To receive a presentation from the Chief Operating Officer of Havering Clinical Commissioning Group on the local health economy and plans for intermediate care.
Minutes:
The Chief Operating Officer of Havering Clinical Commissioning Group (CCG) explained that the CCG, which had been in operation since April 2013 commissioned a large number of services community health, mental health and secondary or hospital care. Services were commissioned across London, not just from the local Hospitals’ Trust. The CCG was principally made up of GPs and GPs themselves were mainly accountable to NHS England.
The CCG’s overall commissioning budget was £304.7 million per year while annual running costs totalled £6.3 million. The CCG’s work was supported by a Commissioning Support Unit that worked across the whole of North East London. The CCG was a statutory body with a governing body elected annual. The governing body included seven GPs, a senior nurse, a secondary care consultant and lay members covering audit and patient involvement. The CCG leadership was accountable to the Members’ Committee which included all 49 GP practices in Havering. There was also a Joint Executive Committee working jointly with the CCGs in Barking & Dagenham and Redbridge.
The CCG was also part of the Integrated Care Coalition and was involved, with the Council, in drawing up the Joint Strategic Needs Assessment. The population of Havering was continuing to get older and there was an associated low satisfaction with e.g. access to primary care.
The CCG was focussing on a number of key areas including improve access to urgent and primary care and developing a new model for complex care. This would aim to help the most regular visitors to hospital. A system of integrated case management was also being developed for people with long-term conditions such as asthma and diabetes.
It was also hoped to integrate urgent and emergency care services by combining the contracts for these. It was acknowledged that the BHRUT Hospitals’ Trust had been put into special measures and the Trust’s improvement plan had been published in the last week.
As part of its focus on elderly people and long-term conditions, the CCG had commissioned a Community Treatment Team. This was a rapid response team that visited people at home who suffered from long-term conditions such as deep vein thrombosis. This could be accessed via the NHS 111 service or through a referral from another health professional. Patients with long-term conditions were also given details of the service. From April 2014, Integrated Health Teams had been introduced for the six GP clusters in Havering. These would co-locate nursing and community therapy teams and would also involve secondary care clinicians in managing long-term conditions. The Government Better Care Fund could also be used to promote integrated care services that were run jointly between the Council and the CCG.
The CCG was committed to having care provided closer to people’s homes and services such as dermatology and ophthalmology were being provided in local settings rather than in hospital. This would be applied to more services in 2014/15 including cardiology and diabetes services.
The CCG had received a total of £5.6 million from the Prime Minister’s Challenged Fund which was the highest amount nationally. This funding was to be used to transform primary care. It was planned that one GP in each Havering cluster would provide care 8 am to 10 pm, seven days per week. The development of a GP Federation in Havering would assist with this. It was also hoped to develop electronic sharing of care records across GP practices. A map of local health services and GP clusters would shortly be put on the GP website.
As regards intermediate care, the CCG wished to improve the productivity of community-based beds and the trial of Community Treatment Teams would continue across the three local CCGs. Intermediate care helped recovery from illness and prevented admission to hospital or long-term residential care where this was not necessary. Both the Community Treatment Teams and the new Intensive Rehabilitation at Home service had received high satisfaction rates in patient surveys. While these services were on a trial basis at present, the CCG wished to introduce them permanently in Havering. A business case for this change would be considered by the CCG executive that week and this would lead to a consultation exercise on the proposed changes.
The CCG was responsible for commissioning services for children with disabilities although the Council would have a role in this from September 2014. Public Health was also involved in work to discourage parents from taking their children to A&E unnecessarily.
Work was ongoing with social care colleagues on how care funding could be better invested in the community and more details could be provided to the Committee on this. Plans on the impact of personal budgets had recently been shared with the Health and Wellbeing Board.
It was clarified that extended GP opening times would only be for patient needing urgent or emergency treatment. The Chief Operating Officer added that the new GP contract that would commence from 2016 would require GP practices to open 8 am to 8 pm, seven days per week. Feedback from Queen’s Hospital had indicated that relatively few attendances at A&E had been due to people being unable to obtain GP appointments.
It was confirmed that there was an out of hours GP service covering Havering although Members reported that telephone guidance given had stated that specifically not the case. It was hoped to appoint in the future one contractor for the whole pathway as this would allow a greater consistency of message to be given.
There were a total of 104 rehabilitation beds for Havering residents available at King George Hospital and other sites. The CCG felt it that only 40-60 beds would be needed, provided these were all based at one site. It was planned to start a 12 week consultation on these issues from 7 July.
The Committee NOTED the presentation.