Agenda and draft minutes

David Lammy MP

Derma Ioannou, Haringey Racial Equality Committee

Haringey Local Medical Committee

Haringey Association of Voluntary Sector Organisations

None.

None.

To review minutes of previous meeting.

Item LC5: It was noted from the previous meeting that the PCT discouraged the use of non geographic (084) numbers by general practices in Haringey.  A number of Members had raised concerns with the Chair about the continued use of these non-geographical numbers, particularly the cost to patients who have to access them from non-standard BT lines.  The use of 084 numbers places an unfair burden on patients who only have access to mobile phones (such as those who live in temporary accommodation) as they may incur costly call charges when contacting their GP.  Seven General Practices are known to use such 084 numbers in Haringey.  The Panel felt that the continued use of 084 numbers was unacceptable and that the PCT should continue to discourage their use.

Agreed: The minutes of the meeting held on 17^th July were approved.

To finalise arrangements for Members to visit Newham Polyclinic, Brocklebank Centre and Lordship Lane.    

A number of visits to super health centres / polyclinics have been arranged to guide and inform Members review decisions.  Members were invited to attend and report back at the next meeting.  Venues and times are set out below:

Venue                                                                                     Date

The Centre, Church Road, Newham PCT              5^th September 3p.m.

Lordship Lane, Haringey PCT                                             20^th September a.m.

Heart of Hounslow, Hounslow PCT                                     28^th September p.m.

To inform Members of planned consultation events: Equalities Impact Assessment, Area Assemblies & Public Presentations.

Copies of the consultation strategy and programme for the Haringey PCT Primary Care Strategy were distributed.  Particular attention was drawn to a number of public consultation dates at which the PCT will present the strategy and to hear public responses.  Planned presentations include dedicated events (17^th and 19^th September), all local Area Assemblies (11^th September to 25^th October) and an Equalities Impact Assessment (5th October).  The consultation strategy, which contains a full calendar of consultation events, is attached.  Members are invited to attend consultation events and report back to the Panel.

Elizabeth Manero will provide an independent assessment of the Haringey Primary Care Strategy.

Elizabeth Manero, Chair of Health-Link,

Elizabeth Manero was appointed to act as independent adviser to the Panel.  The Panel was addressed by Ms Manero.  A summary of some of the key points made within this presentation are described below. A full copy of a presentation given by the Elizabeth Manero to the Panel is attached for information. 

·        Health-Link is an independent, not for profit social enterprise which explores new ways to improve health and health services, with patients and the public. 

·        The consultation for the Darzi review of London NHS services is explicitly concerned with models of care and delivery models only.  Further national and local consultation will be necessary for the application of models e.g. where polyclinics/ super health centres might be located.  Further clarification may be necessary from NHS London concerning the consultation process for the London NHS Strategy (A Framework for Action) and possible implications that this may have locally.

·        To assess what impact proposals set out in the strategy may have on health inequalities, an explicit formula needed to be developed.  A template of such a formula was presented to the Panel.

·        As GPs are independent contractors, PCTs and the NHS more generally have limited powers to direct their work.  The Primary Care Strategy does however appear to strengthen local commissioning arrangements which may be beneficial in helping to achieve change locally.

·        Haringey may be in a stronger position than other PCTs to deliver change given the number of salaried GPs working within the locality.  This may further help to reconfigure primary care services.

·        The way in which the Haringey Primary Care Strategy is applied will be of critical importance, particularly in the way that planned developments (super health centres) acknowledge and respond to local health needs.  

·        The PCT should provide further clarification of the costs of the Primary Care Strategy.  There were some inconsistencies in financial planning, such as the presumption of staff costs to be neutral despite the intention to extend and develop services.

·        There was a need for further detail and clarification on some aspects of the Primary Care Strategy, in particular, what services will be offered from super health centres and whether all super health centres will offer similar services.

·        A number of gaps in the strategy were identified including the views of the Local Medical Committee, the views of local Practice Based Commissioning Groups, the effectiveness of local Practice based Commissioning and the willingness of local GPs to re-locate and financial implications for GPs.

·        There was a need for the Primary Care Strategy to include a community based monitoring system, so that the impact of planned developments can be assessed as the plans are implemented.  Similarly, the PCT should establish a baseline health position from which to assess future impact of planned changes.

The Panel will hear evidence from Members:

• Councillor Bob Harris, Executive Member for Adult Social Care & Well Being

Councillor Harris

Councillor Harris presented a response to the Primary Care Strategy as Cabinet Member for Adult Social Care & Well Being. 

·        It was noted that there were aspects of the strategy which were positive and which were to be welcomed. 

·        The most pressing observation of the Primary Care Strategy was that it was clearly grounded within the medical model of health.  As a result, if there were criticisms of the strategy, it was that the proposals concentrated too much on ill-health and further development of health services.  This approach failed to recognise the wider social determinants of health which were very important in places like Haringey.  Further consideration of the primary care strategy may be necessary to ensure that the broader well being agenda is being met.

