Agenda and minutes

Please note this meeting may be filmed or recorded by the Council for live or subsequent broadcast via the Council’s internet site or by anyone attending the meeting using any communication method.  Members of the public participating in the meeting (e.g. making deputations, asking questions, making oral protests) should be aware that they are likely to be filmed, recorded or reported on.  By entering the ‘meeting room’, you are consenting to being filmed and to the possible use of those images and sound recordings.

The Chair of the meeting has the discretion to terminate or suspend filming or recording, if in his or her opinion continuation of the filming, recording or reporting would disrupt or prejudice the proceedings, infringe the rights of any individual, or may lead to the breach of a legal obligation by the Council.

The Chair referred Members present to agenda Item 1 as shown on the agenda in respect of filming at this meeting, and Members noted the information contained therein’.

To receive any apologies for absence.

Apologies for absence were received from Cllr Kemi Atolagbe (Camden), Cllr John Bevan (Haringey), Cllr Anne Hutton (Barnet), Cllr Andy Milne (Enfield). Cllr Chris Dey (Enfield) attended the meeting as a representative in place of Cllr Andy Milne.

The Chair will consider the admission of any late items of Urgent Business.  (Late items will be considered under the agenda item where they appear.  New items will be dealt with under item 10 below).

None.

Cllr Pippa Connor declared an interest by virtue of her membership of the Royal College of Nursing.

Cllr Pippa Connor declared an interest by virtue of her sister working as a GP in Tottenham.

Cllr Jilani Chowdhury declared an interest by virtue of his son working as a doctor in Margate.

To consider any requests received in accordance with Part 4, Section B, paragraph 29 of the Council’s constitution.

None.

To approve the minutes of the North Central London Joint Health Overview and Scrutiny Committee meeting on 6^th February 2023as a correct record.

The responses received so far to the actions from the previous meeting were noted and it was reported that further responses would be circulated by email shortly. Cllr Tricia Clarke referred to the information provided about the consultation on the St Ann’s primary care contract and expressed concerns about the role of AT Medics and the use of physician associates. Claire Henderson, Director of Integration at the NCL ICB, responded that this issue had previously come up at other AT Medics practices. She explained that, given the current challenges associated with GP recruitment and retention, mixed skills in GP practices were being seen more often when procurement processes were carried out. However, the ratio of GPs on site was an important consideration as part of this process. Asked by Cllr Connor whether members of the public were able to observe discussions on this issue at the Primary Care Commissioning Committee (PCCC), Claire Henderson explained that the meetings included a ‘Part 1’ section held in public and a ‘Part 2’ section held in private. Public questions could be submitted to Part 1 of the meeting.

The minutes of the previous meeting were approved.

RESOLVED – That the minutes of the meeting held on 6^th February 2023 be approved as an accurate record.

To provide an overview of the £5m health inequalities fund which supports schemes targeted at the most deprived communities in NCL.

Ruth Donaldson, Director of Communities at the NCL ICB, introduced this item, noting that further funds had been allocated since the previous overview that had been provided to the Committee 18 months previously. The original purpose of the scheme had been to develop innovative solutions to health inequalities and some details of the schemes had been provided in the pack.

The schemes highlighted included:

• The ‘Supporting People with Severe & Multiple Disadvantage’ scheme (Haringey) aimed at working with people with compounding inequalities (for example because of their ethnic background or their employment/housing status) and poor health outcomes. The scheme worked across services to offer proactive wraparound care with a small cohort of people which led to a reduction of 800 A&E attendances.
• The ‘Peer Support for Cardiovascular Disease Prevention’ scheme (Barnet) connected people of South Asian, African and Caribbean heritage and had led to reductions in blood pressure.
• The ‘Black Health Improvement Programme’ (Enfield) had included cultural competency training for GPs and the feedback had been positive.

