Action Plan and presentation for objective 4A:  Development of four new healthy living centres

Rahul Chaudhari

Action Plan and presentation for objective 4B: Care will be organised around the individual

Mark Tebbs

Action Plan and presentation for objective 4C:  People will feel in control of their own care

Catherine Wilson

Action Plan and presentation for objective 4D:  High quality GP and hospital care will be available to Thurrock residents when they need it

                                                                                                            Rahul Chaudhari

*Health and Wellbeing Board members are asked to note that presentations on action plans 4A and 4D will be presented together and will be followed by presentations on action plans 4B and 4C.

The Item in Focus for this meeting was Goal 4 Quality Care Centred Around the Person which comprises four objectives:

·         4A, Development of four new healthy living centres

·         4B, Care will be organised around the individual

·         4C, People will feel in control of their own care

·         4D, High quality GP and hospital care will be available to Thurrock residents when they need it

Action Plan 4A, Development of four new integrated healthy living centres, was presented by Rahul Chaudhari, Head of Primary Care, Thurrock Clinical Commissioning Group.  A system wide, consistent approach was being adopted by Thurrock Clinical Commissioning Group (CCG) and partners.

·         Thurrock CCG has established 4 localities across Thurrock (Corringham, Grays, South Ockendon and Tilbury) with General Practices aligned to work collaboratively within these areas. 

·         Thurrock CCG has secured additional funding from NHS England which has supported the development of Health Hubs across the four localities to provided 6000 additional appointments and 15,000 extra GP nursing appointments during 2015/16.

·         An Integrated Healthy Living Centre will be built in each of the four localities (the first being in Tilbury and Purfleet) providing state of the art estate which facilitates a collaborative model of service delivery.  Integrated Healthy Living Centres will provide a mixture of locality-specific and generic services.

During discussions the following points were made:

·         It is important to ensure that GP practices across Thurrock are raising awareness of evening appointments being available within each of the Hubs. 

·         A paper on the effectiveness of Hubs is to be considered at the next Health and Wellbeing Board meeting in March

Action Thurrock CCG

·         It is envisaged that business cases for two Integrated Healthy Living Centres (Tilbury and Purfleet) will be approved within the next six months.

·         It is important to recognise that Thurrock Council has been working closely with Thurrock CCG. 

·         It was agreed that Thurrock’s Children’s services should be engaged

Action Plan 4B, Care will be organised around the individual, was presented by Mark Tebbs, Head of Integrated Commissioning, Thurrock Clinical Commissioning Group.  During the presentation the following points were made:

·         Focus will be provided on improving case finding. .

·         A new primary care frailty index is to be rolled out across Thurrock which will support frailty being identified at an earlier stage in a person’s life.   Board members were advised about a pilot in one GP surgery which showed that 25% of people that had been identified as part of the frailty index had not been in contact with health services.

·         An integrated data system is being developed which will enable an individual’s treatment pathway, while pseudo anonymised, to be recorded and tracked.  This approach aims to help primary care providers to identify patients at risk of health challenges, shifting from a reactive to more proactive health system.

During discussions the following points were made:

·         Board members were asked to note that Thurrock CCG is leading on developing the Electronic Frailty Index across Essex.

·         Thurrock CCG, through its primary care development team is supporting GP practices to contribute towards, maintain and use the Electronic Frailty Index. 

·         All GPs are also being supported by Thurrock CCG to undertake NHS Health Checks.

·         The importance of ensuring that Thurrock’s Voluntary and Community Sector (VCS) are engaged and part of the integrated data system was acknowledged by Board members.  Members were advised that the VCS will be involved and that consideration will be provided to creating a web-based system that will not require partner agencies to update their current IT systems.

Action Plan 4C, people will feel in control of their own care,was presented by Catherine Wilson, Strategic Lead Commissioning Thurrock Council.  During the presentation the following points were made:

·         It is important to increase the emphasis on prevention - local authorities and other providers of support will encourage and assist people to lead healthy lives which will reduce the chances of them needing more support in the future. 

·         Thurrock Adult Social Care is moving towards a model involving more community based services, delaying the need for more expensive statutory services.   

·         In response to the national crisis in Domiciliary Care Thurrock is developing a new model, Living Well at Home.  This approach aims to create neighbourhood based solutions which include a mixture of formal and informal responses to the outcomes an individual wishes to achieve.

·         Thurrock is taking forward the national Transforming Care Programme as part of the pan-Essex Transforming Care Partnership Board.  A key part of the programme is ensuring people with a learning difficulty are supported to have control over their lives.

During discussions the following points were made:

·         Only 11% of LD Healthchecks for people with learning disabilities were completed last year.  The work of Thurrock CCG and partners has increased the proportion of completed LD Healthchecks to approximately 30% to date.  A key challenge is to get up to date data.  Thurrock CCG has therefore been visiting individual GP practices to ensure Healthchecks are being completed.

Action Plan 4D was presented by Rahul Chaudhari, Head of Primary Care, Thurrock Clinical Commissioning Group.  During the presentation the following points were made:

·         One of Thurrock CCG’s ambitions is to ensure that no practices are in special measures and at least 50% of practices achieve a GOOD CQC rating.  It is important to recognise the baseline with only 3 practices receiving a rating of ‘good’ approximately 18 months ago.  Board members were advised that 40 GP practices now have a CQC rating of ‘good’.

·         Workforce design is a key element of improving GP services.  If Thurrock was to continue using the traditional model an additional 45 GPs would need to be recruited.   Utilising the skills of Allied Health Professionals (AHPs) such as physiotherapists, paramedics and pharmacists is one way of freeing up some of the GP workload.

·         GP practices are receiving support to improve their existing premises through Premises improvement grants, Estates and Technology Transformation Fund (ETTF) and Section 106 monies.

During discussions the following points were made: 

·         Board members acknowledged the progress that had been made with improving CQC GP practice ratings across Thurrock but it was recognised that there is more to do. 

·         Members were asked to note that there is a time lag between improvements being delivered within a GP surgery before the CQC rating is amended.

·         The Chair welcomed Thurrock CCG’s target of 50% of Thurrock GP practices receiving a CQC rating of ‘Good’.

·         The timing of commissioning responsibilities being devolved from NHS England to CCGs was considered.  Board members acknowledged the importance of ensuring that Thurrock CCG can continue to focus on Thurrock Transformation programmes and the potential risk created on the CCG’s capacity to co-commission health services following powers being devolved while driving forward Thurrock’s transformation programme. 

Community engagement feedback

The Chair invited Thurrock Healthwatch to report on engagement feedback received from members of the public about Goal 4, Quality Care Centred around the Person.  

·         Board members were advised about the comprehensive engagement report that has been provided by Thurrock Healthwatch, which has been circulated with these minutes. 

·         It was agreed that action plans should reflect feedback received from members of the public as much as practicable.

RESOLVED:

Action plans developed to support the achievement Thurrock’s Health and Wellbeing Strategy Goal 4, Quality Care Centred Around the Person were agreed.