Agenda and minutes

There were no declarations of interest.

The minutes of the meetings held on 11^th and 18^th October, 2017 were signed as true records. There were no matters arising.

Report of Andrea Green, Coventry and Rugby Clinical Commissioning Group

(CCG) who has been invited to the meeting for the consideration of this item  

The Board considered a report of Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) which set out the current position of primary care within Coventry and outlined the future primary care planning arrangements. Andrea Green and Jenni Northcote, Coventry and Rugby CCG, and Justine Richards, Coventry and Warwickshire Partnership Trust (CWPT) attended the meeting for the consideration of this item. Councillor Abbott, Cabinet Member for Adult Services was also in attendance.

The report set out the background to Coventry and Rugby CCG which was formed in 2013 and whose membership was derived from local General Practice provider contract holders. The CCG had 59 member practices located in Coventry. These made up the general practice provider market for providing primary care medical services for registered patients across Coventry. The practice membership included 9 single handed practices as well as practices with multiple partners. The Board were informed that the smallest practice, Anchor Centre, had a registered population of 582 patients with the largest being Engleton House Surgery with a population of 23,020, this included Coventry University branch. Providers of general practice services were independent contractors within the NHS family and their responsibilities included delivery of a nationally prescribed Core Contract for specified primary care services. The main challenges and top 5 workforce priorities were detailed.

The Board were provided with a definition of primary care noting that it encompassed a wide range of contractors and services included pharmacists, opticians, dentists and General Practice. It encompassed all health care taking place outside acute and mental health trusts.

The report informed that the CCG had been accepted on a national primary care development programme led by the National Association of Primary Care called Primary Care Home. The programme supported primary care collaboration and delivery around registered patients lists of around 30,000 to 50,000 to deliver 4 core objectives.

Reference was made to the quality and performance management of General Practice. There were two types of contracts for primary general medical services in Coventry: General Medical Service contracts (GMS) which were not time limited and Alternative Provider Medical Services contracts (APMS) which had a contract life cycle of typically 5 years. In Coventry there were 52 GMS contract holders, 6 APMS contracts and I practice with a PMS agreement.  Details about the contract specifications were outlined. Under delegation the CCG was responsible for the overall performance management and quality assurance of general provider contracts. Individual GP Performance standards and clinical competence assurance was retained by NHSE. The CCG monitored a range of indicators to assure the quality of general practice which were outlined in the report. The CCG worked with practices on action plans to address any areas identified as requiring improvements.

The Board were informed that in Coventry 2 practices were rated overall outstanding; 49 practices were rate good; 3 practices had an overall requires improvement rating; 1 practice was rated overall inadequate; and 3 practices were still awaiting inspection.

Detailed information was included on the key pressures on  ...  view the full minutes text for item 30.

Report of Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) who has been invited to the meeting for the consideration of this item

The Board considered a report of Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) which informed of the current status of the Out of Hospital project, key areas for development and the anticipated progress to March, 2019. Andrea Green and Jenni Northcote, Coventry and Rugby CCG, and Justine Richards, Coventry and Warwickshire Partnership Trust (CWPT) attended the meeting for the consideration of this item. Councillor Abbott, Cabinet Member for Adult Services was also in attendance.

The report indicated that the Out of Hospital (OoH) programme represented a significant component of the Health strategy for the CCG and the Better Health, Better Care, Better Value partnership plan. It was an ambitious programme which aimed to achieve integrated community services capable of meeting population needs through using an outcome based commissioning approach. Commissioners had jointly undertaken a process which aimed to transform the commissioning and delivery of the service across Coventry and Warwickshire. Underpinned by extensive public, patient and stakeholder engagement the programme sought to address the structural, cultural and professional barriers to delivering person centred care. 

The Board were informed that Coventry and Warwickshire Partnership Trust and South Warwickshire Foundation had collaborated to develop a new operating model to support the future delivery of the OoH services across Coventry and Warwickshire. The Coventry and Rugby CCG Governing Body subsequently adopted this clinical model. In July the Governing Body gave approval to progress the Coventry element by developing a lead provider contract with CWPT. The report detailed the CWPT contracted services included in the scope of the model.

