Presentation by Jacqui Bunce, Associate Director, East and North Hertfordshire Clinical Commissioning Group, which gives an overview of the health of residents of Welwyn Hatfield and of the Strategic Transformation Fund for the NHS.
Minutes:
The Committee received and welcomed a presentation from the Associate Director, East and North Hertfordshire Clinical Commissioning Group (ENHCCG). The presentation gave an overview of the health of residents of Welwyn Hatfield and on the Hertfordshire and West Essex Sustainability and Transformation Plan (attached at Appendix 1).
The Associate Director, on behalf of the ENHCCG, thanked colleagues in the Public Health Team for their contribution. The Council had given a great deal of support to the ENHCCG.
Following the presentation the Associate Director addressed the points raised by Members:-
Availability of appointments continued to be an on-going issue for many constituents. How would this be addressed?
A number of solutions had been proposed:-
· The NHS needed to do things differently.
· For individuals who were concerned about their health – the ‘worried well’, other services to whom they could be directed needed to be made available and easy to use.
· The alternative services could be talking to the practice nurse or the NHS.
· This development was not the responsibility of the GPs.
· Joined up services, one which could share records about a patient’s treatment would free up resources.
· Pathways for a patient’s care needed to be clearer as did the overall control of care.
· Improved use of resources now and in the future.
· Changes in how the services were delivered without patients being detrimentally affected.
The voluntary sector, who undertook a considerable amount of community work, were under increasing pressure. Funding was being cut whilst the needs of the community increased. The sector may not be able to keep pace with demand on their services.
The NHS recognised and valued the role the voluntary sector played in the provision of services. There needed to be joined up thinking around patients being discharged from hospital and into a care placement to enable patients to come out of hospital as soon as they were well enough.
Work more effectively with the voluntary sector, with the NHS finding out how it could support the voluntary sector to work to together to sustain the services provided.
Sharing of good practices within the voluntary sector.
Alternative ways of consulting GPs was also being looked into to ensure the efficient and effective use of resources. This included:-
· Development of the role of pharmacists to provide advice and support.
· Increased usage of telephone consultations for an initial risk assessment so as to ascertain the best next step for the patient, be it to consult their GP or pharmacist, or to attend hospital.
· Information technology needed to be easier to use, with telephone consultations regularly taking place.
· It was often very difficult to see or speak to a GP as there were many barriers in front of a patient before they were able obtain a consultation.
· Another difficulty was the complexities of care. If a patient happened to be under two specialists then the different departments appeared to work in silos and independently of each other. There was little or no communication between the departments.
· People were confused about where to go for what treatment, whether it should be the QEII at Welwyn Garden City or the Accident and Emergency Department at the Lister hospital in Stevenage. People were going to these facilities due to the lack of alternative provision.
· More use should be made of carers’ champions, who were based in GP surgeries, who would provide support to patients and free up GP resource.
· The ENHCCG recognised the work which needed to be carried out around supporting patient champions and carers.
· Due to the telephone triage system used by GPs, surgeries appeared to be empty whilst it may take many hours for a patient to be able to speak directly to a GP.
· The ENHCCG had also recognised the difficulties with regards to the telephone triage and that a simpler system had been required and had now streamlined that system.
· Was there a significant problem in this area due to a third of the GPs in the Hertfordshire and West Essex thinking of retiring in the next five years? There was no recruitment issues in this area as there were in other areas. There were some very successful practices within the Welwyn Hatfield area. The challenge for the ENHCCG was how to make working in the area attractive with workloads and the environment in which the GP would work.
The ENHCCG were working with the NHS on the recruitment and retention of health professionals and was keeping a watching brief on the developments.
Today newly qualified doctors viewed their careers and training very different than they had previously. Work had to be undertaken by the health service on how the potential career of the salaried doctors could be accommodated. These were the challenges for the ENHCCG.
Members, with reference to the Carter report, expressed surprise that the NHS and Trusts did not have a comprehensive joint procurement strategy in place.
The Trust monitored NHS improvement and the cost of procurement. There was a drive on a national level for a joined up procurement strategy to make the procurement of services easier and more effective for the NHS as a whole. The various sectors of the organisation needed to be able to work differently together to improve the management of contracts and contractors.
It was acknowledged that technology could assist with improving the services of the NHS. The information technology used within the NHS was very complex as was the interoperability. Ideally there would be one gateway into all services of the NHS where patients would be able to book an appointment through one system, regardless of the health need. It was only very recently that all GPs in the Borough were on the same computer system which could communicate with each other. Members noted and welcomed this improvement.
Members of the public had a certain perception regarding the need to share information. There was a need to give assurance to members of the public that their information would only be shared when it was appropriate to do so.
Could the duplication which appeared within the NHS be avoided?
The Associate Director acknowledged that there was considerable duplication which was not good practice. Ideally this would be avoided as it impacted on patient and health practitioners’ time which drained resources and added to costs. A different approach was under review where the service looked at a person as a whole. New initiatives were looking at the patient’s journey time and whole experience. The need to improve this was recognised as a person’s overall experience would impact on the patient’s wellbeing. A better relationship with the patient which would result in them being more co-operative, which would improve efficiency and effectiveness
Members thanked the Associate Director for her presentation which had been very informative and to receive reassurances about the future health services for the residents of the Borough. There had been considerable concern before the publication of the Sustainability and Transformation Plan due to the high levels of secrecy surrounding the proposals. There had been great uncertainty regarding what was expected and the involvement of the local authority.
RESOLVED:
(1) That the presentation on the overview of the health of residents of Welwyn Hatfield and on Hertfordshire and West Essex Sustainability and Transformation Plan be noted.
(2) That the Associate Director bring an annual update of the work of the East and North Hertfordshire Clinical Commissioning Group (ENHCCG) to the Social Overview and Scrutiny Committee.
(3) That a presentation on the changes which had taken place as a result of the Strategic Transformation Fund and their impact on the residents of the Borough be brought to the Social Overview and Scrutiny Committee.