Agenda item - Formal Public Involvement

This is the part of the meeting when members of the public can formally ask questions of the Board or present a petition.  These need to be notified to the Board in advance of the meeting.  Ring the Secretary to the Board, Mark Wall on 01273 291006 or send an email to mark.wall@brighton-hove.gov.uk

 

Note:           

 

It is intended to hold a question and answer session in relation to Personal Medical Services GP Contract Review for a period of 30 minutes and therefore any specific questions relating to this issue should be submitted by no later than 12noon on the 10^th March 2106.

 

The Panel answering the questions will consist of representatives from NHS England, Healthwatch and Community Voice, together with the Board Members.

 

An FAQ sheet has been published in advance of the meeting to help with any queries and deal with any possible questions.

 

 

Personal Medical Services GP Contract Review – Panel Q&A Session

 

62.1         The Chair noted that 30 minutes had been set aside for a question and answer session and invited the following to join the Board as Panel members:

 

Stephen Ingram, Head of Primary Care NHS England

Sally Polanski, CE Community Works

Nicky Cambridge, CE Brighton and Hove Healthwatch

Jenny Moore, Commissioning Engagement Lead, B&HCC

 

62.2         Prior to taking questions, the Chair invited Mr. Ingram to outline the reasons for the review and process that was being followed.

 

62.3         Mr. Ingram thanked the Chair and stated that a commitment had been given at the last meeting of the Board to report back on the deliberations of NHS England in regard to the contract review.  He noted that the Director of Commissioning had written to the Chair outlining the situation and that the local commissioning panel had met on the 1^st March and made a number of recommendations in relation to the 5 sites affected.  It was recognised that more time and consideration was required in regard to 4 of the sites and that further work would be undertaken with a view to reporting back to the panel on the 25^th April.  This included having an Equalities Impact Assessment for the possible closures, the potential for neighbouring practices to take over those affected as branch surgeries, the management of dispersal lists and support arrangements for that process.

 

62.4         The Chair thanked Mr. Ingram for the update and noted that several written questions had been submitted and invited Mitch Alexander to come forward and put her question to the Panel.

 

62.5         Ms. Alexander asked the following, “What steps are NHS England, Brighton and Hove CCG and Brighton and Hove City Council doing to ensure that a GP provision can be kept going at The Willows surgery in Bevendean after The Practice Group have ended their contract?”

 

62.6         Mr. Ingram thanked Ms. Alexander for her question and stated that he shared her view of the importance for patients to have access to a GP and it was the intention of NHS England to ensure that remained.  The local commissioning panel had decided to take more time and gather more information and had been able to agree an extension of contracts with the Practice Group to enable a staggered exit.  There was a need to have certainty that a a Practice can be maintained and operated, and a re-procurement exercise would be held if there was a viable option for a practice to continue, if not then there would need to be a closure and reallocation of patients.

 

62.7         Ms. Polanski noted that the feedback from patients was that access to services remained paramount in their view along with service continuity.  There was concern that other practices were already at capacity and the lack of information / communication in regard to the process needed to be addressed.

 

62.8         The Chair then invited Linda Miller to come forward and put her question to the Panel.

 

62.9         Ms. Miller asked the following, “How many GPs are there in Brighton and Hove, and how many are expected to retire in the next 5 years; and with this in mind is it difficult to recruit GPs when vacancies are advertised.  Are there already surgeries or areas of the city with unfilled vacancies and is there any financial penalty being imposed on The Practice plc for pulling out of its contract, leaving others to deal with the problems this will cause?”

 

62.10      Mr. Ingram stated that Practice PLC had a contractual right to give notice of an intention to withdraw and this had been submitted just before Christmas.  However, as he had indicated an agreed exit plan had since been achieved to enable a staggered end to the various contracts. 

 

62.11      He also noted that there was a difficulty in recruiting to the Practices across the city and the country and that there was a need for more GP’s to become partners.  He was also happy to provide written information in regard to the number of GPs in the city as he did not have this information to hand.

 

62.12      The Chair then invited Anthony Coyne to come forward and put his question to the Panel and noted that he was not present and therefore read it out, “Has it been acknowledged that a possible reason for the collapse of our GP surgeries is because pharmaceutical drugs do not work, hence making the GP's position untenable because the patients are not being healed by the drugs?”

