Health Scrutiny Panel Minutes

Health Scrutiny Panel Minutes

Wednesday 23 April 2014
4:00 p.m.
Spencer Room, Town Hall, Middlesbrough

Attendance Details

Dryden (Chair), Biswas, Junier, Mrs H Pearson, P Purvis
J Bennington and E Pout.
Apologies for absence:
were submitted on behalf of Councillors Davison and S Khan
Declarations of interest:

There were no declarations of interest made at this point of the meeting.

Item Number Item/Resolution

The minutes of the Health Scrutiny Panel held on 31 March 2014 were submitted and approved as a correct record.


The Panel considered a draft Final Report an updated version of which was circulated at the meeting on the findings following the Panel's investigation into the topic of how people in Middlesbrough were able to access GP practices. The revised report included information which had been gained following a visit to a GP Practice to view the operation of the Doctor First appointment system.


The Panel suggested that the charges in relation to 03 telephone numbers be checked and references to premium line numbers be clarified in the main body of the report and acknowledgement given that the desk top review of the telephone numbers of GP Practices had been undertaken by the Scrutiny Support Officer.


Members referred to views obtained regarding a suggestion that there was a notable decrease, since the introduction of the Doctors First system, of people presenting themselves to walk in centres. An observation had also been made of another benefit of the system in freeing up appointments thus allowing GPs to schedule home visits earlier in the day which had resulted in staggering demand for ambulances and hospital beds throughout the day. It was suggested that the report should make it clear that such comments were made by an individual Practice Manager at the GP Practice visited to view the Doctor First system. 

Members discussed possible conclusions for inclusion within the Final Report based on the following:-


(a) The Panel was reassured to hear from NHS England that they were encouraging GP practices to remove the premium rate telephone service.


(b) Members acknowledged that 77% of people within the South Tees Clinical Commissioning Group area had indicated that it was very or fairly easy to get through to someone at a GP Practice as shown in the December 2013 GP Patient Survey. Although it was noted that a significant number of people, 23% experienced difficulties there was recognition of the likelihood of increased access to GP services through Government proposals for extended GP practice opening hours.


(c) In terms of data made available which indicated that there were 45,000 GPs registered in the UK it was noted in particular that such figures did not provide a breakdown of full-time, pat-time or the days/hours per week each GP worked and there was a concern that it may be misleading and did not reflect the potential problems in relation to recruitment of GPs. Evidence had shown that factors such as continuing administrative changes, varying levels of remuneration to doctors based in hospitals, increasing workloads, changes to pension scheme and an increasing number of patients with complex conditions had impacted on the number of people entering the profession. There was also a trend for GPs to move outside of the UK, in particular Canada where there was a current shortage of GPs but the cost of living was lower but the wages were higher. It was also felt that in circumstances where a GP returned to the workforce after a break within two years they would need to pay for required training before returning which could be a barrier to recruitment.


(d) While the Panel acknowledged the benefits to patients of the Doctor First system in that it provided greater choice and increased the likelihood of a same day appointment for those wishing to see a doctor there was a concern that in certain cases underlying medical problems may not be picked up during a telephone conversation without visual observations of a face to face clinical assessment.


(e) From the evidence available it was considered that there were inconsistencies across the Town in terms of access to GPs.


(f) The Panel acknowledged the changing role of receptionists and to an extent were part of a triage system in that they would follow an immediate course of action in certain circumstances but stressed the importance of appropriate up to date training being provided on a regular basis which included aspects of interpersonal skills.


The Panel suggested that the recommendations within the Final Report should focus on the following:-


(i) That the Panel is pleased to note that there will be no GP Practices within Middlesbrough by August 2014 which operates a premium telephone number.


(ii) That the Secretary State for Health be advised that it would be beneficial if more detailed information, a breakdown of full time /part time/hours worked, was provided in terms of the national data provided with specific regard to the number of GPs registered in the UK in order to provide a clearer picture in addressing potential problems of recruitment of GPs and if sufficient to cope with the likely increasing demand.


(iii) That further information and a position statement be sought from the Local Medical Committee with regard to proposals for extended hours for GPs.


(iv) Following changes of impending legislation in October 2014 which would mean that people would be able to register with a GP Practice from outside their traditional practice boundary area the Panel considered it important for an assurance to be given that people registering will be made aware that the practice would be under no obligation to provide home visits for such patients.


(v) Given the evidence which suggests a potential barrier to the recruitment of GPs in circumstances whereby GPs taking time out away from practice within a period of two years such as women leaving to start a family, have to pay for refresher training the Secretary of State for Health examines ways of encouraging GPs to return to practice and reduces the requirement for such training in certain cases but ensuring the same standard of service.


