Agenda and draft minutes

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The Chair referred to the notice of filming at meetings and this information was noted.

To receive any apologies for absence.

Apologies for absence were received from Councillors Linda Freedman, Larraine Revah, and Christine Hamilton.

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 12 below).

There was no urgent business.

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Cllr Connor noted that she was a member of the Royal College of Nursing and that her sister worked as a GP in Tottenham.

To consider any requests received for deputations, petitions, presentations, or questions.

The Chair noted that a deputation had been received from NCL NHS Watch on the Integrated Care Systems (ICS) White Paper, integration and innovation and primary care post-Centene.

Brenda Allan, NCL NHS Watch, explained that NCL NHS Watch had addressed the Committee in March 2021 and that, since then, further information had been provided in a White Paper. It was noted that the written deputation set out a number of concerns and the Joint Health Overview and Scrutiny Committee (JHOSC) was urged to raise these concerns.

It was stated that the core NHS ICS Board was expected to have three additional partners from primary care from the local NHS, from general practice, and from social care. Brenda Allan noted that there was no local authority or public representation and that there was no mention of any documents being open to the public. It was stated that private providers could be on this Board and that they were not subject to Freedom of Information requests. The JHOSC was urged to argue for parity of representation, or at least increased representation, for primary care and local authorities to ensure accountability. Brenda Allan added that NCL NHS Watch believed that independent providers should be excluded from resource allocation boards.

There were concerns that the proposals set out in the White Paper would result in the increased allocation of contracts to private providers. NCL NHS Watch asked the JHOSC to argue to make NHS organisations ‘preferred providers’.

Brenda Allan noted that the social care proposals had been further deferred which was concerning and that the plans for public health were brief. She asked the JHOSC to argue for more investment in social care and public health and for comprehensive reform of social care.

NCL NHS Watch noted that there had been a significant shift to virtual services, particularly as a result of the Covid-19 pandemic, but considered that face-to-face consultations should be made a right for patients. The JHOSC was also asked to urge the reconsideration of capped budgets which may have a significant impact on health services, particularly following recent reductions in funding and spending required to react to or recover from Covid-19.

It was stated that there was significant pressure in primary care which provided 90% of patient contacts but received 10% of NHS funding. Brenda Allan noted that primary care was generally much cheaper than emergency care but that pressures had resulted in staff leaving. It was added that, in relation to contracts, there was an uneven playing field for GP providers as large, multinational companies could use substantial teams to respond to tenders. The JHOSC was asked to raise the issues noted by NCL NHS Watch to support and ensure the preservation of primary care.

Jo Sauvage, NCL CCG Chair and Primary Care Lead, stated that the primary focus of the CCG was to ensure that residents were satisfied and able to access GP practices. It was highlighted that the ICS framework had been published recently and  ...  view the full minutes text for item 5.

To note the minutes of the North Central London Joint Health Overview and Scrutiny Committee meetings on 12 March 2021 and 19 March 2021.

The Chair noted that, following a previous resolution by the Committee, she had sent a letter to Professor Stephen Powis, National Medical Director of NHS England and NHS Improvement to urge the use of protected funding for Long Covid pathways. It was reported that a response had been provided which included some positive information relating to funding. It was noted that there was due to be £100 million of additional funding in 2021-22, including £70 million to expand Long Covid services in addition to the £24 million already allocated to Post-Covid Assessment Clinics. It was also noted that there were currently 89 Long Covid clinics and that 15 Post-Covid Assessment Clinics would be established in children and young people hubs. Cllr Tomlinson enquired how many of the clinics would be based in North Central London and it was noted that this would have to be checked.

RESOLVED

To note the minutes of the North Central London Joint Health Overview and Scrutiny Committee meetings on 12 March 2021 and 19 March 2021.

To receive a report on the Mental Health and Community Services review.

Joanne Murfitt, Programme Director, introduced the report which provided information about the mental health and community services review. It was explained that these were two reviews that were being run concurrently as they provided a number of related services. A key aim of the review was to ensure that there was a core, consistent offer across North Central London.

