Agenda and minutes

1.1  An apology for absence was received from Cllr Oguzkanli.  Apologies also received from Dr Kathleen Wenaden, Dr Sandra Husbands and Helen Woodland.

2.1  There were no urgent items and order of business was as per the agenda. The Chair stated that this would be the last meeting of this administration prior to the elections.

2.2  The Chair thanked Jon Williams who would be departing as Executive Director of Healthwatch to begin a new engagement role at NEL CCG in Tower Hamlets, for his service to the borough and for his always positive engagement with the work of the Commission. 

3.1  It was noted that Cllr Snell was Chair of the Trustees of DABD UK.

4.1  The Chair stated that most of this meeting would be devoted to this discussion and the purpose was to to gain a better insight into the strategic issues which are driving primary care locally and to look forward to what GP services might look like in five years’ time. There would be 8 short presentations and there would be a Q&A after the first 4. 

4.2  Members gave consideration 5 briefing papers:

4b Note from NEL CCG Primary Care (to follow from Richard)

4c Note from GP Confederation

4d Note from Office of PCNs

4e Note from Clinical Effectiveness Group at QMUL

4f  Note from Healthwatch Hackney (primary care section of draft strategy)

4.3  The Chair stated that unfortunately the current Chair of PCNs Dr Kathleen Wenaden had to give late apologies.  He welcomed to the meeting:

Dr Kirsten Brown (KB), Primary Care Clinical Lead for C&H Partner at Spring Hill Practice and The Lawson Practice

Laura Sharpe (LS), Chief Executive, GP Confederation

Dr Deborah Colvin (DC), Partner at Spring Hill Practice and The Lawson Practice

Dr John Robson (JR),  Clinical Reader in Primary Care Research and Development and Clinical Lead for the Clinical Effectiveness Group at the Queen Mary University of London

Malcolm Alexander (MA), Chair, Healthwatch Hackney

Richard Bull (RB), Programme Director Primary Care, NEL CCG

Dr Vinay Patel (VP), Clinical Director for Woodberry Wetlands and Springfield Park PCN and Chair of Local Medical Committee

Dr Ellie Jacob (EJ), Clinical Director, Hackney Downs PCN

Dr Haren Patel – joint Clinical Director for Hackney Marshes PCN

Caroline Millar, Chair, GP Confederation.

4.4  Dr Kirsten Brown, Primary Care Clinical Lead for C&H gave a presentation on how GPs are commissioned and the different types of contracts - GMS, PMS and APMS.  The majority are on GMS, 8 are on PMS and 5 are on APMS.  All new contracts are APMS contracts now.  She clarified that GMS and PMS are in perpetuity and are very similar. PMS contracts were being phased out as they had been equalised with GMS. The APMS contracts were just for 15 years and have to be re-procured. The majority of Practices are Partnerships but AT Medics runs Trowbridge and Hurley Group runs Allerton Rd Practice. She also detailed how the ‘core contract’ worked and the Carr-Hill funding formula. She also explained how Directly Enhanced Services and Local Enhanced Services operated. 

4.5  Richard Bull (NEL CCG) detailed how the CCG handled the contract management on behalf of NHS England.

4.6  Laura Sharpe(CE of GP Confederation) gave a presentation on local commissioning arrangements on top of the national arrangements. C&H has the greatest number of additional services in East London, delivered via the GP Confed, resulting in an additional £10m a year going into local Practices. She explained the switch from having a reactive to a more proactive model of service in supporting for example those with Long Term Conditions. She explained the principle of ‘total population coverage’ which underlines the Confed’s  ...  view the full minutes text for item 4.

5.1  The Chair stated that the Local Pharmaceutical Committee had contacted the Commission expressing concern about plans to end the current arrangements under the Medicines Optimisation Scheme which they say will adversely impact nearly 4000 patients locally. The Commission last dealt with this issue in March 2018 and had expressed concern then about planned reductions in these services then.

