Agenda item

Officers will present on the Transforming Services Together proposals which are currently the subject of public engagement. Report, summary of proposals and engagement plan attached.

Officers explained that the Transforming Services Together (TST) project was now in an active engagement phase concerning the strategy and investment case. The engagement period would last until 22 May.

It was emphasised that there were no plans under the proposals to close any A & E or maternity units given the predicted large increase in the population of east London over the next 15 years. It was also not planned to build a new hospital.

Primary care was of key importance to the plans as it was a priority to prevent hospital admission where possible. Some impact of the plans would be felt further into Outer North East London with for example the planned closure of A & E at King George Hospital and one third of Redbridge residents using Whipps Cross as their local hospital. Some Barking & Dagenham residents also used Newham General Hospital. A Member pointed out that residents of the southern part of the Epping Forest District Council area also used Whipps Cross.

Offices accepted that the urgent care system was confusing for patients and were trying to make this clearer, with a single point of access. Too many people went to A & E and there was a need to improve primary care access. Officers agreed that it was not acceptable for example for people in Redbridge to wait 25 minutes to get through to their GP. It was possible that one overall phone system for GP appointments could be introduced. Officers would check how much liaison had taken place with West Essex CCG regarding the urgent care proposals.

The existing integrated care programme covering CCGs and service providers in East London would also seek to avoid unnecessary admissions to hospital. A further issue was to establish better joined up working with social care. At present, zero hours contracts could sometimes mean that carers were not available quickly.

For long-term conditions, it was felt that a key issue was the continuity of patients being able to see the same GP. The bringing together of GPs with other teams would improve access but it was also important that the community supported these changes by not using GPs unnecessarily. The vanguard project to improve access to services was in the planning stages but had not commenced as yet.

Barts Health was leading work on integrated care across London. It was accepted that there remained challenges around sharing care plans with both London Ambulance Service and colleagues in social care. It was confirmed that there remained a role for NHS walk-in centres in the new model.

Officers agreed that it was often difficult for people to see their own GP if they worked in another area. More evening appointments would therefore be made available although there were no current plans to introduce dual registration of GPs at this stage. It was also hoped to introduce more on-line booking of GP appointments together with the provision of medical advice on-line in some cases.

Delayed discharge from hospital remained an issue and some hospitals had schemes to discharge people first and then follow up with their medication. Barts Health were also looking to improve issues around To Take Away forms and the hospital pharmacies generally. Concerns Members raised around the provision of medication to in-patients with mental health issues would be taken back to the relevant organisations.

Officers agreed that home births had not been previously encouraged in North East London and that mothers should be given this as an option. A home birth service was offered at Homerton Hospital and this was usually a safer method of delivery if a low risk birth was expected. In the Netherlands, 20% of births were at home.

It was agreed that there were a high number of GPs due to retire in the next five years and that there was a shortfall of around 200 GPs in inner North East London. Discussions re succession planning for the loss of these GPs had taken place and the East London CCGs had funded a physician’s associate course in response to this in order to increase the local primary care workforce.     

A lot of work on mental health services was also taking place. Planning was also underway to allow the Police to contact mental health professionals directly where required.

It was emphasised that the only proposals being considered were those shown in the engagement document and that nothing had been hidden. The rising population would eventually mean the release of further income and not having to build a new hospital would also mean significant cost avoidance. Work with partners such as Public Health and London Ambulance Service could also allow access to untapped resources.

Travel times to GPs had been considered under the proposals as had provision for disabled or housebound patients such as consultations by Skype.

In summary, the main points discussed by the Joint Committee in relation to the proposals were:

·         Use of zero hours contracts in social care

·         Services for disabled patients such as Skype consultations

·         A unified telephone system for booking GP appointments

·         Merged budgets and sharing of information

·         Expected GP retirements

·         On-line GP appointments

·         Increasing the numbers of home births

·         Duplication of services

It was AGREED that officers should give an update on the plans to the Joint Committee, following the end of the engagement period.