Agenda and minutes

24.1     The minutes of the meeting held on 30 November 2017 were agreed.

25.1     Apologies for absence were received from Cllr Bob Bowdler (substitute: Cllr Martin Clarke) and Cllr Johanna Howell (substitute: Cllr Jo Bentley).

Disclosures by all members present of personal interests in matters on the agenda, the nature of any interest and whether the member regards the interest as prejudicial under the terms of the Code of Conduct.

26.1     There were no apologies for absence.

Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgent.

27.1     There were no urgent items.

1.1.        The Committee considered a report on the state of access to GP practices in East Sussex.

1.2.        Dr David Warden, Chair, Hastings and Rother Clinical Commissioning Group (HR CCG); Amanda Philpott, Chief Officer, Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG) and HR CCG; Jessica Britton, Chief Operating Officer, EHS CCG/HR CCG; Ashley Scarff, Director of Commissioning/Deputy Chief Officer, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG)  Dr Peter Birtles, HWLH CCG; and Sally Smith, Director of Primary Care and Integration, HWLH CCG responded to questions from HOSC.

Extent of GP vacancies

1.3.        Amanda Philpott explained that the greatest number and highest proportion of GP vacancies are in the HR CCG area, where there are currently 16 vacancies out of 97 GP positions. In the EHS CCG area the vacancy rate is 11 out of 120. Sally Smith said that the greatest number of vacancies in the HWLH CCG area are in Newhaven and Peacehaven, but recent vacancies have arisen in Rotherfield, Crowborough, and Wadhurst.

Work to support individual GPs

1.4.        Amanda Philpott explained that newly qualified GPs are increasingly looking for a ‘portfolio career’ where working as a GP forms part of a wider clinical role. To accommodate this new working practice and to tackle GP shortages CCGs in the East Sussex Better Together (ESBT) area have implemented the following initiatives:

·         A GP portfolio fellowship scheme that allows junior doctors to work in a GP practice for 2-3 days alongside working, for example, in an acute hospital or within mental health services. This improves the variety of a GP’s working week and improves the spread of knowledge between primary and secondary care.

·         The availability of a GP bursary scheme for new GPs;

·         The employment of physician associates to reduce the administrative burden on GPs; and

·         The option for part-time, flexible mentoring work for older GPs who are otherwise planning to retire.

Amanda Philpott confirmed that work to support GPs had all begun to be put into practice and was either in a pilot stage, or in the process of being rolled out across the ESBT area.

Work to support GP practices

1.5.        Amanda Philpott and Dr David Warden outlined some of the initiatives established by the ESBT CCGs to help GP practices, including:

·         supporting the GP Federation to run a GP locum bank that administers requests for locum GPs centrally that would otherwise be made by individual GPs.

·         Encouraging pharmacists in the ESBT area to work with networks of 3-4 GP practices, or be employed directly by a GP practice. Pharmacists perform medication reviews of patients in consultation with the GPs and perform care home visits. Most practices that have used pharmacists have achieved considerable savings in their prescribing budget.

1.6.        Sally Smith outlined the initiatives established by HWLH CCG to help GP practices, including:

·         The Enhanced Help in Care Homes team, which is a GP-led multi-disciplinary team (including a pharmacist) that supports patients in care homes and nursing homes. The team  ...  view the full minutes text for item 28.

1.1.        The Committee considered a report providing an update on the redesign of the urgent care system as part of the ESBT programme, with a focus on the development of Urgent Treatment Centres (UTCs).

1.2.        Mark Angus, Urgent Care System Improvement Director, EHS/HR CCG; Jessica Britton, Chief Operating Officer, EHS/HR CCG; and Ashley Scarff, Director of Commissioning/Deputy Chief Officer, HWLH CCG responded to questions from HOSC.

Capital requirements

1.3.        Mark Angus explained that during 2017/18 £1.7m was invested in the A&E Departments at both East Sussex Healthcare NHS Trust (ESHT) hospital sites to create the Primary Care Streaming Services. He said that he believed the capital works were completed effectively and with little disruption to the A&E Department.

1.4.        Mark Angus said that the Primary Care Streaming Services have been assessed and it has been agreed that the Conquest Hospital site can provide a UTC in its current configuration, however, the Eastbourne District General Hospital (EDGH), whilst able to support a UTC, requires some additional capital investment to optimally provide the service. Mr Angus said that the CCGs are in the process of sourcing the capital funds and are confident that the necessary works can be completed by the 1 April 2019 deadline.

Procurement process

1.5.        Mark Angus confirmed that the decision about the UTC procurement process will now be formally considered by the CCGs’ Procurement Committee in May.