5.2  Members gave consideration to:

a) Briefing NHSE Commissioned Medicines Optimisation Scheme from

b) Briefing from Local Pharmaceutical Committee

5.3  The Chair welcomed for this item:

YogendraParmar (YP), Chief Support Officer, Local Pharmaceutical Committee

RozaliaEnti (RE), Medicines Management at NEL CCG City and Hackney

5.4  YP took Members through his briefing paper which outlined their concern that NHSE was terminating the scheme which had funded dosette boxes and blister packs and it would now only be funded for the much smaller cohort identified as having a need under the Equality Act and carers and care agencies among others had expressed concerns about this.

5.5  YP clarified to the Chair that there were c. 500 patients in Hackney who might still be supported under the Equality Act but there was another c. 3000 who would lose out. Members noted that the scheme had been discontinued in the vast majority of London boroughs. The Chair asked whether the pharmacies were backfilling the funding by requesting 7 day prescriptions and using this as a lever. YP explained that in other boroughs, where it's not funded, there is now a mixed economy in operation and the scheme is funded informally from general practice via use of 7 day prescriptions or the pharmacies absorb the loss so it was difficult to properly benchmark the impacts. The Chair observed that unfortunately it was typical of how central government worked - to provide funding for a new scheme for a time, then to withdraw it and then expect professionals to pick up the shortfall, and this happened in other public sector spheres. The Chair invited the CCG (who are not the commissioners here) to explain their position on the issue.

5.6  Rozalia Enti (NEL CCG) detailed the background and history of the scheme to provide context to NHSE London’s decision. She stated that the NEL CCG City and Hackney had been pushing back on NHSEL to not end the scheme without proper mitigation being put in place. The CCG had started to facilitate the evolution to a new system by analysing the underlying data and providing guidance to the local pharmacies. She explained that some GPs were of the view that as many of the patients did not fall under the Equality Act definition, pharmacies should therefore not be requiring 7 day prescriptions for them. She clarified that the formal national position of NHSE was that pharmacists should not be routinely using 7 day prescriptions to backfill this loss of income. She added too that there was a misconception that having a dosette box would always make patients compliant with the proper use of their medicines.  ...  view the full minutes text for item 5.

6.1  The Chair stated that he had asked Public Health to provide a further update on the Covid-19 situation in the borough. The Commission had been receiving these at each meeting during the course of the pandemic.  He welcomed to the meeting: Chris Lovitt (CL) Deputy Director of Public Health for City & Hackney.

6.2  Members gave consideration to a TABLED briefing report Covid-19 update to HiH 16 March 2022. CL advised that as there had been a surge in cases since the previous week he was therefore presenting an even more updated set of slides than in the circulated paper. The most up to date data was now on the Covid dashboard at Coronavirus data | Hackney Council.  This indicated a 49% increase in cases overall and a 51% increase for the 60+ age group. Hospitalisation rates had also risen and one of the challenges now was that immunity from the booster infections was waning and current levels of natural immunity do not provide sufficient protection against the current sub variant. The numbers getting vaccinated had also eased off significantly.  He added that they now only have 1 or 2 weeks of full data before the end of mass free testing (and reporting) which will have the effect of lowering Public Health’s ability to track the epidemic as they will only have hospital admissions and the ONS studies to work with. He added that while the end of legal requirements was welcomed by many, the epidemic had not passed and the same Public Health messages must still be heeded. These messages had been crowded out in the media. He urged the public to continue with such measures as mask wearing, frequent hand washing and attention to ventilation. These local figures were part of an unfortunate national trend and we could be stirring up significant difficulties for ourselves over the next few weeks, he added.  He clarified that the current spike was down to a new sub-variant of Covid called Omicron BA.2.

6.3  The Chair thanked Public Health for the update and stated that this was sobering news.

RESOLVED:

That the reports be noted.

8.1  Members gave consideration to the draft minutes of the meeting held on 9 February 2022 and the Matters Arising.

RESOLVED:

That the minutes of the meeting held on 9 February be agreed as a correct record and that the matters arising be noted.

8.1  Members gave consideration to the updated work programmes. 

RESOLVED:

That the Commission’s work programmes for 21/22 and the rolling work programme for INEL JHOSC be noted.

9.1  There was none.