Agenda item

• Flu vaccination update/lessons learnt and potential future Covid-19 vaccination
• Alternative Provider Medical Services (APMS)
• Further update on services at Finchley Memorial Hospital (FMH)
• GP Federation at FMH and services they provide

 

 

 

The Chairman invited the following to the meeting:

 

·       Colette Wood, Director of Primary Care Transformation, NCL CCG

·       Kelly Poole, Deputy Director of Primary Care Transformation, NCL CCG

·       Carol Kumar, Deputy Director of Primary Care Transformation, NCL CCG

·       Mr Michael Whitworth, Chief Executive, Barnet GP Federation

·       Cllr Anne Clarke, London Borough of Barnet

·       Cllr Peter Zinkin, London Borough of Barnet

 

Flu vaccination update/lessons learnt and potential future Covid-19 Vaccine distribution

 

Dr Stephens presented the report written by Nicholas Ince, Senior Primary Care Transformation Manager, NCL CCG.

 

Dr Stephens noted that flu vaccination providers have for some months been delivering the flu vaccine to those in groups at higher risk and from December they have been offering the vaccine to 50-64-year olds who are not at risk. She reported that the latest data for over 65s vaccinated as of 23 November 2020 was 69.7% in Barnet, which has already surpassed the final 2019 achievement of 65.9%. For the cohort of under 65s at risk, the percentage was 37.3% which has nearly surpassed the final 2019 figure of 40.3% and for the 2-3 year old cohort the percentage was 44.2% which has already surpassed the 2019 achievement of 31.1%. She confirmed that where there were initially problems with supplies of the vaccine, this has been remedied. Feedback from patients on the safety of environments for receiving the vaccine has been positive.

 

Dr Stephens reported that the programme was supported by a comprehensive communication and engagement plan to help to spread the word on the benefits of vaccination using social media, contacts with patients in acute trusts and the voluntary and community sector. Community outreach is also ongoing with Care Homes and the homeless.

 

The Chairman asked whether the Mutual Aid Strategy is up and running whereby GPs and pharmacies can give unused supplies of vaccines to surgeries and pharmacies which have run out. This was mentioned by Nicholas Ince at the last meeting. Dr Stephens confirmed that it is.

 

A member enquired about the three Covid vaccines: what the differences are and which would be used. Dr Stephens responded that only the Pfizer vaccine has been approved so far and the Oxford/Astra Zeneca vaccine is currently in the process of being approved by the MHRA, followed by the Moderna vaccine. It is not yet known how long the vaccines will protect patients. The Pfizer vaccine presents more problems as it requires storage at a temperature of -70C, can only be moved four times and is produced in large amounts so must be used as soon as it is defrosted. Each of these vaccines require two doses.

 

A Member asked what is being done to encourage flu vaccine take-up as there may be some communities which may be missed who are also more vulnerable to Covid and whether it was known where the deficits are. Dr Stephens responded that there is data on vaccine take-up and demographics and this does help to direct the focus of the CCG. She also mentioned that there is a Homeless Outreach Project starting at the end of November to provide opportunities for flu vaccination for the homeless population in Barnet.

 

Dr Stephens noted that that the CCG has made huge efforts around public communication with regard to immunisation in general. NCL CCG is putting together a cohort of clinicians who speak second or third languages to record video endorsements in numerous languages and the same approach could also be used for Covid vaccinations.

 

A Member referred to Section 4.4 of the Paper which refers to ‘Homelessness outreach’ and enquired whether this group had been accessed. Dr Stephens would ask Nicholas Ince for feedback on this after the meeting and would forward this information to the Chairman for circulation to the Committee. 

Action: Dr Stephens

 

A Member asked what had been done to try to encourage take-up of immunisation in groups who refuse it. For example, although mainly poor take-up is associated with deprived groups, he is aware of two large Pentecostal Churches in Haringey which had had speakers telling the congregation not to be immunised. It may be worth arranging for a pastor to be involved in the communication videos mentioned. Dr Stephens responded that PHE tries to monitor such dialogue and it is not uncommon affecting other aspects of health as well. The Department of Health (DH) is concerned about how it communicates on such matters and how its actions might be interpreted as it is such a sensitive issue which is probably best dealt with in one-to-one dialogue.

 

RESOLVED that the Committee noted the written report and verbal update.

 

Alternative Provider Medical Services (APMS)

 

Ms Poole reported that the APMS contract, provided by Barndoc Healthcare, ends on 31 March 2021. Barndoc was due to be evicted on 31 December but an extension to their tenancy had been negotiated until 31March 2021.

