Agenda and minutes

There were no declarations of interest.

The minutes of the meeting held on 11^th September, 2019 were agreed and signed as a true record.

Further to Minute 11/19 concerning the realignment of liver and pancreatic services at University Hospitals Coventry and Warwickshire (UHCW), Andy Hardy, UHCW, reported that there were no plans to transfer any of these services away from UHCW to Birmingham Queen Elizabeth Hospital.

Briefing note of Rachael Danter, Coventry and Warwickshire Health and Care Partnership, who has been invited to the meeting for the consideration of this item

The Board considered a joint briefing note and received a presentation on the draft Coventry and Warwickshire Strategic Five Year Health and Care Plan 2019/20 - 2023/24, a copy of which was set out at the appendix to the briefing note. The draft Plan was submitted to the Board as part of the current consultation process. The draft Plan had recently been considered by the Coventry and Warwickshire Joint Health and Overview Scrutiny Committee at their meeting on 14^th October 2019. Andy Hardy, University Hospitals Coventry and Warwickshire (UHCW) and Rachel Danter, Coventry and Warwickshire Health and Care Partnership attended the meeting for the consideration of this item.

The briefing note indicated that Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) were required to create five-year strategic plans covering the period 2019/20 – 2023/24, setting out how systems would deliver the commitments in the NHS Long Term Plan. The NHS Long Term Plan Implementation Framework sets out an expectation that STPs/ICSs would bring together member organisations and wider partners as they developed and delivered the plans. A key principle was that the plans should be locally owned. Local systems were required to share a draft of their plans with NHS England / NHS Improvement regional teams by 27 September 2019. The regional team had since provided feedback on this submission. There was now the opportunity for local engagement prior to submission of the final plan, by 15^th November 2019.

The draft plan was informed by a focused engagement exercise undertaken with staff groups across the system (an on-line staff survey), as well as targeted engagement with patients and carers undertaken by Healthwatch. It also drew on engagement activity with a range of public and community groups conducted by the CCGs and local authorities. The understanding of population needs outlined in the draft plan was drawn directly from the local joint strategic needs assessments. The plan had been developed by the senior responsible officers for each of the workstreams, with involvement from stakeholders across the system. Clinicians had been fully engaged in developing the plan and the supporting clinical planning templates.

The briefing note referred to the current period of engagement on the draft Plan from 27 September to 15 November and set out details of the engagement plan in place, which included opportunities for the plan to be considered and approved through formal governance arrangements within the NHS; formal and informal engagement with local authorities; and informal opportunities for awareness-raising and engagement on the content of the plan with key stakeholders, such as Healthwatch Coventry.

The Board noted the summary of the draft plan priorities as follows:

Prevention – Through a strategic and targeted approach to earlier intervention, we will make it easier for people to lead healthy lives and stay well for longer.

Population health – Focus on education, affordable and appropriate housing, stable employment, leisure opportunities and a healthy environment.

Primary care networks – Building on our ‘Out of  ...  view the full minutes text for item 15.

Briefing note of the Director of Public Health and Wellbeing

The Board considered a briefing note and received a presentation of the Director of Public Health and Wellbeing concerning her Annual Report for 2019 ‘Bridging the Gap: Tackling Health Inequalities in Coventry, a Marmot City’, a copy of which was set out at an appendix to the report. The report included recommendations for health and wellbeing partners across Coventry. This year the report focused on health inequalities in Coventry; the determinants that contributed to these inequalities and the work being carried out to address them.

The briefing note indicated that health inequalities were important because they had a significant impact on how long a person would live and the number of years they would live in good health. People in more affluent areas would live a longer live, with more years of good health, than people living in more deprived areas. In Coventry, this gap between groups could result in men in some areas of the city living on average 10.9 years less than people in better off areas. For women, the gap was 10 years. The gap in the number of years lived in good health was even bigger, with men in the most affluent areas experiencing 17 more years in good health than men in less affluent areas, and for women, the gap was 18 years. The Annual Report set out the reasons that these differences existed and how Coventry was working in a partnership approach, bringing together individuals, communities, organisations, businesses and universities, to reduce inequalities and improve health and wellbeing for all citizens.