Patient access to the UTC

1.6.        Mark Angus explained that the UTC will include a bookable service. In order to book an appointment to the UTC, patients will be triaged by their GP, ambulance service, or the NHS 111 Clinical Assessment Service. He said that walk-in patients will use the triaging system established for the Primary Care Streaming Service, which is led by fully trained senior nurses who can call on the support of doctors and consultants if necessary.

Reason for co-location of UTCs

1.7.        Mark Angus said that  the decision to develop co-located UTC was informed by what local people had said what was important to them when accessing urgent care services together with the outcome of engagement with local stakeholders and providers. The plans would provide 24/7 access to urgent care services, including access to a broad range of simple diagnostics where required and immediate access to co-located emergency and specialist acute assessment services for sick patients. Audit work undertaken indicates that approximately 20% of current attendees at the local A&Es would also benefit from primary care delivered services. The proposed UTC model addresses this need and should take pressure off of the A&E departments.

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Risk of staffing shortages

1.8.        Mark Angus agreed that the development of UTCs faces similar workforce challenges to the rest of the healthcare system, however, the UTCs should mitigate workforce challenges somewhat by providing existing services in a single location more efficiently and effectively. He said that feedback from staff suggests that the proposed model offers a better work-life balance.

Out of Hours GPs involvement in UTCs

1.9.  ...  view the full minutes text for item 29.

1.1.         The Committee considered a report on the quality and performance of maternity services for East Sussex residents, including feedback from local women obtained from a survey undertaken by Eastbourne Borough Council.

1.2.        Councillor Robert Smart, Eastbourne Borough Council; Peter Finnis, Assistant Director – Corporate Governance, Eastbourne Borough Council; Amanda Philpott, Chief Officer, EHS/HR CCG; Jessica Britton, Chief Operating Officer, EHS/HR CCG; Vikki Carruth, Director of Nursing, ESHT; and Sarah Blanchard-Stow, Head of Midwifery, ESHT were present for this item.

1.1.        In addition to the written report submitted to HOSC by Eastbourne Borough Council, Cllr Robert Smart made the following additional points:

·         The Eastbourne Borough Council survey is the most extensive of its kind and was sent to all mothers who gave birth in East Sussex during 2016, based on Office of National Statistics (ONS) data. The response rate was 35%.

·         The survey provides evidence that 93% of mothers in the EHS CCG area who responded to the survey would wish to give birth at EDGH if there were a full obstetric service available.

·         There should be an independent review to consider whether the ONS figures for stillbirths in Eastbourne are in any way correlated to the single siting of obstetrics services at Conquest Hospital, Hastings, and the related travel times.

·         The extensive Netherlands study (of over 700,000 mothers) simply concludes that a travel time of over 20 minutes increases risk.

·         The National Maternity and Perinatal Audit published in 2017 shows that maternity services are not performing as well as is set out in the CCGs’ report.

·         Any complete review of maternity services should look into its share of ESHT's reported clinical negligence liabilities of £80 million, with £13m being paid out. Nationally, maternity accounts for 50% of payouts, according to NHS Resolution, so this would amount to approximately £6.5m maternity payments.

1.2.        A number of questions from HOSC were answered by witnesses.

Transfers during labour

1.3.        Councillor Robert Smart said that a figure of 90 patients transferred during labour referred to the number of respondents to the survey who had been transferred to the Obstetric Unit at Conquest Hospital during labour. He said that 55 came from the EHS CCG area, 15 from the HR CCG area and 20 from the HWLH CCG area.

1.4.        Peter Finnis observed that the survey findings indicated more Eastbourne mothers experienced transfer than the rest of the county put together and suggested that this was an inequality of service that is an ongoing concern to the Eastbourne community.

1.5.        Sarah Blanchard-Stow said that the Midwife Led Unit (MLU) at Eastbourne District General Hospital (EDGH) is staffed solely by midwives. Normal, low risk labour can take place at the MLU, but if at any point there is a deviation from normality or the woman requests more pain relief then a transfer will take place. A lack of other MLUs in the local area makes comparisons of transfer rates difficult, but the figures are compared to those published by the Birthplace Study.

1.6.  ...  view the full minutes text for item 30.

31.1     The Committee considered a report providing an update on the Review of Stroke Services in Kent and Medway and establishment of a joint HOSC.

31.2     The Committee RESOLVED to:

1) confirm that the proposed reconfiguration of stroke services in Kent and Medway constitutes a ‘substantial development or variation’ to services for East Sussex residents requiring formal consultation with HOSC;

2) note that a Joint HOSC has been established to respond to the NHS consultation; and

3) agree that the nominated HOSC Members undertake local evidence gathering as required to inform the East Sussex contribution to the JHOSC process.

32.1     The Committee considered its work programme.

32.2     The Committee RESOLVED to:

1) note its work programme; and

2) Request that NHS work undertaken to tackle Delayed Transfers of Care (DTOC) is included as part of the Urgent Care report at the June 2018 meeting.