To receive a presentation by the Clinical Commissioning Group updating the Committee on Primary Care services in West Cumbria followed by questions and answers with Members of the Committee.
The Committee firstly received an update from the Clinical Commissioning Group on primary care in West Cumbria which included recruitment/staffing issues and development of primary care communities in Allerdale and Copeland. Secondly, together with North Cumbria Trust an update was provided on discussions regarding hospital services and other key issues such as feedback from discussions with the Northern Clinical Senate and issues concerning the North Cumbria Trust’s Options Appraisal paper.
A concern was raised regarding managing conflicts of interest if CCGs took on more of the role of commissioning GPs from NHS England with the introduction of ‘co?commissioning’. It was explained that as only level 1 (lowest level, therefore, the area team of NHS England would retain responsibility for GP commissioning) had been applied for this was not a significant issue. It was agreed that a copy of the ‘Managing Conflicts of Interest’ policy document would be circulated to the Committee for their information.
The Committee raised their concerns regarding the future of GP services in rural areas and it was acknowledged that flexibility was required to deal with individual community needs.
Members discussed the role of specialist nurse practitioners and were informed that extensive training had taken place which enabled nurses to take on certain GP roles but were assured that support was always available from GPs. The problem with recruitment and retention of nursing staff was highlighted and it was emphasised this needed to be investigated as soon as possible as the situation was critical.
The Committee received feedback on discussions regarding the Options Appraisals paper which included:-
Ø acute medicine
Ø obstetric and midwifery care
Ø planned care and outpatients
The Trust had sought views of the public and its staff through public roadshows facilitated by Healthwatch and an online survey which had also been analysed by Healthwatch. The North Cumbria University Hospital Trust emphasised their commitment to continue engagement and update the Committee as necessary.
The Committee received feedback on discussions regarding hospital services with the Northern Clinical Senate which comprised independent senior doctors and nurses hosted by NHS England. They were invited to provide advice about a small number of high risk patient pathways where it was thought seriously ill patients may benefit from transferring to Carlisle for their treatment ie heart problems, significant bleeding in the stomach or bowel, respiratory problems, stroke and very poorly older people when they were discharged from accident and emergency.
Members were informed that with regards to the first two pathways the majority of patients with those conditions would continue to be treated at Whitehaven with a small number being transferred to Carlisle for 24 hour specialist care to improve their chances of survival. It was emphasised that the patients who were transferred for treatment would be discharged home or returned back to Whitehaven as soon as possible. Discussions continued with the Senate regarding the last three pathways.
During the course of discussion Members raised their concerns at the lack of communication between the CCG and the Committee regarding the full Clinical Senate paper and it was agreed that this would be circulated to Members as soon as possible.
In conclusion the Committee were informed that the immediate priorities for the CCG and North Cumbria University Hospital Trust were:-
Ø meet with the Cumbria Health Scrutiny Committee and request them to consider whether the proposals constitute a ‘substantial’ service change in high risk pathways for heart patients and those with significant bleeding in stomach and bowel;
Ø agree a process for consideration of other high risk pathways as and when necessary;
Ø consideration of all feedback from the Trust’s Options Appraisals paper be taken into consideration:-
· maternity (and paediatrics) – await outcome of Cumbria-wide independent review of maternity services
· moving forward with acute medicine (including high risk pathways)
· moving forward with planned care
Ø consideration be taken of the Care Quality Commission revisit at the end of March.
The Chair thanked everyone for their presentation and highlighted the need for careful consideration to be taken of the consequential impact of incremental changes in all parts of the system and the knock?on effects they could have.
The Committee recognised both the desire to improve safety and external regulatory pressures which meant that all partners in the health system needed to be able to alter their operations in an agile and timely manner.
Health Scrutiny was committed to work with their partners to ensure that their internal processes did not unnecessarily delay the necessary improvements. However, the Committee had an important role in ensuring that any changes that were proposed met the needs of the people of Cumbria and, therefore, brought a different perspective that balanced clinical issues with an individual’s right to access services and the overall impact of any proposals on the whole health system.
The primary aim of health scrutiny was to strengthen the voice of local people, ensuring that their needs and experiences were considered as an integral part of the commissioning and delivery of health services and that those services were effective and safe. The Committee would, therefore, continue to ensure that the impact of any proposals, including any cumulative impact, was scrutinised in a transparent way ensuring appropriate accountability for any suggested changes.