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Name: HARLOW PCG
Date: 18 Oct 2000
Time: 14:07:14
HARLOW PRIMARY CARE GROUP
OPEN PUBLIC BOARD MEETING
THURSDAY 5 OCTOBER 2000 DRAFT MINUTES OF THE OPEN PUBLIC BOARD MEETING HELD IN THE COUNCIL CHAMBERS, HARLOW COUNCIL, TOWN HALL
Chairperson: Dr Cliff Bishop
Present: Dr Cliff Bishop Sally Gorham Peter Pearson Rita Cutts John Wright Dr John Portelly Irene Jein Dr Mukesh Rajani Dr Hassan Khimji Matthew White Dr Trevor George Cll. Roy Collyer Apologies: Dr Rob Gerlis Dr Arvind Chhibber Fiona Gilmour In Attendance: Alan Cudmore Dawn Poon Anne Reeder Paul Wrighter Jan Dixon Liz Shoolbred Pam Hicks
97/00 PRESENTATION BY SARAH DUKES – HEALTH PROMOTION Health promotion is the process of enabling people to increase control over, and to improve their health. The main principles of health promotion are based on:· Build Healthy Public Policy.· Create supportive environments.· Strengthen community action.· Develop personal skills.· RE-orient health Services. Sarah Dukes then went on to explain the work being undertaken within Harlow.
Young People & Sexual Health One of the major projects currently in progress has been around Young People and Sexual Health. Sarah Dukes has been working with local Primary School teachers to provide sex and relationships education training, It is important that this partnership is developed between schools and health.
The ‘A PAUSE’ project is aimed at Secondary school pupils and involves lessons being delivered jointly by the teacher and a school nurse. There is also a peer led aspect to the project, students from Harlow college will be delivering sex education lessons to pupils in secondary Schools. The government are planning to roll this project out nationally.
There will also be a mult-agency project targeting ‘excluded young people’ (who do not attend main stream school) to deliver sex education.
Sexual Health Training is also being provided at the Young Peoples Information Centre and made available to Receptionists, making the service more user friendly to young people requiring advice on sexual health issues, it was felt that this required as Receptionists provide the first point of contact in primary care.
CHD Considerable amount of work has been done on CHD, The GP referral Scheme, activity for life has been established in partnership with Harlow Sportscentre. A protocol has now been written on phase four of the cardiac rehabilitation.
Considerable amount of time has been spent on the development of six local smoking cessation groups, supporting and assisting local residences at the sessions whilst taking the drug Zyban. These sessions are being held across the Town i.e sportscentre, clinics and community halls.
The success of the groups has been such that there is a need for patients to be held on the waiting list.
Tackling Inequalities Three community link workers are working with the PCG to ensure health needs of the Chinese community.
The Chinese community have asked the Diabetic nurse and a dietician from PAHT to attend a workshop this evening.
Healthy Schools
Department of Health and DFEE launched the National Healthy Schools Project last year.
Essex and Southend Healthy Schools Partnership has already existed in Essex for two years, Sarah Dukes role is in supporting schools in carrying out an audit and writing action plans.
Sarah Dukes finished her presentation by explaining that all of this was not possible without good partnership links.
Dr Mukesh Rajani welcomed the work, but stressed the work needs to be sustained long term, if we are to have the desired out on the community.
Dr Trevor George asked what provision had been made for social behaviour, Sarah Dukes explained that the projects are aimed not just at health and sexual health but try to address all basis core skills.
John Wright agreed with Dr Mukesh Rajani stressing that this could only be achieved if the PCG/T secure additional funds, as he felt that although Sarah Dukes has done well, it is unrealistic for her to continue this good work without additional support.
Dr Hassan Khimji asked what the drop out rate was for the smoking cessation groups. Sarah Dukes explained that a third of the first group had discontinued with the sessions, with a further four meetings planned. An audit would be carried out on the success rate of each course.
Dr Hassan Khimji also expressed his disappointment at the news that the Wellness Wheels bid had been turned down. John Wright confirmed that although the bid was refused, it is anticipated that further submissions will put forward. The feedback received indicated that more work was required around developing more community involvement.
Dr John Portelly felt that projects should be monitored before the organisation considered making any further investment. Sarah Dukes explained that all of the projects are monitored. Therefore there would be no problem in making this available to the Board. He was also concerned whether the organisation would be able to find additional funding in light of the deficit. Peter Pearson felt that this would not just be the responsibility of PCG/T, as this affects the objectives of most organisations i.e. Social Services, District Councils and the major private sector organisations in the Town and would therefore welcomed by these organisations.
