Agenda and minutes

The Chairman advised the Committee that since the previous meeting, she had received a letter dated 5 October 2015 from Tony Griffiths, Regional Director at NHS Property Services, in relation to the East Barnet Health Centre.  The Committee noted that the letter contained the following information: 

·         That the Practice was temporarily located at Vale Drive Primary Care Centre whilst essential works took place to remove asbestos from the building and that other significant works had also taken place including replacing windows and installing a lift.

·         That the refurbishment of the East Barnet Health Centre has been completed and that services at the East Barnet Health Centre would resume on 19 October 2015.

The Committee noted that they would be receiving an update report on the East Barnet Health Centre at their meeting on 7 December 2015.

A Member pointed out that three Members’ names had been spelt incorrectly in the minutes and requested that they be amended.

RESOLVED that the minutes be agreed as a correct record.

Apologies for absence were received from Councillor Amy Trevethan.

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The Chairman introduced the report from Barnet Clinical Commissioning Group (CCG) and NHS England which provided the Committee with an update on plans to improve utilisation of the Finchley Memorial Hospital site.  The Chairman invited Jill Webb, Head of Primary Care Commissioning at NHS England (NHSE), Dr. Debbie Frost, Chair of Barnet Clinical Commissioning Group (Barnet CCG) and Mr. Alan Gavurin, Barnet CCG’s Finchley Memorial Hospital Project Manager, to the table.

Mr. Alan Gavurin explained that in January the CCG had launched a project to review how the CCG could make more use of the facilities on the FMH site in order to deliver its objectives for improving healthcare for the local population.  The Committee noted that the CCG had been working with NHS England on the commissioning of GP Services, for which NHS England is responsible.

The Committee noted that the project had reviewed all of the commissioning plans and the areas of local health care need, which had then been presented to a stakeholder workshop in April 2015.  The Committee were informed that a list of possible options was agreed at this workshop and presented to a meeting of the CCG’s Clinical Cabinet in July 2015.

Mr.Gavurin informed the Committee that the CCG wanted to have a focus on the frail elderly and that the Clinical Cabinet had identified four priority schemes, which are as follows:

1.    An Older People’s Assessment Service (OPAS): The Committee was informed that the OPAS was designed to keep people well and independent at home for as long as possible, and would have the advantage of being able to work closely with the existing Falls Clinic at Finchley Memorial Hospital. 

2.    Filling the Empty Inpatient Ward: The Committee noted filling the empty ward would help local system sustainability. The Committee noted that there were 17 unused beds at Finchley Memorial Hospital and that on average there were 18 – 20 Barnet residents in community rehabilitation beds at Chase Farm Hospital following transfer from Barnet Hospital. By opening these beds, the CCG would be able to repatriate those patients back to Barnet. 

3.    Breast Screening: North London Breast Screening Service (NLBSS) are planning to move to providing services from permananent locations rather than their current mobile service. NLBSS and the CCG are agreed that this service should be accommodated at FMH and they will require two rooms  to replace the current mobile facility.

4.    General Practice services: The Committee noted that the CCG are exploring how they could  develop a specialist primary care facility focused on the frail elderly and care home patients.  There would be a meeting with NHS England on the matter the following day. 

Ms. Webb commented that she recognised that previous primary care proposals for the site had not worked out and that she hoped collectively as co-commissioners they could make this proposal work.  Mr. Gavurin informed the Committee that he hoped one day there would be a specialist practice on site that could also take  ...  view the full minutes text for item 7.

The Chairman introduced the report which had arisen as a result of a Member’s Item raised by Councillor Barry Rawlings at the meeting of the Committee on 6 July 2015.  The report provided an outline on the management of GP Provision in the London Borough of Barnet within the context of:

·         The number of GPs expected to retire

·         Regeneration programmes

·         The management of future seven day GP services. 

The Chairman invited Ms. Jill Webb, the Head of Primary Care Commissioning at NHSE, Ms.Su Nayee, Senior Contracts Manage at NHS England, and Dr. Debbie Frost, Chair of Barnet CCG to the table.

Ms. Webb informed the Committee that London was considered over target by 2.29% based on recurrent revenue budgets, which meant that the current budget was considered too high compared to the size of our population. It was noted that this had led to only a 1.8% recurring increase in Primary Care allocations in 15/16 against a national average recurrent increase of 2.3%. Taking into account the Inflation uplift of 1.1% 15/16 and London’s increase in population of 1.3% as a result of regeneration programmes, London had a cost pressure.

