Agenda and minutes

Apologies had been received from Cllrs Baker and Cooper.

The Chairman reported that since the last meeting, Dr B Cooper, the Councillor representing Bromsgrove District Council, had been appointed to the District Council Cabinet and was therefore no longer eligible to be a Member of HOSC.  Brian had been a Member of HOSC for a number of years and widespread thanks to him were recorded.

None.

Members of the public wishing to take part should notify the Head of Legal and Democratic Services in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 4 April 2017). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 7 February 2017 were agreed as a correct record and signed by the Chairman.

Attending for this Item were:

Lynda Dando, Director of Primary Care for the Worcestershire Clinical Commissioning Groups (CCGs)

Dr Jonathan Leach, Clinical Lead Redditch and Bromsgrove CCG

Members received a presentation on the General Practice (GP) Forward View which outlined current context, local and national developments and what the future may hold for access to Primary Care, including GPs.

The Committee was reminded that Worcestershire had an increasingly ageing population, many of whom had complex health needs.  Although the overall population was roughly the same as the 2011 census, there had been a 28% increase in those aged over 75.  In addition, as the number of procedures undertaken and conditions that could be treated in a Primary Care setting developed, patient visits to a GP Practice had increased to around 12 to 15 per year, compared to a historical 2 to 3.

Alongside this, there were national recruitment issues for GPs and it was reported that the number of GPs leaving the service was four times as many joining.

Against this backdrop, Worcestershire had 65 General Practices, all of which benchmarked within the top 10% of Practices nationally for patient satisfaction, access and performance.  From a July 2016 national GP Survey, Wyre Forest responses in particular were extremely positive compared with responses nationally.

In April 2016, the General Practice Forward View was published and although there were other developments across the health economy, including the developing Sustainability and Transformation Plan, new ways of working must include GP services as well.  This was aimed at reducing pressure on secondary care.  The development of GP Hubs, whereby Practices work together to ensure access is improved, was seen as a positive way forward.  However, it was noted that patients may have to accept that they would not necessarily see their usual GP. 

In the ensuing discussion, the following main points were made:

·         The presentation referred to the term 'at scale'; it was clarified that this did not mean Practices merging, rather working together.  This was the case in Redditch, where 6 GP Practices were developing a Hub to improve access

·         Everyone agreed that communicating any changes to residents was vital to ensure that all patients knew what services were available, where and when

·         It was reported that around 26% of GP appointments could be better dealt with elsewhere, whether by another employee within the Practice or elsewhere in the community.  Generally for every three hours of appointments, one hour was required for administration including analysing test results

·         Signposting patients was sometimes more appropriate, especially when queries involved care in the community.  It was noted that Receptionists were very able to undertake this role and there was increased investment in training to support this

·         Some Members questioned the perception of the integrity of Receptionists and reported public concern over a potential lack of confidentiality.  After learning that employee code of conducts were in place, Members suggested a poster in each Practice highlighting that all Staff were bound by strict confidentiality

·         As there was a  ...  view the full minutes text for item 846.

Attending for this Item were:

David Mehaffey, Director of Strategy, Transformation and Planning for the Worcestershire Clinical Commissioning Groups (CCGs)

Dr Anthony Kelly, Chairman of South Worcestershire CCG

By way of presentation, it was reported that a review of the Commissioning Policy for Hip and Knee Joint Replacement Surgery was required as part of the need to save £36m from the combined Worcestershire CCG budgets for 2017/18.  During a budget consultation in 2016, the general public was not supportive of restricting joint replacement surgery. 

The three Worcestershire CCG areas had different clinical activity, resulting in unexplained variations in hip and knee replacement activity with Redditch and Bromsgrove CCG having a higher level of activity when benchmarking nationally. A different approach to treating hip and knee replacement was taken between the north and south of the County, with physiotherapy offered prior to more radical treatment in the South.  This was not offered in the North.

Although there had always been a Commissioning Policy for providers to comply with, the variations across the County were as follows:

One of the objectives of the refreshed Commissioning Policy would be to reduce the variation across the County and for patients to consider other routes before resorting to major surgery.  Ways in which this could be achieved include the consistent use of the Oxford Scoring Tool as part of the clinical review which would be required before surgical referral and routes including considering weight loss and appropriate physiotherapy.  Prior Authorisation would also be required. 

It was reported that in 2016, 90 procedures were undertaken outside of the Commissioning Policy.  

In the ensuing discussion, the following main points were made:

·         It was clarified that there had always been a Commissioning Policy and the proposals were intended to tighten up procedures and ensure a more consistent approach across the County.  The number of hip and knee replacements in Redditch and Bromsgrove were higher than the other two CCG areas and the Policy would tackle the clinical variation

·         It was noted that due to a shift in national policy, the proposal around the use of the Oxford Scoring Tool was on hold, awaiting further national guidance

·         Surgery should be seen as the last resort, as joint replacement surgery was major surgery, an aspect which patients often overlooked.  Lifestyle changes could make a difference, such as weight loss or physiotherapy, and had the potential to reduce symptoms

·         When asked why the rise in numbers, it was suggested that Worcestershire's demographic profile had been well documented and the rise in the number of older people was a contributing factor.  Alongside this, it was known that nationally that there was a decrease in physical activity which was a clear contributing factor

·         Pain was difficult to interpret as everyone was individual.  However, questions  ...  view the full minutes text for item 847.

This Item was deferred until the next meeting.

As this was the last HOSC of this four year Council, the Chairman thanked Members for their commitment to Health Scrutiny.