Agenda and minutes

Apologies for absence were received from Karen Chouhan, Chair Healthwatch Leicester, Frances Craven, Strategic Director Children’s Services, Chief Supt Sally Healey Head of Local Policing Directorate, Dr Avi Prasad, Co-Chair, Leicester City Clinical Commissioning Group, Tracie Rees, Director of Care Services and Commissioning (Adult Social Care) and Trish Thompson, Director of Operations and Delivery, NHS England Local.

Members are asked to declare any interests they may have in the business to be discussed at the meeting.

Members were asked to declare any interests they might have in the business to be discussed at the meeting.  No such declarations were made.

To note the membership of the Board for 2015/16 approved by the Council on 18 June 2015:-

City Councillors

Councillor Rory Palmer - Deputy City Mayor – Chair

Councillor Adam Clarke – Assistant City Mayor – Energy and Sustainability

Councillor Abdul Osman – Assistant City Mayor - Public Health

Councillor Sarah Russell – Assistant City Mayor – Children, Young People and Schools

NHS Representatives

Professor Azhar Farooqi – Co-Chair of the Leicester City Clinical Commissioning Group

Sue Lock, Managing Director - Leicester City Clinical Commissioning Group

Trish Thompson - Director of Operations and Delivery, Leicestershire and Lincolnshire NHS England

Dr Avi Prasad - Co-Chair of the Leicester City Clinical Commissioning Group

City Council Officers

Andy Keeling - Chief Operating Officer and Acting Director of Adult Social Care

Frances Craven - Strategic Director – Children’s Services

Ruth Tennant - Director of Public Health

Note: Stephen Forbes will be joining the Council on 7 October 2015 as Strategic Director - Adult Social Care and will become a member of the Board.

Local Healthwatch and Other Representatives

Karen Chouhan - Chair, Healthwatch Leicester

Chief Supt Sally Healy - Head of Local Policing Directorate

Professor Martin Tobin - Professor of Genetic Epidemiology and Public Health

Richard Clark - Chief Executive, The Mighty Creatives

The membership of the Board for 2015/16 approved by the Council on 18 June 2015 was noted as follows:-

City Councillors

Councillor Rory Palmer - Deputy City Mayor – Chair

Councillor Adam Clarke – Assistant City Mayor – Energy and Sustainability

Councillor Abdul Osman – Assistant City Mayor - Public Health

Councillor Sarah Russell – Assistant City Mayor – Children, Young People and Schools

NHS Representatives

Professor Azhar Farooqi – Co-Chair of the Leicester City Clinical Commissioning Group

Sue Lock, Managing Director - Leicester City Clinical Commissioning Group

Trish Thompson - Director of Operations and Delivery, Leicestershire and Lincolnshire NHS England

Dr Avi Prasad - Co-Chair of the Leicester City Clinical Commissioning Group

City Council Officers

Andy Keeling - Chief Operating Officer and Acting Director of Adult Social Care

Frances Craven - Strategic Director – Children’s Services

Ruth Tennant - Director of Public Health

Note: Stephen Forbes will be joining the Council on 7 October 2015 as Strategic Director - Adult Social Care and will become a member of the Board.

Local Healthwatch and Other Representatives

Karen Chouhan - Chair, Healthwatch Leicester

Chief Supt Sally Healy - Head of Local Policing Directorate

Professor Martin Tobin - Professor of Genetic Epidemiology and Public Health

Richard Clark - Chief Executive, The Mighty Creatives

To note the Board’s Terms of Reference approved by the Council on 18 June 2015.  The Terms of Reference were amended to add the following responsibility at paragraph 3.14:-

“The Board will agree Better Care Fund submissions and have strategic oversight of the delivery of agreed programmes.”

Delegation of Urgent Action to the Chair – Better Care Fund

The Board is also requested to delegate authority to the Chair of the Board to ‘sign off’ information requested by NHS England about the Better Care Fund, or other data to be submitted by the Board when there is insufficient time for these to be considered at a formal Board meeting.

The Board’s Terms of Reference approved by the Council on 18 June 2015 were noted. The Terms of Reference were amended to add the following responsibility at paragraph 3.14:-

“The Board will agree Better Care Fund submissions and have strategic oversight of the delivery of agreed programmes.”

Delegation of Urgent Action to the Chair – Better Care Fund

The Chair stated that frequent requests are received from NHS England for information to be sent back at short notice which does not make it feasible to submit it to a Board meeting and asked for delegated authority to deal with these between Board meetings.  Any such submissions would be circulated to Members of the Board for information.

