Agenda item

This paper serves to update Brent HWBB on developments in primary care co-commissioning in North West (NW) London up to the end of February 2015, plus next steps for March to April and beyond. Furthermore, this paper is intended to initiate and progress conversations between Brent HWBB and Brent Clinical Commissioning Group on the future role of the HWBB in primary care co-commissioning, to ensure a timely and transparent dialogue as decisions are made about whether to enter into formal co-commissioning arrangements from April 2015.

Rob Larkman (Chief Officer, Brent, Harrow and Hillingdon Clinical Commissioning Group) introduced a report on primary care commissioning in North West London (NWL). It was explained that NHS England currently held sole responsibility for primary care commissioning but had invited CCGs to submit expressions of interest in assuming a heightened role. NHS England had published proposals detailing three potential models for primary care co-commissioning with CCGs; greater involvement, joint commissioning and delegated commissioning. Brent CCG had initially pursued the option of delegated commissioning; however, having identified issues that required further consideration, the NWL CCG Chairs jointly with NHS England (London Region) local area team had deferred the application in favour of a joint co-commissioning arrangement for 2015/16. It was emphasised that, as member led organisations, CCGs would be required to seek the support of their constituent member practices with regard to any decisions to enter into primary care co-commissioning arrangements. 

Dr Chris Cotton (NWL CCGs) explained that the proposed joint commissioning of primary care services in Brent would be conducted via a joint committee between Brent CCG and NHS England. In order to align services across NWL, it was intended that all NWL joint committees would meet in common; this would allow discussions to encompass issues of importance across NWL but ensure that each CCG made an individual decision with NHS England for its respective area. It was intended that the new co-commissioning arrangements would enable Brent CCG to shape primary care in Brent in line with local strategies for integrated and coordinated care. A new contractual offer for General Practice would be pursued to create a foundation for a new model of primary care in Brent; this enhanced role for General Practice would be supported by influencing necessary investment in primary care estates.

In the subsequent discussion, the board sought further details regarding the proposed arrangements for ensuring HWBs and Healthwatch groups were appropriately represented at the joint committee with NHS England. Further queries were raised regarding the frequency of the joint committee meetings, the publication of work programmes and when the views of the Brent CCG members would be known.

Dr Chris Cotton advised that statutory guidance permitted each HWB and Healthwatch to nominate a representative to attend meetings of the joint committee as a non-voting observer. As there was a potential eight CCGs across NWL who could engage in the joint commissioning arrangements, this could result in there being a total of sixteen HWB and Healthwatch representatives. It was currently proposed that this group nominate two of its number to attend meetings of the joint committee; it had been suggested that the nominations comprise one representative for Inner London and one for Outer London.  Rob Larkman confirmed that the joint committee would meet monthly and would publish a forward work programme. The views of Brent’s CCG members would be known by 31 March 2015.

During discussion, members of the board emphasised that Brent was demographically very different from neighbouring boroughs; it was therefore essential that there be an appropriate means for HWBs and Healthwatch groups to submit their views to the joint committees, where they would not be directly represented at the meetings. It was acknowledged that a key challenge for the board  lay in developing a shared view of the priorities for primary care in Brent to enable that view to be clearly communicated to the joint committee. The board subsequently agreed that the planned additional HWB meetings encompass discussion on the strategic commissioning priorities for primary care in Brent.

RESOLVED:

    (i)        That the approach pursued by the Brent Clinical Commissioning Group (Brent CCG) regarding primary care commissioning in Brent, as detailed in the report from Brent CCG, be endorsed;

  (ii)        That Brent Clinical Commissioning Group note the board’s view regarding the need to develop an appropriate medium through which Health and Wellbeing Boards and Healthwatch groups could submit views to the joint committee when their representatives would not be in attendance at a meeting. 

 (iii)        That the proposed additional Health and Wellbeing Board meetings encompass discussion on the strategic commissioning priorities for primary care in Brent.