Agenda item

(To receive a report by Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) which provides an update on the activities of Lincolnshire East Clinical Commissioning Group (LECCG) and includes information on the lead commissioning arrangements undertaken by LECCG.  Gary James (Accountable Officer – LECCG) will be in attendance for this item)

The Chairman invited Tracy Pilcher (Chief Nurse – Lincolnshire East CCG) to provide an update on the announcement of the temporary closure of the Wainfleet Surgery.

 

During an inspection of 30 GP practices, the Care Quality Commission (CQC) had identified significant concern within this practice.  An action plan was developed and implemented however a follow-up inspection by the CQC identified that sufficient progress had not been made which resulted in the practice being placed in a high risk category.  As a result, the following action was taken:-

·       A suspension was placed on the practice from 8.00am on 10 November 2016;

·       Discussions with the nearby Hawthorn practice resulted in an agreement to temporarily transfer all 2200 patients from the Wainfleet practice;

·       Patients were given the option to register with other practices on a permanent basis;

·       All high risk patients registered with the Wainfleet practice were considered to ensure access to appropriate services was maintained;

·       Communication was being undertaken to advise all concerned of a helpline;

·       Additional non-emergency transport for Wainfleet patients to attend Hawthorn Practice had been deployed on a short term basis; and

·       Practice boundaries were being redrawn in line with patient lists to ensure access to primary care services for all residents.

 

The Committee was invited to ask questions, during which the following points were noted:-

·       CQC registration had been suspended although payment for the GMS contract had continued to ensure the running of the surgery whilst the necessary changes were made;

·       A risk assessment had been undertaken by the CQC to enable a decision to be made.  Some of the data presented suggested to the CQC that patients were not being assessed safely with one minute appointments being held;

·       Temporary home services had been put in place for patients unable to travel to the temporary practice;

·       It was reported that the Hawthorn practice had 10k patients registered currently.  A telephone line in to the Wainfleet practice was currently transferred to a staff member at the Hawthorn practice dedicated to taking calls from Wainfleet patients only.

 

The Committee congratulated Lincolnshire East CCG on the actions taken to deal with this issue.

 

A report by Gary James (Accountable Officer – Lincolnshire East CCG) was considered which provided an update on the activities of Lincolnshire East CCG (LECCG) and included information on the lead commissioning arrangements undertaken by LECCG.

 

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

 

Lincolnshire East CCG was in its fourth year of commissioning services for a population of 245,000 patients with the last twelve months facing unprecedented demands for services across the NHS as a whole.  It was clear that there was a requirement for the NHS to change and adapt in order to meet the needs of patients and to become more effective and efficient.

 

The report presented key facts and figures for LECCG:-

·       Coverage of three localities;

·       244,907 people looked after;

·       Approximately 296,800 outpatient attendances;

·       802,000 GP appointments in 2015/16 in 30 GP Practices;

·       Approximately 2,200 babies delivered;

·       Approximately 55,500 A&E attendances;

·       Approximately 23,300 emergency admissions;

·       £1,484.00 resources per person per year;

·       £996k healthcare services spend per day; and

·       £363.4m total spend on healthcare services in 2015/16.

 

Lincolnshire East CCG had become the lead commissioner for United Lincolnshire Hospitals NHS Trust (ULHT) in the last year, having previously been the commissioners of services from Lincolnshire Community Health Services, East Midlands Ambulance Service NHS Trust, non-emergency patient transport and NHS 111 services.  Development of the relationship with ULHT was thought to have gone well over the last twelve months and, despite being challenging, discussions had remained positive. 

 

Agreement on the 2016/17 ULHT contract had been reached on time and without recourse to arbitration for the first time in over a decade which was good for patients and the NHS as it was an indication of the service working together and avoiding engagement in lengthy bureaucratic issues.

 

The CCG had also fully delegated authority for Primary Medical (General Practice) services, the commissioning of which was managed through the Primary Care Co-commissioning Committee (PCCC).  The PCCC was constituted to avoid any conflicts of interest with GPs as members of the CCG.  The focus this year had been on the sustainability of general practice, development of a primary care strategy and management of the development and investment of GP services.

