Agenda item

10:45

The item (JHO7) gives feedback on progress made on recommendations made by the Independent Reconfiguration Panel (IRP) to this Committee and the Oxfordshire Clinical Commissioning Group (OCCG). The recommendations emerged following a referral made by this Committee to the Secretary of State relating to the decision by OCCG not to re-procure services at the Deer Park Medical Centre.

The item will cover progress on:

(a)  development of a comprehensive plan for primary care and related services for Witney and its surrounds. OCCG representatives will share the West Oxfordshire Locality Plan with the Committee;

(b)  feedback from the independent review of the OCCG’s process for developing a comprehensive plan for primary care in Witney and its surrounds. This review was commissioned by NHS England and representatives will attend to introduce this item; and

(c)  a review of the relationship between this Committee and Health to ensure it commands public confidence. The Committee will receive feedback from the review and the next steps following a joint HOSC/Health ‘ways of working workshop.

Prior to the discussion of this item the Committee was addressed by the following members of the public:

Brenda Churchill made the following points:

-       She had been unable to find any trace of the content of the IRP report and recommendations in the Witney and its surrounds Locality Plan;

-       The review of Locality Plan patient engagement was misleading. Two meetings had been held in Carterton and Witney and only 125 people had attended them. Some locals had been refused entry as they had failed to book a place at the venue – it was her view that it was an insult to those people who had found it necessary to book a place as they were local residents;

-       It was misleading to call the Plan a review document. She had not been made aware that NHS England had employed people to review the Locality Plan – nobody had approached her about this; and;

-       New houses were in the process of being built now and patients would have to cope with more and more demand for the existing primary care services. She implored the Committee to instruct the OCCG to do as the IRP instructed and refute the plan.

Jane Southworth

-       It was now over a year since the OCCG’s decision to close the Deer Park Surgery and seven months since the IRP had made its recommendations to incorporate patient views into the plan. Nowhere had the Deer Park Health Group been engaged in the co-production of the Plan to address and provide solutions to the current future health needs of the area;

-       She made reference to a personal experience of misdiagnosis by a paramedic and subsequent shambolic access to GP appointments;

-       She asked about a proposal to relocate the Nuffield Health Centre – this had not been debated.

Yvonne de Burgo

-       Had been a patient at Deer Park Surgery and a member of its PPG;

-       As a patient suffering with complex health needs, she had always received good care from Deer Park Surgery;

-       She recounted her recent experiences of patient care at the surgery of which she was now a patient and had found it wanting in a number of areas including a lack of monitoring or follow up care;

-       She expressed her hope that Deer Park would re-open;

-       She was very concerned and stressed about the new housing being built in the area and the resulting numbers of new patients; and

-       In all, the above had caused her great distress and fear that her life could be cut short.

The Chairman welcomed Louise (Lou) Patten, new Chief Executive of the OCCG to the meeting, together with Catherine Mountford and Julie Dandridge, OCCG.

Catherine Mountford, in introducing this item stated that the main focus was about ensuring safe and sustainable primary care in Oxfordshire. The focus that day was on the changing needs and changing population in the West Oxfordshire area.

With regard to progress made on recommendations put forward by the Independent Reconfiguration Panel (IRP) on Deer Park Medical Centre, Catherine Mountford reported that there were still 285 people who had not yet registered with another practice. The OCCG had asked for guidance from NHS England as to whether it should re-allocate these people and the resulting advice was to re-allocate them to another surgery by the end of March.

The OCCG welcomed the review commissioned by NHS England and had expressed a wish to continue to engage with parties on how best to go forward. She added that the OCCG had learned from experience from one year ago and had given some examples to NHS England on their changes of approach. For example, Kennington Surgery had been taken over by another surgery but continued to provide some services on the original site. Engagement in relation to the future of Banbury Health Centre had been another example.

With regard to the development of a comprehensive plan for primary care and related services for Witney and its surrounds Catherine Mountford made the following points:

-       She stressed that the OCCG acknowledged that there was more work to be done in relation to engagement and on the opportunities for co-production. This first version covered west Oxfordshire divided into two groupings, one for Witney and East and one for rural west Oxfordshire. She added that an urgent piece of work to be undertaken with the people of Witney was to review housing growth and what that would mean for primary care in terms of the location of surgeries;

-       Engagement on the first version of the Plan would end in December 2018. In the intervening time ‘people friendly’ plans would be developed with the local Forum chairs; and

-       The engagement report had been worked up alongside the local Forum in a round table format to ensure that all were given the opportunity to contribute. The workshop had proved to be very productive and useful with some very rich discussion and the OCCG looked forward to taking the work forward.

