The Monitoring Officer to report on the receipt of any questions, representations and statements of case submitted in accordance with the Council’s procedures.
Minutes:
The Monitoring Officer reported that no questions, representations and statements of case had been submitted in accordance with the Council’s procedures.
The Chair indicated that she had received the following questions submitted at late notice and would take them at the meeting:-
QUEENS ROAD MEDICAL CENTRE
Mr David Shelley asked the following questions and responses had been submitted by the Leicester City Clinical Commissioning Group prior to the meeting:-
1) There is public concern that the meeting on 14th January which decided the future of the Queens Road Medical Centre was held in private. Consequently it is difficult for the decision making process to stand up to scrutiny, and public confidence in the CCG has been damaged. Why was it necessary for this meeting to be held in private, particularly given that the CCG has said that they had no access to the financial records of the practice when making the decision?
Response from the CCG
This question was answered in the meeting with Jon Ashworth MP on 26th February. It was necessary for this item to be taken in confidential session as the papers considered by the committee contained information that was commercially confidential and information personal to individuals employed by the practice. Although the CCG did not have access to the full accounts of the practice the papers presented disclosed information relating to the full NHS income of Queens Road Medical Centre, from which it may have been possible to deduce the profit of the practice. It also contained information about the personal details of employees of the surgery. This included their annual salaries, length of service and redundancy liabilities. This information was vital in making an assessment as to the likely ongoing viability of the practice. It would not have been appropriate to make this information available publicly and to do so is likely to have been unlawful as it may well have represented a breach of data protection legislation.
The CCG tries to undertake as much business as is possible in its public meetings. However, from time-to-time this is not possible. Where an item is deemed necessary to be considered in confidential session the reasons for this must be clearly explained to the relevant committee.
2) Campaigners reported there were parties who have expressed an interest in taking over the running of the practice, who believe that the practice would be financially viable, and who have said they would be able to deliver continuity of care for patients in the available time. Why did the CCG believe that this would not be the case when taking the decision to disperse the patient list?
Response from the CCG
This question has been answered at the public meeting on 25th February and the meeting with Jon Ashworth MP on 26th February. The CCG could not have sought to establish a partnership arrangement on behalf of Dr Lenten or the practice. Contractual partnerships between GPs are private matters between the individuals concerned and it would be wholly inappropriate for the CCG as a commissioner of services to attempt to influence arrangements of this nature. Indeed, to do so may have been considered to be anti-competitive and a breach of European procurement law.
In considering its response to Dr Lenten’s resignation, the CCG was obligated to consider the reprocurement of the contract as an APMS time-limited contract, which would have most likely been re-let at a rate considerably below the current per patient income of Queens Road Medical Centre. It is national policy that all re-procurements of GP contracts must be as APMS contracts. Had Dr Lenten entered a partnership agreement with another GP it would have been possible for the current GMS contract to be maintained. This would also have secured the step down funding available to former PMS contract holders as part of the review of those contracts, making it a much more financially attractive to potential partners. It was our view that an APMS contract would not have been considered to be sufficiently attractive or viable.
3) Was adequate consideration given to the needs of patients, particularly elderly and disabled patients, in respect of transport and accessibility to alternate practices?
Response from the CCG
This question has been answered at the public meeting on 25th February and the meeting with Jon Ashworth MP on 26th February. In reaching its decision the CCG considered a range of information about the practice and its patients. The CCG has also undertaken a full Equality Impact Assessment.
Fewer than 10% of Dr Lenten’s patients are aged over 75, with only 20 patients living in care homes. The largest proportion of patients at the practice is between 15 and 44 years of age. Patients tend to have fewer chronic long-term or life-limiting illnesses than patients at many other practices in the city. The CCG considered that the area is well served with 23 practices within 1.5 miles of Queens Road Medical Centre, while there is also a wide distribution of Dr Lenten’s patients across the city and into the county. The four closest practices to Queens Road Medical Centre are Dr Mansingh, Willowbrook Surgery at Springfield Road, Clarendon Park Medical Centre and Victoria Park Health Centre. These practices range from 0.1 to 0.5 miles from Queens Road Medical Centre and are all in areas heavily populated by Dr Lenten’s patients. Some of these have car parking facilities. As such, the CCG is of the view that suitable alternative GP facilities are available for patients within the local area. Indeed, the availability of alternative provision in this area is much greater than in some other parts of the city.
4) Do you think given his association with the GP federation that is dominant in Clarendon Park, it was appropriate for Prof. Farooqi to play such a public role in managing the closure of the surgery, and would it not have been better for him to distance himself from the entire process?
Response from the CCG
No. The advantage of clinical commissioning groups is that they are clinically-led organisations and it is right and appropriate that the CCG’s most senior clinicians are prepared to lead from the front, especially when difficult decisions need to be made. Professor Farooqi has been elected to chair the CCG by practices within Leicester. There are no benefits to either Professor Farooqi, his practice or the federation of which his practice is a member from dispersing the list of Queens Road Medical Centre.