Ms. Webb also informed the Committee of the need for more key/priority worker schemes.  There was now more focus on skill mix for general practice, with the development of the role of physician assistant and pharmacist in general practice.

The Committee noted that there was a Government policy to create 5000 new GPs by 2020 and that GP training places within London were always fully subscribed.  Ms. Webb advised the Committee that whilst GPs often want to work in London because of partnerships, it wasn’t always feasible.  Ms. Webb also informed the Committee of the need for more key worker schemes and an increased focus on working.

The Committee noted that Barnet has one of the highest numbers of Practices in London and that smaller Practices are well scattered in meeting the needs of the population.  Ms. Webb advised that it was difficult to provide information on future retirements because there is no retirement age, and that there was no bar to when a GP must stop working, as long as they are competent.  The Committee noted that 3% of GPs in Barnet are locums, which is comparatively low to the national average.

The Committee noted that in 2014, the Office for National Statistics had estimated the population size of Barnet to be 367,265 whereas the current registered list size is around 400,000.

Ms. Webb informed the Committee that the Clinical Workforce within Barnet was 0.72 nurses per 1000, which is below national clinical the ratio which is 0.84 per 1000. 

The Committee noted the following in relation to Patients Access to GPs:

·         Only 13% (8) of Practices across Barnet are open 100% of Core Hours (8am to 6.30pm)

·         48% (30) are open between 80-100% of core hours

·         8 / 30 Practices are delivering 80% (+/- 2%) of core hours per week. They are closed for 10.5 hours per  ...  view the full minutes text for item 8.

The Chairman invited Dr. Laura Fabunmi, a Consultant in Public Health Medicine from Harrow and Barnet Public Health to introduce the report, which set out the rates of Tuberculosis in Barnet. 

The report outlined some of the challenges in tackling TB, who is affected by the disease and what is planned at national and local levels to identify people with TB and to provide the required treatment. Dr. Fabunmi informed the Committee that rates of TB in Barnet have dropped in the three-year average data, from 30.0/100,000 (2010-12) to 23.2 / 100,000 (2012-14). Although this is lower than the London average of 30.1 / 100,000 (2013), there are still hot-spots within the Borough, notably in Colindale and Oakleigh Wards.  Dr. Fabunmi noted however that the statistics for the Borough were based on a very small number of people, approximately 25 – 30 cases.  She informed the Committee that the rate of infection in non-UK born people is approximately 10 times greater than those who are U.K born.

The Committee noted the following responsibilities of the Public Health team in relation to dealing with the issue of TB:

·         Commissioning delivery and co-ordination of sessions and agree provider responsibilities

·         Sourcing promotional material from TB Alert for information packs

·         Organise staff awareness sessions for council staff

·         Encouraging GP uptake of Royal College of General Practitioners online training for TB

·         Organising TB seminar on World TB Day

Responding to a question from a Member, Dr. Fabunmi informed the Committee that, as is the case in London and the UK, the majority of TB cases in Barnet arise due to the reactivation of latent infection and so the main challenge to reducing TB in Barnet is the identification and treatment of those with latent TB.  The Committee noted that approximately 80% of people who develop active TB do so as a result of the reactivation of latent TB rather than through transmission from someone with the active disease. She stressed the importance of prompt identification of active cases of disease, supporting patients to successfully complete treatment and preventing new cases of disease.

The Committee were informed that Harrow and Barnet Public Health would be running the second phase of the project in relation to TB and that voluntary groups would be able to bid for money to fund work on the disease.

A Member noted that whilst the rate of TB was low in Britain, it was comparatively high compared to the rest of Europe and expressed concern at people delaying treatment.  Dr. Fabunmi commented that the delay in treatment was likely to be in part down to Latent TB, the stigma attached to the disease or the association with witchcraft in some cultures. 

Responding to a question from a Member, Dr. Fabunmi advised that control of TB came under Public Health England, who have a national strategy and that whilst Harrow and Barnet Public Health led on the work locally, they had to work along with health providers. 

A Member commented that the  ...  view the full minutes text for item 9.

