Agenda item

David Sharp, Director, Leicestershire and Lincolnshire Area Team, NHS England, to submit a report on the Draft Operational Plan 2014/15 and Emerging Strategy update.

Trish Thompson, Director of Operations and Delivery, Leicestershire and Lincolnshire Area Team, NHS England, presented a report on the Draft Operational Plan 2014/15 and Emerging Strategy update.

The draft plan had been prepared by taking account of the health needs of the population from resources made available and by canvassing Directors of Public Health to identify key strategic issues.  The draft plan was being shared with all Health and Wellbeing Boards and public health colleagues with a view to receiving comments during April so that the final plans would take account of commissioning appropriate services to meet the needs of the population.

The Strategic Director for Adult Social Care and Health referred to the floor targets in the Commissioning Intentions for NHS England nationally and to the undertaking made by the Area Director at the last meeting that where the targets in Leicester were higher than the floor targets, there would be no reduction in these targets as Leicester wished to see a process of continual improvement particularly in relation to immunisation and cancer screening.  The Strategic Director also made the following comments:-

a)    The performance data in the plans related to Leicester, Leicestershire, Rutland and Lincolnshire and these average figures did not present a true picture for Leicester as it tended to perform less well than Leicestershire, Rutland and Lincolnshire.  Specific performance data for Leicester would be preferable.

b)    Equally, the overall targets for Leicestershire, Rutland and Lincolnshire could also be made specific to Leicester.

c)    It was unlikely that the 75% target for seasonal flu immunisations for the over 65 year olds would be achieved in 2014/15, and it was suggested that, as public health and social care staff with voluntary sector partners had already taken part in work relating to this, they could work with NHS England to strengthen the outputs required.

d)    The 5 year strategic and 2 year operational plans currently being prepared relied heavily on a robust primary care sector and it was difficult to see what means of funding for primary care was in these draft plans.

e)    It was welcomed that the importance of oral health in the City was recognised given the last dental survey which had led to the City putting in place a local strategy to improve the situation. The support from NHS England in this strategy was also welcomed.  Increasing the overall provision of dental services would also be welcomed to improve dental care in the City.

In response, the Director of Operations and Delivery stated that:-

a)    The comments relating to providing more focused performance data and overall target aims were noted and it should be possible to provide more Leicester focused information and targets.

b)    In relation to the funding issues it would be possible to provide a further briefing specifically relating to Leicester.

Members of the Board referred to recent communications and a meeting the previous day relating to the loss of practice differential rates for GPs funding.  A number of points raised included:-

a)    It was not totally clear where this left GP practices in the City and anything that reduced access to GPs was of concern.

b)    The CCG would need to work closely with GPs to improve the understanding and uncertainty caused by the recent communications from NHS England.

c)    It was understood that the proposal would also mean NHS England moving funds from the target part of the budget to the basic global sum part of the budget as a result of removing the differential payments which were designed to allow GP practices in the City to complete equally.

d)    It was understood that the removal of these payments amounted to a continued recurrent loss of £2 million in the Leicester, Leicestershire and Rutland budgets. This was likely to reduce access to primary care at a time when increased access was required.

e)    The proportion of NHS budget spent on primary care had decreased in the last decade from approximately 11% to 7-8% and if more primary care was required under the Better Care Together Strategy then this trend needed to be reversed.

f)     Different areas had different needs and Cities with large areas of deprivation would now be expected to provide services for the same costs as areas with higher levels of affluence.            

In response the Director of Operations and Delivery stated that:-

a)    All GP practices received letters on 1 April 2014 informing them of the proposed changes and the reasons for the changes in order to realign funding in primary care so that is was equitable and consistent for all practices.

b)    The previous minimum income guarantee payments dated back to 2004 and it was viewed that, as some practices received more in payments per patient for providing the same care, this was not considered fair and equitable.

c)    The National Guarantee Payments would be phased out and the standard payment was being increased from £66 to £73 in November 2014.  Some practices in Leicester received up to £74 under the previous guarantee payment scheme.

d)    The changes would enable services to be commissioned in line with national standards.                  

A member of the public stated that it seemed as though the situation was leading to less funding for primary care cloaked in equality balance etc.  They commented that if care was being moved into primary care, more money was needed to pay for it.

A member of the public referred to the comprehensive review of all specialised services outlined in the report which was intended to ensure that care was centred around centres of excellence and asked if the data for making any subsequent changes in the service provision could be made available for public scrutiny.  The Director of Operations and Delivery stated that it was expected that any evidence submitted as part of the review would be made available.

RESOLVED:

1)    That the contents of the draft plans be noted.

2)    That the comments made above be noted by NHS England and that any further comments be fed back through the Strategic Director of Adult Social Care and Public Health.

3)    That a further presentation be made at the next/future Board meeting to provide more clarity and a specific overview of the funding proposals for Leicester.