provided and what finances were available for each of these and how did this service compare with London boroughs with similar profiles.  In addition, the Chair asked that a community provider be invited to attend the meeting.

The Chair stated that maternity services in Brent was to be added to the work programme.  Councillor Hunter advised that mental health, abortion services and teenage pregnancy were all items of future discussion for the committee.

The next meeting of the Health Partnerships Overview and Scrutiny Committee is scheduled to take place on Wednesday, 4 December 2013 at 7.00 pm.

It was noted that the next meeting of the Health Partnerships Overview and Scrutiny Committee was scheduled to take place on Wednesday, 4 December 2013 at 7.00 pm.

None.