The Board to receive a joint presentation on the future of co-commissioning of Primary Care services.

Dr Paul Hardy and Nicola Jones, NEW Devon CCG provided the Board with a report on Co-commissioning of Primary Care Services.  It was reported that-

(a)           co-commissioning would focus on the integration agenda and about breaking down barriers and getting the systems to work in a more cohesive way;

(b)          the Health and Social Care Act generated clinical commissioning groups (CCGs) to come into existence.  The legislation was quite divisive and had resulted in a fragmented approach to commissioning.  This was disruptive for service planning but co-commissioning provided a real opportunity for the CCG to take on primary care commissioning which would help to ensure services run more smoothly;

(c)           the recent publication of various papers that set out the challenges the health community had to face.  The Call for Action report highlighted –

·         the demographic challenges;

·         that the GP workforce was changing with a significant 25% reduction in next 5 years.  The NHS faces a challenge in drawing people into general practice;

·         current financial constraints with all organisations looking to make savings in an environment of higher and rising demand;

(d)          in the future General Practice would need to operate at a greater scale and with greater collaboration with other providers, professionals, patients, carers and the local community;

(e)          developing a modernised primary care service aligns with CCG Strategies for a shift of services into the community and maintaining people at home;

(f)            a focus on how we look at harnessing technology for the benefit of patients for the future e.g. using Skype was required;

(g)           Peninsula Primary Care  Commissioning Group (PCOG) had been established with membership including the Area Teams, CCGs, Local Medical Committees (groups of GPs), PHE;

(h)          a successful bid for the Prime Ministers Challenge Fund was submitted one of 11 that won funding.  There was a need to have local discussion on how money was used to make a sustainable shift in our primary care;

(i)            work was on-going with the local professional networks (pharmacists, dental, opticians) to improve how we work together to consider whether care was being delivered in the right way and to harness the skills of professional networks within primary care;

(j)            An expression of interest would be completed by 20 June 2014;

The following questions and comments were made -

(k)          it was noted that there was evidence to suggest that –

§     variation in primary care could be found across a number of key domains, such as:

·                      systematic implementation of primary and secondary prevention initiatives such as immunisation screening;

·                      management of ambulatory care sensitive conditions, e.g. through self-management, lifestyle advice, use of disease registers, etc;

·                      quality of end-of-life care;

·                      elective referral activity;

§     As much as a 10-fold variation can exit between practices in elective referral rates within specialities;

§     Nearly 1 in 5 emergency admissions for adult social care conditions can be avoided be removing variation in primary care and spreading good practice.

(l)            The Board should encourage both the CCG and the local authority’s public health function to undertake a programme of work that uncovers and tackles variation where it exists in primary care.  The CCG taking the position of getting the highest level of co-commissioning was welcomed;

(m)         co-commissioning could lead the CCG into issues of conflicts of interest the Board was assured that this was being dealt with;

(n)          co-commissioning gave us an opportunity to undertake preferential investment to deal with health inequality which exists in Plymouth;

(o)          the Quality Outcome Framework (QOF) had resulted in a large amount of micro-management.  This arrangement could potentially get rid of some of the QOF and could re-use the money in a more creative way;

(p)          when Plymouth Community Healthcare (PCH) first started they worked with one commissioner and now have 9 commissioners.  The fragmentation and lack of common themes through those commissioning streams does cause issues for service delivery so any opportunity to combine commissioning would be welcomed.    PCH were also having discussions with schools but would need to link with the GPs to progress these discussions further;

(q)           the Joint Commissioning Partnership was the vehicle to use on how we commission together against the Health and Wellbeing Strategy.  The only way the Board would make a difference is by using a systems leadership approach and look at how we co-commission and make the money and resources in the city deliver a better service that makes us more sustainable;

(r)           an understanding of CCG activity with bodies like Health Education England (HEE SW) was required for input into future workforce discussions.  Where is the dialogue around this and ensure that scenario planning and the role of IT and technology in driving healthcare for the future workforce was placed in a better position.  Not sure how we link with education but we do have exciting initiatives we will be delivering locally with workforce planning but need to give some focus to the education component, to have a conversation with education on professional growth would be a worthy conversation;

(s)           Steve Waite responded that he is a Board member of the HEE SW and happy to take that challenge to them to ensure this Board where has been significant challenge in developing the primary care workforce and beyond and work is in hand;

(t)            the Board needed greater visibility of strategic partners;

(u)           ensuring that every citizen has good access to a GP was picked up by the fairness commission.  Barne Barton was identified as an area that needed to have more accessible services and work was ongoing to ensure that it was addressed;

(v)           part of the problem was the take up of services and how we influence the culture of communities to look after their own health better.  Preventative services would not addressed by putting in more GPs.  The Pharmacy needed to be used in a new way to tap into the knowledge base in that sector.

Agreed that –

1.            The Health and Wellbeing Board is invited to engage and contribute views in relation to the potential new arrangements for co-commissioning of primary care services.

2.            The Health and Wellbeing Board encourage both the CCG and the local authority’s public health function to undertake a programme of work that uncovers and tackles variation where it exists in primary care.

3.            Discussions take place with Health Education England SW and other strategic bodies to build links with the Health and Wellbeing Board.

4.                  The public and patient voice is involved in this process.