Agenda and minutes

Janet Cree reported that Dr Tim Spicer would be stepping down from his role as Chair of the Hammersmith and Fulham Clinical Commissioning Group governing body and that Dr James Cavanagh had been appointed as the new Chair.  Keith Mallinson reported that this would be his last meeting as the Healthwatch representative for the Health and Wellbeing Board.  Nadia Taylor confirmed as the new representative.

Janet Cree reported that Dr Tim Spicer would stepping down from his role as Councillor Coleman thanked Dr Spicer for both his contribution to the work of the Health and Wellbeing Board, facilitating transparent debate, and commended his commitment to the residents of Hammersmith and Fulham.  Councillor Coleman also thanked Keith Mallinson for his unstinting support and commitment as the Healthwatch representative and looked forward to welcoming Nadia Taylor to her first meeting as a member of the Board in September.

Resolved

That Vanessa Andreae be elected vice-chair of the Board.

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on 20 March 2019.

(b)   To note the outstanding actions.

Under the item on Opening Doors London, “pride and practice” was amended to “pride in practice”

As a matter arising, Anita Parkin reported that the Council was in dialogue with Opening Doors London regarding a proposal to establish two support groups for the LGBTQ+ (lesbian, gay, bisexual, transgender or queer) community in two locations.  The initial views were that each group would be supported by a small team of volunteers and based on identified, local need. Development of the proposals will also align with pride in practice, and care quality standards. An update will be reported to the Board in the autumn.

RESOLVED

That the minutes of the previous meeting were agreed as an accurate record.

Apologies for absence were noted from Dr Tim Spicer.

None.

The purpose of this report is to provide an update on the work the Council is doing to address issues of social isolation and loneliness within the Borough.

Anita Parkin confirmed that the report author, Fraser Serle, was leading this work, which was a top priority for the Borough.  It was well recognised that there was a clear correlation between health inequalities and social isolation and loneliness (SIL).  The Board had considered SIL in March 2019. Following engagement work, stakeholders had been involved in workshop discussions and an updated delivery action plan was being drafted, to be brought back to the Board later in the year.

The aim was to precipitate a change in culture within the Borough and to embed this, working with all ages, and social groups such as young people, older people and carers. This would recognise that SIL was an issue that was a community wide concern.  This was not about achieving a quick fix but about building a borough identity.  A bid for the national lottery was being developed to secure resources.

Anita Parkin reported that they were also working closely with emergency services and that she had met with Helen Harper, Borough Commander. Emergency services often worked with vulnerable individuals who might experience SIL. In collaboration with established groups, the work might potentially alleviate some of the pressure on blue light services.  The Council was also examining social value indicators within its own contracts, encompassing all areas of social commissioning.  The Economy Department was looking at a service model which could link up communities, not just those in social housing, and explore how the Council signpost support. 

Janet Cree referred to paragraph 4.4 and social prescribing within the NHS.  It was explained that there had been discussions to explore how social prescribing could be linked into wider provision. More resources would be made available as part of the development of primary care networks (PCNs) to collate information in an accessible way for residents. This will be in a leaflet format and could help signpost services for SIL. Further details would be reported to the Board in due course.  Sue Spiller welcomed the concept an information leaflet and suggested that it include references to what was available in the voluntary sector. In addition to highlighting their work, the leaflet could be distributed through local third sector voluntary groups and organisations and help make them more visible. 

It was observed that some residents who experienced SIL did not fit into categories for example, older people.  Anita clarified that this point had been identified in the original strategy (considered by the Board in March 2017) and that this was cross-cutting issue that affected a broad range of different groups.  The key was to understand how to signpost residents to SIL support services, connecting them to local, community events within the Borough.  Lisa Redfern confirmed that Council aimed to be an exemplar.  Many staff lived outside the Borough and commuted significant distances, balancing work and life priorities. While they would not necessarily have an SIL condition, the Council wanted to raise the profile of SIL need and how to harness the support that existed. Councillor Coleman  ...  view the full minutes text for item 5.

The purpose of the report is for the Board to consider implications that there will be a change to the structure of CCGs with one CCG developed to correspond to each of the proposed integrated care system areas. 

