Agenda and minutes

Health Overview & Scrutiny Committee
Tuesday 10 September 2019 10.00 am

Venue: Council Chamber - Shire Hall, Gloucester. View directions

Items
No. Item

1.

Apologies for absence

Minutes:

See above.

2.

Declarations of Interest

Minutes:

Cllr Stephen Andrews - Community first responder – SWASFT

 

3.

Minutes of the previous meetings pdf icon PDF 107 KB

Draft minutes are attached for 16 July 2019 Health Overview and Scrutiny Committee meeting.

 

Draft minutes are also attached for the Joint meeting of the Adult Social Care and Communities Scrutiny Committee and Health Overview and Scrutiny Committee.

 

Included are the action responses from the meeting on 16 July including a glossary of acronyms.

Additional documents:

Minutes:

The draft minutes of the Health Overview and Scrutiny Committee meeting on 16 July were agreed as a correct record.

 

The draft minutes of the joint meeting between Health Overview and Scrutiny Committee and Adult Social Care and Communities Scrutiny Committee held on 30 July meeting were agreed as a correct record.

 

4.

Public Representation

The Health Overview and Scrutiny Committee is piloting an approach whereby members of the public can make representations at committee meetings.

 

At each meeting of the Health Scrutiny Committee there shall be up to 20 minutes set aside for representations (3 minutes allocated per member of the public).

 

Any person who lives or works in the county, or is affected by the work of the County Council, may make a representation on any matter which relates to any item on the Health Overview and Scrutiny Committee agenda for that meeting.

 

Notification of your intention to attend the meeting and make a representation should be given by 4pm three clear working days before the date of the meeting.

 

The closing date for notification  is 4pm on 4 September 2019.
Please email  stephen.bace@gloucestershire.gov.uk

 

If any individual has any particular requirements please include in the email.

 

Minutes:

Rebecca Myers, Partnership Manager – Gloucestershire Local Pharmaceutical Committee made the following representation:

 

We would like to highlight a potential issue that needs to be considered and addressed within the development plan for the Primary Care Networks.

On page 40 of the public papers (page 10 of the Primary Care Strategy Refresh), the workforce projections for the Primary Care Networks state that by March 2024 there will be 74.3 FTE pharmacists working within the networks. This is an increase of 200% or 50 FTE over the next 4 and a half years.

 

The LPC has discussed this with Martin Pratt, Chief Pharmacist at GHT, and we have serious concerns about the impact that this recruitment will have on the community pharmacy and hospital pharmacy workforce, and pharmaceutical services locally.

The county (and indeed the South West Region in general) already has a problem recruiting and retaining high quality pharmacists due to its semi-rural nature, lack of a large ‘lifestyle city’ and distance from schools of pharmacy.

 

GHT have recently increased their training places and now train 5 pre-registration pharmacists a year. There are only 3 pre-registration pharmacists training in community pharmacies across the county this year – with pre-reg places being advertised and not filled.  These trainees fill vacancies created by ‘business as usual’ HR situations- retirements, maternity leave, business growth, staff relocations etc.

 

We are already seeing pharmacists with concerns around patient safety and who are unable to deliver additional patient services because of workload pressures due to staff losses; pharmacies unable to fill vacant posts: and costs to contractors increasing due to running with expensive locum staff (who are not trained to deliver locally commissioned services) and additional recruitment/retraining costs. We are worried that if recruitment into the PCNs progresses at the proposed rate then this situation will become much worse. Even our Local Pharmaceutical Committee is struggling to fill vacant representative posts having lost 2 members to PCNs in the past 6 months, and one of our newer members travels daily from the Heathrow area to work in a Gloucestershire pharmacy.

 

We are extremely happy that pharmacists are finally being recognised for the valuable contribution they can make within the primary care setting, but would ask that the developing PCNs also consider the value of Pharmacists within Community Pharmacy settings- providing high quality services in the evenings and on weekends in 113 easily accessible locations across the county - without the need for an appointment and at low cost to the NHS.

