- Presentation by Chris Edwards, NHS Rotherham
Minutes:
Chris Edwards, Chief Officer, NHS Rotherham/Rotherham Clinical Commissioning Group, gave the following powerpoint presentation:-
What do the changes mean for Rotherham?
- Rotherham Primary Care Trust/NHS Rotherham would be abolished in March, 2013
- There would be (at least) 6 new bodies in its place:-
· Rotherham Clinical Commissioning Group – Expected to be authorised to formally start in April, 2013
· RMBC – Public Health responsibilities transfer from NHS to RMBC in April, 2013
· National Commissioning Board (NHSCB) – would cover all of South Yorkshire and Bassetlaw based at Oak House, Bramley. Includes GPs/Dentists/Pharmacists/Opticians contracts and specialist commissioning
· HeathWatch – would be formed to promote the views of patients and Service users
· NHS Property Services – all estates owned by NHS Rotherham e.g. health centres
· Public Health England – Health Protection Agency would also lead on commissioning support to the Commissioning Board – specialist commissioning covering vaccination and immunisation
Funding
- NHS Rotherham £460M
· RMBC Public Health = £14M
· Rotherham Clinicial Commissioning Group - £330M
· NHS Commissioning Board GPs/Dentists/Pharmacists = £116M
Who is CCG represented by?
- David Tooth, Chair, Long Term Conditions/Urgent Care
- Chris Edwards, Chief Officer
- Richard Cullen, Vice-Chair, Finance
- Ian Turner, Primary Care
- Phil Birks, Rotherham Foundation Trust
- Julie Kitlowski, Clinical Referrals and Pathways
- David Pokinghorn, Children and Young People
- Jason Page, Prescribing
- Russell Brynes, Mental Health, End of Life Care and Equality and Diversity
- David Plews, Medical Director, NHS Rotherham Metropolitan Borough Council
What Services will the CCG commission?
- Unplanned (unscheduled care)
- Planned (scheduled care)
- GP prescribed medication
- Mental Health and Learning Disability
- Children and Young People
Policy decided that most of Children’s Services would be commissioned by the CCG but School Nursing would remain the responsibility of the Council and Public Health. Health Visitors would come under the NHSCB for 2 years and then transfer. This was a risk area
- End of Life Care
- Transport services for patients
- Any qualified provider services
- Services jointly commissioned with RMBC
- Services the CCG commissions from GPs (small)
Financial Challenges
- Nationally the NHS had to save £20B
- Rotherham would have to save approximately £80M by 2014/15
Challenges for the CCG
- Overall the NHS spent approximately £2,000 per person
- Approximately ¾ of the £2,000 per head was the responsibility of the CCG
- Some areas which were very important for patients such as GP services and very specialised services were the responsibility of others (NHSCB or Public Health)
- Costs and demands for services were increasing faster than NHS spending
- Much of the balance of the spend was hard to change e.g. most of the money was spent on urgent hospital care
- There was a chicken and egg problem in that the CCG could not spend more on prevention until it decreased the cost of acute services
CCG Urgent Care Review
- A new Urgent Care Centre for Rotherham
· Would be open 24/7
· Purpose-built at Rotherham Foundation Trust Hospital
· Staffed by experienced and specially trained nurses and GPs
· Joined up with Accident and Emergency
- Re-investing money from the Walk-in Centre into Urgent Care
· Urgent Care Services currently provided at the Walk-in Centre would transfer to the Urgent Care Centre
· The Walk-in Centre would close (but not the building)
· New NHS 111 service would provide advice and support for non-urgent care (to be launched on 19th March, 2013)
Next Steps
- Finalising proposals
- Continuing discussions with providers, patients and stakeholders
- 12 weeks public consultation starting in the Spring
- Recognition that for some the proposals would raise issues. They would be listened to and work with the local community to address them where possible
- Proposal to open the new Urgent Care Centre in Autumn 2014
Discussion ensued on the presentation with the following raised/clarified:-
· The Legislation governing CCGs recognised that the nursing voice had to be heard and that there should be a hospital doctor. Sue Casson was on the Governing Body representing nursing and a Dr. Ashurst from Bradford Hospital. Any suggestions of a forum that could be engaged would be useful
· There was no requirement in the national guidance to include a specialist health professional on the Governing Body
· The CCG Strategy was to decrease unscheduled hospital admissions. If Rotherham could reduce its number to the national average, the plan was to spend £5M more on Community Services to ensure patients received the appropriate services
· The move of the Walk-in Centre to the Hospital would cause logistical problems for visitors from a car parking/bus route point of view. Consideration would be given to accessibility
· The demolition of the former Mental Health block fronting the main road would provide additional car parking spaces
· A GP practice would remain at the Walk-in Centre for a period of time following its transfer to the Hospital
· There was an efficiency target for the whole health community of £80M over 4 years. A large proportion would be passed to the Rotherham Foundation Trust but the CCG still had to make significant savings. The CCG’s annual commissioning plan, available on the website, detailed what it intended to do in terms of efficiencies
· The Health and Wellbeing Board, Healthwatch and Health Select Commission would be responsible for scrutinising the CCG
· Currently there were no plans to move any services outside of Rotherham. It was not a case of stopping delivery but delivering differently. All CCGs across the country shared the strategy that hospitals were expensive. Rotherham had a lot of people that went into hospital unnecessarily and would receive better treatment outside of it. A big issue was follow-up out-patient appointments a large number of which could take place at GP practices.
· Conflict of interest – GPs were not involved in the decision making; they were involved in the discussion and working up of the business case but the decisions were made by the lay people and independents. This was in accordance with the national Policy
· The Department of Health was introducing Payment by Results not Rotherham CCG. It would be based on a national price rather than a local price for Mental Health Services. The Department of Health had tried to introduce it since 2005 but had struggled due to the difficulties in getting an average price due to the varieties of the client group. It was proposed that it be introduced in 12 months and run in shadow form as from 1st April, 2013, to understand whether it would be realistically possible and whether it was a far way of recompensing providers for providing those services. It would be about numbers going through the Service rather than outcomes. Rotherham CCG had in its contract additional payments on top of the tariff for improving quality
· Rotherham CCG had 2 lay members – 1 for governance (John Gomersall) and 1 for patient engagement (Sue Lockwood)
· The CCG Audit Chair met with the Council’s Audit Chair. It was expected that the current arrangements would continue. Due diligence had been completed
Chris was thanked for his presentation.
Resolved:- (1) That the presentation be noted.
(2) That an item entitled “Walk-in Centre” be included on the next Select Commission agenda.
(3) That the Health Select Commission be provided with a copy of the Clinical Commissioning Group’s annual commissioning plan for information.