 

62.13      The Director for Public Health stated that there were a lot of successful pharmaceutical drugs which were used appropriately and helped patients.  The difficulty was the inappropriate use of prescribing and use of drugs when other alternatives existed.  He did not believe that this was the reason for the issues that currently existed in primary care.

62.14      The Chair then invited Linda Game to come forward and put her question to the Panel.

 

62.15      Ms. Game asked the following, “I understand that NHS England is responsible for providing healthcare but who is the actual person, or group who is responsible for ensuring that we have a GP service in Bevendean and, if our surgery is eventually closed who took that decision.  Was it the same person or group? “

 

62.16      Mr. Ingram accepted that it was a confusing situation and stated that NHS England was the commissioning body for GP Practices but not the provider.  The decision to award contracts was with the local regional office, in this case NHS South/South-East, with Felicity Cox as the Director for Commissioning Operations.  The local panel will put forward recommendations for consideration based on patients’ views, clinical advisers and the EIA outcome.

 

62.17      Mr. Child stated that the CCG would seek to work closely with the partner agencies and enable a full EIA and joint needs assessment to be compiled for the Panel meeting in April.

 

62.18      Mr. Ingram stated that the Chair of the Board and Chair of the Overview & Scrutiny Committee would be invited to attend the Panel meeting and he was happy to extend the invitation to local PPG reps.  He was also happy to meet with the PPG reps before the Panel meeting on the 25^th April to talk through the process and address any concerns.

 

62.19      The Board Members welcomed the offer.

 

62.20      Jenny Moore noted that there was a PPG network meeting scheduled for the 13^th April and hoped that this would provide the opportunity to develop working relations across the city.

 

62.21      The Chair then invited representatives from the Hangleton Manor Patient Group, to come forward and put their question to the Panel. 

 

62.22      Ms. Walker asked the following question, “Theolder and less mobile people patients who use Hangleton Manor might not be able to access an alternative GP due to lack of public transport routes to alternative surgeries. Can you tell us how this issue is going to be addressed?

 

We believe that that Hangleton Manor has a disproportionate use of home visits – will the allocated surgery be able to provide this service to all patients who require them?

 

Hangleton Manor serves a significant portion of disabled and wheel chair bound patients who require an accessible building. What provision will be made for these patients given the nearest surgeries have existing physical access problems?”

 

62.23      Mr. Ingram thanked Ms. Walker for the question and stated that he believed the EIA would be an important factor in the consideration of the situation by the Panel on the 25^th April.  He believed that there was potential for other surgeries to consider having branch surgeries and for alternative nearby surgeries to take more patients; although he accepted there was a question-mark over capacity issues.

 

62.24      The Chair noted that concerns had been raised about other practices closing lists and queried whether this would be taken into account and whether public bodies were able to bid for the contracts.

 

62.25      Mr. Ingram stated that public bodies could bid to be a provider but it was not an option for NHS England.  He was not aware of any practices that had submitted a request to close their lists but was happy to check and report back to the Chair.  He also noted that whilst a practice may have an open list, it was not obliged to take on additional patients but may consider any enquiries that are made to join.  If a decision is taken to refuse an application then there is a requirement to provide written reasons as to why.

 

62.26      Nicky Cambridge noted that there was a need for a joint approach to the situation and queried what the public bodies were doing to respond to it when it appeared the market could not.

 

62.27      Doctor Beasley stated that the CCG had taken steps to ensure greater investment in the affected areas, but under the GMS contract they were the hardest to earn from.  The weakness of the 5 practices under the Practice Group was that they were spread across the city rather than having neighbourhood based practices.  She also noted that discussions were being held in regard to the possibility of establishing a Federation which would then help to support practices across the city.

 

62.28      The Chair then invited questions from the floor.

 

62.29      Mr. Kapp asked the following question, “With the closure of their patient list at Wish Park Surgery following the doubling of numbers resulting from the closure of Goodwood Court, how will remaining patients without a surgery have access to services?”

 

62.30      Mr. Ingram stated that he would need to check on the decision to close the patient list and would provide Mr. Kapp with a full written response.

 

62.31      Councillor Mac Cafferty noted that the public had a right for their needs to be met and queried how NHS England under its constitution was obliged to asses those needs and commission services to meet them accordingly.

 

62.32      Mr. Ingram stated that the consultation process was aimed at identifying what levels of provision were required with as much certainty as possible so that the delivery of services could then be matched to meet those needs.

