Agenda item

This report sets out Brent CCG’s plans to transform the way health care is provided in Brent. The context for this proposal is the need to deliver care at a reduced cost while still achieving better patient outcomes. These plans are reflected in the CCG’s five year draft strategy which is intended to put in place more integrated and locally available services and reduce dependance on acute services.

A report updating members on Brent CCG’s plans to transform the way that healthcare was provided in Brent was presented to the committee by Jo Ohlson (Chief Operating Officer, Brent CCG). Members were advised that there were three major transformational programmes which were closely interlinked and formed part of an overarching five year strategy. The first of these,  Shaping a Healthier Future (SsHF) involved the reconfiguration of hospital services and in particular, the development of long term plans for Central Middlesex Hospital (CMH). Jo Ohlson drew members’ attention to the list of proposed services for CMH set out in the report. She emphasised that planning for CMH was at an early stage and that an Outline Business Case was being developed to further explore and refine the proposals. The second programme, Primary Care transformation, aimed to improve access to GPs and make more treatments available in a community setting. Brent CCG, together with North West London CCGs had secured funding via the Prime Minister’s Challenge Fund in April 2014.  This funding would be used to assist GPs in developing their networks in order to provide extended opening hours, weekend opening and better use of technology.

The third programme, whole systems integrated care (WSIC), involved the joining together of health and social care services. Phil Porter (Strategic Director of Adult Social Services) advised that the Brent Early Adopter, WSIC project formed part of the Brent Better Care Fund Plan and was also one of fourteen Pioneer sites for WSIC in England. He emphasised WSIC was underpinned by a holistic vision which focussed on people, their wellbeing and their quality of life, rather than simply a patient’s health needs or a service user’s social care needs. WSIC placed people at the centre of the care that they received and ensured that providers worked together to provide an individualised and seamless service. The primary objective was to improve outcomes for people, for example feeling safe and secure. The Early Adopter project would initially deliver WSIC on a pilot basis for over 75s with one or more long-term conditions who were registered with a Harness or Kilburn GP. A fundamental part of the Early Adopter process was the idea of a ‘capitated budget’, which would enable a locality to know know how much money it has to spend on its population across all services, and decide where to spend money, and which services and support would make the greatest difference.

The committee raised several queries in the subsequent discussion. Members asked what support would be provided to GPs to assist them in carrying out their additional responsibilities. Further information was sought on the development of GP networks and the accessibility of a patient’s named GP to  other medical professionals treating the patient. It was queried whether the £4m from the GPs commissioning funds that had been directed to improving GP networks and interconnectivity was drawn from monies  allocated for the commissioning of hospital services. The committee also sought clarification of how the total £10m funds were distributed across North West London. Commenting on the performance of GP surgeries, Councillor Kansagra noted the important contribution of all staff members to improved service and questioned whether this was reflected in the distribution of additional funding received by the practice. Councillor Daly advised that NHS England, when discussing the results of a patient survey that had covered all 67 of Brent’s GP practices, had reported issues regarding patient access to GPs and sought an update on this matter.

A number of queries were raised regarding the proposed relocation of Mental Health Services from Park Royal to CMH. The committee sought further detail underpinning the assertion that there would be no negative impact to the relocation. A member queried what changes had been made to the relocation proposals as a result of the feedback received via consultation with patients and the public. A member advised that the former Health Partnerships Overview and Scrutiny Committee had visited the proposed site at CMH and had expressed misgivings about its suitability. It was therefore requested that the current Scrutiny Committee be permitted to undertake a site visit.

The Chair invited questions from other members in attendance at the meeting. Referring to the relocation of Mental Health services from Park Royal, Councillor Hector disputed the assertion that there would be equivalent facilities provided at the CMH site, noting that Park Royal provided eight wards, gardens, a football pitch, parking and a memory clinic.

Responding to the queries raised, Dr Madhukar Patel (Clinical Lead, Brent CCG) acknowledged that GP practices were under increased pressure; however, GP networks had been created to provide support in achieving the desired outcomes. Brent CCG had already implemented Integrated Care Plans and plans for unavoidable admissions and it was recognised that GPs were ideally placed to be the care co-ordinator for the new healthcare system developing. Within this new system GPs would be supported through the development of shared accountability across a range of different providers including other GPs, healthcare providers, adult social services or community services. With regard to the distribution of additional funding in GP practices, it was not possible to comment on the existing contracts in place for individual practices. However, it was noted that improvement in service provision could also be achieved through better ways of working. A Practice Network event had been held on 24 June 2014 and there was a focus on ensuring there was sufficient infrastructure in place to deliver via networks and at individual practice level. Jo Ohlson confirmed that the funding for developing GP networks which the report referred to as having been drawn from GPs commissioning funds had not been top-sliced from monies allocated elsewhere. The £10m total, which included the funding awarded from the Prime Ministers Challenge Fund, had been allocated across North West London on a capitation basis, with Brent receiving £1.4m. Dr Mark Spenser (SaHF Programme Medical Director) advised that NHS England commissioned GP services and Brent CCG was applying to become co-commissioners, with the intention of making those services more relevant and enabling Brent CCG to monitor performance. He emphasised that though there could be improvements currently in Primary Care Services, providers were meeting contract requirements.   

Charlie MacNally, (Central and North West London NHS Trust) advised that the relocation proposals for Mental Health services at Park Royal were currently at the design stage. However, there would be no loss of facilities, with the exception of the Memory Clinic which would be transferred elsewhere and certainly, no reduction in beds provided. The specifications for the rooms size would actually increase. Members were advised that there had been one change made to the initial plans and that had been to locate the Psychiatric Care Unit closer to the Admissions Ward. This change had been made following public consultation. Dr Mark Spencer advised that the Scrutiny Committee was welcome to conduct a site visit, though there was little to view presently as the plans were at initial stages. It was confirmed that patients and staff would continue to be consulted as the plans for relocating the service developed and prior to finalisation, the plans would be submitted to the Scrutiny Committee for review.

Members of the public were then invited to ask questions. It was queried why there was no longer a Health Partnerships Overview and Scrutiny Committee. The Chair explained that the Council had determined the committee structure and that a further information could be provided following the meeting. A question was also raised on admittance routes for Mental Health patients in crises following the closure of the Accident and Emergency department at CMH and the transfer of Mental Health services to the CMH site. Duncan Ambrose (Assistant Director Mental Health, Brent CCG) assured that there would be no change to the current arrangements. 

The Chair thanked everyone for their contribution to the meeting. Members agreed that a further update should be brought to a future meeting of the committee.

Dr Mark Spencer welcomed the submission of written questions to Brent CCG in the interim period.

RESOLVED:

That a further report updating the committee on the progress made in relation to transforming healthcare in Brent be submitted to a future meeting of the committee.