Meeting documents

To consider a report by NHS Dorset Clinical Commissioning Group.

The Committee considered a report by the Head of Primary Care, NHS Dorset Clinical Commissioning Group on Primary Care Update.

The Committee were updated on the key areas of the report and it was confirmed there was a clear strategy supporting general practice and maintaining services within Dorset Primary Care to ensure they were integrated.  There were now 90 practices across Dorset, some of which were looking at how surgeries would share back-office systems, whilst others were looking at merging with another practice.  Officers had regular dialogue with practices regarding the right care and how they could learn from other practices to see what areas were working well and what was not working so well.  They were also looking at the different ways of delivering care into the community.  The CCG had been exploring joint working with hospitals and how to enable 24 hour access across Dorset.  Meetings had taken place between hospitals and GPs to look at how patients currently access NHS care and what improvements could be made.  Some patients used A&E departments as they could not obtain GP appointments, even though GP access in Dorset was considered one of the best in the country.  Data had been taken from both national and local surveys on access and the hard to reach groups.  This information had informed the national GP Forward View programme (GPFV) and in October 2017 engagement events would be held in Dorset to contribute to local planning.  The CCG continued to look at workforce planning, working with universities around primary care needs and how recruitment and retention of staff could be supported.  Investment in infrastructure and estates also continued.

The Chairman referred to paragraph 2.4 of the report and asked where the rest of Somerset, and Devon sat within the Local Medical Committees (LMC).  Officers responded that historically there had always been a Wessex Group with a strong national network and southern network.  It was recognised that patients should be able to access services and not be restricted by county boundaries.

The Committee queried how residents faced with the possibility of surgeries closing would access transport to and from their new surgery when public transport was not available.  Some thought was needed to be given to the way services were provided to ensure these people did not fall outside of the loop as it was no good suggesting changing surgery when there was no regular bus service.  It was reported that the voluntary transport co-ordinators did not have enough volunteers and were overburdened and that voluntary transport could not be relied upon to fill the gap if there was no suitable public transport.  Vulnerable people in rural areas could be disadvantaged if they had to pay for taxi fares that might cost in excess of £40.  In Bridport the community were trying to establish a community bus service to transport people from villages to hospital but this would need support from the CCG. 

The Committee asked for an explanation of what Project 1 and Project 2 entailed.  Officers explained they were looking at access and solution needs as a whole system integrated with the design of systems and hubs to include transport, whether voluntary or funded.  With regard to Project 1 and Project 2 there had been the opportunity to bid for national funding, Dorset had put bids together to the value of £50m and had received £10m.  This was not just bidding for premises but also technology in delivering care systems.  Capital was required to buy both hardware and software to support good work around telecare and using technology in people’s homes.

The Vice-Chairman recognised the importance of delivery of care and joining up of services but had seen a reduction in the number of community nurses.  She felt that surgeries directly employing community nurses was a better model as it enabled them to undertake the role of a district nurse too enabling better communication with housebound patients.

Officers considered it essential to have an integrated community and primary care service fully integrated into general practice teams, but noted that some surgeries preferred not to employ community nurses directly and that it might be better for Dorset HealthCare to be the employer, with the practice managing the nurses.

One member mentioned that merging practices might be beneficial as some practices might close as they could not attract new doctors but the key point was that it wasn’t the practice that was important it was the surgery as it was a point of contact for members of the public.  Services had to be accessible, especially in rural areas.  With regard to services being provided at Christchurch Hospital the infrastructure was such that it could take up to an hour to get from one side of Christchurch to another.  A key point to remember was that if surgeries and practices were merged a point of delivery where members of the public could access must be kept in place.

Officers commented that transport had been highlighted and the whole system would look at transport and determine where the flow of patients were coming from and going to.

The Chairman asked if the Outline Business Case for the New-build replacement for Wareham Health Centre was linked to the re-siting of Wareham School fields.  Officers responded that they were looking at the future of health care delivery and were keen to support a surgery with key provision by trying to manage both.

The Committee enquired as to how the CCG would be looking at east Dorset as there were certain times during the day when Bournemouth Hospital was inaccessible due to traffic congestion.  It was asked if hubs would be provided in the local area if St Leonards Hospital closed.  It was noted that consultation with the public should take place before any changes were implemented, although that had not been the case with the closure of two wards at Christchurch Hospital.

Officers confirmed hubs would be provided in the east across Poole, Bournemouth and Christchurch.  The clinical services review had been carried out and the CCG would be working with GP’s in Bournemouth and Poole looking at transport.  Nothing would close until there was a plan in place for patients to receive NHS service and their interests would be protected.

It was agreed that a report on ambulance services should be considered at a future meeting of the Committee, to look at availability and usage.  An inquiry day on emergency and non-emergency transport would be held and the CCG could inform the Committee of proposals with regard to transport and the data regarding journeys taken and how they would match with the clinical services review.  It was also agreed that the day would be held mid-December 2017 or early January 2018.

Officers confirmed there was a detailed report on the ambulance service which would be circulated to the Committee outside of the meeting.

Resolved

1.         That the Committee agreed recommendation 5.1 of the report.

2.         That a report on ambulance services be submitted to a future meeting of the Committee followed by an inquiry day on health related transport to which the CCG, and other key stakeholder be invited to attend.

3.         That the Deputy Director Transformation and Delivery, NHS Dorset CCG send an email a link to the Health Partnerships Officer, Adult and Community Services on the detailed ambulance services report to enable her to circulate to members of the Committee.