Meeting documents

Also present at the invitation of the Chairman

Mr Geoff Day, Head of Primary Care, North Yorkshire and Humber Area Team, NHS England – for Item 4

Ms Sarah Ferguson, Senior Delivery Manager, NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group – for Item 5

Dr Omnia Hefni, Urgent Care Lead, NHS Scarborough and Ryedale Clinical Commissioning Group – for Item 6

Mr Colin Hurst, Engagement Manager, North Yorkshire and Humber Commissioning Support Unit – for Item 6

Ms Linda Lloyd, Health Engagement Network representative (Whitby), NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group – for Item 5

Ms Debbie Newton, Chief Operating and Financial Officer, NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group –for Item 5

Members are reminded of the need to consider whether they have a personal or prejudicial interest to declare in any of the items on this agenda.  If so, the nature of the interest must be declared at the start or as soon as the interest becomes apparent, of the meeting.  In addition, the attached form must be completed and passed to the Committee Administrator.  The Officers will be pleased to advise, if necessary, and any request for assistance should be made, in the first instance, to the Committee Administrator whose name appears at the end of this agenda.  Ideally, such advice should be sought before the day of the meeting so that time is available to consider any uncertainty that might arise.

Councillor Abbott declared a personal interest in agenda item 5, Vision for the future of community health and social care services in the Whitby area, in his capacity as a member of Whitby Hospital Action Group.

To approve as a correct record and sign the Minutes of the meeting held on 11 December 2013.  (Minutes attached).

RESOLVED that the minutes of the meeting held on 11 December 2013 be approved as a correct record and signed by the Chairman.

Public questions of which due notice has been given and which are relevant to the business of the Scrutiny Committee.

The Chairman reported the receipt of a public question which would be considered under Item 5 on the agenda.

To consider a report (attached) by Geoff Day, Head of Primary Care, North Yorkshire and Humber Area Team, NHS England

The Committee considered a report by Geoff Day, Head of Primary Care, North Yorkshire and Humber Area Team, NHS England, which outlined the background to the national decision made by NHS employers and the British Medical Association to phase out Minimum Practice Income Guarantee (MPIG) to GP surgeries over a seven year period starting this year, and provided an update in respect of the Hambleton, Richmondshire and Whitby area, in particular the effect on the two ‘outlier’ practices in Egton and Danby.  Members were reminded that MPIG was introduced in 2004 as part of the transition to the new General Medical Services (GMS) contract, to free practices from the bureaucracy of form filling and to be paid a global sum of money based on the Carr-Hill formula which had been developed to take into account a wide range of demographic factors that affected demands on primary care.  The MPIG was designed as a correction factor payment to top up practices’ global sum payments to match their income levels before the new GMS contract was introduced.  The future of MPIG had been subject to discussion between the British Medical Association (BMA) and NHS employers for some time.  The intention was to move to a common capitation price based on current average expenditure on global sum payments, correction factor payments made under MPIG, and comparison to the basic elements of funding of the other core contract type, Personal Medical Services (PMS).  This common capitation price would be applied to both GMS and PMS contract types over a seven year period, thereby achieving a fairer allocation of resources across all practices.  NHS England had undertaken a benchmarking exercise to evaluate how the transition to the new common capitation price funding formula would affect all practices nationally. As a result, a small proportion of ‘outlier’ practices were identified, defined as experiencing a reduction in funding at the end of year 7 of £3 or more per weighted patient.  There were four such practices in the North Yorkshire and Humber area which included Egton and Danby.  Nationally, only 30% of outliers were in rural areas.  Mr Day commented that his Area Team was holding discussions with the Clinical Commissioning Group (CCG) and GPs to determine how best to support the outlier practices through this transition.   Although the Area Team could not make up the shortfall in funding to the Egton and Danby practices directly, the Area Team and CCG were examining alternative solutions to make the practices sustainable, such as identifying other income streams, and by transforming service delivery through the CCG’s successful bid to the Prime Minister’s Challenge Fund.  This funding would enable GP surgeries to provide more ‘out of hospital’ services and achieve closer integration of health and social care, creating opportunities for significant savings.  Members then discussed Mr Day’s report and asked him questions.  The Chairman also gave the opportunity to members of the public to put their questions.  In response, Mr Day acknowledged that the CCG could not realise its vision  ...  view the full minutes text for item 4.

