Agenda item

Leicester City Clinical Commissioning Group to submit a report on the CCG’s Primary Care Strategy – 2014-19.  The strategy sets out the vision for primary care over the next five years, describing a service delivery model that addresses the issues and challenges of today whilst transforming primary care services so that they are fit for the future.  There will also be presentation on the report at the meeting.

Leicester City Clinical Commissioning Group submitted a report on the CCG’s Primary Care Strategy – 2014-19.  The strategy set out the vision for primary care over the next five years, describing a service delivery model that addressed the issues and challenges of today whilst transforming primary care services so that they were fit for the future. 

Sue Lock, Managing Director, Leicester City Clinical Commissioning Group gave a presentation on the strategy and the developments which had taken place since the report was written.  She commented that:

a)         The CCG were trying to base the strategy on the health profiles provided by the Director of Public Health’s Annual Report.

b)         The strategy had also reflected the concerns expressed by patients and GP practices.  Patients were mainly concerned about access, information and continuity of care, whilst GPs concerns were around the level of resources, growing workloads and recruitment and retention issues.

c)         The CCG had looked at a number of determinants of health and the health profiles at ward level.  4 distinct areas of the City were emerging based upon deprivation, health needs and the population matrix.  The profiles had also looked at age, health, ethnicity and access rates and patient experiences.

d)         The four areas had been mapped on ward boundaries and took account of other facilities such as pharmacies, dentists and walk in centres etc.

e)         It was recognised that the NHS did not influence all health factors and the recent summits on mental health and alcohol had reinforced the importance of involving stakeholders that were not normally involved in health, such as food outlets, licensing staff and licensed premises.

f)          The CCG were building a multi-agency disciplinary team to work in each of the areas to provide a more focused approach to preventative health measures rather than deal with the consequences of poor health.  The CCG were considering restructuring their operations around the four areas.

g)         The CCG had recently been successful in applying for non-recurring funding to develop federations of GPs and to carry out further Health Needs Neighbourhood development work.

h)        The proposals would need further work to be carried out with the health workforce and developing safe and appropriate methods of sharing personal patient information.

i)          The CCG’s recent expression of interest to jointly co-commission GP services with NHS England would help to have a greater influence on providing service to meet health needs on a more localised basis.

j)          The CCG were undertaking a review of the primary care estate which was owned by both the NHS and Lift.  The majority of GP premises were privately owned which limited the CCG’s ability to affect their use.

Members and the Healthwatch representative made the following comments and observations:-

a)         There should be a core set of services provided by each GP practice.

b)         All patients should be able to access services when they needed them.

c)         There should be a ‘hub’ in each of the four areas offering specialist services and these could be co-located with other service provider such as social services etc.

d)         It was important that there was the capacity within the Better Care Together Strategy process to support the strategy.

e)         Dentists and pharmacy should be used to provide additional services to reduce the pressures on people attending GP practices.

f)          The review of the health estate was welcomed, particularly in relation to the issues involved in the relocation of the Highfield Health Centre.

g)         Close working with GPs would be critical if the ‘left shift’ in service provision was to be achieved.

h)         There was evidence that people were more localised that might be imagined and there were examples of communities not wishing to use Council services if it involved crossing ward boundaries.  4 hubs may not be enough to ensure the desired outcomes.

j)          Ward Meetings could be used as the basis for engaging the public or organising events around them.

Following questions, the Managing Director stated:-

a)         The CCG had made a submission on the consultation on the Issues and Options for the City’s Development Plan.

b)         The current ‘bottom up’ approach by the CCG was not known to be developing elsewhere at the present time.  The next part of the process would be to investigate whether there was a model or structure elsewhere in the country that could be of benefit to Leicester, but it would have to be based primarily on meeting local needs.

In summary the Chair commented that:-

a)         Whilst the intentions were welcomed the proposals, as presented, did not engender inspiration.  As the proposal would involve a number of stakeholders working together it was important the proposals should excite and inspire others to participate and drive initiatives forward.

b)         The proposals had no reference to empowering communities and there were numerous examples in the City where local communities had made positive changes to improve their community.  The NHS should embrace the effectiveness of community groups working within their own communities.

c)         There were already a large number of existing community groups and the proposals should build on what they are already providing.

d)         The proposal for four hubs also needed to take account of the transport systems in the City and recognise that movements around some parts of the city were difficult.

e)         The proposals should identify what were seen as barriers to achieving the desired outcomes and what was required to overcome these barriers.  For example, the number of GPs, the need for all GPs to commit to providing services, improvements to the appointment system, physical access to premises, psychological barriers to access etc.

f)          There were dangers in producing graphs and identifying areas of inequality if sufficient services and resources were not put into them to address all the issues, otherwise there could be a worsening of some services in order to concentrate on the worst inequalities.

g)         There should be more engagement with Patient Participation Groups as they are an underused resource and it was important that they should be free to operate independently from the GP practice.

In response, the Managing Director stated:-

a)         The CCG would be working through the issues, risks and barriers as part of the next stage of developing the proposals.

b)         Transport provision would be taken into account when considering the location of the hubs.

c)         The CCG recognised that every part of the city needed the same provision of service

d)         It was clear that the document needed to be re-written and the comments made earlier would be taken on board.  The next stage was to share the vision with the public and further thought would be given to how the proposals could be presented.

RESOLVED:

That the report and the presentation be received and the Commission welcomes working closely with the CCG in developing the proposal further.