LINks Consultation on Stockport's CCG

Closed 27 Mar 2012

Opened 26 Mar 2012

Feedback updated 10 Jul 2012

We asked

Tell us what you think about our plans for the future of Stockport's NHS

You said

Need to add in a section about Patient Choice

We did

We have added Patient Choice into our plans.

Results updated 16 Apr 2012

A presentation was given to the Local Involvement Network about changes in the NHS and local plans for a Stockport CCG.

Over the next three years, the NHS budget will rise less than inflation, meaning that to deliver current levels of service we must make savings of around £75million.

Q1       What percentage of the budget is the £75m you have to save?

A1       The budget is approximately £470m, so the savings account for around 6.2%.

In line with Government changes to the NHS, PCTs will be abolished in April 2013 and replaced by Clinical Commissioning Groups, which are led by clinicians. The Governing Body will be made up of 15 members: 8 local GPs; a medical consultant and a nurse from outside Stockport; a public health consultant; a chief finance officer, the chief operating officer of the CCG; 2 lay members recruited locally; the Chair of the Health & Wellbeing Board; a social care representative; and a member of LINks / Healthwatch.

Q2       Why do the nurse and medical consultant on the Governing Body have to be from outside of Stockport?

A2       The Governing Body will be responsible for final decisions on how the local health budget should be spent. National guidance makes it clear that the medical consultant and nurse cannot work for a local Trust which the CCG is buying services for, as they would have a vested interest in these services.

Q3       Are these posts full time?

A3       The Chief Operating Officer and the Finance Officer of the CCG will be full-time managers. The GP Accountable Officer will work 3 days a week for the CCG. The 3 GP Clinical Directors will work 2 days a week for the CCG. Other members will only attend the monthly meetings.

Q4       Is Ranjit’s role permanent?

A4       Dr Ranjit Gill has been elected by the local GPs as the Chief Accountable Officer. This is a 5 year position and if re-elected a GP can stay in this role for 2 consecutive terms. That is why the governing body would like to develop the skills of local GPs to take over in future.

Q5       What is the cost of running the CCG going to be?

A5       The Government has given CCGs a fixed budget of just £25.00 per head of population to cover managerial staff and other running costs such as headquarters rent, IT etc. In Stockport we have already reduced our PCT staffing levels and our costs are running at approximately £25.00. To put that in perspective, other Greater Manchester PCTs have running costs of around £40.00 per head of population.

Q6       You say you have a constitution for the CCG – I have not seen this document, could you send me a copy?

A6       Yes, we’ll send that with a copy of the write up of this meeting. It can also be found on our website at: http://stockportccg.org/wp-content/uploads/2012/01/12-01-17_Final_Constitution_v121.pdf

Q7      It seems to me that GPs will be looking at budgets as well as looking at the patient...

A7       The current economic climate means that everyone is looking at budgets - and the NHS is no exception. However, the CCG plans focus on how we can reduce waste so that savings can be used for more of the healthcare services local people need. So GPs will be looking at the budget, alongside medical evidence to decide what is the best option for patients in terms of clinical outcomes and cost, so savings can be re-invested in other areas of healthcare. It will not always be an easy decision to make, which is why Stockport’s CCG wants to ensure that local people are involved in taking those decisions on what is a priority for Stockport.

Where a patient disagrees with a decision – or a GP thinks their patient requires a treatment that is not currently used in Stockport - we have an appeals process. So for example, if there is a request for an expensive cancer drug, this will go via the Individual Funding Request panel. This is a panel made up of medical experts, who look at the individual case and decide whether it is in the best interests of the patient to make an exception to the current funding rule.

Q8       Will there not be a shortage of GPs to see patients?

A8       Where GPs are working for the CCG, their Practice will cover that GP’s appointment with locums. In the case of the GP Accountable Officer, who will be working half of the week at the CCG, he has chosen to work part-time at his Practice, allowing the Practice to hire another permanent GP to work the rest of the time.

