Agenda and minutes

Apologies for absence were received as follows:

• Councillor Hector

Members are invited to declare at this stage of the meeting, the nature and existence of any relevant disclosable pecuniary or personal interests in the items on this agenda and to specify the item(s) to which they relate.

Personal Interests were declared as follows:

• Councillor Sheth – Lead Governor for Central and North West London NHS Foundation Trust
• Councillor Shahzad – spouse employed by NHS
• Councillor Ethapemi – spouse employed by NHS
• Councillor Thakkar – Health and Social Care Co-ordinator for Complex Patient Management Group
• Councillor Sangani – employed by the Sunflower Medical Centre
• Mr Simon Goulden – spouse governor for Sinai Jewish Primary School
• Mr Alloysius Frederick – Chair of governors for St Gregory’s Catholic School and governor for Newman College

To hear any deputations received from members of the public in accordance with Standing Order 67.

There were no deputations received.

To approve the minutes of the previous meetings as a correct record:

·         24 November 2020

·         19 January 2021

RESOLVED:-

that the minutes of the previous meeting held on 24 November 2020 and 19 January 2021 be approved as an accurate record of the meetings.

There were no matters arising.

This report provides information to the Community and Wellbeing Scrutiny Committee on the A&E Performance at Northwick Park Hospital and St Mary’s Hospital.

The Chair invited Simon Crawford (Director of Strategy and Deputy Chief Executive, London North West Healthcare NHS Trust (LNWHT) to introduce the item for discussion. Simon Crawford began by highlighting that the past year had been unusual because of responding to COVID-19 and the challenges in the NHS and at Northwick Park in particular. He explained that 3 March 2020 was when Northwick Park had their first patient admitted with COVID-19. The hospital was under great challenge and one of the hardest hit in the early wave of the pandemic, and there was a need to respond significantly during that early wave in March and April 2020 to ensure the hospitals were not overwhelmed with presentations. This meant treating patients coming through A & E differently depending on their presentations of symptoms, learning new processes and procedures around PPE, infection control, treatment modalities and then standing down elective procedures and processes and focussing the whole response of the hospital to COVID-19. In particular, patients coming through A & E and those most critically unwell needing access to critical care beds. As part of that response beds were increased from 22 to a maximum of 50 critical care beds in Northwick Park Hospital and significantly increased High Dependency Unit (HDU) capacity from 18 beds pre-Covid to 33. This presented a logistical issue such as getting more monitors, equipment and retraining staff to support those beds. Protected pathways were also introduced such as green pathways for those without COVID-19 and red for those with COVID-19. Staff protected patients as best as possible from getting infected within the hospital. In the first wave of COVID-19 the majority of elective care was stood down, but during the second wave and using the learning from the first wave Central Middlesex Hospital and the independent sector maintained 20-30% of elective activity. Cancer patients were also seen at the Royal Marsden Clinic, London Clinic and Cromwell Hospital. Maternity services continued to be offered and there had been 4,000 births during the period.

Jon Baker (Divisional Clinical Director for Emergency and Ambulatory Care, Northwick Park Hospital) highlighted that Northwick Park Hospital was now number one in London for A & E performance and third in the country, which he noted was a huge difference to where it was when he started working there, particularly given Northwick Park was one of the busiest hospitals in London most days. He advised the Committee that Northwick Park now delivered prompt emergency care and received most ambulances, dealing with those the quickest compared to the rest of London. He felt that there was partner working end to end with the pathway starting at the front door and nurse consultants who had helped overhaul the pathways of moving ambulance patients through the system. This included what was nationally known as same day emergency care, managing patients in a more comfortable speedy environment where patients who would have in the past been admitted overnight were now seen in a large emergency floor and could  ...  view the full minutes text for item 6.

This report provides accountability and transparency for quality standards and ratings in GP services in the borough as rated by the Care Quality Commission (CQC) and assurance that there are effective support arrangements for practices to improve.

Jonathan Turner (Borough Lead Director (Brent), CCG) introduced the report which provided information on standards and ratings in GP services in the Borough as rated by the CQC. The report covered the evolving landscape of primary care, the role of CQC, a summary of ratings in the Borough and how the CCG was working with practices to support them. He advised that satisfaction was generally good but there were variations and it was important as part of the work as an Integrated Care System (ICS) to address that variation. As well as GPs’ core role as consultants at the start of a patient’s NHS journey GPs also participated in extended primary care services such as screenings and vaccinations / immunisations, and co-ordinated with social care, the voluntary sector and the acute sector for referring and managing patients.

In relation to how the contracting mechanism worked for GPs, Jonathan Turner advised that generally the more patients a GP surgery had the more funding it would get. This was topped up through the quality and outcomes framework which had been a mainstay of general practice for 20 years. He advised that the key development in the last few years had been Primary Care Networks (PCNs) which had changed the way some practices came together as a group to support each other and consolidated some of the back office functions to standardise care. He pointed to page 44 of the report which set out the configuration of PCNs in Brent and which practices were within them, who was responsible and the clinical leads. Part of the CCGs role was to support the development of integrated care, the coming together as PCNs and the work with community nursing to ensure patients were being managed effectively as part of a whole system approach. The Committee heard that Brent was “underdoctored” in relation to GPs in the workforce with the workforce changing over time as more salaried roles become the norm and GPs took on more roles, with physios and pharmacists playing a bigger role for a more effective skills mix within practices. The additional roles and reimbursements scheme brought in by the NHS paid practices to bring in those additional roles to better support Musculoskeletal (MSK) conditions, aches and pains and those otherwise needing a referral so that they could be dealt with more quickly. A recruitment and retention programme was being introduced to ensure Brent got more qualified and experienced GPs. Jonathan Turner advised that there was a demographics challenge in Brent in relation to the number of people living in the Borough which had increased over the 20 year period and was concentrated in particular wards. As well as this the population was ageing with an increased number of people living for longer including in frail older people and people with complex comorbidities.