Ruth Donaldson commented that the wider lessons learnt from the programme had included that resources were allocated at NCL level but then Borough Partnerships determined how it was spent based on their local insights and understanding which had led to more collaborative and innovative solutions. In addition, the learning from the co-production and community empowerment work could be applied across the system in future, included by monitoring the level of equity in all standard measures and making the best use of limited resources in decision making.

Ruth Donaldson then responded to question from the Committee:

• Cllr Connor observed that this approach appeared to tie in with the Population Health Strategy for NCL. Ruth Donaldson agreed that there was a definite alignment, noting that the Population Health Strategy had five areas and that they were keen to improve outcomes through the delivery part of the strategy and by spending resource in the areas of highest need.
• Cllr Clarke referred to the smoking cessation programme and asked whether the issue of vaping and young people was being incorporated into the programme. Ruth Donaldson said that this had not yet come forward as a particular need and the evidence in this area appeared to be limited. However, she added that a key part of the scheme was about listening to local populations, including young people, about their priorities and then bringing in national evidence and local public health data to determine the use of resources.
• Cllr Cohen noted that the funding for some of the projects was time limited and asked for clarification on the funding situation at the end of those time periods. Ruth Donaldson explained that there were different reasons why schemes might finish. Some schemes came to end because they could not provide evidence of the intended outcomes. Others were time limited because they had completed certain objectives, such as the project on autism in Camden which aimed to bring lived experience expertise into the development of mental health strategies.
• Cllr Cohen referred  ...  view the full minutes text for item 51.

To provide an overview of the approach to winter resilience in NCL for 2022/23 including the High Impact Winter Action Plan and additional funding for winter demand/capacity and discharge.

Alex Smith, Director of Transformation at the NCL ICB, introduced the winter resilience update noting the following key points:

• The winter had been a particularly challenging period with a high level of flu and respiratory illnesses as well as industrial actions.
• Partners across the health and care system had been working closely together to manage safety and to support each other during a period of increased pressure. This included a focus on hospital handover times and discharge delays as these could sometimes be caused by something elsewhere in the system not working.
• Additional funding had been allocated from NHS England for additional capacity and from the Department for Health & Social Care to support hospital discharge and this had helped to get people home quicker when they were ready to do so.
• There had been collaboration with the London Ambulance Service (LAS) to improve the handover of patients. During the period of industrial action there had been the involvement of GPs and senior clinicians to provide the right advice over the phone which meant that, in some cases, it was not necessary to send an ambulance. There were challenges in doing this in the longer-term due to the demands on the workforce. There had also been collaboration between the LAS and the Urgent Community Response services to reduce the need for hospital admissions.
• There would be an evaluation process over the summer to provide learning over what had worked well and not so well in time for next winter.

Alex Smith then responded to questions from the Committee:

• Cllr Dey raised the difficulty of obtaining GP appointments which increased the demand on A&E departments. Alex Smith said that there were a myriad of reasons for this and, while sometimes this may be due to patients not being able to obtain a primary care appointment, it could also be about what patients knew about primary care and how they preferred to access the system. Extended access GP services was a part of tackling this but, in the longer term, a review of primary care services would be commencing soon to look at workforce challenges, how well the full range of primary care services were working and the information available to patients about accessing primary care services.
• Cllr Cohen requested further details about the follow-up reablement care that was provided following discharge and the impact of the additional funding. Alex Smith explained that they worked closely with the five NCL local authorities that provided these services and all had felt that they could meet the financial demands over the winter. While the funding and workforce issues in this area were well known, additional capacity was added so far as was possible with the additional funding over the winter period. However, there were some areas that needed improvement and some further guidance on hospital discharge was expected soon.
• Asked by Cllr Anolue about the lack of resources for personal care in the home, Alex Smith said that this question would need to be  ...  view the full minutes text for item 52.

To provide an update on NCL primary care and an overview of community pharmacy integration in NCL.

Clare Henderson, Director of Integration (Islington), provided an update on the primary care response to winter 2022/23. She explained that:

·         Comprehensive plans had been developed but there had been additional challenges such as Strep A. There was always a lot of focus on primary care access and demand for face-to-face appointments which needed to be balanced against protecting capacity for proactive care and long-term condition management.

