Present:
Dr C. Clayton, Chair, NHS BwD CTP
Dr M. Ridgway, PEC Chair /Medical Director, NHS BwD CTP
Dr A. Garda, Clinical Lead, NHS BwD CTP
Dr P Muzaffar Clinical Lead, NHS BwD CTP
Dr B. Barr,Consultant in Public Health, NHS BwD CTP
Mrs. V. Hollings, Director of Commissioning, Development & Planning NHS BwD CTP
Mrs S. Whiteoak Practice Manager, NHS BwD CTP
Mr. D. Kerambrum, Director of Health & Wellbeing, BwD Borough Council
Mrs J. Thomas, Director of Governance & Standards, NHS Central Lancashire &
NHS BwD PSU
In attendance
Mrs J. Wild, Head of Service Transformation, NHS BwD CTP
Mrs. L. Harwood Head of Mental Health Commissioning, NHS BwD CTP
Mrs J. Riley, Head of Service Transformation, NHS BwD CTP
Mrs A. Westwood, Service Transformation Manager,
Mr. J. Herring, Service Manager LCFT
Paul Conlon, Democratic Services, BwD Borough Council (Minutes)
1. Apologies for Absence.
Apologies for absence were submitted on behalf of Rosemary Emmonds, Linda Clegg, Dominic Harrison, Paul Hinnigan and Dr. Zaki Patel.
Dr Clayton welcomed all those present to the meeting and with the agreement of the board amended the order of the agenda.
2. Carers services specification.
Alison Westwood outlined the work that was on-going on the Carers Service Specification. The impact on health of carers and the economic value and impact of the break scheme that has been funded by Blackburn with Darwen was highlighted. The work of the Liverpool pilot which had proved successful would be used as a model. The costing used in the model would be used here. There was £93k for funding short breaks made available by Care Trust Plus. It was pointed out that the carers did not necessarily need the maximum budget that was available however support and guidance was essential. A further area being reviewed was the carers making themselves known to their GPs and annual health checks. Clarification was sought about the responsibility of carer’s health and that they should not be prescriptive and have to undergo a medical every year but could be reviewed when they felt necessary. In response to a question on the access to the service by children it was started that this service was for adult carers and that money had been passed over to support Young People as carers.
David Kerambrum stated that the council supported carers through day care centres etc and that there was an overlap in provision that would need to be addressed to ensure that need and additionally would be addressed.
It was agreed that the scheme was progressed subject to the minor amendments suggested.
3. Minutes of the meeting held on 31st March 2011.
The minutes of the meeting held on 31st of March 2011 were agreed as a correct record.
4. Matters arising
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Influenza programme for Nursing Care Homes and Housebound- this was being progressed within the LCFT contract for District Nursing as part of the three year contract. The need to ensure that the programme worked was stressed;
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Haemodialysis provision in Blackburn- a further report would be submitted to the Committee in the near future;
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Woman to Woman Project- This evaluation report would come back in draft to the Committee;
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Triple 111 project- a report would be submitted to the meeting in June;
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Direct Access- Pathology/ Laboratory Medicine- work was on-going on the issue to achieve a more cost effective Path service with the aim to rationalise and introduce items of service and not blocks of provision;
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Mental health- there was no further developments to report;
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Re-admissions audit- this was being worked on and Dr. Ridgway would talk to Anne Asher on progressing this issue;
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Date of the next meeting- it was agreed that the next meeting would need to change due to a number of clashes. Proposed alternative date 19 May;
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Prescribing initiative scheme- this had been sent out for comments and the group would try to come up with a reasonable formula. Budgets would be re-examined and Dr. Ridgway would take the lead.
5. Mind Care Organisational Restructure.
John Herring outlined the intended changes to Mindcare service provision. The chair asked how this would improve the service provided and in response it was stated that the key issues were to reduce waiting times by reducing management at neighbourhood level and in doing so increase therapeutic interventions working across the wider Blackburn with Darwen area. There was also an inequity of staffing across the existing neighbourhood teams leading to longer waiting times in some geographical areas and this would be addressed through the changes. There was also scope to share specialist posts across the East Lancs footprint.
In response to a question it was reported that the service update had been brought to this meeting to allow questions and for reassurance. There was some general discussion on the following points;
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The single point of access and the intention to move to Choose and Book
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Referrals from other professionals and agencies – this is limited to reduce inappropriate referrals.
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Referral form – this needs amending – MR to action
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Rapid access to services for urgent referrals
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Choice of therapists/ therapeutic interventions.
It was asked if employment support was built into the proposals. In response it was stated that the service exceeded the IAPT employment targets however, further work and support was being undertaken on the whole social inclusion agenda through the Community Re-start team and two new additional social care posts that had been identified through service remodelling in social services.
A GP complaint was raised through the meeting and it was reiterated that the Mindcare service manager, Vicky Baker, should be contacted by GPs whenever there was a service issue. This would raise awareness of the issues GPs had with the service and would allow them to be rectified quickly.
