CCG Meeting – 28th September 2017

Clinical Commissioning Groups (CCGs) were created following the Health and Social Care Act in 2012, and replaced Primary Care Trusts on 1 April 2013. They are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area.

Bridget and Christine, of IOWSONHS, were able to attend a public meeting of the IW CCG, on 28/09/2017, and Bridget kindly compiled the following report:

Hello All,

Im Bridget,I’m very much an unqualified member of the public, also a service user.

2  ½ years ago i finished treatment for breast cancer which took me to Southampton and to St Mary’s on the Isle of wight. My care was excellent throughout, thorough professional and kind, the process once underway was smooth although in my particular case lasted many months[it doesn’t always every patient is different].  May I add that a routine mammogram and the following treatment saved my life. As this is breast cancer awareness month I’d also like to say you get called for screening between the ages of 50 and 70 possibly a couple of years before or after those ages but  although not called after 70 if you ring up to book  you can still keep having or indeed start having mammograms every three years.Since then I’ve been watching what’s happening to our National Health Service and trying to keep up with what’s happening here on the island.

 

ok what follows is very much my take on the ccg meeting held in public that Christine Lightbody and I attended. It will not cover all that was discussed but I hope you get a flavour of the meeting held on28th September at Northwood House in Cowes.Gathered were approximately 15 to 20 highly distinguished care commissioning group individuals.

We were welcomed, offered refreshments and leaflets the team was also introduced to us. including the treasurer  member of healthwatch nurses and gps. What followed was fascinating, i recommend anyone who has an interest in the health service to attend, I also like to think that the team are aware of some scrutiny from the general public. The meeting lasted over two hours.

 

Subjects raised all concerned primary care and included;  the roll out of 7 day care from gp surgeries the procurement of a specialist diabetes nurse the leg ulcer service and when responsibility was handed over from the gp for this service,, a pilot self blood testing scheme for patients taking warfarin, e consultation , infection control and ’ active signposting,’ ie the method by which gps direct patients to the appropriate help.

Nearly all these issues raised  some matters of contention and although there was some debate all issues raised on the agenda were passed regardless of outstanding matters being unresolved. Some important subjects were pushed down the agenda particularly the subject of the five year forward plan. Although Christine and I didn’t stay to the end of the meeting it is very likely we would have been turfed out anyway as towards the end of the agenda there was a motion proposed motion that the rest of the matters be held in private. It is my belief that the five year forward plan was going to be pushed into that category. In any case it could easily have taken up the whole meeting it is such an important and contentious issue and of course goes hand in hand with STPs  Sustainability and transformation plans.

Although highly motivated , dedicated and skilled individuals and thoroughly professional speakers, the sense i was left with was this team were a) working separately from the trust b)underfunded c)firefighting and desperately trying to implement some new ideas that could indeed be very valuable and welcomed but were doing so without sufficient funds , or indeed staff .

It became clear that the roll out of 7 day access to gps is expecting to use existing, local staff, with some emphasis on telephone consultations,. The patient may not be in contact with their own gp or practice nurse and consent to share record has to be given by the patient. A member of the panel pointed out that the island wasn’t retaining gps, many were retiring and practices are closing. The island are way below the national target for recruiting and retaining gps. The government target (arguably rather too low) has not and will not be met.

Problem Areas with practising GPs numbers being too low were recognised in Southampton ,followed by Portsmouth and most understaffed was the isle of wight., trailing these two cities.

It was pointed out there is a bonus scheme running on the island , as nationally we are recognised as one of the areas with the greatest shortfall. the scheme that reward trainee gps with this bonus was available for ten gps to train on island, only 4 places on the scheme had been or were about to be filled. It was further pointed out that GPs who had already accessed the scheme were proving unlikely to remain to practise on the island and indeed some never even lived on island for the duration of their training preferring to commute from the mainland.We need to ask why health professionals dont want to train up in the whole of the country , what has become so unatractive about our once fabulous health service, and it still is fabulous at times and staff left carry a ever more onerous burden.

No mention was made as to how it was assessed  as viable that gps could roll out this seven day practice, it was also pointed out that shortages were not just with gps but other areas of staffing too. There was quite a bit of discussion about e consultations and telephone consultations. Little attention was paid to whether the island wanted or had asked for these services…there is a possibility in my mind that many particularly the elderly would prioritise a service in which they could see their own gp more quickly rather than spreading existing services ever thinner. there will however be a quality impact assessment to ensure that no one group of patients is disproportionately  disadvantaged.

my view is that this scheme could potentially affect all patients negatively.

i would suggest that telephone conversations can be very valuable with the gp but as 111 has said to me in the past ‘í can’t  see you so i can’t say for sure! ‘ also nothing sometimes beats a home visit (remember them?). GPs are trained to pick up all sorts of signs and symptoms from your appearance. it will be in my opinion detrimental to the general public to further put off the probably already shy of seeing a gp or practice nurse, It raises the risk of opportunities missed to intervene on the patient’s behalf.  this does not replace 111 or the old beacon this service is only available to book in advance.

I see this as the stp system being put into place before we have any ,probably meagre ,chance to challenge it !

The second striking interjection came from a high up nurse on the panel, who seemed very much on the ball.; It was accepted by the panel that each surgery has to have a ‘lead’ nurse in diabetes. However the qualification needed was never categorically decided, it is usually a diploma a year long course. Nor was it decided who would fund  a diploma and it was recognised that it is presently common practice for the nurse to fund it his /her self. This could put both nurses and surgeries in a very difficult position.  Again this background noise suggests very much that STP aims are being stressed ie giving responsibilities to staff below the qualification of doctor. but these aims being put on paper are to be funded and fulfilled goodness knows how and by whom?

Next up was the self blood testing scheme was decided was not significantly useful for warfarin users.It was deemed borderline when it came to value for money. However it was recognised as useful in some cases , so a trial will continue targeting those who might get most benefit from this alternative system. There will be no self testing rolling out across the island but neither will it be completely withdrawn just yet.   I saw this as an example of the ccg working quite well, considering the patient’s needs trying something new and really quite positive.

Lastly the treasurer in giving his report mentioned a spike in his figures caused by the procurement of one particular drug which had rocketed in price and was in short supply and only available from one supplier.

The reports the petered off   although we were patiently waiting to hear the discussion of the five year forward plan, it didn’t look like it was going to happen so we left !

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