Agenda item

The purpose of this paper is to update the Health and Wellbeing Board on H & F CCG’s vote to adopt delegated commissioning of primary care services and on emerging work in development of the H & F Primary Care Strategy.

Councillor Vivienne Lukey, Chair, welcomed Janet Cree, Managing Director of the Hammersmith and Fulham CCG, who provided an update on the vote to adopt delegated commissioning of primary care services.  Briefly outlining the transition plan, benefits of the process and the duties imposed by the delegation, in particular, those that would remain within the remit of NHS England, and those that would pass to the CCG.  With the NHS England expectation that all CCGs adopt level 3/delegated commissioning by April 2018, it was reported that following the voting process earlier this year, the H&F CCG membership in February, 70% voted in favour of the move to level 3.   The change would require some constitutional adjustments but the overall aim was to secure greater autonomy in both leadership and practice.  A range of objectives and benefits, set out in the report, included increased local freedom for investment in primary care, GPs having direct leadership to influence the development of investment in general practice, better delivery of integrated and more holistic, primary, community and secondary commissioned care. 

Section 5.2 of the report set out the key findings of RSM (auditors), which included the fact that NHS England would remain liable for any pre-April 2017 liabilities. Notably, it was reported that additional, ring-fenced funding would be provided for primary care investment.  One of the benefits of the delegated powers was greater freedoms, such as working more closely with the GP federation, to ensure better outcomes for local residents through tailor made, local services. 

With reference to section 4 of the report, Janet Cree provided the salient points of areas that would form the new duties that would now be covered by the CCG and NHS England, respectively.  Section 5 of the report set out due diligence undertaken in the key areas of finance, governance and workforce.  Key governance changes included new committee arrangements with a new Level 3 Primary Care Commissioning Committee affective from April 2017.  The Board were asked to note the revised structure, together with the proposed composition.   

Responding to a question from Co-optee, Keith Mallinson who referred to page 14 of the report, it was explained that patients would be given greater opportunities and input in shaping the delivery of services. 

Councillor Rory Vaughan sought greater clarity on the division of roles with the NHS and the way in this would alter.  Expanding the question further, Councillor Lukey observed that while the changes were a welcome development, that it was unclear how the potential conflict of interest of GPs commissioning primary care was being managed and sought further explanations about the monitoring and scrutiny arrangements by NHS England, noting that this would not be a total delegation.  Janet Cree acknowledged that there existed potential areas where there would be conflicts of interest and anticipated that this would be addressed through the new governance and due diligence arrangements.  She continued that this was an opportunity to bring patients closer to the decision making process.  It was noted that the CCG were following recommended guidance, but expected to there to be issued new guidance by April 2017.  A conflict of interest management policy was in place and would be updated, once the new guidance had been received. 

Clarifying further, Janet Cree explained that they would ensure proper transparency in decision making and that any conflicts of interest will be managed, with input from local governing body members.  The composition of the committee will also include lay-members, ensuring greater accountability.  It was agreed that it would be helpful to provide a link from the LBHF website to the CCG site, so that information regarding dates of meetings and other CCG events would be more accessible.

Action: HWB

In a follow up question, Councillor Vaughan asked about the separation between national and community services and how this could be translated at a local level.  Vanessa Andreae, H&F CCG, explained that she did not anticipate many change.  They had worked closely with NHS England on initiatives such as the immunisation programme, and would continue to liaise with different parts of the organisation, as needed. 

RESOLVED

That the transition progress from Level 2 primary care co-commissioning to Level 3 delegated commissioning from April 2017, and the emerging work on an H & F Primary Care Strategy, be noted.