To receive an update by Sarah Ferguson, Senior Delivery Manager, Hambleton, Richmondshire and Whitby Clinical Commissioning Group

The Committee received a presentation by Sarah Ferguson, Senior Delivery Manager of Hambleton, Richmondshire and Whitby NHS CCG which reviewed progress of the CCG during its first year of operation including their ongoing project to redesign community health and social care services in Whitby and the surrounding area.  Members were advised that among the CCG’s achievements in 2013/14 were the provision of new services and care pathways, for example the GP Urgent Pathway and the Deep Vein Thrombosis Pathway, securing more investment in primary care, achieving a £750k surplus by the end of 13/14 (from inheriting a £1.7m deficit), the dialogue with the public in respect of their service transformation project, Fit 4 the Future, and their successful Prime Ministers Challenge Fund bid in support of the transformation of health and social care services.  Over £6.5m of investment was planned in the next two years in such areas as intravenous antibiotics, carers training, care navigators, autism, in vitro fertilisation and lifestyle referral programmes.  In services specifically for the Whitby area, investment amounted to £407k, including new 24/7 community nursing.  The public engagement so far indicated broad support for the Fit 4 the Future Vision.  The three most important elements of the Vision for people were a sustainable and integrated minor injuries unit and out of hours service, the redevelopment of the Whitby Hospital site, and local access to a range of diagnostic services.  Among preventative services, the public placed mental health, alcohol awareness and obesity as their top three priorities.  The CCG planned to broaden their public engagement as their plans took shape, for example through greater collaboration with the Borough Council and use of the Residents Panel and Whitby Tourist Information Centre.  The next stages of Fit 4 the Future were the retendering of the Community Services contract and the completion of the options appraisal (by Community Ventures) for the future hospital in Whitby.  The contract was valued at £6.2m and the current provider was York Teaching Hospital NHS Foundation Trust (YTHFT).  Some key features of the contract were the development of 24/7 community nursing; specialist nursing including a falls service; care navigators/community agents; integration of minor injuries, out of hours and rapid response services; developing rehabilitation services; and maintaining palliative care but enhancing the role of specialist nursing in end of life care.  The CCG had also taken steps to avoid any conflicts of interest between commissioners and potential tenderers.  For example, Dr Vicky Pleydell, the CCG’s Chief Clinical Officer did not take a practice income but had a dedicated role within the CCG.  Community Ventures had been commissioned to assess all potential sites and service configurations for the new community hospital.  The CCG was keen to scope the potential for the co-location of a hospital, extra care housing, and accommodation for those with learning disabilities and complex needs.  The financial viability of any redevelopment would be assessed including capital requirements and realisation of potential benefits.  The options appraisal was expected in mid June when  ...  view the full minutes text for item 5.

To receive an update by representatives of Scarborough and Ryedale Clinical Commissioning Group

The Committee received a joint presentation by Dr Omnia Hefni, Urgent Care Lead at Scarborough and Ryedale Clinical Commissioning Group, and Colin Hurst, Engagement Manager at North Yorkshire and Humber NHS Commissioning Support Unit on the background to the proposed new urgent care model for Scarborough and Ryedale and the initial analysis of results from the public consultation exercise.  Dr Hefni reminded Members that the outline proposal was to replace the three existing contracts for urgent care with a single contract for an integrated urgent care service based on two 24/7 365 days per year urgent care centres – one in Scarborough and one in Malton.  Members were advised that in respect of the impact on the Castle Health Centre (CHC), only the existing walk-in centre would become part of the new urgent care service, open 24/7 instead of 8am to 8pm as currently; all other services at the CHC would remain.  As the contract for the current walk-in service expired in October 2014, the CCG was looking to provide an interim solution to ensure the walk-in service remained in operation until the new urgent care centre opened.  In terms of procurement, legally, the CCG had to adhere to a strict process to ensure that potential providers had a fair opportunity to bid for the contract and to secure the very best service available.  In order not to limit potential bidders, the CCG could not stipulate the precise location of the two new centres in the specification as this could unfairly disadvantage some providers.  However, the CCG could set specific criteria around location and access to ensure the needs of patients were met.  Mr Hurst then provided details of the CCG’s extensive 12 week public consultation exercise through online/paper survey, focus groups, public meetings, stakeholder events and other methods, which sought to identify themes, ideas and concerns that would need to be considered and addressed in the development of the service specification.  Feedback demonstrated overall support for the case for change, and for the proposals in general terms, but specific concern in some quarters at the loss of an out of hours facility at the CHC.  There were fears that this was simply a cost saving exercise, that a new build would be costly without improving the service, and there were also questions as to why the successful service at the CHC should be altered.  However, others felt that the proposals would simplify current arrangements whilst extending access to urgent care at the same time.  Another concern highlighted in the consultation was that of local difficulties in obtaining GP appointments and whether this issue should not be tackled at the same time as improving the urgent care service.  Members then questioned Dr Hefni and Mr Hurst about their presentation.  There was concern at the low response to the survey, its methodology and the presentation of the results, and a reiteration of some of the points raised in the slides, particularly in respect of the very good accessibility of  ...  view the full minutes text for item 6.

To consider a report by the Director of Democratic and Legal Services (Reference 14/36 attached)

The Committee considered a report by the Director of Democratic and Legal Services (Reference 14/36) in relation to the Committee’s work programme for the current year.  Two items were proposed for the forthcoming year: (i) the growing problem of attacks by other dogs on guide dogs which was still not a criminal offence (although new legislation was under consideration); and (ii) neglect of elderly people in care homes – to invite a representative of the County Council to address the Committee about the registration and monitoring process in respect of care homes in the Borough.

RESOLVED that, subject to the above amendments, the report be received.