The meeting discussed the collective ambition of the CCG

to be known and respected for:

  • Consistent achievement of national and local quality targets
  • Delivering more services in the community
  • Reducing health inequalities
  • Developing personal responsibility for health
  • Delivering a surplus to invest in innovation
  • Lean, agile and innovative leadership.

There was a lot of support for the plan to deliver more services in the community, however a number of questions were raised about how this will be done and ensuring that the CCG learns from what the PCT did.

Q9       When you say you want to deliver more services in the community, you don’t have enough District Nurses already - so how will you do this?

A9       You’re right and that is why we need to look at changing the way our services are delivered so that we have enough District Nurses - these are some of the tough decisions we are looking to you to help us make. At the moment Stockport is one of the most hospitalized populations in the England – that means that where people in another part of the country would be treated by their GP, at a community clinics, or by a district nurse, in Stockport they tend to be admitted to hospital. This is a very expensive way of treating people – not to mention distressing and inconvenient for patients and carers - which means that we have less money for other services.

 Q10    LINks has already written to the Foundation Trust to ask how much money they will be moving into the community

A10     This is difficult to answer at the moment. As you know, Community Health Stockport’s services will be taken over by the Foundation Trust from April, so they will be doing a lot of work on how services are integrated and what services can be moved to community settings. The role of the CCG will be in writing the contracts for what healthcare provision we want to see. It will then be up to the Foundation Trust to deliver that in the best way for patients.

 Q11    How will the CCG keep people out of hospital, when service such as the Early Intervention Service and the Active Case Management service didn’t work?

A11     In the past the PCT has tried various methods such as the EIS to prevent people from being admitted to hospital. In practice, while they delivered a great service to the patients they saw, they did not prevent admissions. The CCG intends to learn from these mistakes. In Stockport we are lucky that we have had GPs working closely with the PCT for some time – so they have seen what does and does not work – we won’t be reinventing the wheel. This is also why we are here asking LINks what you think we should invest in and what can we do to improve the services we already have. We know there is a lot of knowledge in LINks and in the community that can be really helpful to improving the local NHS.

 Q12    Stepping Hill Hospital gets blamed for people turning up at A&E, to what extent is it that GP appointments are not available?

A12     We know that the FT cannot be blamed for people turning up at A&E – they have a duty to treat those people. What the CCG wants to look at is how many of those people who turn up at A&E are then admitted – as we have one of the highest rates in the country for emergency admissions. We then want to look at once patients are admitted, how quickly they are discharged, as there seems to be a lot of delays in the system.

In terms of preventing people turning up unnecessarily at A&E, the CCG will also be working on improving appointment times in GP Practices and the way these are booked. We know there are issues with reception staff in GP practices.  The CCG are looking at getting surgeries to share best practice n their locality meetings This will be one of the roles of Dr Cath Briggs as Clinical Director.

The CCG are working with Stepping Hill to develop a ‘front end’ of A&E with a GP triage in the first instance to ensure that the Emergency Department is only for ‘emergencies’. 

We’ll continue to work closely with Social Care so we can send people home from hospital with the support they need as this can often delay discharge – we will all have to be working together.

We have also been working with community groups who are more likely to use A&E (people with long-term conditions / people in care homes / young families / younger people) to understand why they don’t go to their GP instead and how we can help them to access the most appropriate service.

Q13    Can you make it that all GPs abide by the same rule regarding sending people to hospital?

A13     This will be part of the role of Cath Briggs as the Clinical Director covering Primary Care and CCG Member relations. She will be supported by the 4 GP Locality Chairs, who will develop best practice within their own areas:

  • Dr Sasha Johari               -    Heatons & Tame Valley
  • Dr Andy Johnson             -   Marple & Werneth
  • Dr Viren Mehta                 -   Cheadle & Bramhall
  • Dr Heather Procter           -   Stepping Hill & Victoria

 Q14    Can you share with us your analysis of patients attending A&E?

