West Cheshire Senate
24th March 2016
The Senate met on 24 t h March with Peter Williams as chair . Lee Hawksworth
provided an introduction on the details of the clinical commissioning group’s
2016/17 operational plans followed by an introduction to the check, challenge and
change group discussions on Urgent Care, Elective Care , Medicines Management
and Complex Care. Peter Williams concluded the session with a sum mary and
reflectio ns.
Welcome, Introduction and Apologies
Peter reflected o n the last meeting which was attended by Sir Sam Everington
which he felt was a very enjoyable morning . The espresso sessio ns were really
useful; a lot of feedback was received from these which Peter has been made into
a word cloud to identify the main themes of clarifying the common purpose,
building relationships, communication and finding subject champio ns.
The 2016/17 Operational Plan
Lee provided a presentation to the group on the 2016/17 operational plan which
will address the follo wing issues:
•
•
•
How will the health and wellbeing gap will be closed?
How will transformation help close the care and quality gap ?
How will the finance and efficiency gap be closed ?
These are all statutory obligations for the clinical commissioning group and we are
mandated to deliver them .
Lee advised the Membership Council ha d recently met to look at the programme
pathways to review what we are doing now, what is not working and what we
need to do more or less of in the future . Lee advised t he aim of the Senate
meeting was to build on the feedback from th e Membership Co uncil session. This
will require system leadership with West Ch eshire leaders coming together as a
team to develop a shared visio n with the local community .
Lee discussed the financial challenges the West Cheshire health and social care
economy faces over the next five years and noted all organisations across West
Cheshire are facing financial challenges.
Lee talked the gro up through the nine must dos:
1. Support the developm ent of a high quality Sustainability and
Transformation Plan for the Cheshire and M erseyside footprint.
2. Return the system to aggregate financial balance .
3. Develop and implement a local general practice plan .
4. Ensure access standards are met for urgent and emergency care .
5. Ensure referral to treatment standards are met .
6. Deliver the 62 day cancer waiting standard .
7. Achieve mental heal th access standards .
8. Transform care for people with learning disabilities .
9. Develop plans to improve quality .
Lee advised the draft plan has been submitted and a final version will be
submitted next month. T he Senate meeting is abo ut how the group can influence
things and how ideas will be put forward to go in the re vised plan.
The four areas for focus were:
•
•
•
•
Elective Care
Medicines Management
Urgent Care
Complex and Continuing Health Care
The group were asked to review the initiativ es against each of the four pathways
and then split into two groups to discuss each of the pathways in more detail, to
check, challenge and add to each pathway . Facilitators provided more information
on each of the pathway areas and coordinated d iscussions .
Medicines Management
The group had a number of proactive suggestions and agreed self care is crucial .
Discussions centred o n the minor ailments scheme , how this can run alongside self
care initiatives and m ake s ignificant savings . The public need to be encouraged to
move away from going straight to the GP and be directed to use pharmacies for
support in the first instance. I t was suggested certain medication s could be
charged for , even for patients on free prescriptions but this will need to be
introduce carefully. It was noted that GPs will need to introduce the revised
approach to their patients , that the minor ailments scheme will need to be
advertised and patients made aware of how much prescriptio ns are costing the
NHS.
The group discussed the gluten free po licy and the four possible o ptions for the
way forward:




Restrict what is available on prescription , just offer the basic staples.
Stop prescriptio ns altogether for glu ten free food.
Use the diabetic serv ice to educate patients on naturally gluten free food .
Use a voucher scheme.
It was agreed these o ptions will be brought to the Finance, Performance and
Commissioning Committee with the recommendation of optio n one being adopted.
Once signed off, a three month consultatio n period will take place to
communicate changes to patients and change their expectatio ns in terms of the
provision of gluten free foods.
The group agreed the medicines management plans for self care and gluten free
prescribing should be progressed at pace but cautio n needs to be exercised
around predicted sav ings as these are likely to be lower than anticipated. It is
anticipated self care initiatives will enco urage behaviour change.
Urgent Care
The group agreed there needs to be a review of the a cute v isiting out of hours
service and talked abo ut e xtending GP ho urs to the Out of Hours service as the
figures look v ery positive in terms of reducing A&E admissions. T here will be an
increase in cap acity to support the extensio n. T he gro up discussed the winter
pressures and how early visiting from GPs has helped reduce A&E admissions .
Plans for extending the early visiting service will be considered.
Primary Care St reami ng in A&E
Primary Care streaming in A&E focuses on the whole system, primary, secondary
and social care. The group discussed the pilot that has been running at the
Countess of Chester Hospital where two consultants are based in A&E to direct
patients to the right service . It was agreed we need to l ook at why people go to
A&E and how we can c hange patient behaviours , review how patients can be
redirected from A&E to the Out of Ho urs service and how best to do this as we
don’t want the Out of Hours service to be an extension of A&E . W e need to
understand the perception of those services . The group discussed the option of
co-location of A&E and the Out of Hours service and it was agreed it will be useful
to discuss plans with Wirral providers as they have piloted a single front door
system. It was agreed if there is a single do or pati ents can be signposted to
services more effectiv ely . The group discussed the option of a community
pharmacy in A&E .
The group agreed the extension of GP opening hours from 7am till 7pm is to be
considered as we need to offer instant access to health services. The group
discussed the trial of phone t riage in Wirral where all people are spoken to by a
GP and either an appo intment is offered, advice given or a patient is directed to
other, appropriate support serv ices . Extended pharmacy opening times will also
need to be co nsidered in line with extended GP hours. It was agreed there has
been an increase in A&E attendances caused by primary care failings.
Elective Care
Discussions centred o n the closure of the upper gastrointestinal list at The
Countess of Chester hospital, with access closed to the laparosco py service not
the endosco py service. When asked if diverting patients to the Royal Liverpool is
an optio n it was confirmed the opposite issue exists there, in that there is limited
capacity for the endoscopy service but sufficient capacity for laparoscopy. It was
stated the challenge o f managing patient demand for upper gastro intestinal
services is ‘ the tip of the iceberg’.
In respect of referral management it was stated that GPs need evidenced based
guidelines that assure them they are not taking inappropriate risks and to make the right diagnostic
choices. It was asked if Choose and Book is an issue and confirmed there are two main aspects of
the challenges around referral management; one, of confirming the appointment and two, of
arranging the surgery. It was suggested that sometimes primary or secondary care support is not
required. The support of a Dietician, for instance may be more appropriate. Public Health primary
prevention campaigns are required regarding eating patterns, to include cost benefit analysis and
the reduced use of medication.
The group discussed Procedures of Limited Clinical Value and an example of trigger finger used to
illustrate a condition which does not meet the criteria and where the progression of a referral should
be stopped in Primary Care and not get as far as triage. However, patients are then left with an issue
and it was asked how this should be managed. It was suggested the Adult Musculoskeletal
Assessment and Management Service need support and back up from GPs when a referral is
declined.
Continuing Healthcar e
Debbie Telford confirmed the meeting had been a good opportunity to explain key
points and issues for complex care and continuing healthcare services, which need
to be delivered whilst managing families and patient expe ctations.
The group talked about the single point of entry system and how we need to get
better at signposting patients as t here are still too many attendances at A&E.
Proposed solutions will be reflected in the revised operational p lan.
Summary and Reflections
Peter highlighted the Senate is not a decisio n making group but attendees can
support and influence the strategic delivery of healthcare in West Cheshire. Peter
confirmed he felt the meeting has been useful for the programme leads and was
very pleased at the level of engagement fro m our partners.
Any Other Business
No further business was raised.