Lou Patten welcomed the review espousing a very different approach to engagement in the future. She stated that engagement could only be started with a clear vision and a clear strategy for patients, from which a development plan could emerge. Moreover, there was a need to look at the Health & Care Strategy again and to refresh it with significant engagement.

A member commented that whilst she understood the need for vision, she wondered why services had been taken away when they were needed. Lou Patten responded that small GP practices had a fragility in the County due to demand on the doctors working in those surgeries. The viability of small practices was a challenge. In such instances conversations with local residents and with other GP practices in the area was needed. The Committee asked to see the resources available to the CCG for the significant changes required, together with a breakdown of how much money had been spent on each practice in the past, and how much was currently spent. Lou Patten responded that there had been no loss of resource and she would support that request, adding that the NHS Funding Formula was a national formulation, the money following the patient. She added that there would always be a negative definition as doctors still saw patients who were not registered anywhere. Furthermore, the way funding was allocated was not within the hands of the CCG – it was via the British Medical Association of GPs and NHS England.

A member commented that the Committee had seen a significant improvement in engagement with patients and the public in relation to Banbury Health Centre with a subsequent positive outcome.

Lou Patten was also asked where the funding for the required 25% increase in GPs and other staff increases would come from, together with the money needed for surgery relocations.  She was also asked for evidence that there was a planned approach for a sustainable integration of health and social care – and was the CCG prepared to share in that plan? Louise Patten responded that the intention of the Plan was to be reiterative, that there was no end point and the CCG would continue to build on it. There was a need to understand local health and social care needs, the needs of the local workforce and rurality issues, in order to undertake a realistic way forward. She recognised that there was a substantial amount of work to do in the future. Julie Dandridge added that there would be a need to visit practices, talk to the GPs and the other workforce. Currently there was nothing concrete. Preliminary discussions were taking place with PPG’s and the public and the CCG could start to build a plan arising from these discussions.

Lou Patten confirmed that patients in the Deer Park Surgery who had not re-registered with another surgery would now be allocated to other practices.  The CCG had undertaken a large amount of work to ensure a safe transfer by the end of March 2018 to another practice, in recognition of its duty to ensure these patients were safe and had access to important screening and immunisation processes. Moreover, other services such as those that were subject to referral to Social Care, were based on GP registration. Julie Dandridge gave her guarantee that if there was a need to allocate patients in the future, then those patients would be allocated automatically according to their choice if given. She stressed that patients still had a choice to leave the practice that they were allocated to and to re-register elsewhere in the locality. This issue had formed part of the learning going forward.

In response to an enquiry about whether Phase 2 of the Transformation Plan would emerge in the near future as more localities worked out their requirements for primary care services, or whether accountable care systems would replace this concept, Lou Patten responded that the term ‘Integrated Care Systems’ would replace ‘Accountable Care’ which was American in origin. She added that there were no plans for this as yet and in order to embark on Phase 2 of the Programme, it would be necessary to reflect on and learn the lessons from Phase 1 first – and in particular in light of the CQC report findings. She confirmed also that there were no current plans to consult. She explained that the STP was in existence to help Health to think about how to embark on what was required to meet the needs of larger populations in localities, such as how to tackle workforce issues by, for example, upskilling staff and making changes to training needs.

In response to questions from some members about whether the CCG was confident with the way in which it was going about the changes to GP services, Lou Patten stated that one of the things that the OCCG did in its role as commissioner when dealing with Bicester and Banbury Health Centres was to give clear statements that local providers would need to work together with other providers in order to ensure a satisfactory outcome from the changes.

At the close of the discussion, the Chairman, on behalf of the Committee thanked Lou Patten, Catherine Mountford and Julie Dandridge for their attendance. The Committee, whilst acknowledging that the plan was an iterative process AGREED to request the CCG to take the following actions:

(a)  produce a response to the recommendations made by NHS England in their review of engagement on the West Locality Place Based Plan;

(b)  report back to the Committee on actions taken in response to meetings it had undertaken with stakeholders in West Oxfordshire; and

(c)  update the Committee at its next meeting on 19 April meeting about expectations in relation to the next part of the Transformation Programme -  and to request the submission of a detailed plan in the future.