·         Rates for face-to-face appointments in NCL were slightly lower than the national average but NCL was one of the best performers in terms of same day appointments. In Camden there had been a focus on high intensity users, while in Islington there had been an approach based on speaking to a PCN reception rather than an individual practice for triaging purposes.

·         A shift in focus to same day access was anticipated and NHS England were expected to publish a document on this shortly.

·         Primary care services still had a range of telephony systems which was a currently a significant topic of conversation.

Cllr Chowdhury raised the difficulties for patients in obtaining GP appointment by calling at 8am. Cllr Connor noted that there was often availability at GP hubs at evenings and weekends but that this was not widely known or communicated by GP practice reception staff. Clare Henderson acknowledged that there was scope for better communications about how people can access GP hubs. She added that the recruitment and retention of reception staff was an area where many practices struggled and this added to the challenges of primary care access.

Kristina Petrou, NCL Community Pharmacy Clinical Lead, provided an overview of community pharmacies, noting that there were just over 300 community pharmacies in the NCL area, 80% of which were independently owned with 20% provided by chains such as Boots or Superdrug. She also explained that:

• The Pharmacy Integration Programme was a drive from NHS England to improve services in community pharmacies. The aim was to increase the presence of pharmacists in primary care and to make pharmacists the first point of call in many situations to help people to self-care and to free up primary care capacity. This would also better utilise the clinical skills in community pharmacies that were currently underused.
• The table on page 56 of the agenda pack provided a list of community pharmacy services. From March/April the Community Pharmacy Consultation Service (CPCS) would be accepting referrals from Urgent or Emergency care settings which meant that a large amount of presentations could be managed through community pharmacies rather than GP practices or A&E.
• A hypertension case-finding service was being expanded to identify risk of strokes, heart attacks and cardiovascular disease. 204 pharmacies in NCL had signed up to this, of which 142 (as of Dec 2022) were actively providing appointments so far. They could also accept referrals from GP practices that did not have the capacity to monitor blood pressure which could help to identify long-term conditions at an earlier stage.
• Another service was the Discharge Medicine Service  ...  view the full minutes text for item 53.

This paper provides an outline of the 2022-23 work programme for the North Central London Joint Health Overview and Scrutiny Committee. This item provides an opportunity for Committee Members to select items for inclusion in the 2023-24 work programme.

The Committee then discussed possible items for inclusion in their work programme for 2023/24, with the following suggestions made:

• Cllr Revah proposed that an item could be included on loneliness and isolation, not just with regard to older people but also other demographic groups. This could include looking at the support available (including in relation to mental health and wellbeing), community activities and signposting to appropriate services and support organisations.
• Cllr Connor noted that further updates on population health and on health inequalities could be scheduled and it was agreed that it would be necessary to liaise with officers on the appropriate timescales for this. These issues could also be relevant to the item on social isolation.
• Cllr Connor noted that update reports on finance, workforce and estates would also be included in the 2023/24 work programme, with the estates item usually scheduled for November. Cllr Clarke suggested that the finance paper could include details of the financial impact of recent industrial action.
• Cllr Revah commented that the meeting on mental health in February 2023 had been positive and suggested that the issue could be revisited in the following year. Cllr Connor added that the involvement of local community groups had provided some strong evidence.
• Cllr Anolue suggested that concerns about paediatric services could be included in the work programme.
• Other topics raised included smoking cessation (including vaping and young people, potentially involving speaking to schools), diabetes and cancer.

Dates for 2023/24 TBC.

At the time of the meeting, the dates for 2023/24 were still to be confirmed. The meeting dates were subsequently confirmed as:

• 26^th Jun 2023 (10am)
• 11^th Sep 2023 (10am)
• 13^th Nov 2023 (10am)
• 29^th Jan 2024 (10am)
• 18^th Mar 2024 (10am)