Minutes:
*O&S(E) 16
As highlighted in the Public Forum session (Minute *O&S(E) 14 above refers), Ms Crawley was in attendance at this meeting to address the Committee and respond to Member questions. In addition to Mr Eady’s submission, the following questions had been received in advance from Council Members:
Questions from Cllr Robert Oxborough:
1. Is the Devon Doctors service being withdrawn?
2. If so, what arrangements will be in place to provide out of hours GP cover in WD?
3. In the event that the service is withdrawn, will there be additional community nurse support provided from the outset (current community nursing staff appears to be at capacity).
Questions from Cllr Neil Jory:
1. There has clearly been considerable pressure on social care budgets and spending in recent years and much publicity about the adverse knock-on effect that this has had on the NHS and its ability to deliver services. This situation is likely to have the greatest impact on the most vulnerable members of our society - those who are elderly, homeless, learning disabled, alcoholic, drug dependent and have low incomes. Can you tell me what is being done to protect those members of our community from these pressures?
2. The answer to the problem outlined in my previous question is widely promoted as being the delivery of integrated health and social care (through the Better Care Fund). Can you tell me what progress has been made towards the integration of health and social care services in this area?
3. There has also been considerable publicity over the financial pressures on Doctors' surgeries in recent years. My understanding is that the vast majority of income for surgeries comes from commissioned services funded by the NHS. Can you outline the extent to which surgeries are subject to audit - both in terms of their financial management and the delivery of commissioned services - to ensure that public funds are being properly accounted for and to ensure that patients are receiving the level of care and services that are being funded?
4. What effect, beneficial or otherwise, is political devolution and the proposed creation of the Heart of the South West authority likely to have on the delivery of NHS services in this area?
In responding to all of the questions received in advance, Ms Crawley made particular reference to:-
(a) lessons learned from the closure of the surgery of the Ockment Centre, Okehampton. Ms Crawley advised that a number of lessons had been learned from this closure including the need to involve and consult with local authorities and local ward Members from the offset. Specifically regarding the closure of the Ockment Centre, the Committee was advised that this decision had been taken since it was not considered to be financially viable moving forward;
(b) the relationship between NHS England and the NEW Devon CCG. Ms Crawley made the point that a number of the advanced questions that had been submitted were in fact the responsibility of the NEW Devon CCG (e.g. the commissioning of out of hours care provision). A detailed and lengthy debate ensued during which it was apparent that there was a lack of clarity and great confusion around the different roles and the relationship between the NHS England and the NEW Devon CCG. The Member frustrations were echoed by members of the public who were present and, at the discretion of the Chairman, Dr Gude was invited to address the Committee. In so doing, Dr Gude read the following statement:
‘I am Dr Gude, who was a GP here for 25 years. Thank you for coming here to answer our questions. I want to ask about something that you are not directly responsible for but wish you to take back to NHS England.
Simon Stevens, as Head of NHS England, is responsible for the health service in England. The CCG’s are responsible for commissioning health care and their actions are the responsibility of NHS England.
1. Will you take back to NHS England the very strong feelings of local people about the outrageous action of the CCG to cut back out of hours services without any local consultation either with the Council, the local GPs or the public?; and
2. Will you be able to persuade NHS England to send a directive to the CCG to put the changes on hold so that appropriate local discussions can take place?
When the CCGs were created as a result of the Health and Social Act being passed in 2011, it was said that power would be passed to GPs. This has obviously not happened since local GPs were not consulted.’
Specifically regarding this statement, Ms Crawley assured Dr Gude that she would ensure that these comments are relayed accordingly.
In reflecting the frustrations of the meeting, the Chairman made the formal request that NEW Devon CCG representatives should be invited to a future meeting. Furthermore, in light of the tight time constraints associated with a number of these issues, it was felt that this would need to be a special meeting that was organised at fairly short notice. The Committee endorsed these sentiments and felt that the representatives would be in a better position to both respond to a number of the questions raised in advance and highlight the role of the organisation and how it fitted into the wider public health agenda;
(c) the need for a pro-active approach to be taken to care planning was recognised and welcomed by the Committee;
(d) the funding for GPs surgeries being based upon the numbers registered and the consequent age and gender profile. However, Ms Crawley proceeded to inform that there had been a recent move to standardise the payment for all GP surgeries, which would result in smaller surgeries benefiting more than larger practices. In respect of audit requirements and spending reviews, the importance of these were recognised by NHS England, but there was also felt to be a balance to be struck to ensure that these were undertaken in a proportionate manner.
In concluding the agenda item, the Chairman thanked the Members and the public who had contributed to this agenda item. In addition, the Chairman thanked Ms Crawley for her attendance and responses but felt that this item had unearthed a number of issues that required the further detailed consideration of the Committee.