Recommendation

Discussion

SectionA -Continuity of Care

A1

The appointment of a Neighbourhood Teams Manager was questioned.  The Associate Director clarified the co-ordinating role this postholder would undertake.

Section B Equitable Access

B1

Members sought information on the effect the opening of the Equitable Access Medical Centre had had on GP practices and the out of hours service.  It was agreed that this information would be incorporated into the quality assurance report to be provided to the Committee in September.  The general view of GP practices was that they had not seen their workload decrease.  NHS Herefordshire’s analysis was that the Centre had not prompted a reduction in A&E attendances and neither had it reduced demand for GP appointments.

It was asked whether the existing temporary Centre at Asda in Belmont would be retained once the permanent Centre adjoining the hospital had been constructed, noting that a petition had been submitted to Council making this request.  The Associate Director said that the benefit of retaining a facility at ASDA would be considered.  He commented on plans to develop a greater degree of integration between the new Centre and the Accident and Emergency (A&E) Unit to try to address the inappropriate use of A&E.  National guidance was awaited on the flexibility available in developing the Centres.

B5

The scope for GPs to engage more in preventive work was discussed, recognising that prevention was both better and cheaper than providing treatment at a later date. The Director of Public Health commented that, once on offer, such preventive services were used.  His annual report set out a structure which would encourage the provision of preventive care.  The West Midlands Region was operating a pilot scheme whereby a certain number of patients at risk within selected GP practices received specific attention.  Four practices in Herefordshire were part of this pilot.

B8

Noting the reference to the Valuing People Partnership Board (VPPB) Members requested a glossary of the various Boards in the County with responsibility for considering health and social care matters.

It was also requested that the VPPB should be asked to comment on its evaluation of the outcomes for adults with learning disabilities from the Learning Disability Locally Enhanced Service incentive scheme.

B9

The Cabinet Member (Adult Social Care, Health and Wellbeing) highlighted support to those with mental health problems as a key area of concern.

D Rurality

The Committee was not satisfied that the responses from the Director of Regeneration, now the Sustainable Communities Director, addressed the Committee’s recommendations.  It was requested that officers reconsider the responses giving further thought to how services could work together to address the challenges of rurality, including scope for co-ordinating use of transport resources as a whole and co-ordinating appointments.  The role of communities in helping themselves was also discussed.

The Committee noted that 21 of the 24 GP Practices were now participating in the scheme to offer extended opening hours.  14 practices had been participating when the response had been prepared.

I Collaboration/co-ordination/ integration/communication

Members noted that this was an area of continuing frustration where further work needed to be done.

J Relations between GPs and NHS Herefordshire and how they affect patients

The Scrutiny Review had found that “most GPs and NHS Herefordshire officers interviewed stated that this relationship gave cause for concern”.  Although the last set of recommendations in the review, Members considered these were some of the most important.

The Director of Public Health commented on the complexities of the relationship between NHS Herefordshire as Commissioners and the GPs as independent contractors.

During the period in which the review had been carried out a number of significant policy changes had been taking place including, for example, the development of the Equitable Access Medical Centre.  This had inevitably led to differences of opinion. 

He acknowledged that there were areas where NHS Herefordshire working with local GPs could improve further but the overall direction was positive. 

He added that one of the aspects examined in the World Class Commissioning Panel Assessment was GP engagement with the commissioning body.  The relationship compared favourably with most other areas.  He considered considerable progress had been made.