A14     A breakdown of A&E attendances will be sent to LINks for distribution.

The group looked at the CCG’s priorities for change over the next three years:

  • Unscheduled Care
  • Long-term Conditions and Complex Care
  • Demand Management
  • Quality
  • Staying Healthy
  • & Reform.

With regard to Unscheduled Care, the group noted that many people go straight to A&E if they can’t get an appointment within 24hrs. It was also suggested that some practices are generally not welcoming to patients. Again, this is an area where the Clinical Director for primary care and the locality chairs will lead in the CCG.

It was also suggested that some people go to A&E as any medication prescribed if free from the hospital pharmacy and scans are done straight away, rather than waiting.

This is why one of the collective ambitions of the CCG is to try and develop personal responsibility for health. While the NHS may be free at the point of access, we all pay for it in our taxes and going to A&E as a quick or cheap option for the individual is very expensive for Stockport as a whole, meaning that we have less money to spend on services. The CCG are working with the FT on prescribing antibiotics and asking them to prescribe for only a few days until the patient can see their GP. 

The group expressed the opinion that not enough was being done around the issue of alcohol misuse outside of the health services and stated that there seems to be no determination to remove licences from those giving alcohol to people recklessly. It was suggested that LINks write to the department in the Council who have the power to remove licenses to let their concerns be known. 

On the topic of long-term conditions and complex care the group suggested that GPs should be sharing information with Carers about the person being cared for as they need to know how they are progressing. 

It was agreed, however, that the NHS needs to maintain its duty of patient confidentiality unless the patient expressly agrees to carers being informed.

The group were also informed that the CCG has Expert Patient courses so conditions can be better managed. After recent engagement with the Carers Forum this training will be opened up to carers so they can learn what to expect and how to manage conditions of those they care for.

Another long-term condition discussed was mental health. Members of the group said that medication is a major problem for those with enduring mental health who often forget to take medication or stop taking it when they feel better and relapse. This means some of them will end up in hospital instead. It was suggested that injections would be preferable to tablets for these patients.

The group were reassured that decisions on prescribing are taken with the best needs of the patient in mind and that ‘black listed’ medications can be used if it is felt that it would be of substantive benefit to a particular patient. This is done through Individual Funding Requests which look at the specific needs of the patient in question.

In terms of End of Life Care, the group suggested that doctors – in General practice and Hospital settings - need more training in communications and how to tell patients and their family that they are at the end of their life. It would be useful to run a GP Masterclass on this.

Q15    In your presentation ‘choice’ doesn’t seem to feature anywhere, our choice should be infinite it seems

A152  A large part of the CCG’s plan is about improving access to local services. If we can move more care out into the community, then this should free up appointments in hospitals, improving choice. Similarly, if we reduce the amount of people using the wrong services, there will be appointments freed up to allow for patient choice. However, we will take this message back to the Governing Body to make sure that Patient Choice is adequately reflected in the strategy.

 Q16    Why do GP’s still prescribe paracetamol when it is so cheap to buy?

A16     Over the past year, Stockport has made great in-roads in reducing medical waste and the prescribing of medication which is either not cost-effective or does not have enough evidence to show a real clinical improvement. Stockport’s ‘Black List’ and Grey List’, whereby some medications cannot be prescribed, or can only be prescribed in certain circumstances, has helped local GPs to share best practice and up-to-date evidence on the best medications to use. This work is now being replicated across Greater Manchester and is something that we will continue to look at in Peer to Peer GP support.

 Q17    With regard to breast screening, why are there age limits?

