Councillors and committees
Agenda and minutes
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Venue: Guildhall, Kingston upon Thames
Contact: Marian Morrison 020 8547 4623 email: firstname.lastname@example.org
To consider questions from the gallery on items which are not on the agenda
There were no questions.
Apologies for absence and attendance of substitute members
Apologies were received from Kate Dudley, Advisory Member, Kingston Carers’ Network and Steve Taylor, Director, Adult Services.
Declarations of Interest
There were no declarations of interest.
To agree the minutes of the meeting held on 13 July 2017
Agreed that: the minutes of the meeting held on 13 July 2017 were a correct record of the meeting.
Tonia Michaelides, Managing Director of Kingston and Richmond CCGs and Jim Smyllie, Chair of KCCG’s Primary Care Committee and Lay Member for Public and Patient Engagement will introduce the report
The Panel considered a comprehensive and detailed report by Kathryn MacDermott, Director of Primary Care and Planning, Kingston and Richmond CCGs. Members of the Panel had scoped the report in a meeting with Kathryn MacDermott.
The report was introduced by Jim Smyllie, Lay Member of Kingston CCCG and Chair of the Primary Care Commissioning Committee. He reminded the Panel that GPs are independent contractors and operate as small businesses. There are 22 GP practices which fall under Kingston CCG (including one which is located in Merton). In addition, 3 practices have branch surgeries giving a total of 26 locations where people can see a GP. Details were given of which surgeries fall under which contract type – General Medical Services (GMS) or Primary Medical Services (PMS) contracts. The split is 50:50 which is atypical of most CCGs.
All surgeries provide essential GMS services, but the PMS practices provide additional services eg childhood immunisation, cervical cytology, mental health, obesity etc. All practices can opt in to provide locally commissioned services (funded locally) eg leg ulcer care, COPD, diabetes, sexual health, substance misuse etc. Practices can also choose to provide National Enhanced Services which include extended hours, minor surgery, and learning disability.
The Kingston CCG primary care strategy is seeking to deliver the national GP Forward View Transformation which includes the development of a range of new services, which in the local contract will be Key Performance Indicators (KPIs). These include referral management, weekend additional capacity, paediatric same day appointments and mental health & early intervention. Additional funding has been allocated to take this forward. However, additional services and clinics in primary care are only sustainable if patient flows to hospitals and other patient behaviours can be changed.
Details were given about the hours of opening of individual surgeries included extended weekday and weekend surgeries plus the availability of on line services (pages A17 & A20/21). Three locations known as “hubs” - Surbiton Health Centre, Kingston Health Centre and Merritt Health Centre - provide access to GP and/or nurse appointments 8am – 8pm 7 days a week. Out of hours services, from 6.30pm to 8am on weekdays and all day at weekends and bank holidays, are provided by a partnership of Vocare and SELDOC. There is an intention to integrate NHS 111 with GP out of hours services.
An Urgent Treatment Centre (URT) i.e. a community and primary care facility providing access to urgent care and led by GPs - is being developed at the front end of Kingston Hospital’s A&E. Precise ways of working are being discussed.
The report gave a range of other detailed information and the following are of note:
· The numbers of registered patients by practice and age profiles
· Information on deprivation and ethnicity by practice
· 27% of GP appointments could have been seen by a community pharmacist or a nurse
· Weekend appointments are under used and have higher levels of “did not attend” (DNA) than on weekdays.
· As at March 2016 Kingston had 70 GPs ... view the full minutes text for item 15.
Tonia Michaelides, Managing Director of Kingston and Richmond CCGs, will update on the community beds
At the last Panel meeting questions were raised by a member of the public about the proposal to relocate 35 community beds from Tolworth Hospital and the Panel was asked to scrutinise this.
A report on the community beds was presented at Kingston CCG’s Governing Body on 5 September in response to a number of queries about this proposal and included at Annex 1 to Appendix B on the agenda for this meeting.
The Tolworth hospital site is being redeveloped for new mental health facilities and the community beds need to be relocated and it is understood that the move will need to take place by April 2018. In the short term 25 of the community beds will be re-provided at Teddington Memorial Hospital. Additional enhanced provision will be provided to support people in their own homes to compensate for the reduction of 10 beds. The CCG report drew attention to the need for meticulous planning and implementation to minimise disruption to the service and planning is already underway.