Dr.Fabunmi, a Consultant in Public Health Medicine from Harrow and Barnet Public Health introduced the report which set out the Barnet and Harrow Public Health team’s strategy to prevent Sexually Transmitted Infections (STIs) among Barnet residents in general and in particular for the older population.  In introducing the report, Dr, Fabunmi noted the increased incidence of STIs reported in the 2015 Annual Director of Public Health report.

The Committee noted the following update in relation to sexual health in Barnet:

·         That there has been a rise in rates of STIs amongst those over 45 years of age from 214.2/100,000 to 267.8/100,000 between 2010 and 2013 (Genitourinary Medicine Clinic Activity Data - GUMCAD). However, the actual numbers of STI diagnosis remain small compared to other age groups.

·         That in 2013, individuals under the age of 35 years had the highest prevalence of STIs in Barnet. During this period, males aged 25-34 years represented 21.8% of the male population but had 43.9% of STI diagnosis. Similarly, females aged 20-24 years represented 7.5% of the female population but had 35.9% of the STI diagnosis.

·         In comparison, men over the age of 45 years represented 43.5% of the male population but had 11.6% of the STI diagnosis; and women in the same age group represented 46.6% of the female population but had 4.8% of the STI diagnosis

Dr.Fabunmi informed the Committee that Public Health’s initial conclusion on the sexual health strategy had shown the need for an integrated service and stressed the need for increased collaboration between service providers. 

The Committee noted a Pan-London plan to procure Genitourinary and Urinary Medicine (GUM) and sexual health provision as one system. 

A Member queried whether the age group statistics relating to to the prevalence of STIs were comparable.  Dr. Fabunmi informed the Committee that the data was intended to show that, compared to younger age groups, there is a much lower prevalence in older groups of people.

Dr.Fabunmi tabled a document which contained a graph extrapolation of data already contained within the Committee report which was made available to Members and the public. 

A Member expressed concern that she had been talking to a young female who had run out of her contraceptive tablets and had not been able to access a repeat prescription from a Walk in Centre.  Dr. Fabunmi informed the Committee that a GUM clinic has a different function from a clinic providing contraception.  The Member expressed the need for that message to be communicated to young people. 

Referring to the report, a Member questioned why there were higher rates for STIs in people of black or ethnic minority groups.  Dr. Fabunmi advised that she would respond to the Committee on that point outside of the meeting.

A Member questioned what could be done to reduce the demand for services.  Dr. Fabunmi informed the Committee of the importance of health partners working together and commissioners developing more efficient services.  The Member commented that people would be less anxious about  ...  view the full minutes text for item 10.

The Chairman invited Councillor Helena Hart, Chairman of the Barnet Health and Wellbeing Board, Zoe Garbett, t Commissioning Lead for Health and Wellbeing, and Luke Ward, Commissioning Lead for Entrepreneurial Barnet, Growth & Development, to the table.

Councillor Hart introduced the Joint Strategic Needs Assessment (JSNA) and noted that the Health and Wellbeing Board had considered this extremely important document on three occasions before approving it for publication. A Member questioned the purpose of the report.  Councillor Hart informed the Committee that the JSNA provided a clear evidence base and understanding of the health and social care needs of both present and future residents of Barnet. It would be an invaluable source of information across the Council, NHS and Voluntary Sector. 

Councillor Hart informed the Committee that the Clinical Commissioning Group had been very engaged in the production of the JSNA and that there had been a high level of involvement from both user groups and residents.  She noted that this should ensure that all Members of the Health and Wellbeing Board were fully signed up to the Joint Health and Wellbeing Strategy which is based on the JSNA. The JSNA would also be used to inform the wider decision making process to issues relating to regeneration, housing and the economic situation.

The Committee were informed that a website had been established by the Council and would be managed by the Public Health team in order to keep the JSNA reflective of relevant updates.   A Member noted that the JSNA had shown that people who were older, female, or affluent were stated at being more risk of social isolation and challenged if this went against the evidence which says the same of lower social groups.  Mr. Ward advised the Committee that the conclusions came out of a designated piece of research conducted by Capita colleagues and he suggested that different questions may have been asked. The data could be drilled down to postcode level and Member requested that this raw data was circulated to the Committee.

A Member commented that the JSNA referenced targets set out in the Local Plan and the Local Implementation Plan to increase cycling usage to 4.3% of journeys by 2026 and challenged whether this was an unambitious target.

A Member commented on non-smoking services and noted that the Royal Free London NHS Foundation Trust had a very good non-smoking service.

