Agenda and minutes

(1)       Mr Adrian Crowther declared a personal interest in the Agenda as a Governor of Medway NHS Foundation Trust.

(2)       Councillor Michael Lyons declared a personal interest in the Agenda as a Governor of East Kent Hospitals University NHS Foundation Trust.

(1)       It was indicated that the Minutes of 1 June 2012 needed amending on Page 1 so that under those present it read ‘Cllr Ann Allen’.

(2)       RESOLVED that, with this change being made, the Minutes of the meeting of 1 June 2012 are correctly recorded and that they be signed by the Chairman.

Dr Stephanie Munn (Dermatology Lead, South London Healthcare NHS Trust), Alison Poole (Service Manager, South London Healthcare NHS Trust), Diane Hedges (Project Director – Strategic Commissioning, Bromley CCG), Gail Arnold (Locality Commissioning Director for West Kent and Weald CCG), Sue Luff (Lead Commissioner Ashford Locality), and Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) were in attendance for this item.

(a)       The Chairman introduced the item and explained that in April the Committee discussed information sent in to it from NHS Bromley about the Orpington Health Services Project. This information indicated a large number of patients from West Kent accessing dermatology services at Orpington Hospital. More recently, as had been reported in the media, a Trust Special Administrator (TSA) had been appointed for South London Healthcare NHS Trust and the Committee was reminded that the focus was on dermatology services, so detailed answers on the implications of this recent event would not be expected. 

(b)       NHS representatives were invited to provide a overview of the subject. Beginning with the situation in West Kent, it was explained that a recent review had led to a service shift. There was a lot of independent sector provision in West Kent as well as two key NHS providers in the area. Teledermatology was now available for non-urgent cases, with results of pictures returned from consultants within 48-hours. There were a number of GPs with a Special Interest in dermatology (GPwSI) who were able to provide additional services. Light therapy was available locally and Darent Valley Hospital provided outreach services at Sevenoaks and Borough Green. No services were actually commissioned in South East London, and any patients accessing services there chose to. It was clarified that the 3,223 patients from West Kent accessing services in Orpington referred to attendances, not patient numbers. As each patient may make a number of visits in a year, the actual number of patients was lower.

(c)        In East Kent, a complete dermatology service review was carried out in 2010 as the secondary sector was not able to cope with the volume of activity and there was a fragmented service. Following engagement with patients and GPs, all of which supported moves towards community dermatology, a tendering process was carried out to start the community dermatology service from a fresh base. More resources were put into GP training and turnaround for tests went down from 13 weeks to 2 with more cancers being picked up earlier. For chronic dermatology, such as psoriasis, patients were educated to manage their conditions and 7 new providers have entered the arena. Services are also provided by Medway Foundation Trust and East Kent Hospitals. Self-referral was also possible in some circumstances, avoiding the need for a GP referral. Members of the Committee had experienced the East Kent service, including self-referral, and praised it. On the other hand, it was commented that the waiting room facilities at Medway Foundation Trust were inadequate for the  ...  view the full minutes text for item 4.

Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) and Chris Greener, (Associate Director Commissioning Development, NHS Kent and Medway) were in attendance for this item.

(a)       The Chairman introduced the item and explained that this was a subject the Committee had considered in the past, and will return to in the future as the preparations for April 2013 continue. NHS representatives were then invited to provide an overview of the situation regarding transition locally and respond to questions.

(b)       A clear theme through the comments, questions and concerns of Members was the perceived complexity of the new system being established and the sense that this current reorganisation would not change anything and not be substantially different to the current arrangements.

(c)        The initial area of discussion was around the role of GPs in commissioning, which was stated as a goal of change. Reference to media reports around the secondary role of clinicians in Clinical Commissioning Groups (CCGs) was made. It was explained that increasing clinical leadership in the NHS was wider than just involving GPs. Kent and Medway was reported and having very good GP involvement. The Boards of CCGs appointed the Accountable Officer and the Chair and though the specifics varied, one of these top positions in each of the 8 CCGs in Kent and Medway was filled by a clinician. It was also explained that the CCG Boards were only in their interim iteration and were developing organisations and so the balance on the Boards would change. The Local Medical Committee was supporting the development process. It was recognised that there was a need to be transparent and publish details of the Board composition. In answer to a specific question, the proportion of Non-Executive Directors to Executive was a matter of local decision. There was a lengthy national assessment process for CCGs before they could be approved, led by the National Commissioning Board (NCB). Out of area independent assessors were used, with Ann Sutton, the Chief Executive of NHS Kent and Medway, carrying out this role outside the area and other Chief Executives doing so within Kent and Medway.

(d)       Commissioning Support Services (CSSs) were being established to provide back office functions such as finance. There was a capped budget of £25/head of population for CCGs to use on management which was a change from the past. Running costs locally were already at this level.

(e)       There was discussion about how far CCGs would differ from current Primary Care Trusts (PCTs). It was explained that CCGs would receive about 80% of the budget (proportionally) that PCTs currently received but that overall the PCT budget and responsibilities were being divided into four. Along with the CCGs, responsibilities would transfer to local authorities, Public Health England and the National Commissioning Board. On the subject of the latter, it was explained that the work of the NCB would be carried out by 27 Local Area Teams. Although the first  ...  view the full minutes text for item 5.

Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway) was in attendance for this item.

(a)       The Chairman introduced the item and explained that, although two formal responses had been received to the HOSC report Not the Default Option, a full evaluation of the responses would need to wait until such time as others had been received.

(b)       On behalf of the local health economy, Helen Buckingham undertook to coordinate a collective response before the winter and the Chairman asked for discussion of this response to be added to the Forward Work Programme.

(c)        RESOLVED that the Committee note the report.

(a)       The Chairman introduced the item and drew attention to the changes made subsequent to the previous Forward Work Programme. In addition, the Chairman suggested that ambulance services may be something the Committee would wish to look at in the future.

(b)       On behalf of the Kent LINk, diabetic services and patient choice were put forward as possible suggestions and the Chairman undertook to give the ideas consideration.

(c)        Referring to discussions which had taken place earlier in the year, it was suggested that an update on the progress of the new Pembury Hospital be received by the Committee once the new hospital had been operational for a full year. The Chairman agreed and requested Officers to explore the possibility of bringing this item to the October meeting.

(d)       AGREED that the Committee approve the amended Forward Work Programme.