Agenda and minutes

Apologies for absence were received from Councillors R P H Reid, G P Scalese (South Holland District Council) and R Kaberry-Brown (South Kesteven District Council).

It was noted that Councillor M A Whittington (South Kesteven District Council) had replaced Councillor R Kayberry-Brown (South Kesteven District Council) for this meeting only.

An apology for absence was also received from Councillor Mrs S Woolley (Executive Councillor for NHS Liaison, Community Engagement, Registration and Coroners).

No declarations of member's interest were made at this stage of the proceedings.

Councillor Mrs A White wished it to be noted that like other members of the Committee, she had received copy of information in relation to services at Grantham Hospital and District Hospital from two campaign groups in Grantham.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 15 September 2021 be agreed and signed by the Chairman as a correct record.

Further to the Chairman's announcements circulated with the agenda, the Chairman brought to the Committee's attention the supplementary announcements circulated on 12 October 2021.  The supplementary announcements made reference to:

·       The Covid-19 Update, a copy of the latest data compiled by Lincolnshire County Council Public Health Division was attached at Appendix A to the supplementary announcements;

·       Cliff House Medical Practice, Lincoln - Contract extension; and

·       Healthwatch Lincolnshire – Yourvoice@healthwatch public face to face event on 3 November 2021 from 10.00am to 1.00pm at the Boston United Football Club.  The theme for the event was Community Wellbeing.

Some members expressed concerns at the increased number of Covid-19 cases in schools.  The Chairman agreed that he would discuss the matter with Cllr R J Kendrick, Chairman of the Children and Young People Scrutiny Committee.

RESOLVED

That the Supplementary Chairman's announcements circulated on 12 October 2021 and the Chairman's announcements as detailed on pages 15 to 17 of the report pack be noted.

(To receive a report from John Turner, Chief Executive Lincolnshire Clinical Commissioning Group, which provides an introduction on the content of the consultation for the Lincolnshire Acute Services Review and invites the Committee to agree its arrangements for responding to the consultation)

The Chairman advised the Committee that before he invited the representatives from the Lincolnshire NHS Clinical Commissioning Group to present the report, he had received a request from Jody Clark (Fighting 4 Grantham Hospital) to speak at the meeting.  The Committee was advised that a time period of three minutes would be allotted to Jody to address the meeting via Teams.

The statement made reference to some of the following points: the opposition in Grantham to the overnight closure of Grantham A & E; the troubles with recruitment and retention of staff at Grantham Hospital; the travelling incurred by local patients due to the reduced service and the impact of travelling on families in the Grantham area; with no A & E provision, there was a need for a 24/7 Urgent Treatment Centre with walk in access, and access to medical and acute beds.

On behalf of the Committee the Chairman extended his thanks to Jody Clark for her statement.

The Chairman invited the following representatives from the Lincolnshire NHS Clinical Commissioning Group who were present in the Council Chamber to present the item to the Committee: John Turner, Chief Executive, Charley Blyth, Director of Communication and Engagement and Tom Diamond, Associate Director of Strategy (who attended the meeting via Teams).

The Chief Executive extended his thanks to the Committee for their continued interest and support shown over the last eighteen months.

The Committee was reminded that the on the 21 September 2021 the Chairman had received notification from the Chief Executive of the Lincolnshire Clinical Commissioning Group (CCG) that the CCG would shortly commencing a formal public consultation exercise in relation to the four NHS service change proposals.  It was noted that at the Lincolnshire CCG Board on 29 September 2021 had agreed to proceed with the consultation, which was then subsequently launched on 30 September 2021 for a period of twelve weeks up to 23 December 2021.

