Agenda and minutes

Matters arising from the minutes of the meeting held on the 28 July 2021:

Agenda Item 10, Page 8 of the Minutes of the meeting held on 19 May 2021 – NHS Trust Quality Accounts 2021/21 RFL NHS Foundation Trust Quality Account. The Dementia Care plans requested by Councillor Rutter at the meeting held on 19 May 2021 had been circulated to the Committee on 15 September 2021. Members were also sent a contact name and an email address for any further queries they might have.

Agenda Item 10, Page 8 of the Minutes of the meeting held on 28 July 2021 – Alternative Provider Medical Services (APMS) Cricklewood Update. Four questions had been raised at the last meeting:

1.Who are the other shareholders apart from Sree Agarwal?

2.How many services do Penceat Medical Ltd run?

3.How long had they been running these services?

4.What type of questions were asked during the procurement process?

The answers to these questions had been circulated to Members on 12 October 2021 and hard copies were available at the Meeting. The Chairman raised concerns in relation to the answer to Question 3: ‘The Service was registered with the CQC in June 2020’. The Chairman enquired as to whether the services could have been running before Penceat Medical registered with the CQC and, if they were not, she was concerned that the services had been running for a very short amount of time which did not allow for much long-term reassurance on the ability of the company to provide the medical care required.

Members reiterated the concerns of the Chairman and commented that parts of the local Community already had a distrust of health services. Members advised that any company taking over this contract would need to be able to deal confidently with significant challenges to regain the confidence of the Community. Members expressed their concern that the company did not have a proven long-term track record of being able to provide quality services.

Colette Wood, Director of Integration, North Central London Clinical Commissioning Group (NCL, CCG), explained that the procurement had been undertaken in-line with the relevant laws and procedures. She also updated Members that her team had met with Penceat Medical around 4 to 5 weeks ago to confirm what plans the Company had around working with the Community. Colette Wood commented that the responses the CCG received had been very reassuring, that the company demonstrated they had conducted due diligence of the area and that the group of GPs working there had significant experience. She also assured Members that, as with all GP Practices in Barnet, Penceat would be subject to stringent contractual arrangements.

Members asked what the handover procedure would be. Colette Wood explained that the CCG recognised that the Practice had gone through a difficult time over the last few years with a high turnover of staff. Therefore, the CCG had held a number of meetings with Penceat and the GP Federation, who would continue to be the care takers  ...  view the full minutes text for item 1.

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The Minutes of the meetings of the North Central London Joint Health Overview and Scrutiny Committee held on 12 March, 19 March and 25 June 2021 were noted.

TheChairmaninvited the following to the table:

·         Dr Tamara Djuretic - Director of Public Health, LondonBorough of Barnet

·         Deborah Sanders - Chief Executive, Barnet Hospital

·         Colette Wood - Director of Integration, North Central London Clinical Commissioning Group (NCL CCG) (Joined virtually).

Dr Djuretic provided an update on the Coronavirus cases and Vaccination Programme in Barnet. Similar rates of infection levels had been recorded over the last 10 to11 weeks, which suggested there was now a baseline of case rates within the Borough.

Dr Djuretic said that 40% of children had been infected with Coronavirus, which equated to around a quarter of all infections and this demonstrated why it was important for the vaccine to be rolled out to young people. She also commented that the booster programme was underway and would increase the immunity of those vaccinated at the start of the pandemic. A decrease in hospital admittances had been recorded over the past few weeks, however a slight increase had been seen during the week commencing 4 October, but the increase was not significant.

She explained that the Country was now moving into Phase 4 of the pandemic, which included learning to live with the virus, vaccinating as many people as possible and building back the economy. The Government’s containment framework advised that there were no plans for any future national lockdowns but management plans needed to be in place to respond to any significant increase in rates locally that were above the national or London average. She explained that management plans could include measures such as the requirement to wear masks in schools and the acceleration of vaccination rollouts to help contain the transmission of the virus.

Dr Djuretic informed the Committee that there had been a good reception from schools in relation to the vaccines for 16 to 17 year olds, with vaccinations having been offered in ten schools with an uptake of around 30%. This figure was above the national average, but still not at the ideal level. The reasons for lower uptakes were due to practical issues around getting the vaccine, capacity to administer the vaccinations and the reluctance of some parents who wished to see how things progressed further before having their child vaccinated. Only one dose of Pfizer was being offered to 16 to 17 years olds and it would be delivered in schools with the support of Primary Care if required. Evidence would be used to decide whether a second dose of Pfizer was appropriate in the future.

Members enquired as to whether the data on the number of people vaccinated in Barnet equated to the number of Barnet residents vaccinated, or if this included people from outside the Borough who had been vaccinated at Barnet vaccination centres. Dr Djuretic confirmed that 250,000 people had been registered as having been vaccinated in Barnet and, of those, 200,000 were residents.

A Member raised a concern about side effects, including heart palpitations, that had been reported after receiving the second dose of  ...  view the full minutes text for item 8.

