Agenda item

Refreshment Break

Mr A Cole (Head of Commissioning) NHS Eastern and Coastal Kent, Ms Z Fright (Senior Lead Commissioner Urgent Care) NHS Eastern and Coastal Kent, Mr K Gill  (Procurement Manager) NHS Eastern and Coastal Kent, Ms D Robertson (Deputy Chief Executive) NHS West Kent,  Ms D Stock  (Strategic Commissioning Manager) NHS West Kent were present for this item.

(1)       The Chairman welcomed colleagues from NHS Eastern and Coastal Kent and NHS West Kent to the meeting and invited them to give a brief introduction to the papers that they had submitted to the Committee. 

(2)       Members were invited to ask questions which including the following:-

• In response to questions on the way in out of hours GPs engaged with patients, both PCTs explained that there were a number of ways in which patients could be seen out of hours, GPs were available at certain bases and, if appropriate, patients could be asked to travel to them, generally an out of hours GP visit tended to be a option of last resort in order to make effective use of resources.
• What happened with the plan for integrated call centres?  An East Kent colleague explained that South East Coast Strategic health Authority had decided not to participate in the Department of Health’s single number or non urgent care pilot scheme.  However, they were ensuring that if this was rolled out nationally there would be a directory of services ready to use to support this service.
• How does information get from the out of hours service to the patients GP in a timely manner? Members were informed that at the end of every out of hours session all notes were faxed or conveyed electronically to the relevant GP’s by 8.00am on the next working day.
• Are there any plans to offer GP’s inducements to provide an out of hours service for their patients?  West Kent colleagues explained that their new out of hours contract would require the use of GPs who knew the local area, and if it was necessary to use locums from abroad the PCT would be informed so that checks could be carried out on training and language skills.
• In relation to the statement in the West Kent survey results (page 19 of papers) that half of patients had waited longer than half a day to make contact with the service, it was explained that this related to how long the patient had had the condition for before deciding that it was serious enough to contact the out of hours service.  The question was designed to help establish how patients were using the service.
• Regarding the figures (page 17 of the papers) which compared the value for money aspect of services, Eastern and Coastal Kent stated that the national audit office had carried out this survey in 2006 and that most providers had expressed concern that a standard approach was not used.  Work was being done with the Department of Health to produce a better tool to compare providers.   In their new out of hours contract they would be looking to provide the best service for patients which may not be the cheapest option.  West Kent colleagues also confirmed that patient care and safety was paramount for the new contract.
• The issue of out of hours health professionals having access to patients records was raised.  Ms Robertson acknowledged the importance of good communications and access to records for the out of hours service.  Currently for patients with long term conditions or at the end of their life there were processes in place to make sure that their medical information was available when needed.  In the longer term the aspiration was for GPs and other relevant professionals to be able to access patient information at the point of contact.
• Mr Cole (Eastern and Coastal Kent) explained that they regularly performance managed their out of hours providers against 13 national requirements.  He was unsure how these related to clinical outcomes but agreed to look at this and assess whether they needed to put something in place to assess clinical outcomes. 
• Regarding what changes they had made as a result of complaints, Mr Cole confirmed that they a robust complaints process where they were required to respond with an action plan. 
• In relation to feedback from patients, Mr Cole stated that they had strengthened their citizen engagement arrangements over the past few months and had sought feedback from residents on issues including the out of hours service.
• Colleague from both PCTs undertook to supply information on the Performance Indicators and complaints, compliments and comments.
• In response to a question on the scores from the Healthcare Commission review, Ms Robertson stated that West Kent did quite well on some but had scored lower in relation to integration and their vision for going forward, they recognised that there was a need to improve. 
• Mrs Green asked for a copy of the survey that had been carried out by the NHS Eastern and Coastal Kent in June 2009 and a copy of Key Performance Indicators.  Both PCTs offered to send in further information on patient surveys.
• In response to a question on the cost per head for their out of hours service, which ranged from £3.50 - £12.00 across the country.  West Kent colleagues stated that they had two providers for out of hours services and the costs ranged from £7 to £ 9.50 per head.  The cost per head in East Kent was £9 per head.
• In response to a question on the average waiting time to see an out of hours GP, Ms Stock explained that all out of hours calls should be triaged and if it was deemed urgent should call the ambulance within 3 minutes, if the call was urgent the caller would be asked to come into a centre, or there would be a telephone consultation, or if a visit was the only option this should be carried out within 20 minutes of the call.  The Committee were assured that both East and West Kent were robust in their triage process.
• Regarding the percentage of health professionals there were of different types, and how many GP’s there were on call out of hours, Ms Stock replied that they did not have a specific percentage but when they carried out their review they would try to establish whether people wanted to just see a GP or whether they would see nurses who are qualified in specialist primary care.  South East Health had GPs at bases, if one base was overloaded then called would be diverted to other GPs who could attend, it was not just about the number of GPs available out of hours but of making best use of resources.
• The key factor was whether the needs and demands of local people were being met rather than the number of GPs available out of hours.
• Ms Robertson emphasised that anyone handling an hour of hours call would be appropriately qualified and able to follow through a triage process, it was usual to start with a qualified nurse and if necessary go through to a qualified GP if required.
• In response to a question on how the PCTs were going to make sure that people understood the out of hours systems in place, Mr Cole agreed that this was an area of high importance of this and were working hard to ensure the public knew what services were available.
• An assurance was given by Mr Gill that although they needed to have a new contract in place by January 2010, in time for the current contract to end in July 2010, the new contract would be able to take account of any issue that came out of the review currently being undertaken by the Care Quality Commission.  Ms Stock stated that their new contract would also have a provision to enable them to do this as well. 
• Ms Robertson clarified that it was the role of PCTs to monitor the services that they commissioned and the role of the Strategic Health Authority to ensure that PCTs delivered what they were supposed to.

(3)       RESOLVED that the reports and answers to questions from Members be noted.

(Mr K Ferrin and Mr S Manion declared personal interests in this item, as their wives were GPs and took part in the discussion on this item).