The Committee noted the four NHS services change proposals were in the following areas:

·       Orthopaedic Surgery – the development of a 'centre of excellence' in  Lincolnshire for planned surgery at Grantham and District Hospital and a dedicated day-case centre at County Hospital Louth, for planned orthopaedic surgery;

·       Urgent and Emergency Care at Grantham and District Hospital – the establishment of a 24/7 Walk in Urgent Treatment Centre, in place of the current Accident and Emergency department;

·       Acute Medical Beds at Grantham and District  Hospital – The establishment of integrated community/acute medical beds, in place of the current acute medical beds; and

·       Stroke Services – the development of a 'centre of excellence' in Lincolnshire for hyper-acute and acute stoke services at Lincoln County Hospital; which would be supported by the enhancement of the community stroke rehabilitation service to support stroke patients with more complex needs.

The Committee was advised that the vision was to provide the very best health care for the people of Lincolnshire and to continually improve services wherever possible. It was felt that the benefit of the proposed changes would improve  ...  view the full minutes text for item 37.

(To receive a report from the Lincolnshire Medical Committee (LMC), which provides the Committee with an update on access to general practice services.  Dr Kieran Sharrock, Medical Director, Lincolnshire Local Medical Committee will be in attendance for this item)

The Committee gave consideration to a report from the Lincolnshire Local Medical Committee, which provided an update on General Practice services.

The Chairman invited Dr Kieran Sharrock, Medical Director, Lincolnshire Local Medical Committee, to present the item to the Committee.

Also present for this item to help with questions was: John Turner, Chief Executive Lincolnshire Clinical Commissioning Group and Sarah-Jane Mills, Chief Operating Officer (West Locality) Lincolnshire Clinical Commissioning Group.

The Committee was advised that general practice nationally was overstretched, due to an increasing workload before the pandemic, and that the pandemic pressure had then exacerbated the issue. Also, due to hospital trusts being under pressure with long waiting lists, general practice was seeing an increase in the number of patients seeking support for their increasing health needs, which were not being managed by secondary care.

It was reported that the number of GPs had been falling consistently, in March 2016 there had been 51.5 GPs for every 100,000 patients, and that now in March 2021 the figure had fallen to 46.3 for every 100,000 patients.  It was highlighted that since March 2021, the British Medical Association had seen a loss of a further 597 GPs and 920 general practice nurses.  In order to compensate for the loss of GPs, Primary Care Networks were now employing other health professionals to manage patient conditions such as: clinical pharmacists, paramedic practitioners, first contact physiotherapists, social prescribes and mental health practitioners. It was highlighted further that these professionals were qualified to manage conditions in their sphere, but did not have the holistic skills that a GP would have.

The Committee was advised that to help ease the situation, practices had moved to a 'Total Triage' model of providing services. This allowed practices to navigate the patient to the most appropriate professional to manage their condition.  Further details of relating to total triage was shown on page 100 of the report pack.

It was highlighted that Lincolnshire had always had difficulty recruiting and retaining clinical workforce.  The Lincoln Medical School and other development at the University of Lincoln would help with recruitment in the long-term, but was unable to offer support to the short-term shortages.  The report highlighted that by 2025 there would be a shortage of 220 "autonomous" practitioners.

In conclusion, as Lincolnshire's general practice were experiencing  increasing workload and workforce shortages, Lincolnshire and other health systems were considering moving to a Primary Care Home model, which would require public and stakeholder engagement.  It was also highlighted that self-care and prevention needed to be prioritised to alleviate further pressures on health and social care.

During discussion, the Committee raised the following points:

·       The number of face to face appointments figures on page 100.  The Committee was advised that the only figures that could be provided were those from the NHS Digital GP Appointment Data;

·       The need for better communication to the public of the changes that had been made to mitigate the workforce problems and the increased workload issues, particular reference was made  ...  view the full minutes text for item 38.

(To receive a report from the Lincolnshire Clinical Commissioning Group, which advises the Committee of the support for general practice.  Sarah-Jane Mills, Chief Operating Officer (West Locality), Lincolnshire Clinical Commissioning Group will be in attendance for this item)   

The Committee gave consideration to a report from the Lincolnshire Clinical Commissioning Group, which provided an overview of the key areas of work being undertaken to support local GP services.