The report set out the following objectives required to be delivered by the project:

·  To reduce health and wellbeing inequalities

·  To address the care and quality gap by ensuring more services use evidence based best practice

·  Identify those in most need and co-ordinate their care more effectively by commissioning and ensuring interdisciplinary working

·  To work within tight financial parameters by developing and delivering services around the needs of patients and carers, and reduce duplication and waste of resources.

Further information was provided on the City Wide Hub which co-ordinated the delivery of the Coventry and Rugby wide services. The Hub would support active case management for planned care and deploy resource responsively across the care system. It would co-ordinate access for urgent community and hospital services which had extended operating hours and was universally accessible for all healthcare professionals. The hub would hold information and be the central contact for the local hubs supported by access to shared care plans.  In addition, placed based teams would be set up, built around populations of 50,000 based on groups of GP practices who would work together to co-ordinate and lead the local placed base system i.e. primary care homes. There would be multi-disciplinary teams with primary care at the centre.

The report detailed what the first year of the three year implementation period would look like including anticipated improvements and the impact for Coventry residents. This included people experiencing more  ...  view the full minutes text for item 31.

Briefing Note of the Acting Director of Public Health

The Board considered a report of the Acting Director of Public Health which provided an update on the prevention element of the Better Health, Better Care Better Value Proactive and Prevention workstream.

The report referred to the Coventry and Warwickshire Better Health, Better Care and Better Value vision and priorities. The vision had been developed in agreement with both Coventry and Warwickshire Health and wellbeing Boards and was ‘To work together to deliver high quality care which supports our communities to live well, stay independent and enjoy life.’ It was based around a number of transformational work streams, one of which was ‘Proactive and Prevention – helping people to live healthier lifestyles and fulfil their potential so that they avoid or reduce the need for medical and social care.’

The Board were informed that improving health required a strong focus on prevention and early intervention. It required a refocusing away from services designed to deal with the consequences of severe health and care problems and/or services that rescued people in crisis situations. Instead the NHS and partners needed to ensure that strategies, service models and workforce development had a greater focus on keeping people healthy (prevention) and proactive early intervention to reduce the impact of health and wellbeing risks.

The Proactive and Preventative programme vision was ‘To galvanise effort, expertise and resource to stimulate a step change in commitment to prevention across the Health and wellbeing system’. This workstream had the biggest direct connection to the Council. The programme was governed by an Executive Group, chaired by the Deputy Chief Executive (People), consisting of representatives from the partner agencies.

The upscaling prevention programme aimed to manage individual health risks by focusing on early prevention to prevent health risks turning into ill health and, where people had health problems, to stop them escalating to where they required significant, complex and specialist health and care interventions. The project would be aimed at individuals ‘at risk’ and would take an early intervention/prevention. The Board noted that the Council’s Public Health team were leading on this area to develop a joint approach to prevention.

The report highlighted that the upscaling prevention work would be split into two phases:

Phase 1 would create service and organisational ownership of the prevention agenda

Phase 2 would look at key areas of focus, for example staff health and wellbeing, making every contact count training and consistent community messages.

The Board noted that 20 days support from the Local Government Association had been secured for the project and would be used to deliver phase 1. This work included a series of workshops/events for leaders and champions; film/record stories; establish a cohort/network of champions; and develop a prevention toolkit. Further information was provided on the delivery of the key areas of phase 2.

The approach to upscaling prevention was currently being discussed at both the STP Board and the Health and Wellbeing Board. It was anticipated that the Upscaling Prevention work would be launched at the Joint Coventry and Warwickshire  ...  view the full minutes text for item 32.

All outstanding issues have been picked up in the Work Programme

The Board noted that all outstanding issues had been picked up in the work programme.

Report of the Scrutiny Co-ordinator

The Board noted their Work Programme for the current municipal year.

Any other items of public business which the Chair decides to take as matters of urgency because of the special circumstances involved

There were no additional items of public business.