Tonia Michaelides stated that the community beds are currently located in the Cedars Unit which is managed and operated by Your Healthcare on the Tolworth Hospital site. The Hospital is owned by South West London and St George’s Mental Health Trust. It has never been the intention to retain the provision for physical illnesses on the Tolworth site. Contractors will need to move on to the Tolworth Hospital site in the near future to start redevelopment of the hospital.
Tonia Michaelides confirmed that it is intended to retain the community beds in the short and long term. It has been difficult to provide the full number of 35 beds in the short term but arrangements have been made for 25 beds to be located at Teddington Hospital in Richmond. A longer term solution for beds will be developed in Kingston and the PCSS site in in Ewell Road is being considered.
Siobhan Clark confirmed that formal notification had been received from SWLSTG on 9 October and the date to vacate the unit has been set as 13 April 2018. This change will also affect neurorehabilitation services and the continuing care team.
A number of comments and questions were made by members.
Concern was expressed that visitors and carers will need to travel to Teddington. In response to a question it was confirmed that the length of stay is of the order of 15 to 30 days. Teddington already used for some people in Kingston as there are flexible arrangements across Kingston and Richmond to manage the demand and optimise the use of beds. Siobhan Clarke confirmed that Your Healthcare will ensure the transition as seamless as possible.
In response to a question about when the transition will take place it was stated that this was likely to be in the early spring. For patients who are admitted for a longer stay the transfer will be done safely and with great care.
In response to a question about any consultation arrangements, it ... view the full minutes text for item 16.
Tonia Michaelides, Managing Director of Kingston and Richmond CCGs, will update on progress of the STP in Kingston
The report by the Managing Director of Kingston and Richmond CCGs gave an overview of progress with the SWL STP, the Five Year Forward View programmes (Urgent & Emergency Care, Cancer, Primary Care and Mental Health), together with enabling programmes (Digital, Workforce and Estates). A detailed document was appended to the report which covered the current developments including a shared approach across SWL to Musculo Skeletal services (MSK) to ensure equity in access and delivery of services.
Assurance was given in the report that all hospitals in SWL will be needed in future, but not all will provide the services that they currently provide.
Communication and engagement is being taken forward locally within SWL by the four new Transformation Boards – Kingston & Richmond, Sutton, Croydon and Merton & Wandsworth and each area will undertake further engagement to involve people in service planning.
It is anticipated that an updated and refreshed SWL STP document will be published in November. The overall aim of the plan is to keep people well; provide early intervention and support at home to prevent any illnesses from getting worse and avoiding unnecessary admissions to hospital.
In the event that proposals mean there will be significant change then formal consultation will take place, including with Overview and Scrutiny Committees.
Tonia Michaelides explained that this update was the first in a new series of regular reports to CCG Governing Bodies, Local Transformation Boards, Health and Wellbeing Boards, Trust Boards, Local Authorities and wider stakeholders across South West London.
The original plan was published in the autumn of 2016. A refresh of the SW London STP is being undertaken in order to ensure progress is made towards local planning and delivery and the strategy document is expected to be available in November. Sarah Blow is the Senior Accountable Officer for the STP and she is also the Accountable Officer for 4 of the 6 CCGs in South West London.
The overarching SWL STP Programme Board receives updates on the 4 national programmes – urgent and emergency care, primary care, cancer and mental health plus updates on progress from the four local transformation Boards.
Locally the Kingston and Richmond Transformation Board has been formed to plan local developments. This Board is currently looking at the development of the health and care model, taking forward the local transformation work plan and considering the development of an accountable care system. The overall aim is to ensure a system which delivers the best possible outcomes within the available resources. Recent areas of work include a refresh of the bed audit, modelling demand, particularly for intermediate care, care homes and end of life care.
Tonia Michaelides stated that the initial SWL STP received a favourable comment in the King’s Fund review of STPs in England earlier this year. She explained that the STP has evolved into a sustainability and transformation partnership which is considering both the Five Year Forward View and the STP. She confirmed that there will be no hospital closures in SWL but the ... view the full minutes text for item 17.