The Chairman invited John Turner, Chief Executive of Lincolnshire Clinical Commissioning Group (CCG), and Sarah-Jane Mills, Chief Operating Officer (West Locality) Lincolnshire CCG to present the item to the Committee.  Dr Kieran Sharrock, Medical Director, Lincolnshire Local Medical Committee was also in attendance for this item.

As a lot of what was contained within the report had been discussed in the previous item, the Committee's attention was brought to section IV on page 6 of the report which made reference to Communication and Engagement, which highlighted that the CCG appreciated that there could never be too much communication and engagement and as such were investing additional capacity to support enhanced engagement with local communities, to ensure that patients were better informed of changes and developments.

It was highlighted that following feedback the CCG would be working jointly with Healthwatch to develop a programme to support people to understand the digital offer and provide a step by step guide on how to use it and that this would be ready early December 2021.

During discussion, reference was made to:

·       The need to promote the NHS App as well as this linked primary and secondary care and that information should be provided as to how to set it up.  Representatives agreed to take back the comments raised with regard to the NHS App.;

·       One member asked for further information as to where the 14 Primary Care Networks were situated across the county; and how many GP practices were within each network.  It was agreed that this information would be sent through to the Health Scrutiny Officer to circulate to members of the Committee;

·       Whether the training hub was a physical building.  The Committee noted that the training hub was a team who co-ordinated and supported training;

·       Using County News to get important message out to the residents of Lincolnshire; and

·       To what extent could the CCG intervene, using the GP contractual provisions, if the CCG were to feel a particular practice was not offering a good level of service.   The Committee noted that the approach taken in Lincolnshire was to work with practices, primary care and the Local Medical Committee to provide additional support to deal with whatever issues they had. It was highlighted that contractual provisions would be an absolutely last resort.

RESOLVED

1.    That the various support provided by Lincolnshire CCG to general practice in Lincolnshire be noted.

2.    That the Committee's concerns that the shortage of practitioners not only impacts on general practice itself, but also on the wider health system be recorded.

3.    That a further update on Lincolnshire CCG Support for General Practice be received by the Committee in six months.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to approve the Committee's response to the NHS consultation on the eligibility criteria for non-emergency patient transport)

The Chairman invited Simon Evans, Health Scrutiny Officer, to present the item which invited the Committee to agree its response to the Eligibility for Non-Emergency Patient Transport – Consultation, for submission to NHS England by the consultation closing date of 25 October 2021.  The Committee had received a copy of the response document circulated by email on 11 October 2021.

The Committee noted that it was the intention that new contracts from April 2022 would reflect the new criteria, and that this would be applied by the provider of the new contract for non-emergency patient transport from 1 July 2022.

RESOLVED

That the Committee's response to the NHS consultation on the eligibility criteria for non-emergency patient transport as circulated on the 11 October be approved.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on its forthcoming work programme)

The Chairman invited Simon Evans, Health Scrutiny Officer, to present the report, which invited the Committee to consider and comment on its work programme as detailed on pages 108 and 109 of the report pack.

During consideration of the item, the Committee raised the following comments/suggestions:

·       Clarification as to the remit of the Humber Services Review.  The Committee noted the proposals would include Northern Lincolnshire and Goole NHS Foundation Trust, and that in terms of Lincolnshire residents it was mainly, but not exclusively changes to the Diana Princess of Wales Hospital in Grimsby;

·       The NHS recovery Plan post Covid-19.  It was agreed that due to the number of items on future agendas that an update would be provided as part of the Chairman's announcements.  If it was then felt that the matter should be discussed further, it would then be added to the work programme.

RESOLVED

That the work programme presented be agreed subject to inclusion of the items agreed at minute numbers 37 2(a),(b),(c) and (d), 38(3), and 39(3).