To consider an update on the commissioning of services in Herefordshire.

The Committee received a presentation on behalf of the Primary Care Trust (PCT).

Mr Chris Bull, Chief Executive of Herefordshire Council and Herefordshire Primary Care Trust introduced the report, commenting on the commissioning agenda and the provider services review. 

Dr Ian Williams, Director of Integrated Commissioning, elaborated on progress with the provider services review, emphasising the consensus on the need to integrate health and social care services and to develop clinical networks.  He said that the review report from the Health Services Management Centre, Birmingham was due on 31 October 2008.

He then provided an update on the requirements of the national world class commissioning programme with its clear focus on delivering improved health outcomes.  There was a national assurance process to review PCTs' progress towards world class performance and achievement of better health outcomes and provide a common basis for agreeing further development.  The PCT had to make a submission to the Strategic Health Authority by October, with the results being known by March 2009.

He further reported on progress made by the Council and the PCT in making appointments to the Joint Management Team, bringing together management processes across the two organisations, and the Herefordshire Public Services review of governance arrangements.

He updated the Committee on the provision of radiotherapy services reporting that Worcestershire County Council’s Health Scrutiny Committee had confirmed that they would not require a public consultation on the Three Counties Cancer Network’s (3CCN) recommendation to site one Linear Accelerator at both Worcester and Hereford.  Work was now underway to plan the development of the service in Herefordshire.

He also reported on success in reducing waiting times in pursuit of achieving an 18 week referral to treatment time; continuing focus on dealing with healthcare acquired infections; intermediate care; sexual health; that there were still GP practices where extended hours had not been provided; and progress in relation to the letting of a contract for the GP out of hours service and the GP led Health Centre.

In relation to the GP led Health Centre he said that the contract being let would provide for the delivery of essential primary care services and for the delivery of additional and enhanced services as defined in the national GP contract.  On clinical governance grounds it had not been feasible to restrict the Centre to only providing “essential” services.

Dr Akeem Ali, Director of Public Health, gave a presentation on Health in Herefordshire.  He reminded the Committee that health in Herefordshire was good with low childhood and infant mortality rates and life expectancy already close to 2010 national targets.  However, there were challenges, including an unequal experience of poor health and early deaths, poor oral health compared to the regional average and avoidable differentials in the County in the following: admissions for coronary heart disease, respiratory illnesses, psychiatric admissions, children admissions, smoking quit rates and admission rates for alcohol related matters.

An update report had also been included with the agenda papers.

In the course of discussion the following principal points were made:

·         Members questioned the range of services to be provided at the GP led health centre.  The Director of Integrated Commissioning clarified that in relation to enhanced services there were directed services that had to be provided to every patient, national services which did not have to be provided for every patient but for which there were national specifications and local services where the PCT had discretion as to what was provided.

·         That when the proposal for the walk-in GP Health Centre development had been presented to the Committee in June there had been a clearly understood objective of not undermining the County’s good base of primary care.  It had been envisaged that the Centre would provide essential services but not enhanced services that might take patients away from existing providers.

The Director of Integrated Commissioning said that it was not proposed to commission services at the Centre that were superior to those already provided by GP practices.  The Chief Executive reinforced the point that the new service would provide the same service as current GP practices under their contracts.  He added that negotiations would need to take place with whoever provided the service at the Centre and with other GPs.

·         The Director acknowledged that some GPs were concerned they might lose patients.  In the circumstances there was a degree to which the PCT’s interests as commissioners in securing high quality services might not be wholly aligned with the interests of the GPs as independent contractors.  However, the quality of primary care service in the City and the County was high and he considered that the risk of patients leaving existing providers was low.  He reminded the Committee of the potential which existed in the innovative approach to combining provision of the out of hours service with the Centre development and the scope to reduce pressure on the hospital’s Accident and  Emergency Unit.

·         The Director said further information could be provided to the Committee on the enhanced services it was proposed to provide under the contract for the Centre if required.  The Chief Executive emphasised that existing primary care services were of a high quality and it was a case of seeking to add to that high standard of care.

·         A question was asked about progress in developing the ICT linkages between health and social care.  In reply it was stated that whilst work was continuing under the Herefordshire Connects programme, this was a national issue with national developments in NHS ICT and there was no easy local solution.  It was proposed that a report on the issue should be added to the work programme.

·         The potential to improve public health by exercising a community leadership role was noted.

·         The position on the number of dentists in the county and oral health including fluoridation was discussed.  It was proposed that a report on oral health should be added to the work programme.

·         A question was asked about MRSA.  In reply it was said that the number of cases locally had been reduced.  The need for preventative action and the maintenance of monitoring systems was emphasised.  The Chief Executive of the Hospitals Trust reported that three quarters of patients were currently screened.  From April 2009 all patients would be screened.

The Chief Executive confirmed that Members were welcome to visit health properties in their wards to enhance their understanding of them provided the visits were arranged in advance.

RESOLVED:

That    (a)        the Committee welcomes the decision by 3CCN to locate a LiNAC machine and satellite radiotherapy services at Hereford Hospital and that given the decision to form 2 satellite services with Herefordshire and Worcestershire concurrently that it will not be necessary to undertake a broader public consultation on the decision;

            (b)       the GP Out of Hours and GP walk in Health Service should include the basic levels of GP service as it would reasonably be expected by a patient to include such as family planning, vaccinations and the like but should not offer services over and above those existing GP practice groups in Hereford City without further consultation with the Committee;

            (c)        a report on ICT linkages between health and social care be added to the work programme; and

            (d)       a report on oral health be added to the work programme.