A17     This is based on national guidance developed by clinical experts looking at research into the likelihood of people in different age groups getting cancer. The NHS has to balance the positive impact screening has in catching cancer early so that it can be treated, against the negatives of the radiation used in screening which can cause harm itself. For this reason, regular screening starts at the age when women are most likely to develop cancer, but ends in the 70s, so that women are not exposed to too much radiation from scans when their likelihood of cancer recedes. However, if a woman finds a change or lump and suspects breast cancer, she should go to her GP who will refer her for a scan regardless of her age.

 Q18    I am concerned about what was said about cuts – we need to look at delayed discharges from hospital and the amount of town centre property the PCT have.

A18     The emphasis in the CCG plan is around efficiencies - not cuts - looking at the best ways to do things for patients, with the least cost to the NHS. In some cases this may mean switching from one statin to another, which has the same results, but costs less. It could also be reducing the number of follow-ups, where a patient goes back to the hospital, when they could have their check up in the community.

However if we do decide it is necessary to cut a particular service, or make major changes to the way specific services are delivers, the CCG will first undertake consultation with more detail given.

Delayed discharges from hospital are a key element of the CCG’s plan and work will continue both with the Foundation Trust - to improve their internal processes – and with the Council’s Social Care team – to ensure that adequate support is available to allow patients to go back home.

Under the NHS Act 2012 all NHS property will be managed by PropCo – the NHS’s national estates organisation, so this will not be a function of the CCG. However, the CCG is looking at the headquarter space they rent in Stockport to ensure that the local NHS is getting the best possible deal.

Finally, the group looked at how the CCG plans to involve patients, carers and the public in its decision making process:

  • Patient Reference Groups at each GP practice
  • Review of Patient Satisfaction Surveys as part of service reviews
  • Public engagement events
  • Continued engagement with LINks / Healthwatch
  • A ‘Patient Panel’ to meet the CCG
  • & the Governing Body’s rules on decision making, which mean that proposed service changes must undergo consultation before decisions are taken.

Q19    What influence can LINk members have on the Governing Body?

A19     LINks (or Healthwatch in the future) will have a member on the Governing Body. This is also a public meeting, so other LINk members are welcome to attend.

In addition, all proposals to the Governing Body which involve a new service, a cut to services, or changes which affect the way services are delivered, must first be consulted upon. LINk members can feed into this via meetings like this, our online consultation website, attending CCG engagement events, or by e-mailing:

sto-pct.haveyoursay@nhs.net

Q20    LINk members have heard little about the PRGs – how do they work?

A20     Last year, the NHS developed a new ‘Direct Enhanced Service’, which created an incentive for GP Practices to develop a ‘Patient Reference Group’. This is a forum, which Practices use to ask how well they are doing and what improvements patients would like to see. Many GP Practices have had a Patient Group for some time now, but the PRGs were intended to be a wider group reaching more patients by offering the possibility of email surveys, for example, so that people who don’t have the time to attend regular meetings can still have their say on changes.

In Stockport, we want to develop these PRGs so that patients can give their views, not only on the Practice facilities, but on wider NHS decisions, that will be fed into the CCG’s governing body through locality meetings.

Q21    Regarding PRGs, how will information from these get back to the Governing Body, as communication is often via the practice manager.  We also feel it is vital that PRG’s are chaired by a patient and not a practice health professional.

A21     Feedback from PRGs will be discussed at the Locality Meetings and then fed into the CCG. PRGs can also send comments to the CCG directly thought the engagement website www.citizenspace.com/stockport-haveyoursay.

Files:

Overview

The NHS is changing.

In Stockport, we think it's important for our plans to reflect the views of local people.

On the 26th March, we will be meeting with Stockport's Local Involvement Network to ask their views on our plans for Stockport's Clinical Commissioning Group.

Stockport LINk logo

10am, Monday 26th March, Walthew House

Areas

  • All Areas

Audiences

Interests

  • General Practice
  • Hospital Care
  • Screening
  • Community Clinics
  • End of Life Care
  • Prescription Medication
  • Unscheduled care
  • Surgery
  • Input into decision making
  • Access
  • Patient Satisfaction