Agenda item

Report of the Chief Officer, Southampton City Commissioning Group, seeking the Health and Wellbeing Board’s support of the Expression of Interest for Southampton City Clinical Commissioning group undertaking Co-commissioning of primary care with NHS England, attached.

The Board considered the report of the Chief Executive, Southampton Clinical Commissioning Group, seeking the Health and Wellbeing Board’s support of Southampton City Clinical Group's Expression of Interest for undertaking co-commissioning of primary care with NHS England.

A discussion ensued around the development and delivery of primary care and the Board noted the following issues and concerns:-

·  that the concerns and challenges around primary care were not unique to Southampton and there was a recognised need for a clear strategic approach to supporting the development of general practice, to create a model of primary care that was sustainable;

·  the challenges being faced included:-

Ø  demands on general practice from an increasing ageing population with long term conditions and complex needs;

Ø  increased expectations on general practice;

Ø  difficulties in recruiting medical students into the general practitioner service due to its increased demands, long working hours and negative media coverage;

Ø  many general practitioners were choosing to work overseas or opting to work part-time; 

Ø  over the next three years 500 general practitioners would be leaving the service and out of 300 in training only 40% wanted to be full time general practitioners;

Ø  in Southampton and Gosport there were six surgeries in crisis as a result of these issues; and

Ø  what the contingency plans might be to secure access to primary care in the event of practices closing and the need for a 3-5 year vision to develop a more sustainable system;

·  it was important that general practitioners integrated with other parts of the health service and there was a need for a greater skill mix with other elements of the service including physiotherapy and pharmacy;

·  walk-in-centres had not reduced pressure on general practice.  They had been another service that brought in additional work to the NHS.  However, it was noted that walk-in-centres had provided a service for homeless people.  It was noted that officers would provide members with an explanation on the differences between walk-in-centres, minor injury centres and urgent care centres outside of the meeting;

·  delivering 7-day working would be a challenge.  It could not be delivered at practice level and would need to be organised on a wider scale.  It could cover urgent care but not routine care;

·  the importance of engaging with the public, not only to ascertain what primary care services were important to them, but informing them of what care could be provided and how care would be delivered in the future; and

·  99% of the population were registered with general practitioners and Health Watch were investigating how the 1% of the population who were not registered could better access services.

The Board noted that Clinical Commissioning Groups had the opportunity to apply to co-commission primary care in partnership with NHS England.  Southampton City CCG had recently submitted an Expression of Interest to take on delegated responsibility for commissioning elements of primary care and would carry out defined functions on behalf of NHS England who would hold them to account for how effectively they carried out these functions.  Southampton City CCG would not however, be taking on transactional operations and activities associated with these functions and would agree a contractual arrangement that allowed NHS England to discharge the functions on behalf of the CCG.

RESOLVED

  i.  that the Board supported Southampton City Clinical Commissioning Group’s Expression of Interest for undertaking co-commissioning of primary care with NHS England;

  ii.  that the Board recognised the importance of high quality primary care in delivering the ambitions of the  Better Care programme;

  iii.  that Southampton City Clinical Commissioning Group agreed to work with commissioners to ensure that a sustainable model for primary care in Southampton was developed whilst proceeding with caution to ensure that potential conflicts of interest were avoided; and

  iv.  that a progress report on the Expression of Interest process be submitted to a future meeting of the Board.