The Managing Director, Leicester City Clinical Commissioning Group (CCG) to give a presentation providing an overview of Leicester City Clinical Commissioning Group’s 2 Year Operational Plan which has to be submitted to NHS England on 4 April 2014.
Minutes:
The Managing Director, Leicester City Clinical Commissioning Group (CCG) gave an introduction to the presentation providing an overview of Leicester City Clinical Commissioning Group’s 2 Year Operational Plan which had to be submitted to NHS England on 4 April 2014. The whole of the health economy in Leicester and the County were required to submit a 5 Year Strategic Plan setting out the medium term direction of travel for health care and support provided across Leicester, Leicestershire and Rutland by the three CCGs, the three local authorities with responsibility for health and the two main health NHS Trust providers.
Sara Prema, Chief Strategy and Planning Officer, Leicester City CCG, gave the presentation, a copy of which is attached as an appendix to these minutes. In addition to the points illustrated in the presentation, the following comments were made:-
a) Whilst everyone over 75 years old would have an accountable GP and a care plan, not everyone would need a detailed care plan, as this would be dependent upon their health condition.
b) The Urgent Care Working Group were taking action to deliver improvements in urgent care and to deliver the NHS responsibility to provide access to A&E and this would be discussed further at the later meeting of the Board.
Following questions on the presentation it was noted that:-
a) Transforming primary care services would require a new model of GP service delivery. The old model for basic patient care had worked well but there would not be any improvements in service delivery without a new service model. Discussions on a new model were at an early stage and other models that had worked well elsewhere in the country were being appraised. The new models would need to provide for more team working and integrated coverage based upon federation or locality working, particularly in view of the large number of single doctor practices in the City.
b) GPs recognised that the existing model was not sufficiently robust to meet the challenges on meeting the transformation of primary care services, through the Better Care Fund, and a major challenge was getting sufficient resources in the community to ensure that it was possible to move from one model to another. There were challenges to recruit more GPs to work in City practices, develop a trained workforce that was fit for purpose, develop effective team working and ensure there was good communication with all sectors of the heath economy and social care, if the desire to keep people out of hospitals was to be delivered.
c) There was more to be done on ‘patient education’ within the context of communications as part of the strategic objectives to make patient aware of different referral pathways. Specific work was taking place with local authorities around the lifestyle hub as part of this. More communications work was needed reducing the need for hospital care and retaining patients within the primary care and community care sector for longer to reduce hospital admissions. A strong communications plan would be would be essential for this to be achieved. It would also be essential to get the communications right to explain other changes and to get commitment from both clinicians and the public to the changes otherwise any system that was established in the future would be liable to be undermined by patients not following the appropriate pathway.
d) In response to a question about CCG surpluses, it was clarified that there were NHS planning requirements for CCGs to plan for a budget surplus and as these were required to be recreated each year, the surplus did not effectively exist and was not available to the CCG to spend.
e) The CCG had an obligation to work with its member practice GPs to improve quality and outcomes for patients. Within the operating plan there were a number of requirements including that by March 2015 all GP practices in the City would have to offer online facilities to make an appointment and to request a repeat prescription.
f) A learning and development event (Projected Learning Time or PLT) was held each month attended by all 63 practices and an invitation was extended to the members of the Board to attend, observe and see for themselves the progress being made.
g) NHS England worked with CCGs to improve and offer better access to patients and there was also a joint responsibility with the CGGs to improve quality in patient care.
A representative of the Older People’s Forum stated that older people had two areas of concern. The first was that a number of elderly people did not have access to the internet to make appointments and to ask for repeat prescriptions and the second was that older people preferred to see the same doctor each time for their treatment. It was requested that this be borne in mind in future planning. In response Karen Chouhan stated that Healthwatch had made primary care and access to it a priority and they would be discussing this with the CCG. It was also stated that the introduction of a named doctor for patients over 75 years old would ensure that the same person could be contacted for patient care issues.
It was noted that whilst the comments of the Older People’s Forum representative were accepted, it must be remembered that most GP practices in the City were working hard under difficult circumstances and were experiencing difficulties in recruiting staff in some parts of the City. Public expectations were increasing and it must be recognised that operational difficulties existed.
Following a question from a member of the public in relation to people over 75 years old being susceptible to fragility fractures, it was stated that this would be considered when each person’s care plan was prepared and reviewed.
RESOLVED:
1) that the presentation be received and noted; and
2) that further update reports be submitted to the Board during the life of the Plan.
3) That members of the Board be invited to the next PLT meeting.