 

Ms Poole added that procurement of a new contract for Cricklewood Health Centre for a GP APMS contract had been agreed in August 2019. In December 2019 and January 2020 there had been a patient and stakeholder engagement including surveys and forums. Procurement is currently underway further to this and recommendations would be presented to the NCL Primary Care Commissioning Committee in January 2021. CCG is also carrying out a search for new premises and has identified two sites, however these were more than 2.4 miles from the current building so a search is ongoing to find a site which is nearer. Patients and stakeholders have been informed and bidders have been asked to identify premises as part of the procurement process so that the contract can commence on 1 April 2021. 

 

The Chairman reported that two of the Childs Hill Ward Councillors, Cllr Anne Clarke and Peter Zinkin, had requested to speak on this item.

 

Cllr Anne Clarke commented that although planning permission was granted on the current site, she had only been informed of this in a letter, despite her previous involvement in the campaign against the Walk in Centre’s closure. She commented that when it did close some comfort was provided to residents by the fact that the new service would have extended opening hours. Residents had often used the Walk in Centre because they were unable to get a GP appointment.  Cllr Clarke mentioned that the planning permission included ‘D1’ use, so a temporary arrangement needs to be found especially as the population in Cricklewood is increasing. She added that losing the current service without an alternative would be a catastrophe for the local community which has a high deprivation level. She proposed that a further conversation needs to be had with the planning team and developer.

 

Cllr Zinkin said he agreed with Cllr Clarke and stated that as both of them were clearly stakeholders on behalf of the residents, it was disappointing to only learn of this through the paper submitted to the HOSC agenda. He felt that both he and Cllr Clarke had been ignored. 

 

Ms Wood responded that the APMS contract is up for renewal every five years and the CCG is contractually bound to procure a new contract. The CCG had no say in the planning decision for the use of the building and it was hoped that it could continue to have a healthcare use. She offered to look into how the decision had been made. The CCG is aware that the Practice is important to residents and huge efforts have been underway to source premises in the vicinity. She hoped that in January 2021 the CCG would have some more definite news on the Practice. Ms Wood apologised that both Councillors felt they had not been involved in the process. 

 

A Member noted that when planning permission was given there was a provision for D1 space and it was anticipated this would be the home of the Practice whoever won the contract. Cllr Zinkin added that he recalled discussions with the developer where he made the point that the provision of a medical facility was a big local issue and that they needed to ensure that it continued throughout the process of development, even if this meant in temporary, alternative accommodation. He added that if the CCG had contacted the Ward Councillors when there was a problem, they could have helped by engaging with planners and the developer to find out exactly what was going on. 

 

Cllr Clarke reported that a GP had contacted her to say that they were only aware of the letters being sent about the issue when they received calls from confused and worried patients. She stated that this is a vulnerable community and this is happening during a pandemic. Cllr Clarke added that she is not satisfied that the CCG has searched sufficiently for premises and Ward Councillors should have been contacted to help with this.

 

A Member noted that this appeared to be an issue that the Council’s Planning Department needs to take up with the developer, given that permission for D1 was expressly given with the planning application. He said that the building should not be rebuilt without that condition and he sympathised that the CCG’s attempts to provide services for patients in the Cricklewood area have been disrupted by the planning issue.

 

The Chairman confirmed that developers must comply with the planning permission they are granted and that if developers wish to make any changes they have to submit a new application. The details of the current permission need to be looked at.

 

The Chairman proposed that the Ward Councillors meet with the Chairman of the Council’s Strategic Planning Committee, the Director of Planning and representatives of NCL CCG as soon as possible. The Committee unanimously agreed to this recommendation and to ask for an update to be brought to the next HOSC meeting on 22 February 2021. A Member noted that it is important that the CCG works with local Councillors to look at alternative premises in the meantime.

 

RESOLVED that the Committee noted the written report and verbal update and unanimously agreed to the recommendation.

 

 

Further update on services at Finchley Memorial Hospital (FMH)

 

Ms Wood presented her report summarising the current services at FMH.

 

Ms Wood stated that around 95% of the space is in use at FMH. It currently has a whole range of services and service providers from the Mental Health Trust, Central London Community Healthcare, University College Hospital, the Royal Free, Whittington Health, the new Path Service, the GP Federation Extended Access Service, a pharmacy, InHealth Screening Service, a Dementia Club, the GP Out of Hours Service and many more as listed in her report.