RESOLVED:

That the Board’s authority be delegated to the Chair of the Board to ‘sign off’ information requested by NHS England about the Better Care Fund, or other data to be submitted by the Board when there is insufficient time for these to be considered at a formal Board meeting.

The Minutes of the previous meeting of the Board held on 26 March 2015 are attached and the Board is asked to confirm them as a correct record.

RESOLVED:

That the Minutes of the previous meeting of the Board held on 26 March 2015 be confirmed as a correct record.

To receive a presentation from John Adler, Chief Executive, University of Leicester NHS Trust (UHL) the Trust’s strategic priorities and current challenges.

The Chair stated that he had deferred this item to the next meeting as a number of apologies had been received and he felt that the presentation by John Adler should be made to the full Board membership in view of its importance.

To receive a report providing an update on progress in primary, community and acute care in implementing seven day services as directed by the Seven Day Services Forum.

The Managing Director, Leicester City Clinical Commissioning Group submitted a report providing an update on progress in primary, community and acute care in implementing seven day services as directed by the Seven Day Services Forum.

The Managing Director stated during the introduction and in response to subsequent questions from Members that:-

a)         Leicester City GP Practices were successful in receiving an allocation of £3.2m from the Prime Minister’s Challenge Fund to pilot a number of initiatives to promote seven day access to primary care.  The GP practices had formed a Steering Group to oversee the introduction of these initiatives which involved longer opening hours during the week, opening at weekends and greater use of online services including patient registrations.

b)         The CCG had a representative on this Steering Group to influence the alignment of the initiatives with local strategies and to develop key performance indicators so that their operation could be measured and assessed.

c)         The four pilot sites for longer and extended opening hours were Willows Medical Centre (Rowlatts Hill Road), Belgrave Health Centre, Brandon Street, Westcotes Health Centre, Fosse Road South and Saffron Group Practice, Saffron Lane.  There was a phased launch with one centre joining the initiative each week during September.

d)         Each pilot site would have a GP Principal and a Nurse available at all times the service was open.  GP Principals had been encouraged to provide the service rather than rely on locum Doctors. The new arrangements were seen as a success of the GP Federation working in collaboration to change working practices that would be sustainable.  The pilot sites would be able to access patients’ records from other GP practices through IT systems and data sharing arrangements.

e)         Discussions were taking place between the pilot sites and local pharmacies to provide access to pharmacies during the extended opening hours.

f)          It was recognised that effective communication plans had to be in place to underpin this initiative.

g)         The effectiveness of the pilots would be assessed by the CCG in December/January and they would determine whether any improvements to the arrangements were required and whether it was effective to rollout and extend the scheme.

h)        The data collected would identify where patients came from and part of its analysis would identify whether the attendances were genuine and a true reflection of the expected demand for the extended service.

i)          The provisions for seven day access to services were already built into the Better Care Together Fund as it was a key part of work to improve patient flows in and out of hospitals and reduce hospital admissions. This involved a more integrated seven day working model across front-line health and social care services as well as developments in the Clinical Response Team, Unscheduled Care Team and the Planned Care Team.  Each of these has proven that integrated seven day services provide both high quality care for patients and aids the flow through the urgent care system.

j)          Following an assessment of UHL in  ...  view the full minutes text for item 7.

To receive a report which sets out the detail of the plans which have been produced local and the progress that has been made in relation to the General Practice Incentive Scheme.

The Managing Director, Leicester City Clinical Commissioning Group submitted a report which set out the detail of the plans which have been produced locally and the progress that has been made in relation to the General Practice Incentive Scheme.

Members noted the following comments:-

a)         There was a national and local shortage of GPs and a number of initiatives were being undertaken to address these shortages.

b)         Professor Farooqi was the CCG’s representative on the Leicester, Leicestershire and Rutland (LLR) General Practice Delivery Group, which was overseeing a 10 point plan to support the recruitment of GPs, which was outlined on the report.

c)         The Government had made a commitment to train an additional 5,000 GPs by 2020, but current evidence suggested that there were insufficient numbers on GP training programmes to achieve this.

d)         Currently 30% of places on the East Midlands GP training scheme were unfilled.

e)         Locally issues under consideration were:-

            i)          Selling the East Midlands as a place to work for GPs.

ii)         Encouraging GP’s to take medical students from local universities to provide an introduction to and experience of primary care provision.

iii)        Encouraging GPs trained in Leicester to remain in Leicester.  Feedback from young doctors indicates that Leicester is not seen as an attractive place to work for a number of reasons, although there were a number of highly committed GPs who valued the chance to work in an area of high need. 

iv)        Incentive schemes including financial and non-financial elements were seen as useful in recruiting more GPs.  Non-financial elements could include offering young GPs the opportunity of various experiences as part of their employment, including research opportunities, specialist work experience in hospitals, working in 2-3 GP practices, protected learning time within the contract of employment etc.  The Council’s Public Health directorate could also look at offering opportunities for experience and development.

