Agenda and minutes

1.1  Apologies for absence were received from Dr Sandra Husbands, Janet McMillan and Cllr Maxwell (Cabinet Advisor for Older People).

2.1  There was none.

3.1  Cllr Samatar stated she was a Wellbeing Network Peer Coordinator for Mind in City and Hackney.

4.1  The Chair stated that Members have been raising a number of concerns about GP access and quality and these are summarised on pp.12-14 of the agenda pack, and NHS NEL was invited to the meeting to address these.

4.2  He welcomed: Dr Kirsten Brown (KB), GP partner at Spring Hill Practice and The Lawson Practice and Primary Care Clinical Lead for City and Hackney, NHS NEl and Richard Bull (RB), Commissioner for Primary Care at NHS NEL, formerly at City and Hackney CCG

4.3  Members gave consideration to 2 reports: Local GP Services - access and quality’ and Patient feedback from Care Opinion, both from NHS NEL Primary Care Commissioning.

4.3  KB took members through the report. She focused on workforce issues and the crisis in General Practice adding that the complexity of presentations at GPs was now much greater and that people were now living longer with Long Term Conditions, there were more mental health issues and high levels of deprivation such that people don’t know where to turn for help.  She noted how heart disease and diabetes for example wee now looked after in General Practice whereas they used to be in hospitals.  In addition A&E was bursting at the seams and so there was a knock-on effect on primary care.  She explained how Hackney had one of the highest GPs-Patient ratios in London. She explained that a key part of their response to this challenge was the recruiting of Additional Roles so that she now works as part of a multi disciplinary team, rather than a sole practitioner, which she found much better. On Patient Experience data, Hackney performs very highly vis a vis London and England and there were more GP consultations and Hackney has one of the highest rates of Face to Face appointments.  On telephone triage there is no perfect system but they work continually to improve it.  City and Hackney has very low levels of calls to NHS 111 within standard GP practice hours which is testament to high performance. She explained the Duty Doctor contract which is not universally available but a major part of the mix in Hackney. 

4.4  Members asked Questions and the following was noted in the responses:

KB explained that Triage refers to all patients contacting primary care and the need to direct them to the right service.  ‘Duty Doctor’ relates to urgent on-the-same-day care. Patients get called back within 2 hours as do paramedics or other professionals who require quick responses.

RB explained that the Duty Doctor was funded through the GP Confederation and they get extra money to ensure they can employ additional doctors to fulfil that role.

KB explained that there is a need to increase the understanding and awareness in the community about these additional roles and a need to continue to work with patients to make things as easy as possible.

RB explained that another indicator of high performance was not having any closures as a result of CQC inspections (unlike  ...  view the full minutes text for item 4.

5.1  The Chair welcomed Cllr Chris Kennedy (CK), Cabinet Member for Health, Adult Social Care, Voluntary Sector and Culture, adding that this is an annual item where all Cabinet Members are required to attend their relevant Commission. There is no written report but three topic areas are sent to the Cabinet Member in advance so that the discussion can be focused.  The three questions are:

Q1) How to protect a local voice for Hackney and to retain a meaningful element of local commissioning, fed by local knowledge, within the ICS 

Q2) How to develop and expand Homecare and intermediate solutions (e.g. Housing with Care, step down flats) to reduce the growing need for Care Home places

Q3) How PCNs are working for the community and improving access to primary care

Cllr Kennedy gave a detailed verbal response on the three topic areas and in the questioning the following was noted.

5.2  In a comment on the previous item CK reminded Members that England had lost 4000 EU national GPs post Brexit

5.3  In answer to Q1 Cllr Kennedy explained the NEL and City and Hackney Place Based Structures.  There were now just 42 ICSs in the country with 5 in London. The main NEL ICB meets 4 times a year and the ICPB (above it) has about 40 members on it comprising all cabinet members for health, directors of adult and children services etc from the 8 authorities as well as VCS representatives and others. He explained the local end of the ICS is the City and Hackney Health and Care Board which is our local Place Based Partnership. At the main decision making ICB level there is 1 LA rep for inner NEL and it's on a rotating three year basis and the current rep is Mayor Glanville from Hackney. He is also on the important Treasury Sub Cttee of ICB so Hackney has a strong voice.  In addition Dr Mark Rickets, our former CCG Chair,  is one of two Primary Care reps for all of NEL on the NEL ICB.

5.4  The 4 core priorities of C&H HCB are: Babies, children and young people; Long Term Conditions;  mental health; and employment and the workforce. ICB and ICPB are public meetings and papers are available. They do want to move to in-person and they want to encourage public attendance and public questions. Our old CCG got rated outstanding many times and it is very clear, he added, that the extra funding spent then is now reflected in the better outcomes for patients.  Our worry is how to protect this level of quality, adding that the argument he makes is to remind people what happens to an acute hospital’s performance when you invest in what happens outside of it in the wider community. 

5.5  CK highlighted how the recent statistics on residency of patients presenting at the Emergency Department at the Homerton had shown that the percentage of City and Hackney residents had declined from 75% to 66% due  ...  view the full minutes text for item 5.

6.1  Members gave consideration to the draft work programme for 2022/23.

6.2  The Char outlined the planned items for the next meeting:

Work by ELFT in tackling inequalities in local mental health services

Future options for Soft Facilities Services at the Homerton

Community Diagnostic Centres - local impact (Homerton update)

New Hospital discharge funding scheme - Adult Services update

RESOLVED:

That the work programme for 2022/23 be noted.

7.1  Members gave consideration to the draft minutes of the meetings held 5 December 2022 and the Matters Arising.

RESOLVED:

That the minutes of the meetings held on 5 December 2022 be agreed as a correct record and that the matters arising be noted.

8.1  There was none.