Tonia Michaelides, Managing Director of Kingston and Richmond CCGs, will give an update on the consultation and engagement outcomes
At the meeting on 14 March 2017, the Panel, at the request of Kingston CCG, considered the communications and engagement plan for the CCG’s Choosing Wisely programme was aimed at helping reduce unnecessary expenditure to enable resources to be focussed on where health needs are greatest. If fully implemented the programme could result in savings of £1m. The programme proposed to limit prescribing for self-care medications for acute illnesses (such as colds and flu), gluten free products, Vitamin D supplement and baby milks, plus possible changes the delivery of IVF. It also put forward suggestions to improve patients’ readiness for surgery.
The two reports considered by the CCTG’s Governing Body on 5 September 2017 were included on the HOP Agenda and these were introduced by Tonia Michaelides, Managing Director of Kingston CCG. She explained that engagement on the programme had been launched just before the announcement of the snap general election which led to a delay for purdah reasons. Tonia Michaelides confirmed that the engagement was wide and took on board the comments made by HOP in March.
The engagement survey results showed:
· 84% strongly agree that over the counter medicines for minor illnesses should no longer be prescribed apart from exempt groups
· 61% strongly agreed that gluten free foods should no longer be prescribed
· 58% strongly agreed that soya, thickened or lactose-free baby milk and infant formula should no longer be prescribed apart from exempt groups
· 73% strongly agreed that Vitamin D should no longer be prescribed except for exempt groups
The CCG’s approval for the programme’s proposals was sought and the decisions made were:
· To no longer support routine NHS prescribing for gluten free food, Vitamin D maintenance and over the counter medicines, but recognising that it is the clinician’s decision as to whether to prescribe based on the person’s clinical and/or personal circumstances.
· No changes to the current eligibility criteria for IVF were made, but if there is a proposal to align the eligibility criteria across SWL or London, the CCG will undertake a review.
In response to a question about whether there had been any further developments since CCG Board, Tonia Michaelides stated that there was some national consultation on similar prescribing areas.
Tonia Michaelides emphasised that the CCG was not allowed to stop prescribing particular products/medications and this is a decision for the prescriber i.e. GP. The question of baby milk caused the most debate in CCG Governing Body.
In relation to IVF, in other parts of South West London, Croydon CCG’s decision to stop IVF was referred to Secretary of State and Richmond undertook a full consultation. Clinicians at an assisted conception unit have explained that there are chemical markers which indicate likely success of IVF. Whilst the CCG has made no decision to change the criteria it will look at clinical pathway. If there are clear clinical markers indicating IVF will not be successful then this message needs to be discussed with the person.
In relation to readiness for surgery the CCG ... view the full minutes text for item 18.
To agree the work programme drawn up by the Panel’s working group and note the engagement opportunities set out at Annex 1
At the meeting in September the Panel set up a working group to consider the future work programme and the report set out the proposals for the next two years. Member involvement was sought for the December main item. The Chair suggested that the item on Air Quality proposed for the March meeting may be delayed slightly.
1. The work programme is endorsed;
2. Items for the next meeting on Thursday 7 December meeting are:
· Mental Health Services including progress with suicide prevention and the self–harm plan
· Update on preparedness for winter demand
· Update on Kingston Hospital including progress with the CQC inspection recommendations, particularly those items involving capital expenditure
3. A working group consisting of the Chair, Vice Chair, Healthwatch and Kingston Carer’s network is set up to progress the main item for the next meeting.
Health and Wellbeing Board on 14 September 2017
The last meeting of the Health and Wellbeing Board was held on 14 September 2017. The following items were discussed:
· South West London Sustainability and Transformation plan update
· Child death overview panel annual report 1016/17
· London Mayor’s Health inequalities strategy consultation
· London Crisis Programme Update – health based place of safety
· Better Care Fund Plan 2017/18
The agenda can be viewed via the following link:
Agreed that: The Panel noted the main items discussed at the last meeting of the Health and Wellbeing Board which included:
· London Mayor’s Health Inequalities Strategy Consultation
· London Crisis programme update – health based place of safety
· Update on SWL Sustainability and Transformation Plan.