It should be noted that while practices that CCG board members are part of may be members of a federation, it is not allowed for individual GP board members to also hold executive positions within a federation from 1st April 2016. This is a resolution that was voted on and approved by all practices in Leicester during 2015.
5) Given the concern expressed at the public meeting on 25th February, would it not be wise to consider a different structure for GP federations in Leicester, perhaps as community interest companies which would be seen as more "for the public" and less "for shareholders".
Response from the CCG
This question has been answered at the public meeting on 25th February and the meeting with Jon Ashworth MP on 26th February. GP federations are completely separate to the CCG and how they are legally established is a matter for them. It is not something over which the CCG has any control or influence. However, we are aware that the emerging federations in Leicester have at their heart the principles of developing and providing new and innovative models of care for patients as set out by the NHS’ five-year Forward View.
Federations are groups of like-minded practices that have joined together to find solutions to the challenges faced in primary care. This can include sharing back office functions such as practice managers and accountants to help release money that can be invested in patient care, through to providing additional specialised clinics that can be offered to all patients of practices within the group. It is important to note that federations are no different to GP practices, which are private small businesses that naturally aim to return a profit. This has been the case since the NHS was founded in 1948.
The CCG could provide contact details of those leading the discussions on federations of GP practices to Mr Shelley should he wish to feed patients views and concerns directly to those involved.
The Chair commented that a number of concerns had been expressed in relation to transparency issues for patients and also control/accountability issues once public funds become part of a private business such as a federation. The Deputy City Mayor stated that the concerns expressed about federations would be considered at the forthcoming summit he was arranging.
BETTER CARE TOGETHER
Mr Geoff Whittle asked:-
1. What specific plans have been put in place to scrutinise the Better Care Together (BCT) proposals for Leicester and to ascertain the views of the residents of Leicester? It was understood that some parts of BCT had already been implemented and that no timetable had been received for the public consultation.
2. How will the extent and nature of this scrutiny reflect the scale and long term significance of the BCT programme? It is now believed that savings of more than £400m are being proposed as part of BCT. The Council is does not attend the BCT Partnership Board and we question how seriously the Council is taking this programme given the scale of what is being proposed.
The Chair stated that the Commission had received briefings on the proposed BCT consultation process and the likely contents of the consultation; but these had not yet been finalised or approved for publication. The Council had not received dates for the proposed public consultation in view of the restrictions on carrying out consultations during the forthcoming elections in May for the Police Commissioner.
The Deputy City Mayor stated that many parts of the Council were involved in the BCT process through work on the Health and Wellbeing Board; and service areas and directors had been involved in the process through considering implications for adult social care services within the BCT programme. Service directors attended sub-groups within the BCT Programme which considered how services could be affected and re-shaped to meet the programme’s requirements. The Deputy City Mayor also had regular meetings with BCT directors. He was firmly of the view that as the BCT Partnership body was not a decision making body it was not the most important interface for the Council’s limited resources, which were directed to where the most impact could be made.
CARE AND PLACEMENT OF ASPERGER PATIENTS ON BEAUMONT WARD, BRADGATE UNIT
Mr David Bradly submitted a representation and expressed the following concerns:-
1) The lack of adequate and appropriate facilities in Leicester to care and recover autistic (and Asperger) patients who have experienced a breakdown in residential care or at home.
2) The lack of a properly managed process to find and secure a residential placement for autistic (and Asperger) patients after such a breakdown should they need one.
On the first point, it seems that the only facility in Leicester to house such patients are the acute mental health wards at the Bradgate Unit which are not equipped to care and treat them. The persons who have suffered a breakdown cannot be cured of their autism and so need to be cared for very differently from patients who are suffering a temporary mental illness. The psychiatrists at the Bradgate Unit are trained to treat mental illness largely through medication, whereas autistic persons need a completely different care approach in order to restore them to a level at which they are able to cope with society again – something which is difficult at the best of times. The health service on its own is not the body to meet this need.
On the second point, the involvement of Social Services, Community Mental Health, Continuing Care and the ward staff are all necessary in finding a suitable placement once recovery/restoration has been achieved, but none of these are willing to take overall responsibility of the whole process. No one person is responsible for managing the process and ensure that it is completed in a timely fashion. In fact, there is no process worthy of a name.
The Chair thanked Mr Bradly for his statement and stated that a written response would be sent to him.
The Deputy City Mayor commented that there was a need to reflect and consider lessons learned from examples such as this in operational issues. These comments could be considered at the Joint Integrated Commission Board and the Mental Health Care Pathways as part of the BCT programme.
The Strategic Director of Adult Social Care commented that a new national programme had arisen out of the Winterbourne Agreement which challenged the assessment of patients diagnosed with Asperger’s and Autism conditions. Care was provided by a multi-disciplinary team with funding streams divided between local authorities and the National Health Service.
The Deputy City Mayor invited Mr Bradly to meet with the Strategic Director and himself to discuss the issues further.
The Chair requested that a report on the outcome of discussions with Mr Bradly and whether the policy could be changed to improve the care of people diagnosed with Asperger’s or autism.