 

We ask that PCNs consider innovative ways of working when developing their workforce plans, such as:

 

·         Job shares, joint working agreements or ‘sessional’ working arrangements that would allow pharmacists to work in primary care part time and community/hospital pharmacy part time;

·         ‘Transferring’ workload from primary care under a service level agreement that would deliver measurable outcomes for patients without incurring employment costs or taking up space in surgeries

·         Working with community and hospital pharmacists to optimise existing services such as Electronic prescribing and Transfer  ...  view the full minutes text for item 4.

5.

Fit for the Future pdf icon PDF 882 KB

Indicative Timings – 10:20 to 10:40

 

 

An update on the engagement activity including clarification around Cheltenham A & E.

 

The engagement papers can be found at:

 

https://www.onegloucestershire.net/yoursay/

 

TO FOLLOW

Minutes:

5.1      Mary Hutton presented the slides that had been circulated to Committee members regarding the engagement activity. Members were informed that people could play their part by responding to the survey questions in the discussion booklet and attending events across the County.

 

5.2      The focus was on engagement on urgent and specialist hospital care in Gloucestershire including urgent advice, assessment and treatment services and improving specialist hospital services.

 

5.3      Members were provided with a definition for urgent and emergency care with it emphasised that the focus was on supporting the 25% to 30% of patients who present to acute hospital A & E departments to access more appropriate alternatives in the community and also including elements of a planned approach to urgent care.

 

5.4      It was important to look at the access to urgent care services, wherever the individual lived. Locality workshops were an approach to help people understand what was available in their area. Advice and assessment could be provided in a number of ways.

 

5.5      With regards to ‘improving urgent care in local communities’ it was important to recognise that around 1 in 3 visits to emergency departments in Cheltenham and Gloucester were for injuries and problems that could be treated safely by a different NHS service. Members were provided with the example of the successful rapid response service as an example of a new approach to how urgent care is provided.

 

 

5.6      In considering how to improve specialist hospital services, members were informed of the duplication of specialist services provided at both hospitals and how that was leading to challenges due to the scarcity of specialist staff and equipment. Members recognised the vision of creating two centres of excellence. Over the new few years the centres of excellence vision if implemented would require a number of building blocks to be put in place that included buildings, equipment, technology staff and money. First, it was important to ensure the challenges were understood and hear people’s views on potential solutions. Members were provided with details of the current services at the two hospitals.

 

5.7      It was emphasised that no decisions had been made on the level of care or range of services provided at Gloucester or Cheltenham hospitals. The committee was reminded of the number of ways to get involved and share views.

 

5.8      The Chair emphasised this was about large change across the County and reflected that people can be unsettled by change. It was important to encourage people to contribute to the engagement and the Committee had a role in doing that. She encouraged members to attend the engagement events in their areas.

 

5.9      There was a discussion around concerns expressed in the community about a possible reduction or removal of Cheltenham A & E. Members noted the letter they had received from Cheltenham Borough Council’s scrutiny committee. One member provided the background to years of campaigning against a reduction in Cheltenham A & E opening hours and felt assurances had been given at that stage that there was no  ...  view the full minutes text for item 5.

6.

Primary Care Update pdf icon PDF 2 MB

Indicative Timings – 10:40 to 11:10

Additional documents:

Minutes:

6.1      Dr Andy Seymour provided an update on the progress and improvements that continued to be made in the County regarding Primary Care. He was happy to provide specific information relating to Aston Medical Practice in addition to the details on the overall strategy.

 

6.2      Helen Goodey who was carrying out the Joint Director role introduced the slides outlining the place based approach taken in Gloucestershire. She explained that more work had been carried out with district council partnerships.

 

6.3      In relation to the introduction of Primary Care Networks, the main component was GP practice being able to come together led by a clinical director who was a GP. The example was given of St Paul’s medical centre which included groups of primary and community staff working together to deliver preventative, out of hospital care in their neighbourhood.

 

6.4      Members understood the focus on improving access to services. 82% of services were still delivered by GPs, but there was now a wider skill mix that delivered services as well. Advanced nurse practitioners were given as an example.

 

6.5      Members were provided with results from the National GP Patient survey published in July 2019. 87% in Gloucestershire had said their overall experience was good compared with 83% nationally.