It was noted that resident engagement was at the centre of the review design principles. It was explained that there was a resident reference group with diverse membership and representation from all five boroughs; although there was a lack of younger members, there were parents within the group and efforts were being made to engage with young people. It was reported that there had been approximately 50 responses to the resident survey so far which included positive comments. Joanne Murfitt noted that the review also involved visiting and speaking to the Voluntary and Community Sector (VCS) and other groups, including statutory groups such as Health and Wellbeing Boards and Healthwatch. It was acknowledged that there had been minimal feedback from harder to reach groups and that work was underway to maximise engagement with these groups.

The Chair noted that the aim of the review was welcomed. She explained that the Committee was asked to consider the engagement in particular to ensure that all views were captured within the review. The Chair commented that the review did not plan to consider services offered by the VCS or by councils; she felt that these services should be included in order to capture the wider picture and to avoid the risk of repetition. The Chair added that it would be useful to consider how different service providers, such as the Police, local authorities, and mental health services, could communicate to improve services for patients. Joanne Murfitt explained that the CCG was working hard to include local authorities and the VCS in the review, including in the programme board, and this was positive for joint working. It was noted that the services provided by councils and the VCS were being looked at but that they were not central to the review as the CCG was not able to direct these services. It was added that improved communications between different services was slightly beyond the remit of the review but that it may be possible to consider this.

Cllr Tricia Clarke commented that it was good that the review was honest about the areas that required improvement. She stated that the Covid-19 pandemic had and would continue to have a significant impact on mental health and that it would be critical to focus on prevention and early intervention and to access more funding. Joanne Murfitt noted that more funding had been given to mental health services but acknowledged that additional resources were always helpful. It was explained that the review had a strong focus on increased prevention and would consider whether it was possible to provide more direct services which did not require a  ...  view the full minutes text for item 7.

To receive a report on GP Services.

Dr Katie Coleman, GP and NCL Clinical Lead for Primary Care Network Development, and Dr Peter Christian, GP and NCL CCG Board Member, introduced the report which provided an update on GP Services. Dr Peter Christian noted that the report provided an overview of primary care in North Central London. He explained that the report provided detail about the different types of contracts, including General Medical Services (GMS), Personal Medical Services (PMS), and Alternative Provider Medical Services (APMS), and about which services were commissioned from general practice.

It was explained that all contracts with GP practices were delegated from NHS England to Clinical Commissioning Groups (CCGs). It was noted that, in North Central London, the contracts were managed by the CCG contracts team and the Primary Care Commissioning Committee. Performance and monitoring was routinely conducted on the contracts through various mechanisms and any issues were referred to the Committee.

Dr Katie Coleman noted that primary care had worked exceptionally hard throughout the Covid-19 pandemic, including significant achievements with the vaccination programme. It was acknowledged that there had been a reduction in face-to-face provision at the beginning of the pandemic but that over 50% of appointments were now provided face-to-face. It was added that face-to-face appointments were provided if required.

It was explained that GP practices were working together with local health and voluntary services in groups, known as Primary Care Networks, and that alliances of practices were working together to deliver primary care services, known as GP Federations. It was noted that, under the developing Integrated Care System (ICS), it was envisioned that GP Provider Alliances would ensure a strong, unified voice for primary care to influence and challenge ICS decision-making. In North Central London, it was stated that a GP Alliance reference group had been formed and was establishing its structure.

Jo Sauvage, NCL CCG Chair and Primary Care Lead, stated that the demand on primary care was immense and that some of this could be managed through digital options. It was accepted that the traditional model was still important but that the system needed to consider how it could modernise effectively to deal with demand and ensure high standards for patients and staff. It was commented that Healthwatch was very helpful in providing engagement and reports on these issues, and particularly on access. The Chair added that the recent Healthwatch report on digital exclusion was included in the Committee’s agenda papers for information.