The briefing note provided an update on progress with the recommendations contained in the Director of Public Health’s Annual Report 2017/18 ‘Healthier for Longer’ which explored securing healthier futures for the City’s communities. Much work had been done since the publication of the report and key achievements were detailed.

The briefing note also highlighted Coventry’s commitment to being a Marmot City since 2013. The Marmot City approach had recently been evaluated and the key findings of this evaluation were set out. The Marmot Steering Group members would be reviewing progress to date and agreeing the future of the membership and how to progress action on the Marmot Review recommendations in October 2019. 

The recommendations of the Director of Public Health’s Annual report were to:

1 - Review and revise the Marmot Action Plan taking account of the findings in the evaluation and considering how a One Coventry approach can help to embed partnership working and promote ownership of initiatives throughout organisations and community groups, and how using a place-based strategy as set out by Public Health England can facilitate effective action through civic, service and community interventions.

2 - Improve partnership-working with Place Directorate within Coventry City Council to ensure that public realm works and developments in the city take account of their potential impacts on health inequalities and use initiatives in a proactive way to reduce inequalities.

3 - Utilise community asset based approaches to improve health and wellbeing, maximising the legacy  ...  view the full minutes text for item 16.

Briefing note of Jenni Northcote, Coventry and Rugby Clinical Commissioning Group (CCG), who has been invited to the meeting for the consideration of this item

The Board considered a briefing note of Jenni Northcote, Coventry and Rugby Clinical Commissioning Group (CCG), which outlined the processes in place and approach taken by NHS Coventry and Rugby CCG in relation to the four APMS (Alternative Provider of Medical Services) contracts in Coventry which were due to expire on 31st March 2020. The briefing note also provided assurance that the CCG was seeking to commission appropriate service provision to meet the needs of registered patients along with assurance that the CCG had appropriately discharged its duties in respect to commissioning primary medical services and undertaken appropriate engagement with patients and key stakeholders. Jenni Northcote and Rose Uwins, Coventry and Rugby CCG attended the meeting for the consideration of this item.

The briefing note set out the background to the introduction of APMS contracts. In 2014/15 NHS England invited CCGs to take on greater responsibility for general practice commissioning through one of three models. In 2015 Coventry and Rugby CCG took on delegated commissioning responsibility operating under the terms of a Delegated Agreement with NHS England. This agreement set out the terms and conditions on how delegated primary medical care functions were to be exercised. CCGs were subject to an annual audit in this area. The report detailed the responsibilities of the CCGS under a delegated agreement. The Board were informed that primary medical services were delivered to registered patients through two types of contracts:

General Medical Services Contracts (GMS) – these contracts covered core medical services and were held by a gp or gp partnership and were in perpetuity (not time limited).

Alternative Provider Medical Services Contracts (APMS) – these contracts were provided under directions of the Secretary of State for Health and provided the opportunity for locally negotiated contracts. Primary Care Organisations (PCOS) could contract with non-NHS bodies to supply enhanced and additional medical services. PCOs could enter into contracts with any individual or organisation to meet local needs, as long as core NHS values were fully protected and secured. APMS contracts were time limited, usually 5 years.

The CCG currently had 4 practices in Coventry and 1 practice in Rugby operating under time limited APMS contracts. The Coventry practice contracts were due to expire on 31st March 2020. The practices concerned were Stoke Aldermoor Surgery;   Foleshill Surgery; Broad Lane Surgery and City of Coventry Centre Practice.

The Board were informed that the CCG had followed a due diligence process to consider the most appropriate commissioning response in respect of each of these contracts, within the existing legislative and procurement framework, taking account of existing service provision, future demand for primary medical care including demographic growth, housing growth projections and the anticipated increase in student population.

There were two options available to the CCG which were considered by the CCG’s Primary Care Committee in June: list dispersal (allowing the existing contracts to expire and supporting patients to register at existing local practices) or to undertake market engagement to explore provider interest in securing APMS contracts for the  ...  view the full minutes text for item 17.

Report of the Scrutiny Co-ordinator

The Board received the work programme. The Chair, Councillor Clifford, informed that, in light of the forthcoming General Election which was likely to be held on 12^th December, in might be necessary to rearrange the meeting scheduled for 11^th December.

RESOLVED that the work programme be noted.

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.