Agenda item

·       Winter 2020 Plans – to follow

·       Flu Vaccination

·       Services currently available in GP Practices, Hubs and Walk in Centres

·       Services at Finchley Memorial Hospital and Edgware Hospital

Winter 2020 Plans

The Chairman invited the following to the meeting:

·       Beverly Wilding, Deputy Director, Urgent and Emergency Care, NCL CCG (Barnet Directorate)

·       Daniel Glasgow, Deputy Director of Primary Care Transformation, NCL CCG (Barnet Directorate)

·       Dr Clare Stephens, Clinical representative, NCL CCG Governing Body

·       Colette Wood, Director of Primary Care Transformation, NCL CCG (Barnet Directorate)

·       Nicholas Ince, Senior Primary Care Transformation Manager, NCL CCG (Barnet Directorate)

Dr Greenberg reported that each of the hospital sites in Barnet has plans in place to respond to surges in demand over the winter, which include focusing on supporting and developing the workforce, providing adequate beds and equipment and ensuring staff are skilled so that they can be redeployed where needed. The RFL NHS Foundation Trust has also been working with partners to ensure that they can provide mutual support through the winter. 

Dr Greenberg reported that a change is in place with the temporary closure of the Children’s and Young People’s Emergency Department and Inpatient Ward at the RFH, following a Review of the services across NCL. This is to help manage capacity and support staffing levels over winter including a likely second surge in Covid-19. The Review recommended reopening the Children’s and Young People’s Emergency and Inpatient Unit at Barnet Hospital which had been closed during the first Covid-19 surge. The temporary closure at the RFH has been communicated with relevant stakeholders including patients. A paediatrician will be on site at the RFH to receive any patients that do arrive and are unaware of the closure. The situation would be reviewed in Spring 2021.

Dr Greenberg commented that the critical care capacity has been increased at the RFH, with up to 100 Intensive Care Unit (ICU) beds available. The Rainbow Ward, a new 35-bed ward at BH, was opened in early October which is partly in response to the pandemic and partly a longstanding requirement.

A Member asked whether the Trust has found any asymptomatic staff to have tested positive. Dr Greenberg responded that this is a concern although the Trust has not been aware of any staff-to-patient transmission so far. Inpatients are tested once a week and symptomatic staff are tested, rather than all staff, due to testing capacity. However, the Trust is screening their staff with daily temperature checks and also asking them a list of questions and keeping a record of their answers The Chairman noted that Care Homes are being asked to test staff every week. 

A Member asked why there has been no public consultation about the closure of the Children’s Emergency Ward. She added that there is growing concern being expressed by some residents that this may become a permanent closure. Dr Greenberg reassured the Committee that this is a temporary closure and that the reason for the lack of consultation was due to the urgent necessity for extra capacity over winter. 

The Chairman asked Dr Stephens whether she has investigated the lack of availability of blood testing at FMH as she had emailed her the results of a ‘mystery shopping’ exercise she had done. Dr Stephens responded that she had spoken to the service provider who had explained to her that due to the strict rules around infection control, the capacity of the system was more limited and that only urgent blood tests could be undertaken. However this was under constant review and a plan was in place to increase capacity.  The telephone booking system is also under review as there are some technical problems that need to be resolved. The Chairman noted that she had not been able to book an urgent blood test at FMH as her phone calls were automatically disconnected and that several residents had also contacted her to express that they had experienced the same difficulties in booking a blood test. She also mentioned that residents were disappointed that the phone line was only open from 7am to 12pm Monday to Friday.

Flu Vaccination

Mr Glasgow reported that the NCL CCG has 103,000 additional patients to vaccinate this year. NCL CCG has set up a Flu Delivery Partnership Board to work on an integrated approach and is also discussing Covid-19 vaccinations for the future. The CCG is planning to achieve its 75% flu vaccination target for 2020, with 20% already having been vaccinated.

Mr Glasgow noted that the CCG is working with a community provider to arrange vaccinations for housebound patients and their carers and is also working with acute and mental health providers to encourage them to vaccinate patients and staff. A software system has been developed so that it is clear where the targets are being reached in patient cohorts.

Mr Ince reported that so far in Barnet just under 20,000 over 65’s had already been vaccinated. In 2019, the total number of over 65’s who received the flu vaccination was 60,000. A potential risk had been that patients would not want to attend Healthcare Settings for the vaccination due to Covid-19, but so far this did not appear to be the case.