 

6.6      With regards to the Aspen Medical practice, 4 GP practices had come together and merged. A number had been having significant challenges so they had come together to support and provide resilience. It was a challenging experience with specific concerns around telephony responsiveness.  Members were informed that now things were improving. There were 13 GP partners and 8 salary GPs, as well as recruitment of Advanced Nurse Practitioners. In relation to the telephony issues, there was a new software system and a big screen that informed them how many were waiting and for how long. Waiting time to answer the phone had improved with the mean time now between 4 and 7 minutes.

 

6.7      Members noted the primary care workforce projections 2019-24 and the significant workforce that would be going into primary care.

 

6.8      Members were provided with detail on ‘Digital Enablers’ –with the majority of GP practices following a set template for their websites that allowed for a more consistent approach. There was far more potential in using this system as it allowed patients to electronically message and submit data on their health so that the practice could make an assessment as well as online bookings and orders for prescriptions and sick notes. Members were informed of the Symptom checker tool which would go to medical practitioners and allow them to suggest an appropriate appointment. In Aspen it had reduced the number of telephone calls.

 

6.9      One member provided an example in other areas of the country where GPs had been asked not to refer to hospitals influenced by budgetary factors rather than clinical judgement. He asked if this was an approach being followed in Gloucestershire. In response it was explained that GP practices worked more closely with consultants to consider  ...  view the full minutes text for item 6.

7.

Update on Pharmacies pdf icon PDF 564 KB

Indicative Timings – 11:10 to 11:30

 

TO FOLLOW

Minutes:

7.1      Nikki Holmes introduced the report, which provided an overview of the position with pharmacies across the County. Members understood that there was some planning around an EU exit and the implications as that as well as assessing the role of the pharmacy including its position in rural areas of the County.

 

7.2      One member asked whether there were fully funded courses and routes for mature students to ensure there was a pathway into the workforce. In addition he asked if there were bursaries available. In response it was explained that NHS England worked with Health Education England to help support those coming into the service. There were suggestions of an apprenticeship route such as studies for radiographers through the University of Gloucestershire. There were similar conversations at a national level for pharmacists. Members were provided with assurances that plans were in place to develop a strategy.

 

8.

Winter planning pdf icon PDF 878 KB

Indicative Timings – 11:30 to 12:00

 

Gloucestershire Urgent and Emergency Care Sustainability Plan 2019/20

 

TO FOLLOW

Minutes:

8.1      Maria Metherall gave a presentation on the Gloucestershire Urgent and Emergency care Sustainability Plan 2019/20.

 

8.2      In considering the requirements for winter, the previous year’s requirements had been reviewed and it was felt that they remained fit for purpose. At the top of the list was the importance of maintaining emergency departments, but it was important that emergency admissions did not come at the expense of the elective care system. The importance of consistency across the county was emphasised.

 

8.3      Members noted the information provided on ‘lessons learnt from 2018/19’ this included what had worked well and what were the challenges. Partnership working and system collaboration and rapid response were included in the examples of what had worked well. Challenges included the fact that capacity did not always meet demand and that there was workforce challenges. Members were also provided with details of transport issues which had needed to be overcome. It was explained that the pressure had continued into spring and summer with delays in discharge planning and pathway progress. The term winter planning was not accurate now in that seasonal variations throughout the year had an impact.

 

8.4      The Committee was shown A & E activity tracking with Gloucestershire well above the national average in terms of performance.

 

8.5      In response to the challenges, it was explained that there had been improved modelling across the system and there was close working with the Gloucestershire workforce planning group. There was a programme of work looking to reduce attendances to emergency departments and support effective discharge flow from hospitals. There was a new non-emergency patient transfer provider. Focussed work within the acute trust was taking place to implement a positive decision making program.

 

8.6      Members were provided with a significant amount of detail around what would be different in 2019/20 at the ‘front door’ and ‘back door’. This included working with 111 calls to do an intelligent ‘clinical validation’  for category 3 and 4 calls, as well as progress pathway work within the Acute Trust to directly refer patients to assessment units and look for opportunities for same day emergency care.

 

8.7      Challenges still being working through including matching capacity to demand and mitigating the risks associated with the decision not to proceed with the emergency general surgery pilot. There was a need to maximise ‘home first’ pathways. Further reducing discharge delays by streamlining processes and influencing patient behaviours was still being worked on.

