Adult Services and Health Select Committee Minutes

Tuesday, 15th October, 2013
Ground Floor Committee Room, Town Hall, High Street, Stockton, TS18 1AU
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Mohammed Javed(Chairman), Cllr Kevin Faulks(Vice-Chairman), Cllr Evaline Cunningham, Cllr Elliot Kennedy, Cllr Ray McCall, Cllr Mrs Sylvia Walmsley, Cllr Norma Wilburn,
Peter Kelly (PH), Peter Mennear, Michael Henderson (LD)
In Attendance:
Dr Paul Williams, Deborah Bowden, Jan Talbot, Dr Carl Parker, Gill Carton, Paul Whittingham (CCG); Sue Metcalfe, Jenny Allan (Area Team)
Apologies for absence:
Cllr Paul Baker, Cllr Mrs Mary Womphrey and Deborah Miller.
Item Description Decision
AGREED that:-

1. the information provided be noted.

2. information be provided in relation to, which GP practices walk in centre users were registered at.

3. Stockton ambulance response times for Category A responses be obtained.

4. Members receive an update relating to the use of the One Life Centre at Hartlepool
AGREED that:-

1. the minutes be noted.

2. the Regional Health Scrutiny be asked to consider GP recruitment as a future review topic.
AGREED that the scope and project plan be noted.
AGREED that the update be noted.


The Committee prepared its approach to the meeting.
Cllr Mohammed Javed declared a disclosable pecuniary interest as he was employed by Tees, Esk and Wear Valleys NHS Foundation Trust. Cllr Javed had been granted a dispensation in this regard.

Cllr Ray McCall declared a personal interest as he was an Associate Hospital Manager and Governor for Tees, Esk and Wear Valleys NHS Foundation Trust.
Members considered information provided by the NHS England Area Team and Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG). Representatives from these organisation were in attendance to present the information and answer questions.

During consideration of the information and responses to questions the following points arose:-

• Practices were independent organisations and had significant scope to make decisions about the delivery of the services they were contracted to provide.

• Patient Participation Groups (PPGs) were encouraged for all practices, although some did not have them in place

• Reference was made to incidents where patients did not see the practice staff member they had expected to see e.g. they had requested to see a nurse and saw a health care assistance instead. It was noted that practices were required to correctly inform patients in advance of the position held by the staff member they were seeing.

• The Dr First initiative was being piloted in at least one practice in Stockton and would be assessed. It was hoped that it would relieve some pressure on practices.

• Patients who did not attend (DNA) appointments was a problem area in practices and also across all health services. It was noted that there was a cost associated with non-attendance and a Member suggested that attempts should be made to reduce incidents, such as charging, which occurred in dental practices. Practices did attempt to raise awareness about costs and the number of DNAs. Practices operated on the assumption that not all patients would attend appointments and it was noted that the situation was to some extent ‘managed’ already.

• GP Performance - Satisfaction had declined and it was suggested that this may be a symptom of the pressures on practices. Problems recruiting Drs and other staff could also lead to temporary reductions in patient satisfaction.

• Pharmacies - It was noted that pharmacies were keen to be involved in the planning and delivery of services to augment what was available in General Practices.

• Arrivals Practice - as a PMS contract this was being reviewed nationally by the national primary care team, which was looking at a more standard approach. It was noted that if demand from an increased local asylum seeker population increased significantly, then funding would have to be reviewed

• GP recruitment was a significant issue as General Practice was not the first choice of medical students. The age profile of GPs was maturing.

• The Area Team was working with the CCGs to ensure that the full commissioning picture was being knitted together, as CCGs had a role in promoting the quality of primary care whilst Area Teams were the contract holders.

• Contracts were awarded nationally and the Area Team had no flexibility to vary them in relation to increasing access, but they and the CCG's could ask practices to consider initiatives.

• There were no specific levers in relation to tackling poor performance, regarding access, especially when there had been no breach of contract. Action planning was put into place to try and address particular issues.

• There was no maximum waiting time for a GP appointment. The contracts outlined that patients must be seen within a ‘reasonable’ time frame, dependent on clinical need.

• Practices needed to maximise their skill mix and capacity.

• Locally there was a shortfall in funding for GP practices, which the Area Team managed.

• There had been recent government announcements suggesting that practices should open from 8am till 8pm. If implemented this could have an effect on ‘walk in’ clinics.

• Access and experience surveys could not be used in isolation to assess the quality of GP practices and there needed to be a balanced scorecard approach.

• The view of GPs was that they have never worked harder. Walk in clinics had not reduced pressures. Increased supply had created an increase in demand. Dr First may help.

• Walk in Centre - information to be provided relating to, which GP practices walk in centre users were registered at.

• There were particular pressure during the Winter but there was a recognition that there was now increased year round demand on emergency care.

• Handover times between Ambulances and A&E at North Tees Hospital were very good and patient flow was a beacon of best practice. South Tees was recognised as struggling in relation to handover times.

• Recognition that backlog at A and E was reflective of difficulty in moving people through the hospital and ultimately into the community.

• The recent changes at North Tees in emergency medicine and critical care had included an increase in North Tees beds, so the flow should be maintained, but would be monitored.

• Urgent Care Boards in each area were sharing best practice and would assist South Tees.

• A and E waiting times had improved to such an extent that patients went there as a first step, by-passing practice surgeries and walk in clinics.

• Some patients went to the GP, walk in clinic and A and E for the same issue.

• Rationalisation of ‘A and E’ options should be considered.

• There were problems associated with the recruitment of GPs and hospital based doctors across all grades.

• The ambulance service was meeting ambulance response targets on a regional basis. Stockton picture and trends were requested for Category A calls.

• Winter Publicity Campaign to be undertaken to raise awareness of different options.

• The Directory of Services used for NHS111 was being rationalised. This could see patients being directed to walk in centres as the first option

• Levels of usage of Tithebarn Walk in Centres were different across the population. Some GP practices saw their patients use it more than others, and geographically there was a different spread.

• Community facilities in Stockton as part of Momentum were contingent on the new hospital.

• Some outpatient clinics provided by North Tees & Hartlepool NHS FT at One Life Hartlepool should begin over next three months. The Committee would receive feedback on progress with regard to this.

• It was queried if practices could unofficially close their patient lists. This would be raised with NHS England.
Members were provided with the minutes of the Tees Valley Health Scrutiny Joint Committee held on 17 June 2013.

It was suggested that GP recruitment could be an issue for the Regional Health Scrutiny Committee to review.
Members were provided with the current outline scope and project plan for the Review of Access to GP, Urgent, and Emergency Care.
The Committee was encouraged to complete a survey, that had been circulated to members, relating to the review of access to GP, Urgent, and Emergency Care

The first meeting of the oversight group, relating to recent changes in critical care had been held. The next meeting was scheduled for November.

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