Dr Mukesh Rajani felt that we needed to invest in the future of local residence.
Alan Cudmore asked whether the PCG was working with the Italian community Project, which is lead by Social Services. Sarah Dukes stated that she had not heard of this project would be interested in contacting the leads of the project. Alan Cudmore agreed to provide more details on the project.
Dr Cliff Bishop felt that is should was the way forward.
97/00 MINUTES OF THE MEETING HELD ON THURSDAY 7 SEPTEMBER 2000. 69/00 Declaration of Interests and Hospitality Add the following “ Dr Trevor George has no interests to declare other than his partnership at Lister House Medical Centre.” 95/00 Prescribing Drugs on NHS for Patients Receiving Treatment in the Private Sector. Add the following “ It was agreed that Anne Reeder would write to all GPs clarifying this issue” 98/00 MATTERS ARISING 85/00 Personal Medical Services (PMS) Sally Gorham reported that since the last meeting Dr Singh has agreed to delay his application until February 2001 to allow more time to develop a more robust application with the support of Harlow PCG. Dr Hassan Khimji advised members that due to recent recruitment problems he has submitted a late application to the Health Authority to become a PMS from April 2001following advise from the LMC, Health Authority and the Regional Office. He stressed to members this was only a declaration of interest at this stage and would provide him the time needed to consider all options. Sally Gorham stated that due to the time-scale of this application it has been submitted to the Health Authority without consultation and approval from the PCG Board. 58/00 Walk-in Centre Sally Gorham stated that there was still no confirmation on the future date of the Ministerial Opening. 62/00 Winter Plan Sally Gorham explained to members that the Harlow Plan formed part of the West Essex Plan, which is incorporated into a North Essex wide plan. It has now been confirmed that the North Essex Plan has been classified as medium/high level risk by the Regional office. Subsequently this means that North Essex has not qualified for the second payment of the NHS Performance Fund in accordance to the criteria. It is important that the risk is reduced before the next submission. The North Essex Health Economy will lose the NHS Performance Fund for 2nd and 3rd quarters this financial year if any of the performance targets including winter planning targets are missed. This would have a major impact on the Authority as all trusts are depended on the additional resources. It was noted that the Health Economy was success in achieving its financial, waiting list and trolley wait targets. Dr Mukesh Rajani asked whether the additional funds identified in sector 5.1 of the Harlow plan will be allocated to Harlow PCG. Sally Gorham stressed that this was already allocated to intermediate care scheme to ensure continuation of the service, Roy Collyer asked whether the Walk-in Centre would be supporting the Flu Vaccination Programme. As he felt the process was taking too long and winter would be upon us before the Programme was completed. Dr Cliff Bishop explained that this was considered however it was not considered feasible due to the reduced staffing levels. There was also concern of duplication and more seriously patients being missed. Dr John Portelly felt that practices would want to manage the programme with support from District Nurses for homebound patients, that way they are assured that their patients are not missed. Sally Gorham informed members that Dr Trevor George had agreed to do a radio session promoting the vaccination Programme. Irene Jein reported that nurses will be visiting elderly peoples homes encouraging people to have the vaccination. They will re-visit the centre to carry out the vaccinations. All of this will be evaluated in preparation for next year. 82/00 PCT Progress Report The PCG held a very successful Board Away Day in preparation for April 2001. The Chairperson for the PCT Board has still to be appointed. The delay to due to the recent Petrol Crisis.
NEW OPPORTUNITIES FUND – Living with Cancer
Rita Cutts reported that Harlow PCG’s application was successful. Harlow was only one of two approved in the Eastern Regional and only one of four PCGs in the country. We are still waiting confirmation as to whether we will receive the total £200K as detailed in the application.
John Wright informed members that the New Opportunities Fund for Healthy Living Centres bid had not been successful. A meeting was being convened to look at the feedback and prepare for a resubmission.
JOINT FINANCE PARTNERSHIP BIDS
Bids have now been received and considered by the project team. Unfortunately only the Age Concern for Essex applications met the criteria, which was subsequently approved by the team.
Because not all funds have been allocated as part of this process it was agreed to enter into discussions with HCVS with regard to funding the appointment of a co-ordinator.
HEALTHY LIVING EVENT – HARLOW SPORTSCENTRE.