Following Members’ questions and comments it was stated that:-

a)         It was more difficult for non-EU doctors to be recruited to the health services.  It may be worthwhile to engage local immigrant communities to see if qualified medical practitioners could be retrained as GPs.  The LLR General Practice Delivery Group currently had no data on potential numbers etc so any information in relation to this would be welcomed.

b)         The current Membership of the Royal College of General Practitioners (MRCGP) training programme was more rigorous than ever before in assessing clinical skills and knowledge.  The current failure rate was 15-20% but this reflected the high quality expected from doctors passing the qualification.

c)         Approximately 250 medical places were available at Leicester University and yet few medical students chose to stay in Leicester when they qualified.  This differed from a significant proportion of existing doctors in Leicester, aged in their 40’s, who had stayed following their training at local universities.

d)         A number of GP practices relied on the employment of locums to meet patient’s needs and more work needed to be done in the short term  ...  view the full minutes text for item 8.

To receive a report on Leicester’s response to the consultation on national plans to make in-year savings on the ring fenced public health grant to local councils, following the Government’s announcement on 5 June 2015.

The Director of Public Health submitted a report on Leicester’s response to the consultation on national plans to make in-year savings on the ring fenced public health grant to local councils, following the Government’s announcement on 5 June 2015.

It was noted that:-

a)         The consultation had closed two weeks previously and the Deputy City Mayor had submitted a response, which had previously been sent to all Members of the Board for information.

b)         There had been a great deal of negative response to the proposal to save a further £200m on local councils ring fenced public health budgets from both councils and NHS providers of services funded by the budget.  It was felt by many that the Department of Health were unaware that the budget was used to fund some front line NHS services.

c)         Four options had been suggested in the consultation ranging from claiming a larger share of savings from local authorities that were funded significantly above their target allocation, claiming a larger share of savings from those local authorities that had carried unspent reserves into 2015/16, reducing all local authorities allocation by a flat rate percentage reduction or a flat rate reduction unless an authority could show this would lead to a particular hardship.

d)         Leicester had expressed its reluctant preference for claiming a larger share from local authorities that were funded significantly above their target allocation.  Leicester’s funding was still under its target allocation and therefore it was felt that it should receive less reduction in budget than those authorities that were funded above their target allocation.

e)         A number of planned programmes had already been put on hold to meet the proposed in-year reductions if they were subsequently confirmed now the consultation had closed.

f)          It was uncertain whether the proposed reduction would be a recurrent saving in future years but it had been assumed this would be the case for contingency planning purposes.  It was possible that the proposed reductions could be incorporated into future spending reviews and the current ring-fenced funding for public health could also change.

g)         There were some important areas around children in crisis and prevention within the Better Care Together Fund for which funds were available but it would take more effort to attract the funding than to receive it direct.

h)        The proposed reductions would also have an impact across the whole of the Better Care Together Programme. 

The Chair noted the Board’s dissatisfaction with the recent announcement, following so closely after Simon Steven’s (NHS England Chief Executive) announcements to the NHS Conference on prevention and intervention measures.  Reducing public health expenditure was also contrary to the King’s Fund modelling that £1 spent on primary care prevention and intervention measures can save much larger amounts in acute care expenditure in the future.

RESOLVED:

That the update be noted and that the Board be kept aware of future developments.

To note that future meetings of the Board will be held on the following dates:-

Tuesday 27 October 2015

Tuesday 8 December 2015

Tuesday 2 February 2016

Tuesday 5 April 2016

Meetings of the Board are scheduled to be held in City Hall, at 2.00pm unless stated otherwise on the agenda for the meeting.

It was noted that future meetings of the Board would be held on the following dates:-

Tuesday 27 October 2015

Tuesday 8 December 2015

Tuesday 2 February 2016

Tuesday 5 April 2016

Meetings of the Board are scheduled to be held in City Hall, at 2.00pm unless stated otherwise on the agenda for the meeting.

Note: The dates above have been changed from those published in the Minutes of previous meetings.

There were no items of Any Other Urgent Business.

The Chair declared the meeting closed at 12.30 pm.