·        The provision of social care services is important, especially for those with long-term health conditions.  Further attention should be paid to how social care will be provided within the super health centre model of services, particularly at to how services will work in partnership to support the needs of patients. 

·        The Local Authority would like to engage further with the PCT to ensure that objectives set out in the Primary Care Strategy are acknowledged and supported in local planning processes.

·        Given the relocation of services and the likely increase in distance that patients may have to travel to access services, the Primary Care Strategy has clear transport implications and concerns.  Accessibility concerns were heightened given that two of the planned new super health centres were located outside the borough (Archway Hospital, NMH).

·        With such wide ranging changes proposed within the strategy, particularly those that involved local service reorganisation, the Local Authority is aware of the potential for ‘cost shunting’.  In this context, there was a need for the PCT to provide further details around the financial plan to support the development of the Primary Care Strategy. 

·        Further information is required from the PCT as to longer term plans for established health centres in the borough (e.g. Tynemouth Road, Bounds Green) and how plans for these services are acknowledged within the Primary Care Strategy. 

·        The provision of only 4 super health centres within the borough would be unacceptable without maintenance / or further development of other primary care facilities (health centres/ GP surgeries).

·        Further clarification was needed from the PCT as to how super health centres would operate, particularly those located on multiple sites (i.e. St Ann’s, Laurels). 

The Panel will hear evidence from:

·        Dr Mayur Gor, Chair of Haringey PCT Professional Executive Committee

·        Dr Peter Christian, Clinical Director West Haringey (GP Dukes Avenue)

Dr Mayur Gor (Chair, Haringey PCT PEC)

Dr Gor made a number of points to the Panel and took a number of questions from those present.  A summary of these discussions is given below.

·        The Primary Care Strategy is a positive attempt to tackle some of the health problems that are faced in Haringey, in particular the significant health inequalities that exist between the east and west side of the borough.

·        Whilst the Primary Care Strategy can make a significant contribution to addressing Haringey’s health problems, further input from wider services beyond the health sector will be required to make an impact on the more intransigent health problems (i.e. health inequalities).

·        Consultation documents had been sent to all 59 General Practices in Haringey so that these can be distributed to patients across the borough. 

·        All practices in Haringey have a Patient Participation Group, where patients can directly discuss issues of concern with staff and other patients at their own surgery.  People were encouraged to sign up to and attend these groups to maximise their opportunities to contribute to the development process.

·        Consultations have taken place with GPs through the Local Medical Committee.  In addition, consultations have also taken place with the 4 local practice based commissioning groups in Haringey.  From these consultations, it was apparent that GPs and General Practices are beginning to work together and hopefully tackle the Haringey’s health problems more effectively.

·        The Primary Care Strategy undoubtedly represented a major re-design of services for Haringey.  The PCT would encourage people to become involved in the consultation process to help shape future services.

Dr Christian, Clinical Director West Haringey           

Dr Christian made a number of points to the Panel and took a number of questions from those present.  A summary of these points are given below.

·        Major changes are occurring in the way that General Practices operate.  Before the introduction of Practice Based Commissioning (PBC), General Practices worked independently of each other.  Now, practices are required to work more collaboratively to assess patient needs and commission services for them in each Haringey locality (west, central, north east & South East).  As commissioning of services is at a more localised level (GPs instead rather than then PCT) this may mean that resulting services were more sensitive to the needs of local populations.

·        PBC is still in its infancy and GPs and General Practices are still learning how best this can work. GPs will have to grapple with competing expectations of patients i.e. delivering a wider range of services and speedier access to services.

·        At present, any cost savings derived from PBC are reinvested within the PCT.  In future, commissioning groups will be able to retain 70% of cost savings (for re-investment) and 30% will be returned to the PCT.

·        Positive developments have already occurred in West Haringey as a result of PBC as practices have met to discuss the educational needs of practitioners and how these can be developed further. 

·        The West Haringey PBC group has not had a chance to  ...  view the full minutes text for item 16.

Haringey Local Medical Committee is a statutory body which elects a committee of GPs to represent, negotiate and guide discussions with the PCT on issues affecting patient care. The LMC has indicated it will submit a written response to the Panel.

A representative from Haringey Local Medical Committeewas not able to attend the meeting.  A written response to the Primary Care Strategy is expected.  This will be circulated when this is received.

The Panel will hear evidence from the following organisations:

·        Jenny Privett from Haringey Disabled Association (formerly Haringey Consortium of Disabled People and Carers, HCDC).

·        Derma Ioannou from Haringey Racial Equalities Council.

·        Haringey Association of Voluntary and Community Organisations (HAVCO) will submit a written response to the Panel.

·        Sue Hessel and Linda Lennards, Better Local Health Care.

Sue Hessel and Linda Lennard, Better Local Health Care

A presentation was made by representatives.  A summary of the main issues raised are provided below:

·        There was broad concern at the overall lack of consultation and the absence of a defined consultation process for the Primary Care Strategy. 