This event took place last weekend with good representation from local organisations.
DEAR DOCTOR LETTERS TO PAHT
The Trust have confirmed that they will be writing to all GPs stressing that ‘Dear Doctor’ letters are acceptable and should be encouraged. Members were concerned about this situation as some Consultants are returning letters to practices refusing to treat patients unless the letters are address to an individual Consultant. Sally Gorham confirmed that it was important for GPs to continue to write ‘Dear Doctor’ letters.
ACUTE SERVICES STRATEGY
Sally Gorham reported that there had been a workshop last Friday. Dr Mukesh Rajani, Dr Mike Lurkins and Sally Gorham represented Harlow. There is also a workshop this afternoon for Chairs and Chief Executives.
Dr Trevor George asked whether there was an agreement to monitor DNA’s. Sally Gorham confirmed this was agreed and figures can be circulated.
PAHT have started to pilot an appointment scheme for two specialities, Gynaecology and Orthopaedic services. There is also work being undertaken on establishing a process for follow up appointments, there is even a question as to whether follow up appointments should be the exception not the rule.
Dr John Portelly stated that there was concern amongst the GPs about the validation process, however he stressed that the Trust had improved the systems put in place. The majority of concerns were around the validation of waiting lists. Suggestions that it would be more affective to only carry this out just before the operation was due, however after discussing the matter with Trust he has been advised that this is a national requirement as set out in the targets.
Dr John Portelly asked what happened to the posters providing contact details for patients wanting to cancel or postpone appointments. It was agreed to contact Martin Backhurst about the posters.
PETROL CRISIS
97/00 PETROL CRISIS The Regional Office have sent a letter asking the Chief Executive to pass on their thanks for all the hard work undertaken to ensure frontline services were maintained during the protest. 98/00 MODERNISING NHS DENTISTRY – SUMMARY Members formally noted the attached document. It was also agreed that representation from the Dentistry profession should be invited to the PCD & Commissioning Sub Committee. 99/00 PHARMACY IN THE FUTURE – SUMMARY Members formally noted the attached document. Dr Trevor George raised his concern about providing information to pharmacists twenty-four hours a day. It was agreed that this needed the document should be discussed with presentation from the profession. It was agreed that the PCG should write inviting representatives to a meeting. 100/00 PROGRESS REPORT ON HEALTH IMPROVEMENT PROGRAMME Members formally noted the attached paper. Dr Mukesh Rajani asked for clarification on the introduction of ‘age proof cards’, he has already been approached by patients asking him to complete the relevant section, He asked whether there was a more appropriate way of confirming students age. Dr John Portelly did not feel this was an appropriate use of his time. If patients attending his surgery for this reason there would be charge made for the completion of this form. Peter Pearson stressed that this should not be case. The plan was that the relevant school should complete this form. He agreed to look into the matter. Dr Hassan Khimji informed members that there had been some initial problems with the CHD template as not everyone had completed the follow up forms. Further work is required to try and resolve this problem. It is anticipated that the group will need to produce a form for primary care and another for secondary care. It was hoped that the forms could be made available electronically. The December Clinical Governance shut down will focus on the SNF. 101/00 ANNUAL ACCOUNTABILITY REVIEW MEETING – QUARTER TWO. The PCG recently had its second review meeting with the Health Authority based on this report. Most of the session was focused on the financial position and the recurring problem with the prescribing budget. The Authority have agreed to go away and consider the prescribing allocations and whether there is any flexibility for providing additional support to the PCG for prescribing. 102/00 AGE MATTERS DOCUMENTATION AND DRAFT RESPONSE Sally Gorham explained that the document itself was in two part, firstly it addressed the development of services in the home and then it does on to talk about Elderly Peoples Homes and making best use of Social Services resources. Whist in some parts of Essex there is over provision of Residential Care, it is not the case for Harlow. Peter Pearson confirmed that Harlow is different from other parts of Essex and discussions need to take place the need for increasing the provision. Sally Gorham attended the open public meeting and although there was a level of concern there was also a willingness to work together to improve services for Older people in the Town. The Board formally approved the Draft response. 103/00 DRAFT RESPONSE TO UTTLESFORD PCT TRUST APPLICATION The Board formally approved the draft response. 104/00 DRAFT RESPONSE TO ROYSTON, BUNTINGFORD AND BISHOP’S STORTFORD PCG TRUST APPLICATION The Board formally approved the draft response. 105/00 DRAFT RESPONSE TO MALDON & SOUTH CHELMSFORD PCG TRUST APPLICATION The Board formally approved the draft response. 106/00 DRAFT RESPONSE TO COLCHESTER PCG TRUST APPLICATION The Board formally approved the draft response. 107/00 DRAFT RESPONSE TO HAVERING PCG TRUST APPLICATION The Board formally approved the draft response. 108/00 DRAFT RESPONSE TO BARKING & DAGENHAM PCG TRUST APPLICATION The Board formally approved the draft response. 109/00 DRAFT RESPONSE TO MENTAL HEALTH & LEARNING DISABILITY HEALTH SERVICES IN HERTFORDSHIRE The Board formally approved the draft response 110/00 DRAFT RESPONSE TO CREATING A BETTER NHS IN HERTFORDSHIRE The Board formally approved the draft response