 

8.8      The next steps were for transparency of the actions being taken and regularly reviewing the impact of schemes and link that to demand and capacity modelling. In addition this needed to continue to be stress tested for the winter.

 

8.9      One member questioned whether there was any complacency and emphasised the importance of considering the risks in the future. One example was given around the later flu jabs this year due to issues obtaining the vaccine. In response it was explained that there was no complacency in the planning being undertaken and that likely risks  ...  view the full minutes text for item 8.

9.

SWASFT pdf icon PDF 455 KB

Indicative Timings – 12:00 to 12:20

 

Minutes:

9.1      William Lee introduced the report providing performance data. Overall activity was currently up by 4.38%, when compared against the previous year. This is of an extra 20 incidents per day as opposed to two years previously. 63% of calls came from 999 and there was a slight increase in access through 111.

 

9.2      Members understood the ‘hear and treat’ model which was to give advice and guidance from clinicians in the control room and advise on referrals to GP or pharmacists. The ‘See and treat’ model was when a patient was visited and treatment given or an onwards referral made. 51% of patients were conveyed to emergency departments.

 

9.3      With regards to performance for response times, performance was strong in relation to category 1 which required a response in 7 minutes. There were challenges relating to Category 2 patients with work required to improve response times.

 

9.4      Members were informed of the investment into the trust which included additional investment of £12m in the South West for the ‘our people plan’ which was on top of the contract for frontline vehicles and would lead to 30 additional staff and an additional 630 hours of ambulance cover per week. This included one ambulance from Cirencester, one from Stroud and further cover for Central Gloucestershire (Cheltenham and Gloucester). In addition there were two additional patient support vehicles.

 

9.5      The national standard was for 85% of the fleet to be ambulance with 15% for cars. SWAST was currently at approximately 75% for ambulances and our people plan will move much closer to the 85% DCA model.

 

9.6      Members were provided with details of lifting chairs for community responders to use which allowed for a more timely response to someone at lower acuity who has fallen than having to wait for an ambulance.  Gloucestershire CCG had provided £50,000 to fund 7 more chairs.

 

9.7      In response to a question a breakdown of the categories was provided:

 

·         Category 1 – life threatening – mean response was 7 minutes, 90th percentile 15 minutes.

·         Category 2 – a serious condition – mean response was 18 minutes, 90th percentile 40 minutes.

·         Category 3 – an urgent problem (such as road traffic collision or fall) – at least 9 out of 10 times within 120 minutes.

·         Category 4 – A non urgent problem – 90th percentile of 180 minutes

 

9.8      There was some concern expressed regarding response times in the Cotswold. It was explained that the data presented was not a SWAST report and that the Cotswold had a comparatively low number of calls and that meant that a small number of calls could skew the average by a significant margin. An example was given that some postcode areas had only 30 category 1 calls compared to 400 in Gloucester in the same period. There were a number of different operating models in place such as the fire service being a co responder. There was active recruitment of community responders as the rurality of the  ...  view the full minutes text for item 9.

10.

Gloucestershire Clinical Commissioning Group Performance Report pdf icon PDF 2 MB

Indicative Timings –12:20 to 12:30

 

Minutes:

10.1    The Committee noted the report with Mary Hutton updating members that with regards to the Stroke Rehabilitation work, the national audit had Gloucestershire graded at one mark off a B, having been previously graded at D. With regards to the Vale Hospital, the facilities there had been graded as an A, which represented a quick outcome and delivery from the work being carried out there.

 

10.2    Collette Finnegan as High Sheriff of Gloucester made a statement about World Suicide Day explained that ever 40 seconds someone died of suicide. John Campbell explained that he would provide a presentation at the next meeting in November regarding IAP and talking therapies. The presentation would outline how to improve access to those therapies and provide support to individuals with long-term conditions.

 

11.

One Gloucestershire ICS lead Report pdf icon PDF 1 MB

TO FOLLOW

Minutes:

The Committee noted the report.

 

12.

GCCG Clinical Chair/ Accountable Officer Report pdf icon PDF 193 KB

Minutes:

The Committee noted the report.