A question was raised with regard to access to the service for over 65’s. It was acknowledged that the service was now accepting referrals for this cohort and that this was being closely monitored to ensure that capacity could meet demand. A member of staff from the older adult CMHT had been identified to work in the service to support this development.
6. Primary Care QIPP
The Board considered a report setting out recommendations relating to the primary medical services access and responsiveness recommendations. The issues of ghost patients was highlighted as an area that was being examined and it was stated that this was being looked at monthly by LASCA. This was not a new issue and had been looked at previously. Work was on-going on bringing all the issues together and they would be examined as work streams, particularly on access arrangements. The board would be kept up to date with developments.
7. Urgent/Ambulatory Care
The board were informed that the pathways were being examined and this was on-going. Dr. Garda stated that any condition could be classed as this as long as it did not need a bed. The issues would continue to be developed as there was a strong clinical case however it could be years before fully operational and 12 months before any potential ward closures. It was stated that the costings needed to be evaluated and how this would be done across East Lancashire.
8. Invoicing for Jill Bell and Kathryn Davies
It was noted that the board had paid towards these posts in the past and agreed that this should continue as the work was valuable and that the future funding and from where should be examined and reported back to the board.
Action: VH to check previous budget.
9. GP Referral Pro-forma
Dr Ridgway stated that progress depended on educating clinicians to the requirements and this could be achieved through peer support where necessary. Triage would be looked at separately. Dr. Ridgway also explained the potential use of Shared Decision Making which had been shown to reduce the number of patients opting for surgery. There was a clear need to get GPs to buy in to this. The Board agreed for Dr. Ridgway to progress as lead for Demand Management.
10. Minor Oral Surgery – Demand Management
The Oral Surgery demand management scheme was presented and agreed by TCB members. It was noted that the savings under the scheme were conservative and there is potential in the future to be increased. It was also recognised in the initial stages there would be potential double funding required due to patients already been referred prior to the commencement of the scheme in December. It was agreed that updates and reports would be received at TCB.
11. Insertion of Long Term Tunnelled Drains
The issue of treatment of patients with long term Tunnelled Drains in the community was discussed. It was stated that Community Nursing had not been contracted to deliver services to these patients in the community. The treatment delivered value for money as it kept people out of hospital but transferred a cost on to the commissioning team. Attention was drawn to the fact that community nursing staff may already be visiting the patients and this therefore may not always be an additional visit however it was pointed out that this was having a significant impact as visits to carry out this treatment would be more frequent than carried out at present. It was stated that whilst the business case looked good, there would be a need to look at the threshold where it would impact on the service. This was felt to be at a level of up to 20 cases with a minimum of 8. It was noted that there was also a need to obtain financial sign off for this.
Action: JR to discuss with Finance before progressing.
12. Heath Outcomes
Following discussion the proposals for development of the Healthy Outcomes LES outlined to the Board were agreed. Dr. Clayton requested some further information regarding the evaluation and outcomes of the Health Checks Programme.
Action: JR to forward Health Checks information to Dr. Clayton
13. Locally Enhanced Service for DVT
The board considered a draft report setting out an investment to save money on the treatment of DVT.
The board looked at the two pathways involving the use of the d.Dimer test and the Wells Score. The need to pay GPs for carrying out the tests was discussed and the appropriate levels and what would trigger payment as an incentive for carrying out appropriate treatments. Following discussion the pathways set out in the report were agreed and that the payment to GPs be made following the carrying out of the Wells and d.Dimer tests and this payment be set at £28 and reviewed after a year if implemented. The GPs carrying out the tests would be required to undertake training and assessment. The board noted the contents of the specification and supported the implementation of the new specification within general practice and presentation at LMC in May subject to clarification on pathways issues now discussed.
Action: JW to confirm current payment in NHS EL to ensure consistent
14. Locally Enhanced Service for Minor Surgery
The Board were informed that this would standardise service across East Lancashire. The need to look at the coding to get more robust data for audit purposes was noted and would be reported to the next meeting. The board noted the contents of the specification and supported the implementation of the new specification within general practice and presentation at LMC in May.
15. Locally Enhanced Service for Amber Drugs
The board received a report setting out the LES for Amber Drugs. The need to include Methertrexites would be picked up with Lindsey Holden. The board noted the contents of the specification and supported the implementation of the new specification within general practice and presentation at LMC in May.
16. Falls and Fragility Fracture Prevention and Executive Summary.
The board looked at the work to date in the area of falls and Fragility Fracture Prevention. The need to bring a clinical lead into the area to help move forward and clarify the direction was outlined as was the work of the ambulance service and their pathfinder project. It was agreed that a clinical lead be brought in to the process and that the work be noted.
17. Date of the Next Meeting
It was agreed that the date of the next meeting be amended to take place on 19th May 2011.
