Agenda item

Roger Gough (Cabinet Member for Business Strategy, Performance and Health Reform, Kent County Council), Meradin Peachey (Kent Director of Public Health), Hazel Carpenter (Director of Commissioning Development and Transition, NHS Kent and Medway), Tish Gailey (Health Policy Manager, Kent County Council), Lorraine Denoris (Director of Citizen Engagement and Communications, NHS Eastern and Coastal Kent), Dr Mike Parks (Medical Secretary, Kent Local Medical Committee), and Di Tyas (Deputy Clerk, Kent Local Medical Committee) were in attendance for this item.

(1)       The Chairman introduced the item and explained that although the complete picture around the changes to the health sector was incomplete, it was important to take this opportunity to take stock and gain a better understanding of the ongoing changes. A large part of this was to understand the new language which was developing as time went on with GP Commissioning Consortia (GPCC) now being referred to as Clinical Commissioning Groups (CCG). A number of Members mentioned the plethora of acronyms which needed to be understood. It was observed that the Background Note which formed part of the Agenda was a useful and accessible summary of the changes and the new terms.

(2)       The Cabinet Member for Business Strategy, Performance and Health Reform at Kent County Council then provided an overview of the work which had been going on relating to the NHS Transition within Kent. The main element he wished to stress was the growing and positive relationship with the GP community as a whole and the emerging CCGs in particular. This was demonstrated by the fact that all CCGs wish to be represented on the Health and Wellbeing Board, which had been strengthened as a result of the ‘pause’ earlier this year, rather than delegate their role. County Council had approved the establishment of the Health and Wellbeing Board (HWB) in July and the first formal meeting would take place on 28 September. Precursor meetings earlier this year had looked at the Joint Strategic Needs Assessment (JSNA) which would in the future be produced by the HWB. As a general rule, awareness of it amongst GPs had not been high, but this was being looked at and the JSNA work would also feed into the production by the HWB of the Joint Health and Wellbeing Strategy. It was anticipated that not all work would be carried out at the County HWB level. Dover had also been awarded early implementer HWB status and there was good work being carried out there as well as by locality boards across the County. One ongoing issue was that CCGs tended not to be coterminous with Borough boundaries, with at least one crossing 4 of them. Moving on, he expressed the view that there was a natural and good division of labour between HOSC and the HWB. The Health Overview and Scrutiny Committee (HOSC) would be able to provide necessary challenge to the HWB on key areas such as the success of integrated working. Service reconfiguration had been a core area of HOSC work in the past, and this would continue, but it was possible the HWB would become involved in this also. In answer to a specific question, it was confirmed that the HWB would meet in public.

(3)       There was a discussion about the ongoing uncertainty and some Members felt that the final position regarding how the health sector will work in the future will differ from how it is being expressed currently. It was also observed that a lot of the detail will only be known following Royal Assent of the Health and Social Care Bill when guidance was published and made available.

(4)       Several common themes ran through the discussion. One was a concern that the proposed new structures would add bureaucracy to the NHS, when what was needed was a reduction. Another was that the changes only increased the importance of the HOSC in maintaining a strategic overview of the entire health economy.

(5)       A third was the importance of enabling patient choice and not losing the focus on improving patient pathways, with one Member wondering whether a Select Committee on this latter topic was possible. In answer to a specific question, it was explained that there was no upper limit to the cost of medication, but where two were equally efficacious, then there was an expectation the cheaper would be prescribed. It was also explained that a team of prescription advisors were available to GPs. More broadly it was explained that GPs had been involved in improving clinical pathways and commissioning for a number of years, and that what was happening now was that GPs were becoming responsible for the budgets. There were also some concrete examples already of how GPs had been moved into decision making positions and how this had improved pathways. One example was the joint working between CCGs and social services which had resulted in a memory clinic within each Borough.

(6)       While it was recognised that there may not be many changes to report, the Committee requested that this issue return to the Agenda for the 25 November. The Chairman also mentioned, as a related subject, that he had asked for a discussion paper on HOSC and the local dimension to be prepared for the 14 October meeting.

(7)       AGREED that the Committee note the report and further discussion this item at the 25 November meeting.