Agenda item

The Board received a presentation from Mike de Coverley, NHS England, and Jill Webb, Head of Primary Care - NHS England which gave an overview of key developments related to the provision of additional Primary Care capacity in Tottenham Hale. Following the presentation the Board discussed the findings.

A copy of the presentation slides was included in the agenda pack and the Board noted some of the key points raised. The current progress to date was summarised as:

• NHS England Finance, Investment, Procurement & Audit Group (FIPA) ratified the findings and recommendations of the Strategic Premises Development Plan.

·         NHS England, Haringey CCG and Haringey Council planners were developing a Delivery Plan which set out, in detail, proposed solutions to meet the challenges outlined in the Strategy Plan.

• NHS England Decision Making Group (DMG) approved a process for the selection of a provider to enter into competitive dialogue to establish the proposed pilot practice in Tottenham Hale.
• NHS England, in conjunction with colleagues from the London Borough of Haringey and Haringey CCG, undertook and completed the competitive process of pilot provider selection.

·         A local practice partner was selected as the provider.  The decision was then ratified by PCC DMG and the provider was notified.

• Lea Valley Estates confirmed that they would have builders on site until June 2016, who would be able to rapidly establish services to the facility.
• NHS England and Haringey CCG were working on an IT solution that would rapidly allow connectivity to the new temporary facility.

The next steps and upcoming milestones for the project were noted as:

• Completion of dialogue had been commenced with pilot provider to establish final costs and service specification
• Final Agreement of pilot costs and service specification required by DMG Primary Care Commissioning.
• NHSE had begun the process of drawing up the contract for services
• Preparation of business case for pilot premises
• Dialogue and agreement of co-commissioners on premise funding responsibilities (in progress). Ms. Webb advised that NHSE were undertaking a process to bring primary care medical services commissioning arrangements back within the CCG umbrella.
• Sourcing of temporary facility (commenced)
• Approval of business case for pilot premises by FIPA  
• Site mobilisation with new Partner Practice
• Planned service commencement by early January 2016

Cllr Morton, the Cabinet Member for Health & Wellbeing, welcomed the commitment from NHSE and acknowledged that this was a significant step forward on something that partners had been working on for a long time to get it to the position that it was currently in.  Cllr Morton advised that the process had taken 12 months and a resolution was at least another 6 months away. Cllr Morton emphasised that a resolution could not happen fast enough both for existing residents but also to meet the additional demand as a result of the area being a major regeneration zone for London. Cllr Morton observed that primary care was part of the wider investment in the area and offered an unprecedented opportunity to improve the borough and the lives of the people in it. Cllr Morton commented that it was refreshing to see a large public body being accountable to the public in such a clear way.

Sarah Price, Chief Operating Officer Haringey CCG, reiterated that going forward the arrangements for commissioning would change and that this would involve closer working with CCG colleagues in other areas to plan for primary care investment in the future. Ms. Price agreed that being very clear about what Haringey’s commissioning priorities were would put us in a strong position to ensure that we get the sort of input required from partners. Ms. Price advised that the Board was absolutely committed to ensuring that a resolution was found to the primary care shortfall but also noted that some difficult decisions would need to be made about how things were taken forward. Ms. Price expressed a desire to work together with NHSE to prioritise some of the more difficult decisions and thanked NHSE for supporting the initial investment.

Zina Etheridge, the Deputy Chief Executive, recognised that there were a special and specific set of circumstances around this issue and expressed gratitude to colleagues in the CCG and NHSE for developing a solution. Ms. Etheridge emphasised the importance of local and partnership working across this piece of work, and stated that the Board made a commitment to bring back local needs assessment for primary care at the last meeting. The Board noted that this evidence base would be crucial for accessing future public funding and would support collective evidence based decision making, at a local level, in a way that was transparent and accountable to local people.

Mike Wilson, Director of Healthwatch Haringey, acknowledged the challenges involved in the process and thanked NHSE colleagues for the work that had been undertaken. Mr. Wilson stated that he would like some assurances that the service provided was going to meet resident needs and that it would be a sustainable service that was adequately staffed. In response, Mr de Coverley recognised the concerns raised and advised that NHSE had identified a reliable local provider who would be able to provide experienced GP’s from day one. The committee noted that adopting a local provider added a level of flexibility, and would allow NHSE to increase provision if required.

Ms. Webb advised the Board that it was unusual for primary care infrastructure to be funded by capital, but negotiations were ongoing nationally in order for NHSE to use capital funding within General Practice, as part of the Primary Care Infrastructure Fund. Ms. Webb advised that a move to a more commissioner led strategy by NHSE, around funding and infrastructure would potentially be an advantage as the commissioning structures were already in place in Haringey. This would potentially mitigate the impact and the pressure on revenue by virtue of the type of schemes that could be adopted.

Cllr Reith, thanked fellow members of the task and finish group for primary care for their efforts. Cllr Reith raised concerns with a lack of urgency and advised that many residents in Tottenham Hale Ward currently had no primary care services at all and were unable to register with a GP. Cllr Reith commented that one of the key learning points from this process should be for co-commissioning and NHSE to listen to what patients were saying. Cllr Reith urged that a solution to the funding issue needed to be found and emphasised the need to assure residents that the funding would be long term, in order to ensure that residents felt secure in registering at the new practice.  Cllr Reith also urged NHSE to consider pressures resulting from regeneration schemes, such as in Tottenham and the migration of families to outer-London areas, when planning the future allocation of funding and primary care services.

The Chair thanked colleagues from NHSE coming and presenting to the Board and also thanked those present for their contributions.

RESOLVED:

That the progress to date around additional primary care capacity in Tottenham Hale be noted.