 

Ms Wood reported that there are two exciting new projects at FMH. The same-day GP Access Service which had been put in place partly due to learning from Covid on how services are delivered. Joint working with community and acute services and the GP Federation has resulted in a model to help reduce pressure on Urgent and Emergency Care Services, specifically at Barnet Hospital. The CCG is looking at direct booking from 111, online consultations and they are also looking at how the workforce is deployed. This model will be the first of its kind in NCL and other Boroughs are possibly looking to replicate it.

 

Ms Wood stated that FMH was also identified by the NCL Imaging Working Group, both geographically and because of its facilities, as a key site for a diagnostic hub for NCL in the future. Diagnostics do not all need to happen in acute settings and there is a huge backlog due to Covid.

 

Dr Stephens reported that the Lung Summit Trial has been taking place at FMH looking at the validity of screening for lung cancer using low-dose CT scanning. The CT Scanner has been privately funded and will remain at FMH after the trial. This is a cutting-edge piece of work between the Crick Institute and GRAIL on cancer screening. An added benefit will be that the scanner will remain at the hospital in perpetuity after the trial is completed.

 

A Member commented that a long-awaited bus service is now going into the hospital.

 

RESOLVED that the Committee noted the written report and verbal update.

 

 

GP Federation at FMH and services they provide

 

Mr Whitworth presented the slides and report. He stated that Barnet Federated GPs is a community interest company made up of all GP Practices in Barnet. It has a workforce of around 200 including GPs, nurses, healthcare assistants and pharmacists etc, most of whom work in Barnet GP Practices.

 

Mr Whitworth continued that the GP Federation has a role in being a unified voice for General Practice, and supports GP Practices with issues such as staffing and IT and works in the longer term to help build stronger GP Practices. It also purchases training software and works closely with the Training Hub and Research Unit Hub and has close links with public health.  The GP Federation is also a member of the Barnet Integrated Care Partnership and is active at the NCL level. The Care Quality Commission (CQC) recently rated the GP Federation in Barnet as ‘good’ in all areas.

 

The Barnet Federated GPs’ key services are around extended access to GPs, both in terms of location and hours. It provides an anticoagulation service bringing Warfarin monitoring and adjustment close to patients run by pharmacists and provides domiciliary services to patients who are house-bound, which was maintained through the pandemic. It also provides help with Public Health on smoking cessation.

 

Mr Whitworth reported that on 30 March, a ‘cold clinic’ was set up at FMH to see patients face to face who needed treatments and care, this was later integrated into the Extended Access Service. On 14 April 2020 a ‘hot clinic’, commissioned by the CCG, was opened at Edgware Community Hospital (ECH) to see patients diagnosed with Covid, or with symptoms likely to be Covid, but primarily focusing on other aspects of their care. Any GP Practice unable to see a patient with Covid could refer them to ECH.

 

Since then, the GP Federation has worked with Barndoc to provide local out-of-hours, triage and home visits. This continued until 16 October at ECH but, since then, the home visiting and the phone triage has been operating out of FMH. FMH is one of two centres providing this service. The GP Federation supports the administration and provides staff to run this.

 

Mr Whitworth stated that Barnet GP Federation became the PPE Hub for Primary Care, receiving large volumes of PPE from trucks delivering supplies during the first peak of the pandemic and distributing this to GP Practices. The GP Federation also became the hub for laptops to ensure that doctors could work remotely. This service continues, although may GP Practices are now able to access their own supplies.

 

A Member enquired whether the research aspect is a good recruitment and retention tool across GP practices. Dr Whitworth responded that the GP Federation sees a clear link between developing research, the training hub and staff development, and has employed a Quality Improvement Manager who is an expert in this area. 

 

The Chairman noted that she and Cllr Stock, Chairman of Barnet’s Health and WellBeing Board, had received feedback from many residents that they are still unable to get face-to-face appointments with their GPs. Dr Stephens responded that the recommended approach is that first patients have a telephone triage which may lead to a video consultation. If a patient is unable to use a computer, then GP Practices should make arrangements for them to attend a Primary Care Service for a face-to-face assessment, including home visits.

 

A Member asked how information on accessing face to face appointments is being communicated to residents. Mr Whitworth confirmed that residents can book through their own GP Practices but he agreed that they may not always be aware of how to get appointments and this may need to be advertised more widely. However, it is advertised in GP Practices and on the GP Federation website.

 

RESOLVED that the Committee noted the written report and verbal update.