Agenda and minutes

10.1     The Committee noted that it was awaiting various pieces of information and updates from NHS Sussex under 6.6, 6.8, 6.11, 6.17, and 6.25 of the minutes of the previous meeting.

10.2     The minutes of the meeting held on 30 July 2024 were agreed as a correct record.

11.1     Apologies for absence were received from Councillor Abul Azad, Councillor Terry Byrne, and Jennifer Twist.

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.

12.1     There were no disclosures of interest.

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.

13.1     There were no urgent items.

14.1     The Committee considered a report from NHS Sussex providing a progress update on work underway to enhance routine and urgent dental care access for people across the county.

14.2     The Chair requested that future reports from all NHS organisations should reference data that covered East Sussex only and avoid Sussex-wide data wherever possible.

14.3     The Committee commented that the current levels of provision were unacceptably low and asked how NHS Sussex were working to increase the number of units of dental activity (UDA) across the county.

14.4     Charlotte Keeble, NHS SussexDirector of Primary, Community and Urgent Care Commissioning outlined that nationally the Government had committed to review the NHS dental contract and address known challenges with it which currently presented issues for dental professionals. Locally, there were challenges attracting new NHS dentists to the area, and NHS Sussex was undertaking targeted action to address this. This included uplifting the minimum UDA rate and engaging with local dental providers to encourage them to overdeliver on their NHS contracts, which they were able to do by up to 10%. Providers had also been encouraged to take on temporary UDA, as sometimes they did not want to take these on permanently. An urgent dental care ‘test and learn’ pilot approach, which combined UDA and sessional payments, encouraging providers to take on more complex patients, had proven popular and been extended for the rest of the year. Given there had been five dental contract hand backs in East Sussex, there were plans to hold a market engagement event in Lewes in November to both procure new contracts and understand what would encourage greater take up from providers.

14.5     Nish Suchak, General Dental Practitioner and Chair of the East Sussex Local Dental Committee outlined that the current national contract meant that where practices failed to deliver their number of UDA in a year, they were required to make these up the following year, and the contract was not fit for purpose. There was insufficient funding for the system to meet the level of need and the national contract did not provide sufficient funding to support dentistry practices’ costs, including staff.

14.6     Cllr Turner suggested that dentists should be required to accept new patients onto their books even if they were full, just as GPs were required to do. Nish Suchak commented that dentists were unable to take on more patients because the funding they received from the NHS was ringfenced and cannot afford to do any more NHS work.

14.7     The Committee commented that some people struggled to pay for certain treatments and asked how these people could be better supported.

14.8     Charlotte Keeble commented that NHS Sussex supported there being reforms made to the national contract. The feedback from dental professionals had identified three key drivers causing contract hand backs, which were the low UDA rate, the NHS dental contract and workforce recruitment and retention. NHS Sussex had tried to address these challenges where it was able to, but there were structural  ...  view the full minutes text for item 14.

15.1     The Committee considered a report on primary care services and access to General Practice across the county, following on from a report on Primary Care Networks (PCN) the Committee had considered in September 2023. The report covered a number of areas that the Committee had previously asked about when it had considered earlier reports.

15.2     The Committee asked what the average wait time was for patients to have a GP appointment.

15.3     Garry Money, Director of Primary Care Commissioning and Transformation, noted that at 5.3 in the paper there were average figures for waiting times. The NHS only monitored the number of appointments booked on the same day and the number of appointments given within two weeks. Currently just under 80% of patients in East Sussex who tried to book a GP appointment got one within 2 weeks, which was a couple of percentage points below the England average. Some GP practices’ ways of working skewed these figures slightly, such as by booking recurring appointments for long term conditions in advance, which gave the impression that a patient was waiting much longer than the 2-week target. NHS Sussex was working to address issues of variation between individual practices, to identify where GPs had issues that they needed support to reduce waiting times.

15.4     The Committee noted that workforce absences in East Sussex due to mental health problems was double the national average and asked how access to the Emotional Wellbeing Service would be improved.