In relation to the CQC process, Jonathan Turner advised that every GP had an annual regulatory review which would inform how frequently that practice was reviewed depending on  ...  view the full minutes text for item 7.

This report enables members of the Community and Wellbeing Scrutiny Committee to commission a task group on GP and primary care accessibility in the Borough.

Councillor Mary Daly introduced the report which enabled members of the Committee to commission a task group on GP and primary care accessibility in the borough of Brent. She explained that the paper had been inspired by Councillor Abdi Aden’s constituent experiences in Stonebridge in relation to accessing GP services during the pandemic. Councillor Daly felt that the task group should look at comparisons of the more affluent wards in Brent and North West London and the investment precedent in those wards, including the number of GPs per head and a few other agreed indicators, which may or may not show the degree of equity within primary care. She also thought there should be comparisons of the best and worst GP surgeries in the Borough. She expressed that she looked forward to the first meeting to distil further what the group wanted to look at in the task group sessions..

The Chair thanked Councillor Daly for introducing the scoping paper and invited those present to ask questions, with the following issues raised:

Dr M C Patel (NWL CCG) agreed that looking at comparisons of deprived and affluent wards and good and bad practices would be a useful activity. He highlighted that the scoping paper was based on a paper from 2010 and some factors were relevant but others were not, therefore suggested the group worked together with primary care to look at outcomes as well as access, to develop something with significant meaning that was helpful to GPs, Brent Council, members and constituents.

Sheik Auladin (NWL CCG) reiterated that they were happy to work with the Council on the task group. He advised that a lot of work had been done by the Integrated Care System (ICS) around North West London primary care and levelling up in Brent. He informed the Committee that a lot of investment was coming to Brent as part of that process and there was a need to ensure that was reflected in any discussions on primary care going forward. Jo Ohlsen (Accountable Officer, NWL CCG) emphasised this, expressing that they wanted to be assured in North West London that they were reducing health inequalities within and across boroughs. She highlighted that as part of the merger to a single CCG they had agreed they would move investment from some more affluent parts in North West London to places like Brent, and the first area that was being done was diabetes and mental health. Jo Ohlsen would share the data the group were seeking which would influence where changes were made. In response, the Committee highlighted the importance of not creating a 2 tier set of patients, for example ensuring that if digital access tools were used for the treatment and monitoring of diabetes patients the same treatment and monitoring was available for patients without that type of access.

The Committee also wanted the task group to explore what services Primary Care Networks (PCNs) would provide and the number of doctors attributed to different areas, and  ...  view the full minutes text for item 8.

Notice of items to be raised under this heading must be given in writing to the Head of Executive and Member Services or his representative before the meeting in accordance with Standing Order 60.

Contract with AT Medics

The Chair advised the Committee that he would be taking an additional item under any other urgent business in accordance with Standing Order 60. The item was in relation to the APMS contracts that were held by AT Medics. The item was considered urgent as it had been discussed at the Brent CCG meeting the previous week, resulting in considerable interest amongst residents and councillors.

Jo Ohlson (Accountable Officer, NWL CCG) explained that there were 2 APMS contracts in Brent held by AT Medics. An APMS contract had more detail and KPIs than other GP contracts. AT Medics had approached the CCG at the end of the previous year to seek consent for a change of control. As a result the control had moved to Operose which was a British based company dealing with healthcare. As Accountable Officers across London it was agreed this would be looked at collectively in relation to seeking legal advice and due diligence, including looking at their financial standing and other governance measures. A number of assurance were sought from AT Medics, who the contract remained with, and they concluded there would be no change to the services being provided or to the staff providing them throughout London. Assurance was also sought that the current directors would remain involved in the service, and although they would no longer be statutory directors they would be directors on Operose and involved in the management of the practices. Jo Ohlsen advised that if there were any changes in relation to service provision or concerns about services having changed as a result of the change in control that would be picked up by Fana Hussain (Assistant Director of Primary Care, CCG) and her team who would continue to manage those contracts.

The Chair thanked Joe Ohlson for providing the background information and invited members of the Committee to ask questions, with the following issues raised:

The Committee queried why the change was taking place if nothing would change regarding the services or financially. Jo Ohlson clarified that the APMS contract had not been given up but that there had been a change in the owner of AT Medics, therefore no TUPE indications applied. In relation to the reason behind the change, Jo Ohlson advised she had met with the Chief Executive of AT Medics across London and in their view there was a benefit in coming together with Operose for the skills they had around population health management. She confirmed it was a decision for AT Medics to make regarding who they wanted to work with and the CCGs job was to be assured they would continue to provide the services to the same standard as they were currently doing and hopefully improve them. She added that AT medics was rated good by the CQC and had gone into areas that were difficult to provide services and recruit to and been able to do that.

In relation to Operose’s financial standing, the Committee expressed concerns  ...  view the full minutes text for item 9.