Agenda item

It was explained to Members that the Primary Care Transformation Programme consisted of two key initiatives:

·  Primary Care Co-Commissioning

·  London Primary Care Framework

It was further explained that the transformation programme also consisted of a local initiative:

·  Review of Primary Care Contracts.

Members were advised that the report was going to the Health and Wellbeing Board so that the Board could be notified of developments, and to enable the Board to provide feedback on key areas as part of the engagement process.

Members were informed that three options existed with respect to primary care co-commissioning:

1.  Greater involvement in NHS decision making

2.  Joint decision making by NHS England and by CCGs

3.  CCGs taking on delegated responsibilities from NHS England

Dr Angela Bhan (Chief Officer and Consultant in Public Health) reminded Members that the important issue was to determine what form of co-commissioning of primary care services in Bromley would deliver the best outcomes for the people of Bromley. Members were also reminded that as part of the NHS Five Year Forward View, it was proposed that GP led CCGs be given more influence over the wider NHS budget, the idea being to facilitate a movement in investment from acute to primary and community services.

Members were informed that it was the opinion of Bromley CCG that option 2 would be the preferred option. It was felt that option 1 would not enable the CCG to achieve the progress required for primary care development, and that no CCG would be allowed to move to option 3 immediately. 

Dr Bhan explained how commissioning was currently undertaken, and what the differences would be when primary care was undertaken under co-commissioning. Members were briefed on the strengths, weaknesses, opportunities and risks of joint decision making, and of delegated responsibilities.

Bromley CCG was of the opinion that a primary care system that was shaped by local commissioning intentions would be likely to aid progress in the development of local commissioning objectives, and would be a simpler model than the one currently in operation.

Dr Bhan outlined other issues that required consideration. There was some ambiguity in the financial impact of the changes that would need to be clarified, but this was not seen as a reason not to progress at this stage by the CCG. It was noted that conflicts of interest would need to be managed, and that in terms of resourcing, efficient and effective management of resources and budgets would be required. The matter of potential conflicts of interest was raised by Board Members as a matter of concern. It was noted that G.P.’s were a provider group in the strategic plan, as well as being involved in commissioning. The Board acknowledged a potential conflict of interest, but at the same time noted that it was difficult to proceed with a commissioning process without clinical and GP input. The Board agreed that this was an issue that would require proper governance and scrutiny.

A Member made the point that no information had been provided concerning financial data and financial implications, and questioned the logic of proceeding on that basis. There was also concern expressed about creating another tier of bureaucracy, and more committees.  Dr Bhan explained that there had not been any reduction in Health Care Budgets yet, but it was rather the case of using budgets differently. The plan was to spend less on acute care, and more on primary care. What was being explored was different ways of working, and that co-commissioning was just a vehicle to be used as part of the transformation process. Dr Bhan responded to the concerns raised about bureaucracy by stating that the plan was not to create another layer, but to move decision making from being central, to being local.

A Member raised concerns about what money was being used, especially when the local NHS Trust was overspending. Dr Bhan acknowledged that there were financial pressures that would need attention. 

Dr Bhan referred Members to the briefing that had been provided concerning the Strategic Commissioning Framework (SCF) for Primary Care Transformation in London. The SCF incorporated three primary elements:

·  A new vision for general practice

·  A new patient offer described in a general practice specification

·  A description of considerations for making it happen

It was explained to Members that the new vision for general practice consisted of Accessible Care, Co-ordinated Care, and Proactive Care. Members heard that the SCF had been widely tested in a variety of settings. The SCF outlined various areas of focus to support delivery, including Models of Care, Commissioning, Financial Implications, Contracting, Workforce Implications, Technology Implications, Provider Development and Monitoring and Evaluation. 

Dr Bhan informed Members that further planning and engagement on the SCF would take place until March 2015, and that implementation would take place from April 2015; this would be developed over the next five years. 

RESOLVED:

(1) that the Overview of Primary Care Developments report be noted

(2) that the Board be updated in due course concerning progress on primary care co-commissioning.