15.5     Garry Money explained that NHS Sussex was working closely with Sussex Partnership Foundation Trust (SPFT) and with High Weald and Seaford PCNs to provide the Emotional Wellbeing Support Service in all PCNs in the county. This included exploring how to fund it and simplify employment arrangements. Garry agreed to provide the Committee with an update on the service in these two PCNs, as well as data on current performance, activity and impact of the service broken down by other areas.

15.6     The Committee noted that in some cases GP appointments available to book online were much further in the future than those available to book on the phone, and asked if this was a common issue.

15.7     Garry Money accepted that there was variation between practices in this issue, and that often appointments offered online were with a nurse rather than GP. Different practices varied in how they used online consultation systems, sometimes turning them off in the morning once capacity had been reached. There were other known communication issues and NHS Sussex was working to reduce the level of variation between practices. There was a programme of unwarranted variation quality improvements that it would be possible to provide an update on the next time the issue was discussed by the Committee.

15.8     The Committee commented that patients had a right to choose when being referred to secondary care by GPs and asked how the NHS ensured this right was being upheld.

15.9     Garry Money commented that GPs worked according to clinical pathways, and  ...  view the full minutes text for item 15.

16.1     The Committee considered a report from NHS Sussex on work being undertaken to minimise missed appointments in secondary care (hospitals) across East Sussex. An update on missed appointments in primary care was included in the report on agenda item 6, Access to General Practice in East Sussex.

16.2     The Committee raised a concern that often people would call East Sussex Healthcare NHS Trust (ESHT) and their calls would not be answered, which was a barrier for some people cancelling appointments they could not attend.

16.3     David Garrett, ESHT Divisional Director for Core Servicesaccepted that at certain times of day it was difficult to get through on the phone lines. He added that very few members of the booking team worked remotely, with call handlers based at both Eastbourne and Conquest hospitals. Teams had information on how many people were waiting and how long they had been waiting for, so it was possible to get more staff to answer phones as required. There were periods of high traffic and ESHT was considering implementing a semi-automated switchboard for the booking team which would allow people to cancel appointments without needing to have someone answer the phone.

16.4     The Committee commented that sometimes patients were unable to attend appointments as hospital transport required advanced booking which could not always be arranged in time.

16.5     Ashley Scarff, NHS Sussex Director of Joint Commissioning and ICT Development (East Sussex) commented that communication between patient transport and hospital trusts should be improved to avoid missed appointments. If there were issues with providing patient transport for a patient to get to their appointment, then a link back to the hospital or service should be made so that the appointment can be rearranged for a time when the patient would be able to attend.

16.6     Cllr Turner commented that if a patient missed an appointment because of a lack of available transport, then there was a risk they could go to the back of a waiting list through no fault of their own.

16.7     The Committee asked what the cost to the NHS was of missed appointments.

16.8     David Garrett explained that it was difficult to quantify the cost of missed appointments, as all clinics were booked based on a model of likely attendance to that particular clinic. This meant that if everyone booked in attended their appointment, then the clinic would likely overrun. Where clinics regularly underran then the model would be reviewed, and additional appointment slots would be added. Did not attends (DNAs) added some unpredictability to the running of a clinic that meant while every effort was made to try and adjust for them, it could only be determined on the day whether a clinic would over or under subscribed. Ashley Scarff added that the key cost would be the opportunity cost of having staff present at a clinic without anyone to attend to.

16.9     The Committee asked whether patients were able to request specific times for appointments to avoid having to pay  ...  view the full minutes text for item 16.

17.1     The Committee discussed the items on the future work programme.

17.2     The Committee discussed the development of Integrated Community Teams (ICTs) and asked whether this was something it should receive a report on. Ashley Scarff commented that there was a standing item on the development of ICTs at the Health and Wellbeing Board and agreed to suggest an appropriate time in the future that HOSC may wish to discuss this topic.

17.3     The Committee RESOLVED to amend its work programme in line with paragraphs 14.32 and 15.35.

18.1     None.