To receive an update on the local delivery plan, NHS dental services and primary care led commissioning.

The Committee received an update on three areas of NHS interest upon which it had been briefed in December 2004: the Local Delivery Plan Process, NHS Dental Services and Primary Care Led Commissioning.

A briefing paper prepared by Mr Hairsnape, Director of Development at the Herefordshire Primary Care Trust (PCT) had been circulated with the agenda papers.

Mr Paul Bates, Chief Executive of the PCT, had been invited to attend the meeting.  He commented that he had nothing to add to the briefing note but proposed to  elaborate on the recently published executive summary of the PCT’s Local Development Plan: A Strategy for Success: a Statement of Intent.

He explained that the Strategy had been produced in response to the number of national health initiatives currently underway.   It sought to clarify the policy context within which the PCT was working, described the PCT’s role and key functions, and commented on the current main NHS reforms and the main issues which needed to be addressed in the local agenda.

Since publication of the Strategy the PCT had received confirmation of the funding which would be available to the PCT over the next three financial years. This indicated increases in funding of 9% in 2005/06, 9% for 2006/2007 and 11% for 2007/2008.   Mr Bates commented that these were significant sums.  However, these headline figures did not necessarily mean that the PCT would have that level of additional resources available to it locally, because the headline figures might assume contributions from those sums to initiatives being conducted at national level or additional responsibilities being carried out by the PCT.  It was important to exercise some caution in planning improvements, recognising that in future years the level of growth in funding may not be sustained at those levels.

He added that in response to the Government White Paper:  Choosing Health, the PCT proposed, at its discretion, to reinforce its work on public health initiatives, ring fencing half a million pounds in 2006/07 and a further half million pounds in 2007/08 to fund measures to address public health issues.  These measures would need to be delivered in conjunction with the Council and other partners.  The Government had not explicitly identified either the PCT or the Council as the senior partner.

He noted the changes to the PCT’s core functions since its establishment and the emphasis on improving and protecting public health, providing patient choice and commissioning services from a diverse range of providers.

Section 7 of the Strategy set out the system reforms taking place within the NHS to deliver the objectives contained in the NHS Plan.  Mr Bates highlighted in particular:

·         The requirement that the PCT must offer more choice to patients about the type of care they received, and where they received it from, and support the development of a market place which included a greater range of high quality providers.

·         The Government’s intention that large volumes of services should be procured from the private sector, and the question of how such services were to be accessed in Herefordshire. 

·         The need to prepare for the implementation of the Payment by Results Scheme, under which national tariffs would be set for procedures and treatments and providers paid in accordance with the tariff for the number of patients treated.

·         The implications of the introduction of Practice Led Commissioning, under which GP practices, from 1 April, 2005, had the right to have budgets and commission services for their patients, and the need for the PCT to have appropriate risk management arrangements in place.

·         The further organisational changes associated with the Children Act and signalled in the Government’s Green Paper: Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England.

·         The focus on Public Health and the Government White Paper: Choosing Health – Making Healthy Choices easier, and in particular improving the health of children and growing a healthy nation, and the need for the PCT and the Council to review resources committed to improving Public Health and how through closer integration they might achieve even more effective outcomes.

·         The increased regulatory and inspection framework within which the PCT  had to operate.

He remarked on the consideration being given to whether PCTs should themselves provide services, noting that Herefordshire PCT was a major provider.

He also noted the discussions at national level about NHS structures and the suggestion that PCTs should be co-terminous with local authority areas.  In this regard he cautioned that whilst the PCT recognised the benefits of co-terminosity with Herefordshire Council others might choose to focus on the fact that the PCT as a commissioning body only would be one of the smallest PCTs in the Country.

In conclusion he reiterated the importance of working closely with the Council to improve the health of people in Herefordshire.

In response to questions Mr Bates commented as follows:

·         In relation to financial risks facing the PCT,  the ability to plan over three years rather than one was beneficial.  However, there was a concern that the level of additional resources being made available to the NHS was creating unrealistic expectations on the part of clinicians, patients and advocacy groups.  It had to be recognised that the PCT would still have to prioritise services and would not be able to meet all these expectations.

·         The new market place being created, with payment by results, could provide an incentive to hospitals to seek to attract more patients, lowering the threshold for admission to hospital, and increasing the speed with which patients were treated.  This would lead to increased bills for the PCT.  There were already signs of this happening and it was important that the PCT put demand management arrangements in place to ensure that only those needing hospital treatment went to hospital.

·         The Childrens’ Services agenda was a developing one and he planned to assess with the Council and other partners how best to target resources within the overall public health agenda to deliver practical benefits.

·         He reported that the national programme to ensure compatibility of IT systems across the NHS was proceeding.  He acknowledged that there was no plan to make the NHS systems compatible with local authority systems across the Country.  However, discussions were taking place with the Council about how Children’s records might be shared.

·         The introduction of Primary Care Led Commissioning was a challenge and the PCT would need to regulate service provision.

·         He advised that the PCT was mindful of the future of Hereford Hospital and had to date in making its plans considered the potential implications for the Hospital.  However, the national perspective was that it was the PCT’s job to commission services from a range of providers and offer choice, not to protect the hospital.  It was for the Hospital to create its own future, and take advantage of the opportunities created by the new system.  He noted that Hereford Hospital NHS Trust had recently published its own Strategy.

·         The creation of choice was more problematic in Herefordshire than in urban areas which had both alternative NHS providers and a range of private sector providers for patients to choose.  In discussing choice the PCT and the Professional Executive Committee tried to consider what was best for Herefordshire and what the people of Herefordshire would expect.  His view was that they would wish to see an improved service but with Hereford Hospital being given the opportunity to flourish.

·         The Chairman noted that there was scope for the Committee to reinforce the PCT’s message about the particular circumstances facing the delivery of health services in Herefordshire and support it in seeking to have regard to the local context in responding to national initiatives so as to derive the maximum benefit for Herefordshire.

·         Mr Bates acknowledged that, following all the discussions about health being subject to a postcode lottery, concerns had now been expressed that practice led commissioning might instead create a lottery where provision depended on the choices made by a particular GP practice as to what services it might provide.  The Strategy for Success recognised existing health inequalities and the LDP would set overarching standards.  However, it had to be recognised that the new system would produce different patterns of provision across the County.  The national expectation was that differences would be temporary as other practices would improve to meet the level of service provided by neighbouring practices.  It was also expected that a range of alternative providers would also emerge.

·         He agreed that it was important that patients had the information available to them to make an informed choice about their treatment and that a Strategy to engage and inform the public was needed, noting that the Department of Health had issued guidance in relation to Marketing Health.  He added that the approach to exercising choice differed between generations, with the younger generation much more willing to demand and explore alternatives.

In conclusion the Chairman thanked Mr Bates for his attendance and commented that the Committee would need to monitor the progress of the PCT, the Council and other partners in responding to the various health initiatives.