Agenda and minutes

The minutes of the Health Scrutiny Panel meeting held on 19 June 2023 were submitted and approved as a correct record.

The Scrutiny Panel will receive information on the reasons for the closure and details of how patients will be allocated to alternative general practices to ensure they can continue to access primary medical services.

SUSPENSION OF COUNCIL PROCEDURE RULE NO 5 - ORDER OF BUSINESS

ORDERED that, in accordance with Council Procedure Rule No 5, the scrutiny panel agreed to vary the order of business.

The scrutiny panel received:

·        information on the reasons Foundations (Acklam Road) had served notice on its contract;

·        details of how patients would be allocated to alternative general practices to ensure they could continue to access primary medical services; and

·        information on the new specialist clinical/prescribing service for substance misuse.

The Commissioning Lead for Primary Care from North East and North Cumbria Integrated Care Board (ICB), the Programme Manager from Public Health South Tees and the Partners from Foundations were in attendance to present information.

The Commissioning Lead for Primary Care advised that the Foundations GP practice (previously known as Fulcrum) delivered essential, additional, and enhanced primary medical care services. It was explained that, as per the terms and conditions of the Primary Medical Services (PMS) Agreement, notice could have been served at any time with a standard six months’ notice. The practice had initially served notice on 29 September 2022, with a longer notice period for Acklam Road and a closure planned for 31 March 2024 - that could not be maintained. Subsequently, the practice had re-served notice on 31 March 2023, providing the standard 6 months’ notice, with closure planned for 30 September 2023. The decision to proceed with the closure had been taken by the ICB.

To provide some context, Members were advised that the average list size for a practice was approximately 8,600 (NHS Digital). Foundations list size, at the time the original notice was served, was approximately 734. The list size had increased since then to 748 patients being registered on 1 June 2023 (NHS Digital). Of those 748 patients, 29 were registered on the Special Allocation Scheme (SAS). The Special Allocation Scheme (previously known as the violent patient scheme) had been commissioned via an NHS England Directed Enhanced Service (DES) for patients who had been removed from a General Practice registered list due to violent or threatening behaviour.

The scrutiny panel was advised that Foundations provided a specialist prescribing service, relating to drug and alcohol treatment, which had been commissioned by Middlesbrough Council. Members heard that it was important to note that not all of the 748 patients registered with the GP practice accessed opioid substitution therapy. There were a significant number of patients who accessed Foundations for the opioid substitution therapy who were registered at GP practices elsewhere in Middlesbrough. It was highlighted that the ICB was only responsible for the management of the PMS Agreement termination, which related to the 748 patients registered for primary care services.

Members heard that to ensure continued access to primary medical care services, all patients registered for GP services would be allocated to an alternative practice close to where they lived by 30 September 2023. Patients had been sent an initial letter informing them of the planned closure and a further letter would be issued in  ...  view the full minutes text for item 23/6

The Scrutiny Panel will receive information on the NHS North East and North Cumbria Integrated Care Board (ICB) and Public Health South Tees, including the main duties and areas within the respective remits and an outline of the key priorities, issues and challenges for the year ahead.

The scrutiny panel received information on the NHS North East and North Cumbria Integrated Care Board (ICB) and Public Health South Tees, including the main duties and areas within the respective remits and an outline of the key priorities, issues and challenges for the year ahead.

The Director of Place Based Delivery from the ICB and the Director of Public Health were both in attendance to present information.

The Director of Place Based Delivery provided an overview of the Integrated Care Partnership arrangements in North East and North Cumbria. It was advised that there were 42 ICBs established across England from 1 July 2022, which had replaced the former CCGs. The North East and North Cumbria ICB was the largest of the 42. It was explained that the Integrated Care System (ICS) included all of the organisations responsible for health and wellbeing working together across a region to plan and deliver services for communities.  It was not an organisation but worked through the following bodies:

·        The Integrated Care Board (ICB), which was a statutory NHS organisation that took on the responsibilities of the former CCGs and some of the functions held by NHS England. The ICB also worked with a range of partners at ‘place level’ in each of the 14 local authority areas within its region.

·        The Integrated Care Partnership (ICP), which was a joint committee of the ICB and the 14 local authorities in the ICS area and it was responsible for developing an integrated care strategy for the ICS.

At a national level, ICBs had been set some key strategic aims by the Government, namely:

1.      Improve outcomes in population health and healthcare;

2.      Tackle inequalities in outcomes, experience and access;

3.      Enhance productivity and value for money; and

4.      Help the NHS support broader social and economic development.

Members heard that the ICB’s leadership team included a Chair, a Chief Executive and Executive Directors. The Director of Place Based Delivery, covered the areas of Middlesbrough and Redcar and Cleveland and reported directly to the Executive Director of Placed Based Partnerships (Central and Tees Valley). It was explained that there was a range of Partner Members, which included representatives from local authorities, primary care and NHS foundation trusts.

In terms of the governance framework, the scrutiny panel was advised that Place Sub-Committees facilitated decision-making, enabling decisions to be made in the best interests of local people and local communities. Furthermore, via the Place Sub-Committees, the ICB’s Executive was able to delegate decisions and funding to the Middlesbrough and Redcar & Cleveland areas to meet the needs of the local population.

In terms of the relationship between the ICPs and the ICBs, the ICB was responsible for the delivery of services and the ICP was responsible for setting strategy at three levels i.e. system, area and place. It was advised that the Leader of Stockton-on-Tees Council was the Chair of the Tees Valley ICP. Members heard that the role of the Strategic ICP complemented the work of the Area  ...  view the full minutes text for item 23/7

A proposed meeting schedule, for the Health Scrutiny Panel, was submitted for the scrutiny panel's consideration.

AGREED

That the proposed meeting schedule, for 2023/24, be approved.