AGREED that the draft Final Report in respect of Access to GP Services be approved and in consultation with the Chair and Vice- Chair the conclusions and recommendations based on (a) to (f) and (i) to (v) as outlined above be incorporated prior to submission of the report to the Overview and Scrutiny Board.


In a report of the Scrutiny Support Officer the Panel was advised of minor changes to Dental and GP provision in Middlesbrough.


Following changes to the NHS in 2013 responsibility for the provision of dental care transferred from Primary Care Trusts to NHS England.


It was reported that the Teesdent Dental Practice opened in January 2011 and was based within Teesside University providing dental services to around 1,400 patients. It was noted that the target was for around 3,000 to be registered with the practice. The Panel was advised that there had been a high turnover of patients and the practice had not been able to achieve sufficiently high patient numbers for the contract to run effectively. Although the practice had worked closely with NHS England to try and resolve the situation it had been concluded that it was unsustainable and the provider had served notice to terminate the agreement with effect from 30 April 2014.


It was confirmed that the NHS Area Team was working with the practice to ensure the smooth closure of the practice and the transfer of patients to local practices. A letter had been sent to each patient advising of alternative practices nearby that were currently accepting new NHS patients. Patients were being encouraged to contact an alternative practice as soon as possible to ensure continuity of care. The letter a copy of which was provided at Appendix 1 to the report submitted also contained a list of Frequently Asked Questions to help advise patients.


The Council had been notified by the NHS England, Durham, Darlington and Tees Local Area Team about a service review which was to commence regarding a local GP practice, Park End Clinic. Further information had been received from NHS England copies of which were circulated at the meeting.


The GP practice had opened in 2009 as part of a national initiative to improve access and choice to GP services for local communities.  As the contract for this practice was due to come to an end on 31 August 2014 the role of NHS England's Durham, Darlington and Tees Area Team had been to review the service to evaluate quality, demand, value for money and need.


NHS England had indicated that from information collated and analysed it suggested that the practice may no longer be viable owing to the following main factors:-


(a) the low numbers of patients currently registered at 1512 with a slightly below average number of patients with long term conditions;


(b) choice of a number of other accessible practices locally, all of which were accepting new NHS patients and which provided services to an equal clinical quality;


(c) high costs of providing services to small numbers of patients.


It was noted that whilst NHS England had already considered a range of available quality information and patient feedback they had indicated that an important part of the service review was to gain the views of registered patients, local representatives and partner organisations.  NHS England intended to embark on a period of engagement to ensure local people were able to assist in understanding both the benefits of Park End Clinic and the impact of possible decommissioning the practice.


It was noted that the nearest GP Practices to Park End Clinic were the Crossfell Health Centre at 0.69 miles from Park End and Martonside Medical Centre at 0.76 miles, with a further seven practices within a two mile radius of where the majority of patients resided.


The Panel discussed the proposed stakeholder engagement plan as outlined in Appendix 2 of the report circulated.


The main observations of Members on the proposed consultation focussed on:-


(a) The Panel welcomed the opportunity of submitting views on the review and engagement process so far and suggested that further discussion take place with appropriate representatives on the outcome of the consultation exercise.


(b) In overall terms, Members expressed disappointment if it proved necessary to close the Park End Clinic especially having regard to the recent return of the Smoking Cessation Clinic further details on which were requested as to its future operation.


(c) Members queried the figures and what method had been used in determining the distances stated of other practices within the Ward from the Park End practice as shown in Table 1: patient distribution of the briefing paper received from NHS England.


(d) The Panel concurred with the proposed list of stakeholders to be contacted and suggested that it would be useful if appropriate care and residential homes, a breakdown of the third sector groups and Local Area Co-Ordinators were included in the list to be consulted.


(e) In terms of the method of consultation the Panel indicated the need for direct discussions in certain circumstances in order to assist in gaining meaningful responses especially those in residential or care homes.


AGREED as follows:-


1. That the information provided in respect of the Teesdent Dental Practice be noted.


2. That in consultation with the Chair and Vice-Chair a formal response be submitted to NHS England, Durham, Darlington and Tees Area Team on the review and consultation process in respect of Park End Clinic based on the Panel's findings as outlined.


In a report of the Chair of the Health Scrutiny Panel Members were advised of the key matters considered and action taken arising from a meeting of the Overview and Scrutiny Board held on 1 April 2014.


With reference to the presentation provided in relation to educational attainment in Middlesbrough 2013 and Ofsted Inspection 2014 a Member commented on the high standard of the majority of primary schools some with outstanding features. Members acknowledged the importance of many recent changes to the extent of local authority responsibility in relation to education.





Members thanked the Chair and Vice-Chair for the able way in which they had carried out their duties during the current Municipal Year.



Powered by E-GENDA from Associated Knowledge Systems Ltd