119/00 FINANCIAL REPORT YEAR TO DATE. Sally Gorham explained that Paul Wrighter was on extended annual leave. At the end of August, the PCG finance report shows a deficit of £42K. April’s prescribing costs have now been received. The prescribing data for April is not considered to be a reliable basis on which to base estimates for the rest of the financial year. However it has also cast doubt as to whether the March figure should be used as a bench mark for prescribing costs in this financial year as well. Sally Gorham then went on to explain the four estimates used as a means of forecasting the final expenditure. North Essex Health Authority have expressed concern that not all PCG/T’s are using the same formulary for reporting purposes and will be issues guidance in the near future. Sally Gorham reinforced the problems being experienced by the delay in data from the PPA. Peter Pearson asked whether the PCG could carry out the costing exercise locally with support from the community pharmacists, Dr Cliff Bishop explained that this would not be a feasible option, not only does the Pharmacists not have the correct systems, drug costs change on a regular basis. 120/00 PRESCRIBING REPORT May’s ePACT reports should be available around the 17 October. The West Essex Drugs and Therapeutics Committee has been reformed to include all PCG/Ts. A Drugs Wastage audit is being completed by all Harlow Community Pharmacists. Data is being collated and report will be presented at the next medicines management sub committee and set to all practices. A sub group is to be established to take forward the development of a joint Harlow Formulary and PAHT Formulary. 22 nurses have now completed the prescribing training program and should be able to prescribing around mid October. The prescribing pads will not be the same colour as GP pads and will have the nurses code and well as practice codes, this will enable the PC to monitor activity levels. Only Health Visitors or District Nurses are able to prescribe once they have completed the exam. Anne Rose, Senior Pharmacist from PAHT has started working at Barbara Castle on a six-month pilot. The main objective is to review the whole prescribing system and make recommendations. She is starting the pilot by reviewing people over 65 on repeat prescriptions. Dr Mukesh Rajani felt it was important to share the good practice across the Town. 121/00 NURSING STRATEGY Following the Department of Health’s ‘Making a Difference’ document which identified key areas of development. A nursing strategy document was developed. This will need to be reviewed following the NHS National Plan. Dr John Portelly stressed the impact of national pay increases for nurses. Sally Gorham felt this was a issue for everyone as Nurses employed in Trust are graded differently to Nurses in Primary Care. They are sometimes expected to do more and work unsociable hours compared to primary care. 122/00 HARLOW ECONOMIC DEVELOPING STRATEY ACTION PLAN Roy Collyer explained to members that all local Authorities are required to produce a Economic Developing Strategy. However the Authority recognises it can not develop the strategy without the partnership of the general public, private and public services. The 2020 partnership, which was established in Harlow, it is now one of the most successful partnership group in the country. Harlow currently has an unemployment rate of 3%. However you need to recognise the level of part-time and low paid jobs in Harlow, which would affect this figure. Harlow has 16% of the population of the town receiving income support and 28% of residence claiming housing/council tax benefits. You also need to consider the high level of social depravation and the high rate of single homeless teenage pregnancies in the Town. This has an affect on housing in Town as these people are given priority on the Housing Waiting list. Another major problem for Harlow is the low literacy levels in the town. More resources are need to educate people on their basis skills, this will improve the long term employment prospects. The Board formally supported the document. 123/00 ANY OTHER BUSINESS Dr Cliff Bishop informed members that the next Clinical Management meeting which was scheduled for the 19 October has been cancelled due to the National Primary Care Collaborative Care workshop. 124/00 DATE AND TIME OF NEXT MEETING 125/00 Thursday
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