Agenda and minutes

1.1  Cllr. Snell gave apologies stating that he would have to leave early to attend another meeting.

2.1  The Chair stated that he had accepted a request from City and Hackney CCG and the ELHCP for an urgent item relating to a proposal for changes to the system of Health Based Places of Safety and he welcomed to the meeting:

Dan Burningham (DB), Mental Health Programme Director, City and Hackney CCG

2.2  Members gave consideration to 3 tabled documents:

a)  Cover report  Health Based Places of Safety in North and East London from East London Health and Care Partnership

b)  Executive Summary of Mental Health Crisis Care for Londoners HBPoS Business Case Draft from Healthy London Partnership

c)  London’s Mental Health Crisis Care Programme Stakeholder Engagement Report from Healthy London Partnership

2.3  Introducing the report Dan Burningham stated that Health Based Place of Safety provision across London was very uneven.  The space currently used at the Royal London Hospital was not fit for purpose and would fail a CQC inspection. The Homerton’s space was also fronting onto their busy A&E.  There was an issue about dedicated staffing and all had to pull staff off their wards when required for this purpose.  This London wide report addressed these issues by rationalising the number of sites and introducing dedicated staffing.  The preferred option was Option 3 (p.5 of report) which involved a reduction from 4 sites to 3 (Sunflower Court in Redbridge, Homerton Hospital and Newham General) with the site at Royal London in Tower Hamlets being discontinued.  He added that it was important to reassure Members that there was already a high level of Street Triage in place in City and Hackney (the Crisis Café, the Crisis Line etc) which provided the community support necessary to align with the HBPoS provision. 

2.4  Members asked if police cells had ever been used locally for Section 136 cases  whether there was sufficient capacity in the system, what was in place for 14-16 year olds and what work was being done with the police to better identify individuals in crisis. 

2.5  DB replied that there were no records of police cells having been used.  Staffing was a challenge as 3 members of staff were required at HBPoS sites to ensure proper and safe assessments.  No children would be seen in these sites.  Talk were ongoing with police on dedicated staff on their part for these functions. 

2.6  Members commented that the issue was surely the ability to respond quickly in these cases rather than the number of available sites.  DB replied that this was correct and this cohort wold not be taken to a police station. That category was outside the scope of this proposal.  He added the City of London accounted for half of Section 136 cases and police there had mental health workers with them.  There were dedicated nurses to ensure patients didn’t self-harm.  By having a dedicated staff as a result of these changes the processing times for these cases would be much quicker. 

2.7  Members’ asked about the subset of this group who may have  ...  view the full minutes text for item 2.

3.1  Cllr Snell stated that he was Chair of the disability charity DABD UK.

3.2  Cllr Maxwell stated that she was a Member of the Council of Governors of Homerton University Hospital NHS Foundation Trust (HUHFT).

4.1  Members gave consideration to the draft minutes of the meeting held on 19 November and noted the outstanding matters arising.

4.2  With reference to minute 7.19 on the vaccinations issue, Dr Mark Rickets (Chair, City and Hackney CCG) commented that Amy Wilkinson (Workstream Director, Integrated Commissioning) has asked him to draw to Members’ attention that no additional funding had actually been received from NHSE London over and above the CCG funding.  He added that it takes time the effect of an immunisation drive to show up and while the rate had dipped it was now back up. The first cohort concerned here should now be fully immunised and we would see a consistent fall in cases.  Laura Sharpe (Chief Executive, City & Hackney GP Confederation) added that Haringey CCG had now confirmed that it would now invest in the GP Confederation’s immunisations project in South Tottenham (next to the cohort being targeted in the north of Hackney).  There had been 2 new cases recently identified by NHS 111.  They were still awaiting the overall data from NHSEL.  She added that NHSEL had stated it would pay £2.80 extra per immunisations at Practice level above the standard payment but the main funding for this response was coming via the two CCGs.  MR added that NHSEL was only paying this for immunisations given outside the core hours.  Richard Bull (C&H CCG) added that NHS 10 Year Plan published that day made reference to an overhaul of the immunisations system. 

4.3  The Chair offered the Commission’s support for any necessary lobbying required on this immunisation issue.  He also stated that as the issue crossed NEL borders it would also be raised at INEL JHOSC and that would be meeting very shortly now that Newham had taken on the Chair.  He added that he had also recently attended a London JHOSCs Forum where the issue of the poor engagement of councils with STPs generally had been discussed.