A Member enquired about a vegan flu vaccine availability since most vaccines contain pork and egg. Dr Stephens responded that a porcine-free vaccine is available, although adequate provision for all that require this could be an issue. The Department of Health (DH) and NHSE is aware of this. 

A Member reported that despite being in the priority group for the flu vaccination, she had so far not been able to obtain one via local pharmacies or her GP due to lack of stock.  She noted that some residents had been reporting this problem as well. Dr Stephens reported that GPs are working hard to immunise patients as soon as stocks arrive. There is sufficient provision but it may require phoning several pharmacies and sometimes travelling slightly further. Barnet CCG is in constant contact with NHSE and has made its requirements clear but this is partly a national issue. Mr Ince commented that soon the mutual aid strategy would be instigated which allows transfer of vaccines from one practice to another according to demand. Mr Ince offered to send a link on pharmacy vaccination availability after the meeting but GPs should also be able to signpost people.

Action: Mr Ince

A Member asked whether there is more demand for the flu vaccination this year and whether it would be helpful to focus the flu vaccine in areas with high levels of Covid-19 as this might help members of the population who are more vulnerable to avoid hospitalisation. Dr Stephens responded that internationally there is more demand for the flu vaccine as the awareness of risk relating to Covid-19 has driven demand. Central Government orders the vaccine but Dr Stephens recommended that this issue be raised at the next pan London meeting of the Health and Wellbeing Boards.

A Member asked whether the flu vaccine contains porcine gelatine that may not be widely accepted amongst local communities and added that patients need to be informed of the details when being offered a vaccine. Dr Djuretic responded that current adult flu vaccine does not contain porcine gelatine and shared the following weblink for more information. https://www.gov.uk/government/publications/vaccines-and-porcine-gelatine/vaccines-and-porcine-gelatine

A Member asked whether any arrangements had been put in place for a sufficient provision of the flu vaccine in 2021 after Brexit. Dr Stephens responded that the Department of Health is in conversation with immunisation providers as there may be challenges post Brexit.

Services at Finchley Memorial Hospital (FMH) and Edgware Community Hospital (ECH)

The Chairman noted that a detailed list of services has been published with the papers. She asked what services are currently unavailable due to the pandemic.

Dr Stephens reported that in the Covid-19 environment some of the services listed are provided across the whole STP (five Boroughs) so may have moved. Ms Wood added that the NCL CCG is restarting most services and has reinstated all urgent services. However, many outpatient-based services have moved to a virtual model.

Dr Stephens reported that GPs have been asked to prioritise investigation and appointment requests and additional independent providers are offering direct-access diagnostics for GPs. All Barnet hospitals are also able to ensure any patient with a potential cancer will receive a two-week diagnostic test.

Services currently available in GP Practices, Hubs and Walk In Centres

Ms Wood reported that all 52 GP Practices in Barnet have remained open during the pandemic. All are operating a triage model by telephone and online consultations, although provision is being made for those who need to be seen in person, with the necessary PPE in place.

A Member asked what the current situation is regarding void space, given that the GP Practice did not move into FMH as planned. Ms Wood responded that the space is being used by the GP Federation as an Extended Access Service. Work is also ongoing through the Integrated Care Partnership Same Day Access work stream to design a new integrated model of primary and community service delivery from FMH. Ms Wood confirmed that currently FMH is at 95% capacity. She offered to report back to the HOSC in the very near future on services at FMH. 

A Member asked who triages the patients when they contact their GP. Dr Stephens noted that there is an initial administrative triage followed by clinical triage and there is also the option of submitting a virtual consultation request by emailing GPs via the Practices’ websites.

A Member enquired what extra services would be provided at FMH and ECH to classify them as Urgent Treatment Centres (UTC) as opposed to Walk in Centres. Ms Wood noted that a UTC offers a prescribed list of services which is largely diagnostic. It also offers direct booking. This would be available through 111 from mid October at FMH.  An UTC is open for a minimum of 12 hours, seven days a week.

A Member asked to have an update on bus services to FMH.  Mr Prinsloo reported that the No. 383 bus would provide services to the site very soon and that this was being discussed currently with Transport for London (TfL).

RESOLVED that the Committee noted the written and verbal reports.