A Member noted that the JSNA did not contain much information on end of life care.  Ms. Garbett advised the Committee that it was possible for end of life care to be contained within the JSNA, but that the issue was seldom raised during the production process. 

RESOLVED that:-

1.    That the Committee notes how the JSNA will be used to inform council and public sector decision making in Barnet, and recommend any topics where additional future research into population-level need may be required.

2.    That the Committee comments on the proposed vision, priorities and actions contained in the draft Joint Health and Wellbeing Strategy.  ...  view the full minutes text for item 11.

The Chairman invited Julie Pal, the Chief Executive of Community Barnet to the table.  The Chairman noted that NHS England, who had previously accepted an invitation to attend the Committee and had subsequently confirmed their attendance, were not in fact present.  The Committee expressed its dissatisfaction at this discourtesy.  Ms. Pal advised the Committee that Healthwatch would be refreshing a “mystery shopping” exercise and that it would be looking at access to dental services.  The Committee noted that dental service was one of the priorities set out in the Joint Strategic Needs Assessment.

A Member commented that Healthwatch Barnet had raised some very valid points in their investigation and commended the work undertaken in the investigation of dental services.

That Chairman invited Councillor Helena Hart to the table.  Councillor Hart commented that poor dental health of children is a key concern and is one of the main reasons for children’s emergency treatment in hospital.  She added that one of the priorities of the new Joint Health & Wellbeing Strategy was to improve children’s oral health.

A Member commented that the Units of Dental Activity being delivered had increased and that it seemed that the amount of dentistry provided per head had also increased within the Borough.

A Member expressed concern at children not being able to register for NHS dental treatment.

Councillor Hart informed the Committee that the CQC had very stringent rules in respect of displaying charges and that not doing so constituted a breach. 

A Member questioned whether there would be any implications on health outcomes if Dentists were focussing more on dental work rather than hygiene care.  Councillor Hart informed the Committee that whilst she understood that Dentists could charge a patient to see a hygienist, if the Dentist provided preventative treatment as part of the dental care, then it would be included under the same charge.

The Chairman suggested that the Committee receive a further report at their meeting in February 2016 from Healthwatch Barnet on their “mystery shopping” exercise and that NHS England are invited to attend this meeting.  

RESOLVED that the Committee notes the update from NHS England and ask appropriate questions.

The Chairman invited Maria ODwyer, Director of Integrated Commissioning, Barnet CCG and Lizzy Bovill, Program Director, Westminster CCG, to the table.

Ms.Bovill introduced the report which outlined the progress that commissioners had made so far with the procurement.  The Committee noted that the procurement was a collaboration of seven CCGs in London. 

Ms.Bovill informed the Committee that the service user engagement had included Barnet residents and that the specification includes recommendations that had come from the Wheelchair Alliance, chaired by Baroness Tanni Grey-Thompson.  The Committee noted that commissioners would be meeting with Baroness Grey-Thompson to discuss the specification.

The Committee noted that the service would be commissioned in the new year and that that all CCGs would be represented as part of a procurement panel. 

Ms.Bovill advised the Committee that it is likely there will be one lead provider sub-contracting different parts of the service to different organisations.  The Committee noted that the ambition of the specification was to reduce variations in service to residents and ensure the same high quality across all 7 CCGs. 

Ms.Bovill informed the Committee that all existing contract providers had been given notice that the existing contracts would cease at end of June 2016 so that the new contract could commence at the start of July. 

Ms.O’Dwyer informed the Committee that the draft service specification and draft business case would be coming to each CCG for approval and that it was due to be considered by Barnet CCG in the next few weeks. 

The Chairman requested that the Committee receive another report on the wheelchairs service redesign at the meeting in May 2016.

RESOLVED that the Committee notes the contents of the report, the proposed direction of travel in relation to the re-design of the programme and the required timescales for the project.

The Chairman noted that in addition to the items set out in the forward work programme, the Committee would receive the following reports at future meetings:

·         Colindale Health Centre

·         An update report on Finchley Memorial Hospital

·         Dentistry Report: an update on the mystery shopping exercise undertaken by Healthwatch Barnet with NHS England being invited to attend

·         A further report on the wheelchair service redesign.

The Committee considered the work programme as set out in the report.

RESOLVED that the Committee notes the work programme.

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