 

62.33      Frances McCabe noted that accessibility and neighbourhood were important factors in patients’ minds and questioned whether a cluster model would coincide with patients’ views/understanding of neighbourhood and whether it could adapt to meet such aspirations.

 

62.34      Doctor Beasley stated that the cluster model would differ across the city as groups of practices would need to take into account economic viability, back office provision, the neighbourhood etc.  There was a need to see how this would develop and how practices would support each other.  She noted that patients had been clear in that they wanted to see ‘their’ GP if the matter was an ongoing/serious issue but were happy to see a locum if it was a more general matter.

 

62.35      The Chair stated that he felt it had been a very useful discussion and thanked the Panel members for their time and the questioners for attending and putting forward their concerns.  He hoped that there would be a positive outcome from the meeting on the 25^th April.

 

Public Questions

 

62.36      The Chair noted that one pubic question had been received from Mr. Kapp and that copies of this had been circulated along with a supplementary question.  He therefore proposed that he would provide Mr. Kapp with a full written answer that would also be attributed to the minutes for record and sought Mr. Kapp’s agreement to that which was forthcoming.

 

62.37      The public question and supplementary from Mr. Kapp are listed below for information:

 

Question - “When is the HWB going to call the CCG to account for failing to invite tenders to provide NICE recommended talking therapies to vulnerable people in the city for the £53 m already allocated to treat them?”

 

Supplementary question - “When is the CCG/HWB going to invite tenders to provide NICE recommended talking therapies to at least 2,000 extra patients requiring treatment following the new mandate to treat 25% rather than 15%?”

 

Note:   Written response to the questions from the Chief Operating Officer of the CCG detailed below:

 

62.38     

...

“Thankyou for thequestion thatyou submittedto theHealth &Wellbeing Boardon 15^th March2016.As you knowwe arecommitted toproviding youwith awritten response.

 

Asyouwillbeawarewehavedealt with verysimilarmatters in previouscorrespondencetoanswer to your previous public questions, Ihope youwill find it helpfulto reiteratethem here:

 

(1)       Weareawareofthecorrespondenceyou havereceivedform theCouncil's legalservices department inDecember last year and I think it wouldbe helpfulto reiteratethe structureof theHealth & WellbeingBoard. TheHealth &Wellbeing Board is jointcommittee comprisingof membersof the Council andthe CCG.  As stated in theletter fromthe Council and in subsequentcorrespondence with theCCG,both areseparate organisationsand theCCG doesnot reportto the Council as asupervisory organisation.

 

(2)       The£53M that yourefer to in your questionhas notbeen identified forthe provisionof Talking Therapy.  Themoniesthat you identify arerequired to commission a widevarietyof otherservicesin the City and itwouldbe inappropriateto useelements of thatfundingto commissionTalkingTherapy.

 

(3)       TheCCGhasnotfailedtoinvitetendersforthe provisionofTalkingTherapy.  TalkingTherapy is providedforpatients inBrightonand Hove aspart ofthe WellbeingService.  This contract hasbeen in placesincethe establishmentof theCCG.  It is notnecessary to seektenders until it is necessary for the serviceto bere-procured.  With an effective service in place it is not clearhow youanticipatethe Health& WellbeingBoard might"call theCCG toaccount forfailing toinvitetenders".

 

 

Asthecommissioner ofthisservicetheCCG is responsibleformanaging theservice'sperformanceand wewillcontinuetoensurethatweobtainthebest possibleoutcomes fromourprovider.

 

Asmentionedabove, TalkingTherapiesare currently commissioned as part ofthe WellbeingServicewhichhas been in place forsome years.  As thiscontract is approachingthe end of its term the CCG willshortlycommence a procurement process for theWellbeingService. The new service will also includeTalkingTherapies and sufficientcapacity will becommissionedto meetthe increased levelof servicenoted bythe Departmentof Health.

 

TheCCGwillseektendersfrom organisationssuitably qualifiedto providethese servicesand wewilladvertise this opportunity in appropriatepublications,includingon theCCGwebsite.  Full detailswill beprovidedwhen theyare available,includingthe servicespecification, minimumrequirements for biddersand theevaluation criteria.

 

Sinceyousubmittedtheabovequestionyouhavealsoraisedaseparatequestion oftheCCGaskingwhen we will commissionan increaseto thecurrent TalkingTherapy provision.  I believewe havenow answeredthat questionsufficiently in the paragraphsabove.”