Meeting documents

To consider a report by NHS Dorset Clinical Commissioning Group.

The Committee considered a report by the Lead Director Dorset ACS/STP, Director of Transformation, NHS Dorset CCG which updated the Committee on the status and progress of the Dorset Sustainability and Transformation Plan (STP).  It highlighted the key work streams of the plan, the governance of the oversight and progress so far with implementation of the plan.  There were five enabling portfolios within the plan all progressing at different pace across the system:

·         One Acute Network

·         Integrated Community and Primary Care Services

·         Prevention at Scale

·         Digitally Transformed Dorset

·         Leading and Working Differently

Dr Steve Killen had been appointed as Programme Director to plan and organise One Acute Network.  The Committee were informed the CCG were waiting for deliberations as to what decision would be made on 20 September 2017 before progressing further.

The Integrated Community and Primary Care Services Programme currently included work with the council’s planning and estates teams regarding community hubs,  increasing the depth of work that had already taken place.  A decision on mental health services would be announced the same time as the Clinical Services Review.

There were four main project areas within Prevention at Scale:

·         Starting well

·         Living well

·         Ageing well

·         Healthy places

With regard to Digitally Transformed Dorset there were approximately 20/30 projects the biggest of which was the Dorset Care Record shared system.  Collating the data and inputting the information on to the system was approximately 2 months behind schedule, although it was hoped this backlog would be recovered.  The Committee were informed this was not a technical or design problem it related to the volume of work and manpower available. The NHS digital teams were hoping to develop a single shared IT service across Dorset.  It was hoped the roll-out of the Dorset Care Record Shared System would be later in 2017.

The Community Services Programme had been modelled so that it would be better, if timetabled properly, for the system to have a full caseload of patients all day.  With regard to the digital system and safeguards for older people, the system would not be reliant on one digital system.  Age UK carried out a piece of work, nationally, on how different age cohorts would use technology and how to prepare them for the use of technology, which officers felt it might be helpful to read.

Members commented that retired people between the ages of 55 and 65 were competent with digital media, whereas older people often were not.  Dorset’s population was such that a high percentage were aged 60+ and concern was raised regarding this group of people and how the CCG would ensure sure they would not fall through the net and that safeguards needed to be in place for older residents.

In relation to delivering reductions in the number of out-patient appointments, concern was raised as to how members of the public were to get to Dorchester if there was no transport and, if cutting costs in travelling time for consultations was the motivation, was that clinically led or monetary led.

Officers responded that out-patient appointments would bring everyone together in one area.  This would be clinically based with better community hubs, which should be more holistic for people in outlying areas. 

One member considered the delivery through local GP practices working in collaboration was an aspiration, as there was a shortage of GP’s.  He was sceptical about how Prevention at Scale would realistically and efficiently work.

Officers agreed that it would take time for initiatives to make a real difference, and noted that the Public Health team had changed the way they were working and now had dedicated programmes which would be rolled out in the future.

It was noted that with regard to Prevention at Scale the Live Well Dorset website was very useful, but it would take a long time for people to change their culture.

Officers explained Prevention at Scale was about taking the right care and best practice to other areas.

One member enquired what was being planned to ensure the general health checks for over 50’s were universally accessible across the whole of Dorset. It was confirmed that Public Health Dorset were encouraging every general practice to identify patients and call them in for health checks.

Officers mentioned the Accountable Care System (ACS) in Dorset had been selected as one of 8 pilot Accountable Care Systems and it was hoped to achieve better planned services across the population.  At present all partner services had been asked to sign up to a memorandum of understanding to work towards the aims, in return for which Dorset would be given greater freedom to develop local plans.

One member mentioned research in the USA from the journal Health Policy Law 2015 where the roll-out of Obama-Care had frightening results linked to the bundling of contracts and a lack of penalisation for failure.  This had led to higher costs.  Concerns were raised that the NHS would go down a similar route and she asked whether the CCG or a private company would be expected to run the Accountable Care Organisation (ACO) in Dorset in the future.

Officers responded that there were not very many ACO models that existed across the country and in Dorset it was about a group of people working together as an ACS.  Members asked for confirmation that there was no proposal for the ACS to become an ACO.  Officers confirmed that was the case. 

Reference was made to a recent survey which had revealed that several ACO’s had been awarding payments to GP practices for not referring patients to hospitals.

Members asked what safeguards would be put in place so that the more expensive patients were not refused treatment as they would not want to see cancer patients, for example, unable to receive new treatments as they were too expensive. Although there would come a time when the NHS could not afford all treatments, at present specific hospitals had money ring-fenced for specialist treatment.

Officers noted that they were working with clinical leads to manage needs and demands to give the most effective outcome to patients. Some referral patterns were higher than others and some GP referrals were lower.  The CCG challenged those where necessary.

One member enquired as to what the implications would be for rural practices, for example in Puddletown and Crossways.  Would the public have to travel to Dorchester GP’s.

Officers confirmed the national direction was looking at models of care and how best to deliver them to the public.  Primary Care was a population health model where GP practices would work together.  The NHS supported the approach of what services could be improved and what services would work together well.  There was no intention to close practices, it was about how they met the population need.

Mention was made of the use of acronyms within the reports and it was noted that in future an index be provided with each report to explain the meaning of acronyms used.

Noted