5.1  Members gave consideration to the draft Terms of Reference and Scope for their review on ‘Digital first primary care and its implications for GP Practice’.

6.1  The Chair stated that they would now begin the evidence sessions for the review and he welcomed the following to the meeting:

Paul Bate, Director of NHS Services, Babylon Health/GP at Hand

Dr Mark Rickets, Chair, City and Hackney CCG

Sunil Thakker, Chief Finance Officer, C&H CCG

Richard Bull, Programme Director – Primary Care, C&H CCG

Laura Sharpe, Chief Executive, City and Hackney GP Confederation

Dr Fiona Sanders, Chair, City and Hackney Local Medical Committee

6.2  Members gave consideration to the following papers in the agenda:

(a) Presentation from GP at Hand ‘Progress to date’

(b) Presentation from GP at Hand ‘Variation on NHS payments per patient’

And to the following papers which were tabled:

(d) Briefing from City and Hackney CCG

(e) Briefing from City and Hackney GP Confederation ‘Digital solutions in City Hackney Primary Care’

(f) Briefing from East London Health and Care Partnership ‘Primary Care Digital Across NEL’

(g) Evaluation of GP at Hand Progress Report December 2018 from Ipsos MORI/ York Health Economics consortium report commissioned by Hammersmith and Fulham CCG and NHSE London

The Chair added that Jane Lindo from ELHCP was unable to be present but had submitted a written presentation and would come to a future meeting.  The contribution from Hammersmith and Fulham CCG was via Mark Jarvis their Head of Governance and Engagement who offered further input from H&F CCG if necessary.  It was noted that the Commission would await with interest the publication of the full assessment report on GP at Hand in April and it would feed into the Commission’s own conclusions and recommendations.  The report tabled was essentially an outline of how they were going about this high level evaluation of GP at Hand.

6.3  Introducing his reports Paul Bate (PB) outlined the history of Babylon Health which was the owner of GP at Hand.  Among their other businesses was providing the NHS111 service in NW London.  GP at Hand was a fully registered NHS GP Practice service.  Patients were guaranteed video appointments on their smart phones within 2-3 hours of calling.  95% of their patients gave them 4 star ratings.  Of their patients only 15% required follow up face to face and this was provided in 5 clinics across London including Kings Cross, Canary Wharf, Westminster and Fulham.  They had 200 GPs and they reviewed 50% of all video recordings to ensure quality control.  He added that it was not correct that they only targeted healthy people and that they never took on patients with complex needs.  He explained that they had a Care Coordination Tem who work with those patients.  He added that their second papers described what they maintain was a 6 fold differential in funding between what  a 25 year old and an 85 year old received from the NHS.  Their average NHS income was £91 per patient whereas for others the average was £144.

6.4  Dr Mark Rickets (MR) introduced their paper and explained  ...  view the full minutes text for item 6.

7.1  Members noted the following background reports for the review:

1.)  NHS Digital data update on GP at Hand/ Lillie Rd Practice from City and Hackney CCG/LBH/CoL Public Health Intelligence Team

2.)  NHS UK website note on ‘Patient choice of GP Practices’ and the change in the law which enabled this

3.)  NHS UK website note on ‘Seeing same doctor every time reduces risk of death’

4.)  FT article on “High profile health app under scrutiny after doctors’ complaints” on the controversy around the AI algorithm which is used.

5.)  Review from British Journal of General Practice by a professor of Primary Care Health on recent book on ‘Challenging perspectives on organizational change in health care’

6.)  Louis Peters, Geve Greenfield, Azeem Majeed, Benedict Hayhoe, Imperial College London The impact of private online video consulting in primary care, in Journal of Royal Society of Medicine, Vol 111, Issue 5, 2018

7.)  Greenhalgh T, Vijayaraghavan S, Wherton J, et al Virtual online consultations: advantages and limitations (VOCAL) study British Medical Journal Open 2016; bmjopen-2015-009388

8.1  Members gave consideration to the latest draft of the Work Programme for the year.

8.2  The Chair added that the NEL Estates Strategy would be taken forward at the INEL JHOSC which he hoped would schedule a meeting in early February.  He was also asking for the Single Financial Officer for ELHCP also be on the agenda.

8.3  Carol Ackroyd (Hackney Keep Our NHS Public) asked if the Commission could have a future item looking at The NHS Long Term Plan which had just been published that day.  She stated that the Commission needed to pay particular attention to the proposals in it for legislative change to usher in Integrated Care Systems.  The Chair agreed.

9.1  There was none.