Mark Easton provided an overview of the Case for Change from the North West London Collaboration of CCGs (NWL Collaborative).  Commenting on the title he explained that this should be re-titled as it was not a “draft” document.  As the consultation continued, further information would be incorporated as an update.  The deadline of 24 July as the closing date for comments offered a mistaken impression.  Comments on the Case for Change would be accepted up to 24 August, in advance of the CCG governing body meetings planned for September.

The Case for Change reflected London wide and national reform. NHS England required that CCGs indicated their views as to the proposals for CCG reform by the end of September, to feed into changes that will be implemented in April 2020.  CCG governing bodies will consider whether they wish to merge by April 2020.  If they agreed to merge, then GPs will need to vote to determine whether they too agreed to the proposal.  NHS England will then go through an assurance process. It was explained that the NWL Collaborative was now being supported by the newly established NHS London (following a merger of regional offices).  

The proposals for reform were rooted within NHS Long-Term plan (published January 2019), and referenced a significant reduction of CCGs to align with integrated care partnerships (ICPs) over the next two years. It was clear that to not accept reformation was not an option and that there was an expectation that there will be one CCG per STP (sustainability and transformation partnership, now known as integrated care systems (ICSs) area.  There were five ISC areas in London and other than North West London, all of them had declared their views and agreed to accept reformation.  North West London would be the last area to formally declare their position.   

Mark Easton was of the view that the Case for Change would facilitate a better way of understanding how the care and health system will operate in future. Long term, the strategic aim was to promote the evolution of ICSs.  At place or borough local level, this would encompass the development of links within the framework of a local PCN. Work continued to develop innovative approaches to joint commissioning and integrated provision at place based, borough level and this would form the basis of ISCs. There would be a greater emphasis on collaborative work between providers, heading towards integrated partnerships. Preceding this, there would be an intermediate stage which would encourage the development of local partnerships with the local CCGs. A scheme of delegation would be established to allow the new structure to exercise decision making powers, possibly with joint appointments and shared budgets.  This was something that would need to be shaped and developed locally and would be influenced by the quality of existing, local relationships.

Mark Easton explained the differences between what would be commissioned at North West London level and locally.  Specialist services would continue to be commissioned at North West London level and  ...  view the full minutes text for item 6.

Noted.

a) PCN Update

Janet Cree provided an update on PCNs.  The Primary Care Committee had recommended the configuration of of a PCN in H&F and a more substantial briefing will be provided at the next meeting of the Board.  There would be five PCN covering the north, central (in two parts) and southern areas of the Borough, together with Babylon and GP at Hand, in local partnership. Each network will have a clinical director (all of whom will be GPs, and who will need to be clinicians working within the locality. 

Merrill Hammer commented that in principal, HAFSON supported the establishment of PCNs.  However, these would be new structures and it would be some time before they were fully implemented.  This was in her view, another reason to delay the merger. Vanessa Andreae responded that networking was not a new concept and they had been established in H&F for some time.

b) GP at Hand

Jim Grealy asked about GP at Hand and Dr Jefferies practice, and whether this would continue to be funded from within the Borough.  Janet Cree responded that funding was transparent and that the same financial arrangement was in place as for any other GP practice.  The PCN finance structure was set out in the DES (direct enhanced service) but there would be an opportunity to have a more structured approach to ensure a more sustainable system. It was confirmed that there would be no restriction on having national, out of area patients, and this had been factored in contractually.  The intention had been to recognise the fact that patients might need to travel to their local surgery for treatment or a face to face consultation.  Councillor Coleman offered to forward his letter to the Secretary of State for Health to the CCG about GP at Hand and the Boroughs concerns.

c) Local Physiotherapy Services

Following the recent consultation on the reconfiguration of local physiotherapy services for residents, Councillor Coleman affirmed the importance of ensuring that residents were able to access physiotherapy services quickly, when needed.  It was agreed to bring this back to the Board for further discussion.

Monday, 9 September 2019

The date of the next meeting was noted as Monday, 9 September 2019.