North Central London Clinical Commissioning Group (NCL CCG)
· Executive Managing Director, Barnet, NCL CCG
The Chairman invited the following to the meeting:
- Kay Matthews, Executive Managing Director, NCL CCG
- Dawn Wakeling, Executive Director Adults and Health, LBB
- Dr Charlotte Benjamin, Vice Chairman, Barnet Health and Wellbeing Board and Vice Chairman, NCL CCG
- Colette Wood, Director of Primary Care, NCL CCG
- Ian Porter, Executive Director of Corporate Services, NCL CCG
Merger of CCGs
Mr Porter presented his slides on the merger of the five CCGs which is part of the NHS Long Term Plan. The merger went live on 1st April 2020.
Mr Porter reported that the purpose of merging the CCGs is to optimise the balance between NCL-level and Borough-level services. NCL CCG has a single Governing Body with two elected representatives from each Borough. Barnet’s representatives are Dr Charlotte Benjamin and Dr Clare Stephens. Cllr Caroline Stock attends regular meetings with CCG representatives – with a lead health and social care member from the five NCL local authorities attending meetings of the CCG Governing Body.
Mr Porter noted that the Covid-19 pandemic had meant integrated care working between key partners had accelerated. Many partners had fed back that although this had been a challenging time, they did not want to lose some of the positive changes that had resulted. Engagement with the public remains key – with ten community representatives currently being recruited to support the CCG’s committee working.
The CCG would be tackling health inequalities and also its budget deficit which stood at £59million prior to the pandemic. The budgets for 2020/21 had been set by the legacy CCGs. Prior to the merger, budgets had been agreed with funding for services commissioned on a Borough basis. Mr Porter noted that the CCG would not disinvest from that but any new investment will be applied differently across the NCL CCG. Emergency legislation remains in place with NHS England (NHSE) currently taking control of significant elements of the CCG budget during the Covid-19 response. Further guidance is expected at the end of July.
Mr Porter noted that four voting members sit on the new Governing Body who previously sat on the Barnet CCG Governing Body: Ian Bretman, who was previously a lay member on Barnet CCG, and would be the designated lay member for patient engagement and involvement and Claire Johnstone, Registered Nurse, who was previously on the Governing Body for Barnet and Enfield CCG. The two newly elected GP Members for Barnet also previously sat on the Barnet CCG Governing Body i.e. Dr Charlotte Benjamin and Dr Clare Stephens.
The Chairman asked whether the different governance system in Barnet (Committee System as opposed to Cabinet) could cause any problems for the new CCG. Mr Porter responded that a key aim of the Local Authority representation is to help ensure strong partnership working between health and social care – and the provision of local authority perspectives on key issues. They are non-voting members who provide insight for the decision-making process so the different governance structures would not be an issue.
The Chairman asked about equality of funding across the Boroughs in the new CCG. She mentioned that Barnet has more Care Homes than the other Boroughs in NCL, for example. Mr Porter responded that the merger provides an opportunity to look at providing funding differently. Health inequalities work had been carried out and this has highlighted significant inequalities for the northern Boroughs, so this was currently being reviewed.
A Member pointed out a typo on Slide 5, where Barnet population was noted as the same as Enfield. He also asked whether, given its bigger population than the other Boroughs, two representatives for each Borough provided fair representation. Mr Porter apologised for the typo. He added that the representation had been debated and it had been agreed, through the formal setting of the CCG’s Constitution, to continue with two representatives per Borough. These represented not only each Borough, but also the NCL as a whole.
Primary Care Networks (PCNs)
Ms Wood presented on the current work in Barnet around PCNs. She reported that there are seven PCNs in Barnet which are geographically aligned and are well established. The focus for PCNs in the next year in Barnet will be:
· Enhanced healthcare service to Care Homes
· Structured medication reviews. Additional clinical pharmacists have been recruited by each PCN to work in GP Practices
· Early cancer diagnosis
Ms Wood reported that the PCN’s individual projects, such as enhanced dementia services, are testing their models with a view to rolling them out Borough-wide and, if successful, via the Integrated Care Partnership Board (ICP). The ICP Task and Finish Groups are led by Primary, Community and Acute Trust Clinicians.
Ms Wood presented details of Extended Access Hubs in Barnet offering different numbers of appointments depending on the population. For 2019-20, the utilisation rate was 79%. Work was currently being undertaken to look at how utilisation could be improved.
Dr Benjamin reported that during the Covid-19 period PCNs had worked together to offer mutual aid and support to each other. She added that her PCN is looking at dementia services and ways to support patients, their families and carers, decrease hospital admissions and make dementia less daunting overall. Some data is awaited but, if successful, the model would be rolled out across Barnet.
A Member asked where the Urgent Care Centres are in Barnet. Ms Wood responded that there is one in Barnet Hospital and one in the Royal Free Hospital.
The Chairman asked the Executive Director, Adults and Health, to report on the PCNs from a Local Authority perspective.
The Executive Director, Adults and Health, reported that Barnet Council has worked closely with partners, beginning with Burnt Oak PCN. The Council had ensured that PCN colleagues knew how to make referrals for council and other key services, such as housing and BOOST.
The Council has also been involved with the PCNs in developing social prescribing. The Council and CCG are working to support the dementia PCN work by developing a Borough-wide strategy for dementia. Barnet Council is also working on the Integrated Discharge Team set up as part of the pandemic response, to facilitate faster discharge from hospital and to make pathways clearer for residents.
The Executive Director, Adults and Health, added that the Council is also working with the CCG, Primary Care and Community Health on a model offering in-reach into Care Homes. The Barnet Public Health Team is offering advice to Care Homes seven days a week and has a dedicated PPE operation for Care Homes. Further details on the integration programme will be presented to a future HOSC.
The Chairman asked for more information about Hubs and how appointments could be better distributed. Ms Matthews responded that due to Covid-19 and the radical transformation it had caused, some time was needed to review this as the prior actions may no longer be relevant.
It was agreed that the CCG and Executive Director, Adults and Health, would report back to the HOSC at the next meeting on winter planning, including Primary Care access: and the Integrated Care Partnership work programme including the Care Homes Project. Ms Matthews noted that it would be too soon for a further update on the NCL CCG.
RESOLVED that the Committee noted the slides and verbal updates.