Minutes:
Glenn Douglas, Chief Executive, Kent and Medway Sustainability and Transformation Partnership and Accountable Officer for Kent and Medway Clinical Commissioning Groups, and Michael Ridgwell, Deputy Chief Executive,
Kent and Medway Sustainability and Transformation Partnership, were present for this item at the invitation of the committee.
1. Mr Douglas and Mr Ridgwell presented a series of slides which followed on from the presentations given to the committee at its June meeting. These outlined the NHS Long-Term Plan, how this was being applied in Kent and Medway, key areas of action and the way in which the development of local care would be supported, using integrated care partnerships, primary care networks and a single clinical commissioning group. They then responded to comments and questions from the committee, including the following:-
a) the developments outlined in the presentation were welcomed by committee members;
b) the leadership of Mr Carter in promoting the local care agenda had put Kent’s achievements ahead of other local authorities in the country, but what was needed now was to make innovative practices work successfully at a local level via the primary care networks;
c) the public needed to be helped to understand the new arrangement and be directed to the most effective pathway within it to access treatment, and for some this would need a major education project;
d) Thanet had been described as a beacon of innovative practice in the way in which its GPs organised themselves, but local experience in districts also showed that it could take a week to get an appointment with a GP and that access to dentistry services was also a struggle. Local people wanted to have a guarantee of being able to get an appointment with a GP or dentist when they wanted one. Mr Carter clarified that, due to the problem in recruiting GPs to replace those retiring or leaving practice, Thanet’s ratio of doctors to patients was currently low, leading to a wait for appointments. This situation required an innovative approach to the use of the available resources, for example, triaging patients to be seen by a practice nurse or physiotherapist, where possible, to free up a GP’s time to see the patients who needed to see them. This could reduce waiting lists, despite a wait to recruit new GPs. The development of multi-disciplinary teams would support this, as long as sufficient therapists and others could be recruited;
e) the establishment of multi-disciplinary teams was welcomed but the importance of GPs in the delivery of local care should not be underestimated. It was also important to bear in mind that, in health care, services should be able to be configured to fit the needs of a local population; one size did not fit all;
f) asked if pharmaceutical companies could collude or collaborate on service delivery, for example, for depression and anxiety, for which the use of drugs had increased steeply in recent years, Mr Ridgwell explained that there were statutory regulations to ensure that companies could not collaborate to manipulate the market for their own benefit. A priority for the NHS was to develop consistent approaches across organisations, including across primary care and acute hospitals, to manage drug costs. Mr Douglas added that a change to the way in which GPs worked would encourage a move towards using counselling services first rather than reliance on drug treatment. It was noted that some GPs would see a holistic approach as being too time-consuming, and prescribing drugs easier and quicker, but Mr Douglas pointed out that prescribing would bring an initial cost and then a later struggle and resource costs in encouraging a patient to reduce or discontinue drugs. Overprescribing of drugs, especially for older people, was a priority issue to be addressed. Mr Scott-Clark added that social prescribing would seek to reduce drug use by encouraging exercise and activity to boost mental and physical wellbeing. Professionals would assess and respond to each patient’s individual needs;
g) gathering evidence from outcome-based services could be difficult, and some services, for example, Child and Adolescent Mental Health Services, were still addressing historic backlogs. The Kent and Medway area was ranked 5th in the country for having long waiting lists and Britain was behind Europe in using early screening to identify need and raising public awareness;
h) although nurse training now involved degree courses, the importance of good, front-line, hands-on nursing training should not be overlooked. Mr Douglas advised the committee that the role of Associate Nurses (similar to the former State Enrolled Nurse role) was currently being trialled across Kent and Medway. An unforeseen consequence of introducing nursing degrees was that those who did not want to undertake a degree but were good at caring had been excluded from the profession. The Associate Nurse role offered not only a different way of entering the profession, and way of boosting recruitment, but scope to become involved in activities such as school nursing and health education. He suggested that it would be helpful for the committee to see at a future meeting the workforce strategy and the work being undertaken to address recruitment and retention;
i) asked about the availability and role of pharmacists, Mr Scott-Clark advised that pharmacists were being deployed differently; clinical pharmacists would work in practices and community pharmacists would move away from dispensing to include preventative and monitoring work. They could share information with GPs and play a larger part in the whole-system approach; and
j) asked how clinical commissioning groups’ responsibilities would work across borders with neighbouring counties and other authorities, and how Kent’s services could ensure they were treating only Kent and Medway residents, Mr Douglas explained that administrative borders should not be an impediment to the delivery of care. Patient flows crossed clinical commissioning group and county borders. Just as residents from outside Kent used a range of services provided from Kent hospitals, often as their main and nearest hospital, a large number of Kent residents also received care from hospitals outside the area (for example, in London). Patients would be referred where they could receive the best available treatment; administrative borders would not be a barrier.
2. The Chairman thanked Mr Douglas and Mr Ridgwell for attending to brief the committee and answer questions and advised that the slides used in the presentation would be shared with Members via email. He suggested that any Members who did not have time to ask a question could send them to Mr Douglas and Mr Ridgwell so they could have a written response via email.
3. It was RESOLVED that the information set out in the presentation and given in response to comments and questions be noted, with thanks, and that any outstanding questions be sent to Mr Douglas and Mr Ridgwell via the Democratic Services Officer for a written response.