Councillor Halden presented the report that made a series of recommendations in terms of improving the quality of Primary Care in Thurrock, improving the quality of long term condition management and strengthening the local health and social care workforce.

The Annual Public Health Report had played an important part in public health practice ever since the early days of medical officers of health. Councillor Halden stated they still remain an important vehicle for informing local people about the health of their community.

Councillor Halden referred Members to the Public Health Report that had been set out in seven sections with each one demonstrating the following eight key issues:

1.         Increasing and unsustainable levels of demand on the local health and care system.

2.         Practice-level variation in outcomes and an indication of patterns.

3.         How a revised Primary Care staffing model could address demand.

4.         Key influences on non-elective admissions and inappropriate Accident and Emergency attendances.

5.         Estimates of future activity if no changes are made to provision.

6.         How activity in different parts of the system links to cost.

7.         What was cost effective in terms of prevention/shifting demand.

8.         The need for a “System Wide” response across organisational budgets to solve financial and operational sustainability.

Councillor Halden stated that:

•           83 per cent of all Accident and Emergency attendances needed no medical investigation or treatment.

•           27 per cent of these attendances were conveyed to Accident and Emergency by ambulance.

•           Four Hubs would replace the closure of the Grays Walk In Centre and that meetings with the project manager from the Clinical Commissioning Group had taken place to get these hubs underway.

•           The General Practitioners Plan had been passed.

•           Thurrock would not tolerate poor health care.

•           Back tracking should be undertaken to pin point ailments that had not been treated appropriately.

•           A 0-19 Wellbeing Model had been introduced.

•           Working with schools and introducing the education of health matters.

•           Looking at generation issues and poor health.

Finally, Councillor Halden thanked Ian Wake, Director of Public Health, and his team for all their hard work.

Councillor V Holloway, Chair of the Health and Wellbeing Overview and Scrutiny Committee, echoed Councillor Halden’s comments on the thanks and praise to Ian Wake and his team for the efforts made. Councillor Holloway asked whether the closure of the Walk In Centre had put extra pressure onto general practitioners. Councillor Halden stated the four hubs were active and appointments were available during the week and weekends. These were being delivered by the Clinical Commissioning Group and that better pathways would result in better quality of care.

Councillor Snell also echoed Councillor Halden’s comments on the thanks and praise to Ian Wake and his team for the efforts made. Councillor Snell asked what plans would be in place to tackle the £18 million deficit. Councillor Halden stated there was no baseline and that the deficit was driven by pressure and that the deficit would not go down until the primary care network had been addressed and fixed.

Councillor Okunade asked for an update on the lack of general practitioners in Tilbury. Councillor Halden stated that with the structure of the Hubs this should attract younger general practitioners into the area. That business plans would be drawn up for Tilbury and that Councillor Halden had plans to make frequent visits to oversee these.

Councillor Gerrish thanked the Public Health Team for the good work undertaken and stated his concern on the inappropriate conveyances as reported under avoidable Accident and Emergency attendances and how this may risk the health of younger children. Councillor Halden stated that the appropriate intervention was in place to deal with all patients that only required treatment or most minor treatments/investigations and that Accident and Emergency should be used solely for accidents or emergency and to use the ambulance service if you are unable to get there yourself.

Councillor Spillman requested an update on general practitioner appointment times in Aveley as this was still bad and that a large number of social housing in Aveley had mould and damp to contend with which had resulted in an increase in respiratory conditions being identified. Councillor Halden stated that improving the case finding and clinical management of these conditions and investing in Primary Prevention initiatives to assist people to improve lifestyle behaviour was likely to have a positive impact on reducing the these conditions. Councillor Halden stated that any specific issues that Councillor Spillman had in his ward he would be happy to pick up outside the meeting.

Councillor Collins asked if there were any existing general practitioners willing to work out of hours. Councillor Halden stated yes and that a number of general practitioners were hard working. Particularly Collins Health who were outreaching to other surgeries and encouraging more groups to participate.

Councillor Gledhill stated that education played a vital part in health and encouraged all members to undertake their general practitioners MOT.

Councillor Pothecary stated that it was an impressive report but stated it may have been useful if an analysis on the impact of the closure of the Grays Walk In Centre had on Basildon Hospital. Councillor Pothecary requested a definition of Out-of-Hours. Councillor Halden stated that Basildon Hospital was under immense pressure even when the Walk In Centre had been open in Grays High Street and that the Council had to move to the hub model. Out-of-Hours was based on the timetables and contracts signed by general practitioners and that these contracts would reflect the services required.

Councillor Hebb stated that education and communication was vital and that residents should be aware of the available pathways. Councillor Hebb recommended that correct pathways would be published as part of the Thurrock News monthly email.

RESOLVED:

1.              That the Members note and support the contents and recommendations made in the report and support its publication.

2.              That the Members note the political leadership being undertaken by the Cabinet Portfolio Holder for Education and Health across the local Health and Social Care system and through our local Sustainability and Transformation Plan (STP) to deliver the report’s recommendations. These include:

·         Delivery of a new model of Primary Care to address under-doctoring and capacity issues.

·         Mechanisms to case find and diagnose patients with long term conditions.

·         Significant improvement of the management of long term conditions in Primary Care including the implementation a GP.  Long Term Conditions Management Scorecard.

·         Recommendations to reduce inappropriate A&E attendances and avoidable A&E admissions.

·         Recommendations to reduce delayed transferred of care from the NHS to Adult Social Care.

3.             That the Members note that the recommendations from the Annual Public Health Report were being incorporated within a “Principles Document” to form a “Thurrock Ask” from NHS England.

4.             That the Members note the re-procurement of a new Integrated Healthy Lifestyles Service with a stronger focus on young people’s health in order to break generational health inequalities.

5.             That the Members note that the Health and Wellbeing Board is now acting as the Primary Delivery Arm for implementing the recommendations within this report, and the objectives within the Health and Wellbeing Strategy.