Agenda Item: 1

Patient Reference Group Workshop

8 March 2016

GB.01, Woolwich Centre

PRESENT:

Name / Job Title / Organisation
Dr Greg Ussher (GU) (Chair) / CCG GB lay member CEO / Metro Centre
CliveMardner (CM) / Engagement Lead / Healthwatch
Mary King (MK) / PPG Member / Plumstead HC
Frances Hooke (FH) / PPG Member / Manor Brooke MC
Angela Burr (AB) / PPG Member / TBC
Shirley Gibbs (SG) / TBC / TBC
PaulRichardson (PR) / PPG Member / Plumstead HC
Patricia Kanneh-Fitzgerald (PK-F) / Stakeholder EngagementOfficer / Greenwich CCG
Diane Jones(DJ) / Director of Integrated Governance / Greenwich CCG
Carol Berry (CB) / Compliance Manager / Greenwich CCG
Annie Muhlwa (AM) / TBC / Sensicare UK
Dominic Braima (DB) / TBC / TBC
Gilles Cabon (GC) / Chief Executive Officer / Greenwich Inclusion Project
Deborah McInerney (DM) / Consultant / Attain

APOLOGIES:

Sylvia Nyame (SN)GP Governing Body MemberGreenwich CCG

  1. Welcome and Introduction

Dr Ussher welcomed everyone

  1. Minutes of previous meeting

It was agreed that the minutes from the last meeting was accurate.

  1. Conflict of Interest
  • Clive Mardner declared that he is a Counsellor of the Royal Borough of Greenwich.
  • Greg Ussher declared that he is the CEO of Metro and contract holder for Health Watch Greenwich.
  1. QIPP Programmes

DJ presented the 10 QIPP Proposals

DJ presented an overview of the CCG’s financial position. She reported that the QIPP proposals are to help the CCG be more efficient in spending. Money allocated to Greenwich CCG this year will not meet the anticipated activity / spend for 2016/17. The CCG need to save 19.8 million pounds every year to achieve a 1% surplus. The Plan is focussed on 10 Programmes.

Programme Update

  1. Access

The CCG proposes toincrease acess to GPs at weekends for Greenwich patients. This will replace Walk in Centre provision, which is open to anyone and funded by Greenwich. A third of the people that use the centres are out of borough.

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Discussions:

  • Some members of the group wanted to know if people outside the borough will be seen by the GPs.
  • DJ informed the group that only registered patients will be seen by the GPs.DJ stated that the intention is to ensure the CCG meets the population requirement before closing the Walk in Centre.
  • CM advised that the CCG will face challenges if the CCG do not consult properly.
  • DJ advised that GPs will need to sign up to the proposed Saturday opening to enable more slots for patients.
  • DJ advised that Language Line (Interpreting service) is available to all GP practices.
  • CB advised that a piece of work has being done by NHSE on the guidance around immigration
  1. Acute productivity

The CCG along with Lewisham and Bexley CCGs agreed a 3 year plan with Lewisham and Greenwich Trust, regarding £800k each year across the CCGs. 2015/16 is year 1.

  1. Ageing Well

The Programme is intended to improve efficiency in the care of the over 65’s to that of the National Average, and as such would deliver £5.7m of annual savings by the end of 2018/19 by avoiding hospital admissions and increasing care in the community. This aims to put more preventative measures in the community to tackle the issues

Discussions:

  • DJ told the group that similar models had been tested nationally and has seen changes.
  • This programme does not include continuing heathcare patients.
  • As this is a proposal, the group will get the detailed business case including costs once they are prepared.
  • The group want to know what the engagement plan is going to be and the timeline.
  • The group want to know how they (PRG) are going to be involved.
  • DJ said an engagement plan will be developed.
  1. BAU

There are a number of smaller schemes which are considered worth proceeding with, but simply as Business As Usual, rather than as part of a separate programme. These include such schemes as providing more Anti-Coagulant appointments in the Community, therefore saving transport costs, and Chronic Obstructive Pulmonary Disease (COPD) Pathway improvements to provide more services in Primary Care.

The CCG is reviewing all its contracts using Bravo system to store and monitor contracts.

  1. Better Care Fund

It is proposed to review the existing spend from the CCG’s allocation from the Better Care Fund, to ensure that it is delivering value and benefits to patients and to cease those commitments which are not. That released funding can be used for additional schemes and services.

  1. Children and Maternity

A proposal for an Integrated Children’s Service is being developed. This will aim to reduce emergency admissions to hospital for children by looking at pathways. This will also address duplication of payment.

In addition a plan is being developed for reducing repeat terminations of pregnancy by improving education.

Discussions:

  • SG asked about information on Termination of Pregnancy.
  1. Decommissioning

The CCG has identified a schedule of funding to cease, although the service will continue directly funded by public health. This is because the CCG are not obligated to fund public health initiatives, (although it was a PCT function in the past).

Similarly, certain third sector services, which had been funded directly by the CCG, may be financed through the BCF funding, thereby creating capacity in the CCG’s budget

  1. Internal Efficiencies

This Programme has three workstreams:

  1. Estates void costs. Work is being done to understand the CCG’s void cost commitments and develop a plan to manage them out
  2. Staff Costs. The CCG is using a large number of interim staff, because of vacancies. It needs to develop a plan to fill those vacancies with permanent staff and therefore save the “Interim Premium” going forward.
  3. Review of CCG budgets. To identify any costs which may no longer be needed recurrently. This work is on-going within the CCG.

Discussions:

  • The group would like to know how many interim staff the CCG currently has.
  • GU would like to know how the group (PRG) could help
  1. Medicine’s Management

There are a number of workstreams within the Medicines Management Programme which have been identified, which aim to move prescribing to lower cost drugs, of similar efficacy, without compromising patient care.

  1. MSK

DMpresented the proposed redesign of the Musculoskeletal (MSK) service. Finding of the current service are as follow:

•Nationally, MSK conditions account for around 6-7% of total CCG spend 30% of GP consultations.

•MSK conditions account for c.£15m annual spend and work across the country shows that between 50% and 80% of all adult MSK GP referrals can be dealt with in the community.

Case for Change

Delays to treatment

Duplication of assessments and diagnostics

Difficult to follow patients progress

Varied clinical outcomes

Poor patient experience

Not good value for money

Proposed Pathway changes

Single point of access

Triage and appropriate onward referral

Access to timely diagnostics

Reduction in duplication of diagnostics

Shared decision making

Shift of activity into the community – OP and procedures

Discussions:

  • DM informed the group that there are two pain management services available.
  • All referrals come in one hub, assessed and sent to the appropriate clinician.
  • The service will be provided at different facilities.
  • Some members wanted to know what will be the timeline for treatment.
  • DM informed the group that the CCG will set the criteria for the provider to work towards.
  • FH would like to see the old contract to enable her to decide whether the current service needs redesigning.
  • Members would like an Equality Impact Assessment/analysis included in the business case.

Unfortunately, we could not complete the agenda due to the lack of time. Uncompleted items will be included in the next agenda.

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