Agenda item

(To receive a report from Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) which provides an update in relation to the activities for Lincolnshire East Clinical Commissioning Group (CCG) including the commissioning activities of the CCG and the wider developments the CCG has been involved in)

A report by Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) which provided an update in relation to the activities for Lincolnshire East Clinical Commissioning Group (CCG) including the commissioning activities of the CCG and the wider developments the CCG had been involved with.

Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) and Dr Peter Holmes (Chairman – Lincolnshire East Clinical Commissioning Group) were both in attendance for this item.

Members were given an overview of the report which provided information on the development within Lincolnshire East Clinical Commissioning Group.  The CCG currently had 30 member practices which were structured across three localities covering over 1,060 square miles.  The locality structure was fundamental to how the CCG operated and member practices were embedded within the localities and communities which they served.

The CCG covered a population of 243,650 although a greater population growth than the national average had been experienced since the 2001 census.  There had been substantial inward migration into the CCG area of older people from industrial centres from the Midlands and this had influenced the age structure of the populations and the prevalence of long term health conditions.  24.7% of the population were aged 65 years or older in comparison to England as a whole which was 16.9%.  23.7% of the population within Lincolnshire East had a limiting long term illness or disability which was significantly higher than the England average of 17.6%.

A number of areas had been the focus of the CCG, including the following:-

·       Mental Health:  Dementia

·       Care for the Over 75s

·       Neighbourhood Teams

·       Integrated Urgent Care

·       Care Home Projects

·       Community Hospitals

·       Optimising Prescribing in Primary Care

·       C2 Evaluation and Future

·       Caravan Dwellers

The lead commissioning responsibilities included:-

·       United Lincolnshire Hospitals NHS Trust

·       Urgent Care and System Resilience

·       Information Management and Technology

When the CCG was authorised, NHS England had responsibility for commissioning all primary care services including GP services, pharmacies, optician services and dental services.  In 2014/15 NHS England gave CCGs the opportunity to take on the commissioning responsibility for GP services.  The rationale being that the local focus of the CCG would enable a more tailored approach to local commissioning and stronger links between the strategic direction of other services commissioned by CCGs with GP services.  The statutory responsibility for GP services remained with NHS England but these were delegated to CCGs through the co-commissioning arrangements.

Lincolnshire East CCG achieved full delegated responsibility for GP services.  Appropriate governance arrangements had been implemented to manage any conflict of interest.  The CCG also had a Primary Care Commissioning Committee (PCCC) which was a formal committee of the governing body.  No GP's within the Lincolnshire East CCG sat on the PCCC which was composed of Governing Body lay members and CCG officers.  These meetings were held in public.

Priorities for primary care commissioning would be to develop a primary care strategy detailing the direction of travel and models for GP services in the future. 

The delivery of the NHS Constitution standards for Accident & Emergency, ambulance services and cancer had deteriorated during 2015/16.  The planned care standard had been redefined in terms of incomplete patient pathways and was being met overall (94% against a target of 92%).  Challenges remained at speciality level including urology, plastic surgery and neurology.  Steps were being taken to improve these areas of performance including working with the Emergency Care Improvement Programme (ECIP) to improve A&E performance and working on improvement programmes and referral to other providers to improve planned care and cancer performance.  Planned care and cancer had shown improvement in recent months but A&E performance remained a challenge.  At CCG level performance was 94.95% against a target of 95%.  However, at ULHT specifically, performance for CCG patients was 89.3%.

In relation to Financial Management, the CCG had a total commissioning allocation of £368 million with each CCG required to:-

·       Achieve a 1% overall surplus;

·       Provide for a contingency of 0.5%;

·       Allocate 1% of resources to be spent non-recurrently;

·       Stay within a running cost of £21.20 per head of population

It was reported also that, out of 211 CCGs, they were rated as below:-

·       Diabetes – 6^th worst

·       Coronary Heart Disease – 2^nd worst

·       Hypertension – 5^th worst

·       Chronic Kidney – 5^th worst

·       Stroke – 4^th worst

Focus was on dementia in primary and secondary care which was both challenging and controversial.  Alongside diagnosis rates, the CCG were trying to provide a better process of diagnosis rates.  For dementia patients and those with long term conditions, a more structured care pathway was required for those elderly and frail patients.

Members were given the opportunity to ask questions during which the following points were noted:-

·       Despite being involved in the countywide strategy for dementia care, it was felt that this may lack local flexibility.  Although countywide focus was on diagnosis, care navigators and a structured organised care network, it was acknowledged that the service needs in one area may be very different to that in another therefore local flexibility was required;

At this stage of the meeting, Councillor Mrs P F Watson declared an interest on page 34 of the report, C2 Evaluation and Future, and the project with East Lindsey District Council, due to her involvement in the project in her capacity as a Trustee and Director of Magna Vitae.

·       Recruitment into General Practice remained a challenge but if practices were able to recruit a full cohort of staff, including administration, nurses and GPs then this model would allow more experienced clinicians to deal with more complex patients.  However, not all surgeries had the same view on that type of model so discussions were starting with these practices;

·       It was suggested that many patients from the Louth and Mablethorpe areas travelled to Grimsby Hospital rather than ULHT.  This was acknowledged but reported that Grimsby Hospital was also not meeting their A&E target;

·       IT services in relation to electronic discharged required improvement;

·       In relation to caravan and chalet residents on the east coast, these were complex patients as two types of temporary residency registration were available.  Practices registering a resident on a permanent basis required a considerable amount of paperwork to be completed;

Before taking a question from Councillor Gregory, the Chairman sought assurance that this was not in relation to ULHT given his pecuniary interest as an employee of ULHT.  Councillor Gregory assured the Chairman that his question did not relate to his pecuniary interest.

·       Budgets were calculated and adjusted taking into consideration morbidity in those areas.  The prescribing budget would also be considered alongside performance;

·       Although it appeared that Neighbourhood Teams were a new initiative, this was not the case.  The section within the report described how the Neighbourhood Teams worked, something which had not previously been reported;

·       In relation to Neighbourhood Teams, some East Lindsey practices were nearer to Louth than Skegness so the boundaries were changed to make them closer to the localities;

·       Holbeach was in an unusual situation where they had two practices in two separate CCG areas (Lincolnshire East CCG and South Lincolnshire CCG).  Engagement with two District Councils was also required in this instance.  It was reported that one practice was looking to move premises although it was unclear if it would remain as it was or if both practices would move into one CCG area.

The Chairman thanked both Gary James and Dr Peter Holmes for the presentation which had been well received and requested that a future update be scheduled for a future meeting of the Committee.

RESOLVED

1.    That the report and comments be noted; and

2.    That an update and report on progress be scheduled for a future meeting of the Health Scrutiny Committee for Lincolnshire.