The Chairman invited thefollowing to thetable:

·         Dr Kola Akinlabi - Clinical lead for Long Covid, Central London Community Healthcare NHS Trust (Joined virtually)

·         Deborah Sanders - Chief Executive, Barnet Hospital

Dr Akinlabi updated the Committee on data surrounding Long Covid and the number of cases in Barnet. Dr Akinlabi agreed to circulate his presentation following the meeting which would be published alongside the Agenda papers. Members enquired whether Barnet had more cases than any of the other five North Central London boroughs because it has the largest population, or whether the number of cases is in proportion to its population. Dr Akinlabi advised he would circulate the answer via email.

Deborah Sanders provided an update on the recovery of services which had been suspended due to the pandemic. She informed the Committee that there were currently 13 members of staff at Barnet Hospital off sick due to Long Covid and that various support measures had been put in place to assist these individuals.

She explained that over the last 18 months there had been a significant increase in the waiting list for several services and that the priority now was to recover and reduce this list as quickly as possible. During the first phase of the pandemic, most elective work had been halted, apart from cancer treatment, as the pandemic had resulted in the hospital being unable to deal with elective work as well as caring for Covid patients. Many outpatient and theatre staff were redeployed to Intensive Care Units during this time. During the summer, several services began to be restored with the Royal College of Surgeons’ priority guidance being used to establish the order in which services should be re-opened. New pathways for services had been set up to ensure they were Covid secure. The second wave of the pandemic last winter did start to have some impact on the gains that had been made in the summer however, during the third wave, services continued and numbers on the waiting list had reduced since April 2021.

Deborah Sanders informed that Committee that approximately 9,500 patients had waited more than a year, which was very worrying, and it was the hospital’s top priority to keep reducing this number. Some services had been more affected than others including ear, nose and throat, trauma orthopaedics and ophthalmology.

The Chairman raised concerns about long queues being experienced at Barnet Hospital and that residents had reported that some security staff had been unhelpful and off-hand as well as many patients having to stand for some time queuing in the car park because A&E was full. Deborah Sanders replied that due to capacity issues and the need to keep the Emergency Department Covid secure, there had been times when patients had needed to wait outside. She said that a second entrance had now been opened, as well as a second waiting room. However, due to staff shortages, the hospital was not always able to open the second waiting room. She said  ...  view the full minutes text for item 9.

The Chairman invited to the table:

·         Nitish Lakhman – Manager, Barnet Healthwatch

·         Councillor Caroline Stock – Chairman, Barnet Health & Wellbeing Board

Nitish Lakhman provided a snapshot of the findings in relation to patients’ experiences of accessing GP appointments remotely.

The broad consensus had been that there were many positive aspects to this new way of working which included the following:

-       Being able to access an appointment whenever was convenient thereby allowing patients to schedule appointments around their life, jobs and commitments.

-       Sufficient time being allocated to speak with a doctor.

-       Prescriptions being provided on the same day.

-       Patients feeling protected from Covid and other illnesses that they might pick up within the GP Surgery Waiting Room.

-       The ease of being able to talk to a doctor virtually meant that issues like childcare were not a problem.

However negative aspects of the system had also been reported by many patients which included:

-       Inefficiencies of the system, with long forms and numerous questions having to be completed.

-       Algorithms sometimes being too sensitive and recommending patients attend A&E, therefore ending up using acute pathways unnecessarily.

-       The lack of choice around whether to see a doctor virtually or in person, as the decision is made by the clinician.

-       Some medical concerns not being appropriate in a virtual context, with some patients feeling uncomfortable or concerned about digital security.

-       Accessibility issues for those unable or not confident in using digital services.

-       Privacy and data concerns around sharing personal and sensitive issues on-line and General Data Protection Regulation (GDPR) requirements not always being adequately communicated to patients.

-       Frustration with the inadequate telephone system, with some patients reporting having waited up to 1.5 hours to get through.

-       Frustration of patients leading to abuse of reception staff.

Nitish Lakhman reported that issues with the length of the form had been highlighted as an area for improvement. He also said that often patients had to fill out multiple forms for each issue when booking an appointment, which was a downside of some of the systems being used by GPs. Feedback from some GPs had also been that they had been unable to cope with the increased administrative work associated with using E-consult as they had to spend a long time reading through all the forms.

Councillor Stock, Chairman of the Health and Wellbeing Board, said that some forms involved at least six pages of questions, if not more, and that often the questions were either not applicable or did not meet the needs of patients with multiple ailments. She said that patients became frustrated when they just needed to speak directly with a GP and were unable to do so. She explained that digital diagnosis was not always suitable or satisfactory, with some conditions requiring in-person appointments. She also raised concerns about some patients having reported being asked to show inappropriate areas of their body on camera and how unacceptable and upsetting this was. Councillor  ...  view the full minutes text for item 10.

7 December 2021 Meeting:

-       Update on Coronavirus,the Coronavirus Booster and Flu Vaccination.

-       Mid-year Quality Accounts.

-       Briefing on accessing GP appointments remotely.

-       Childhood Inoculation andBirthRegistration.

To BeAllocated:

-       Early2022 -Children and YoungPeople’sOral Health in Barnet.

-       APMS update six months after opening.

RESOLVED that the Committee noted the Forward Work Programme.