Agenda item

Brent Clinical Commissioning Group has been preparing its commissioning intentions for 2014/15. It has a duty to involve the Health and Wellbeing Board in this work, for the Board to comment and give its views on the proposals.

Rob Larkman, Chief Executive CCG, informed the Board of the work that had been undertaken to date and the future timetable of the CCG’s clinical commissioning intentions.  He noted that the principles underpinning the intentions were similar to those in the Health and Wellbeing Strategy and intended to improve preventative services, working with partners to reduce inappropriate A&E attendance.  Rob Larkman continued to explain that there would be numerous challenges such as meeting an increasing demand with lower resources, meeting and exceeding performance standards such as the 18 week referral to treatment targets as well as the impending merger of acute and community care providers.  Additionally the demographics of Brent were highlighted as a challenging factor due to the high levels of deprivation as well as a high level of young and elderly persons living in the borough.  Rob Larkman drew the Board’s attention to the QIPP requirements whilst commissioning and highlighted that although the CCG were currently in a stable financial position, it was anticipated that annual savings of 4% would be required to meet changes in funding. 

In response to queries regarding the level of consultation and discussion with patients on the commissioning intentions, Rob Larkman explained that in principle it was articulated within the document although recognised it needed to be made explicitly clear. 

Rob Larkman drew the Board’s attention to the various areas that required commissioning including; acute care, community health services, mental health, children’s services and developing primary care.  He continued to explain the intention to improve each pathway of care with the hope to reduce unnecessary emergency admissions and to ensure that the appropriate care was received in a community setting.  It was hoped that the commissioning of urgent services would help deliver the CareUK model as well as improving the 18 week target and improve integration of care to provide a seamless service. 

During discussion, the rationale behind the commissioning intentions was queried.  Rob Larkman explained that although financial challenges were a factor in the decision to commission services, service improvement was the main driver behind plans for new services. .  It was noted that there were few savings that could be achieved through realigning back office support, with services being commissioned through balancing QIPP and ensuring quality for patients.  The Board queried the level of joined up working and whether opportunities to offer support in numerous venues such as children centres were being explored.  Rob Larkman acknowledged that a greater integrated approach was required to release efficiencies and to avoid duplication of resources.  The Board queried whether the extension of GP hour’s pilot had been commissioned.  It was clarified that it had been on a pilot basis from practices in each of the five locality areas. Some were already operating extended hours, whilst others would be starting soon.

In response to queries regarding the need to re-commission Local Enhance Services, the CCG explained that the LES contract could not be used from April 2014 and so the CCG was required to re-commission these services. LES services were delivered as an enhanced service at GP surgeries, but to ensure competitors did not feel blocked or restricted, the CCG will need to consider how it approaches re-commissioning to ensure continuity, but also to abide by requirements such as Any Qualified Provider.  The CCG explained it was important that decisions on LES contracts would need to reduce the risk of challenge whilst retaining services in the best interests of patients.  David Finch, NHSE, highlighted that due to contractual barriers regarding commissioning primary care services, he felt that more could be done, with the need to reshape the delivery of primary care being a large challenge. 

During discussion it was queried how the CCG intended to engage the public during consultation.  Rob Larkman acknowledged that consultation varied across PCTs’ but recognised a need to develop a meaningful dialogue with residents.  Rob Larkman explained the CCG had a commitment to engaging the public and patients and felt that if the current perception was that consultation was not sufficient then alternative methods of engagement would need to be explored.  He continued to explain that the CCG would be looking to consult formally on a new service design and model of care.  Sarah Basham highlighted that as well as a wider consultation, specific groups should be targeted, whilst ensuring the statutory consultation duty was fulfilled through a variety of engagement methods to ensure a diverse consultation.  Following queries regarding how results would be measured and communicated, it was felt that a communication strategy was required with an emphasis on executive summaries that were accessible for all being produced. 

RESOLVED:

The Board noted the report.