 

Achievements over the last year had included:-

·       Isolation in rural areas had been address through "Talk, Eat, Drink (TED" in partnership with East Lindsey District Council;

·       Development of a Diabetes service specification;

·       Delivery of care home schemes in Boston and Skegness;

·       Ongoing work on dementia support services;

·       Antimicrobial resistance addressed; and

·       Investment in GP Practices to deliver case management for the over 75s.

 

98% of the CCG's total resources, which equated to £363.4m, had been spent on the purchase of healthcare during 2015/16.  Buy-in of services from NHS trusts was 60% of that total and was the largest expenditure.

 

Increased funding had been received for 2016/17 however increasing demand for services had led to some significant financial pressures on budgets.  The CCG was reacting to this pressure by taking measures to improve productivity and giving focus to services with the highest priority.

 

NHS England assessed all CCGs through a performance framework of quarterly reviews and provided an annual summative.  For 2015/16 LECCG, in line with all other CCGs in Lincolnshire, was rated overall as "Required Improvement".  It was reported that it was not possible to achieve a better rating than this unless the finance element of the assessment received a "good" rating, which LECCG did not.

 

LECCG did, however, gain a "top performing" rating for diabetes work which had presented a huge challenge.

 

Increased public engagement had been a focus of LECCG and a patient council and patient viewpoint panel had been established in addition to the active patient participation groups within GP practices.

 

The use of National patient feedback systems continued and it was thought that major improvements in patient engagement via these methods would be important as the CCG moved toward public consultation of the Sustainability and Transformation Plan (STP) and LHAC (Lincolnshire Health and Care) plans.

 

In relation to System Leadership, LECCG provided the lead commissioning role for urgent care across the County and had led on Urgent Care, Women and Children's Care and development of the Local Digital Roadmap as part of the STP and LHAC work.  It was acknowledged that the STP was an important strategic plan which aimed to establish the NHS in Lincolnshire on a path to improved and more sustainable services.

 

The future would be an extremely challenging period for the NHS due to unprecedented levels of demand but LECCG stressed that focus remained on the needs of patients within the County.  It was hoped that the improvements made in public engagement and continued strong clinical leadership would strengthen the ability to address the challenges ahead.

 

Members were invited to ask questions, during which the following points were noted:-

·       Concern was raised in relation to the amount of medical equipment wasted after minimal use, e.g. zimmer frames, shower chairs, etc. It was explained that packaged sterile, goods could not be used even if the packing appeared sealed as there was no guarantee that tampering had not taken place.  Additionally, it had been found that replacement of equipment was more cost effective than the process of recycling;

·       The Pharmacy Review continued to be of focus for the CCG but it remained unclear how the new guidance could be implemented in Lincolnshire as over half of GP practices provided dispensary services which meant the community was less reliant on pharmacies than in some areas;

·       The Committee urged Lincolnshire East CCG to promote themselves more within the report in future.  The report did not clearly show all of the challenges faced by the CCG and encouraged them to proudly promote achievements;

·       Continuing care for patients remained a challenge as a full assessment was required for each individual to assess both health and social need;

·       The report stated that £1484 per person per year was allocated for health care.  It was explained that the CCG received slightly more than other areas due to the sparsity and rurality of the county although this amount was minimal.  The formula used to reach this amount depended on age; profile; deprivation; morbidity and rurality;

·       In relation to the temporary suspension of the Wainfleet practice, NHS England did provide some resources to assist with the additional costs involved as a result;

 

The financial position was expected to be clear by March 2017 therefore Lincolnshire East CCG was requested to provide a further update to the Committee in March 2017.

 

RESOLVED

1.    That the report and update be noted;

2.    That a further update be added to the Work Programme for the Health Scrutiny Committee for Lincolnshire scheduled for 15 March 2016.

 

 

At 3.00pm, Dr B Wookey and Councillors Mrs S Ransome and Mrs R Kaberry-Brown left the meeting and did not return.