·        There were elements of the consultation document which contained a lot of unnecessary jargon, which would not be clear and understandable to lay people.  This would inhibit peoples ability to engage with and respond to the consultation.

·        It was felt that the PCT needed to encourage public participation earlier within the consultation to give people time to understand and respond to issues presented within the strategy.  Poor early engagement has been exacerbated by the decision to hold the consultation through the summer months.

·        There was a need to involve local community groups more in to the consultation process.  A number of groups had indicated that they had thus far felt excluded from the consultation process.

·        It was felt that questions set out in the consultation document were not clear or too vague to enable people to provide meaningful responses to the strategy.

·        The consultation also provided no options for the public to appraise in that there were no alternatives provided to the super health centre model.

·        Further data was required as to the likely impact that Primary Care Strategy proposals may have on vulnerable groups such as the disabled or with long-term medical conditions.

·        Further clarification was needed as how comments obtained from the consultation would be analysed, what arrangements were in place to feedback the results of the consultation to those who had contributed and if there would be further opportunities to comment on any amended plans.

A copy of the presentation given by the Better Local Health Care is attached for information.

Representative from HAVCO                 

A representative from HAVCO was not able to attend the meeting.  A written response to the Primary Care Strategy is expected.  This will be circulated when this is received.

Jenny Privett, Haringey Disabilities Association

·        Disabled people and their carers face considerable problems in accessing GPs in Haringey.  There are issues around the physical accessibility of services, the adequacy of transport systems to get people to services and the availability of services.

·        There was also a concern among disabled people and their carers about the level of service available at surgeries with lengthy waiting times to get an appointment and limited time for consultations.

·        In respect of the Primary Care Strategy, the proposals for super health centres raised clear access issues for disabled people. As transport to services was currently difficult, there was a concern that transport problems would become more difficult with the further distance that people may have to travel to new super health centres.  As such, there was a need for further clarification within the strategy as to how transport would be provided for services to those that had mobility problems.

·        Disabled people may have multiple and complex health needs which may have  ...  view the full minutes text for item 18.

The Panel will hear evidence from the following patient groups:

• Maureen Dewar, Haringey PCT Public & Patient Involvement Forum

Maureen Dewaar, Haringey PCT PPI Forum  

·        There has been good working relationship between the PCT and the PPI Forum thus far in developing the consultation for the Primary Care Strategy.  The PCT have involved the PPI Forum in events and lead officers have attended PPI Forum meetings.

·        Consultation works best when this is based in the community and when it is allowed to work its way upwards, rather than top down consultative approaches. 

·        More detail or guidance is needed from the PCT as to how local services will be affected, in particular, those General Practices which may be affected in the reorganisation.

·        Further details are also required on what services are to be provided from super health centres and will this be the same for all those located across the borough.

·        Further information is required from the PCT as to how comments received within the consultation are used to influence the finalised plans for primary care.  Similarly, further information is required as to how the Primary Care Strategy will relate to future London wide NHS developments (A Framework for Action).

·        The PPI Forum will be holding a public consultation on the Primary Care Strategy on the 11^th September 2007.  This meeting will be held at Chestnuts Community Centre in St Ann’s Road and all are welcome.  Discussions and findings from this meeting will be presented to the PCT.

A copy of the presentation given by the PPI Forum is attached for information.

Christina Gradowski, Haringey PCT

Christina Gradowski, Director of Corporate Services and Partnerships at Haringey PCT responded to number of issues which had been raised:

·        The PCT is encouraging communities and organisations to become involved within the consultation process. A full programme of events has been published to notify where local people can get involved.  The PCT is also open to further suggestions as to where and when consultations may take place.

·        All events are listed on the Haringey PCT website (www.haringey.nhs.uk).

·        Patients and public alike were encouraged to complete and return consultation questionnaire.

·        A full equalities impact assessment day will be held on 5^th October 2007 at the Haringey  Irish Community Cultural Centre, Pretoria Road, Tottenham N17 8DX

The Panel raised the following issues in response to the evidence received from all witnesses:

1. There is a need for the PCT to provide further clarification as to how the Primary Care Strategy will redress health inequalities within Haringey.

2. There is a need for the PCT to provide further clarification as to how those areas in Haringey that are currently ‘under-doctored’ will benefit from proposals set out in the strategy (i.e. how will the strategy encourage GPs and Nurses to work in north east Haringey).

3. Whilst the concept of the super health centre/ polyclinic is a model which people may positively engage, there was a need to demonstrate how these facilities will address health needs and reduce health inequalities.

4. There was concern that current plans for the location of super health centres  ...  view the full minutes text for item 19.

None.

To confirm the date of the next meeting as 5.30 pm on Monday 1^st October ’07.

This is at 7.00 p.m. onTuesday 9^th October at Haringey Civic Centre (Committee Room 2)