It was noted that some changes to the way NHS Digital would access and use GP data had recently been announced. It was explained that the new way to use data was called the General Practice Data for Planning and Research (GPDPR). GPs would provide data which would be pseudonymised; this meant that the data would not be directly identifiable but could be used to identify patients if needed. It was added that the data would be used to plan future services and monitor health service delivery. Dr Katie Coleman noted that the changes  ...  view the full minutes text for item 8.

To receive an update on the Covid-19 pandemic.

Chloe Morales Oyarce, CCG Head of Communications and Engagement, and Sarah Mansuralli, CCG Executive Director of Commissioning, introduced the report which provided an update on the Covid-19 pandemic.

Sarah Mansuralli explained that, since the unexpected first wave of Covid-19, a number of measures had been introduced to the system, which included monitoring and escalation and surge plans. It was noted that there was now provision to rapidly provide additional step down beds and that primary care hubs could be stepped up quickly. It was added that there were also options to have more care in the community and remote monitoring in care homes. It was explained that the governance structures, escalation procedures, and collaboration arrangements developed in the first wave had put the system in a strong position for the following surges and had created some strong foundations for the Integrated Care System.

Sarah Mansuralli noted that there had been some temporary changes to paediatrics but that these had now reverted back; evaluation of these changes was underway and could be shared with the Committee when available. It was noted that the system changes had been overseen by the System Recovery Executive which included local authorities.

It was explained that there was now a focus on system recovery from the Covid-19 pandemic. It was stated that North Central London had been selected as the accelerator hub for London which meant that it needed to recover its elective lists faster. Sarah Mansuralli noted that there was an aim to provide 120% activity which was a challenge but that North Central London would be working creatively and using clinical triage, out of hospital, and other support mechanisms. Work was underway to consider how to maintain capacity in the system, including working closely with social care; it was added that the Integrated Discharge Team had been very effective and was being maintained to retain capacity. It was also explained that the pandemic had acted as a catalyst for some culture changes, including recognising the interdependency of different health and care sectors, which had resulted in improved outcomes for patients and learning for the system.

The Chair asked about oxygen resilience and funding options within North Central London. Sarah Mansuralli acknowledged that there were some global issues with oxygen supply during heights of demand and noted that she would check what arrangements were in place.

The Chair noted that, following Brexit, a number of health and care staff had left the country which increased demands on the workforce. She stated that there were concerns that the aim to provide 120% capacity as part of the Covid-19 recovery programme would have a significant impact on the workforce. Sarah Mansuralli acknowledged that this was a concern and explained that work was ongoing as part of the Integrated Care System (ICS) People Strategy to work on workforce retention and resilience. It was noted that new models of care would include progression and professional development opportunities for staff. It was noted that it might be  ...  view the full minutes text for item 9.

To receive an update on AT Medics.

This item was considered under Item 5, Deputations / Petitions / Presentations / Questions.

This paper provides an outline of the 2020-21 work programme for the North Central London Joint Health Overview and Scrutiny Committee.

1 October 2021

·         Digital Inclusion and Health Inequalities

·         Review of Mental Health and Community Services

·         Mental Health Update

·         Integrated Care Systems

The Chair noted that there were a number of items on the Committee’s forward plan and that a more detailed discussion of the agenda for November would be discussed at the Committee’s next meeting. It was added that the Chair would receive briefings on some other developments, such as service changes at Barndoc, and would report back to the Committee if required.

26 November 2021

·         Fertility Review

·         Royal Free Maternity Services

·         Missing Cancer Patients

·         Children’s Services

·         Finance

·         Winter Planning

·         Screening and Immunisation

·         Emergency and Recovery Planning Update

·         Estates Strategy Update

To consider any items of urgent business as identified at item 3.

There were no new items of urgent business.

To note the dates of future meetings:

19 March 2021 (special meeting)

25 June 2021

1 October 2021 (rather than 24 September 2021)

26 November 2021

28 January 2022

18 March 2022 (rather than 25 March 2021)

It was noted that the future North Central London Joint Health Overview and Scrutiny Committee meetings were scheduled for:

1 October 2021 (previously 24 September 2021)

26 November 2021

28 January 2022

18 March 2022 (previously 25 March 2022)