Agenda item

The Council have been invited by the Rural Services Network to take part in scrutinising issues surrounding rural health and rural access to health services.  The CCG have been invited to attend the Meeting.

The project aims to produce a report which can be used to campaign on behalf of rural communities and can also be presented to the All Party Parliamentary Group on Rural Services.  It will also be shared at the Rural Assembly meeting of the Rural Services Network.

The project brief is attached.

The Chairman welcomed Dr Ian Mack and Chris Humphries to the meeting.

The Panel was informed that the Council had been invited, by the Rural Services Network, to take part in scrutinising issues surrounding rural health and rural access to Health Services.  The aim of the project was to produce a report which could be used to campaign on behalf of rural communities and could also be presented to the All Party Parliamentary Group on Rural Services.  It would also be shared at the Rural Assembly meeting of the Rural Services Network.

A response from the West Norfolk Clinical Commissioning Group (CCG), to the set questions provided by the Rural Services Network had been circulated to Members of the Panel in advance of the Meeting and is attached.  Members of the Panel were invited to comment upon the responses and ask additional questions.

Chris Humphries provided the Panel with a summary of the response sent by the CCG.  He highlighted the following points:

·         Almost 98% of Local Authority residents had to travel less than five miles to access their local GP and all residents had access to a GP within ten miles.

·         There were some staff vacancies, mainly nurses as there was a competitive pool in the area.  It was difficult to recruit and retain nurses nationally.

·         A wide range of services were available in the Borough, but occasionally specialist services would have to be accessed out of the Borough.  Transport Services were available.

·         Ambulance response times were set by the East of England Ambulance Service Trust and there was no difference in response time targets for rural and urban areas, however response times would obviously be longer in rural areas.

·         Work was ongoing to encourage and support training of staff to assist with recruitment and retention.

The Chairman thanked the representatives from the CCG for attending the meeting and invited questions and comments from the Panel, as summarised below:

·         In response to a question, Dr Ian Mack explained that there were two ways in which medicines were available to patients, either through a pharmacy or dispensary.  Usually rural practices had a dispensary attached to a Surgery.  The dispensary could dispense medication under the authorisation of the GP.  Therefore it was unlikely that patients would have a problem obtaining the correct medication as a GP would most likely be available for authorisation.  In a Pharmacy a Pharmacist had to be present to authorise the medication.

·         In response to a question regarding the growth of villages and if Practices could cope with the growth, it was explained that up until recently the CCG worked closely with a Public Health Consultant from Norfolk County Council and these arrangements had worked well.  The post had now been withdrawn and the CCG was looking at ways to bring back dialogue between organisations.  The Sustainability and Transformation Plan, when available would show ways that organisations could work together.

·         The Panel was informed that the Clinical Quality Commission (CQC) was responsible for scrutinising Practices, and following a recent review, most Practices were seen to be of good quality.  One Practice had required improvement measures.  It was acknowledged that all services were under economic pressures and if there were not enough staff available to inspect practices, inspections would be prioritised and carried out on a less frequent basis.  The CQC also inspected other health facilities such as care homes and mental health services etc.

·         The Panel was informed that all Practices in West Norfolk belonged to West Norfolk Health Organisation and worked collectively to ensure that services were available to the whole population.  All Practices were independent, and the West Norfolk Health Organisation worked to help ensure that services were accessible across the area.

·         It was not anticipated that any surgeries in rural areas would be closing or availability reduced, however there were occasions when certain procedures could not be carried out in certain Surgeries meaning that the patient would be directed elsewhere in the Borough.

·         There were some challenges in King’s Lynn where buildings were not fit for purpose and planning for the future of the urban area of King’s Lynn would be required.

·         The Portfolio Holder for Culture, Heritage and Health, Councillor Nockolds, informed the Panel that she sat on the CCG Joint Commissioning Committee.  She explained that the Committee received reports on the inspections of GP Surgeries and all reports had indicated good quality services, with the exception of one.  The Committee also received reports showing that the CCG and NHS were looking at the impact of population increase.  She explained that the Committee was proactive and discussions took place on lots of different areas.

·         In response to a question regarding Mental Health and Sexual Health issues in young people.  It was acknowledged that the CCG needed to do more as there was an increasing demand for young people and the demand was not being met in the local area.  Although services were good in King’s Lynn, services needed to be improved in rural areas.  With regards to Sexual Health issues, it was explained that there was a critical mass of numbers in King’s Lynn and it was not felt that the demand could be met by taking the service out into the community, therefore travel would be required to King’s Lynn, which could sometimes be difficult for young people.  Some services could be provided by School Nurses.  Dr Mack also explained that some services could be accessed online in connection with Mental Health.  Sexual Health was contracted by Norfolk County Council, so they would need to work together to overcome any issues.

·         The Health Sector was working towards seven day working which could provide the opportunity for young people to access services over the weekend or in the evening.

·         In response to a query regarding patients seeing a named Doctor, it was explained that previously the NHS had moved away from having a named Doctor, but this had now reverted back and patients had the right to a named Doctor.  If Members had specific issues regarding change of Doctors they were invited to contact the CCG.

·         Chris Humphrey explained that there was a national shortage of Doctors and Nurses and it was a competitive environment.  The Government had announced an increase in medical students nationally, but it would take many years before training was complete and more Doctors and Nurses were available.  Dr Mack explained that retention was also important and guidance was currently being drawn up on how to retain GP’s and bring them back to Practicing as often they retired early.

·         The Assistant Director informed the Panel that the Council worked with the CCG and other Public Sector Partners on the ‘Working in West Norfolk’ website which encouraged professionals to the area and promoted West Norfolk as an area to live and work.

·         The Chief Executive explained that the Sustainability and Transformation Plan would have significant implications and once it was published he suggested that the CCG be invited back to a future meeting of the Panel to discuss the implications and look at how the Council could work with the CCG.  

·         With regards to online services, it was explained that if possible, the first point of contact should be to the GP.  Online services were more about interaction and discussion.  The Panel was informed that people could self-refer via phone with regards to mental health issues.  The Sustainability and Transformation Plan would look at the need for community based infrastructure and support to deal with Mental Health at an early stage. 

·         In response to a question regarding acute services which were only available outside the Borough and any recent changes, it was explained that there was no changes to the services available in the past five years.  The Queen Elizabeth Hospital offered a wide range of services, some by visiting Clinicians.  However weight needed to be given to if a better service with better outcomes could be provided elsewhere. For example, some cases were referred straight to Norwich and Norfolk or Papworth if specialist treatment was required and severe trauma cases taken straight to a trauma centre had resulted in improvements.  Dr Mack explained that Stroke care was one service which had been looked at.  It was important that a Stroke was treated as quickly as possible and the Health Overview and Scrutiny Committee had looked at the evidence base for this along with the quality and need and put a case together to maintain the service locally.

·         With regard to cost reduction the CCG held regular meetings with the public.  Dr Mack explained that it was important to have open dialogue with the public on challenges and they held regular Community Engagement Forums.  Dr Mack explained that Governing Body meetings had a public question time at the beginning of each meeting.  There was also a break in the middle of the meeting so that Governors could meet with members of the public who had attended the meeting.  Dr Mack explained that savings had been delivered over the past few years but he acknowledged that the future would prove difficult with restrained budgets.

·         Chris Humphries acknowledged that there was not enough money to meet all needs and the CCG had to do the best that they could.  At all times the CCG tried to be open with partners and the public.

The Chairman thanked Dr Mack and Chris Humphries for attending the meeting and their detailed answers to all questions.

RESOLVED: (i) Details of the discussion would be forwarded onto the Rural Services Network.

(ii) The CCG to be invited to a future meeting of the Panel once the Sustainability and Transformation Plan had been published to look at ways the Council and CCG could work together.