NHS LOTHIAN SOUTH EDINBURGH COMMUNITY HEALTH PARTNERSHIP

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1 NHS LOTHIAN SOUTH EDINBURGH COMMUNITY HEALTH PARTNERSHIP Note of the twelfth meeting of the South Edinburgh Community Health Partnership held on Wednesday, 7 March 2007 at 2pm in the Facilities Board Room, Blackford Pavilion, Edinburgh. Present: In Attendance: Apologies: Kingsley Thomas, Chairman David Small, General Manager, Edinburgh CHPs Dr Ian McKay, Clinical Director, Edinburgh CHPs Sally Lee, Chief Nurse, Edinburgh CHPs David Jack, Head of Strategic Support, City of Edinburgh Council Dr Sandy Reid, General Practitioner Dr Carl Bickler, General Practitioner Stuart McLauchlan, Staff Partnership Representative Bashir Wadee, Optometrist Seb Fischer, Carer Representative Ian Clement, Public Partnership Forum Jo Scott, Public Partnership Forum Colin Murray, Voluntary Sector Member Dawn Arundel, Clinical Nurse Manager, South East Edinburgh LHP Angela Lindsay, Allied Health Professional Graham Paxton, Head of Service for Clinical Support Services, LUHD Les Malone, PCO Secretary Peter Gabbitas, Director of Health & Social Care, City of Edinburgh Lynne Hollis, Director of Finance Colwyn Jones, Consultant in Dental Public Health (minute 94 only) Alison McNeillage, Primary Care Contracts Manager (minute 94 only) Paul Currie, Health Care Planner - NHS Lothian (minute 96 only) Martin O Dwyer, Pharmacy Representative John Davidson, Dental Practitioner Tim Montgomery, LHP Manager North East Edinburgh LHP Dr Casey Stewart, Acute Medicine Consultant LUHD Margaret Douglas, NHS Lothian Public Health Craig Beveridge, LHP Manager South West Edinburgh LHP 91. Welcome/Introduction 91.1 Kingsley Thomas welcomed members to the last meeting of the South Edinburgh CHP Sub-Committee and thanked members for their contribution to the Sub-Committee. It was noted that the new arrangements for the single Edinburgh CHP Committee would commence in April

2 92. Minutes of previous meeting held on 31 January The minutes of the previous meeting held on 31 January 2007 were approved as a correct record. 93. Matters Arising from the Minutes 93.1 There were none. 94. Oral Healthcare in CHPs 94.1 Oral Health Colwyn Jones and Alison McNeillage attended the meeting. Colwyn Jones provided a brief presentation on Oral Health across NHS Lothian. It was noted that there had been a significant increase in the level of funding from the Scottish Executive for General Dental Services over the past five years. Colwyn Jones explained that the Scottish Dental Action Plan for 2005 has been put in place to address oral health issues in NHS Lothian and improve access to NHS Dentistry Kingsley Thomas referred to the statistics that 50% of the Lothian population were registered with an NHS dentist and asked what percentage of the Lothian population were registered on a private basis. Colwyn Jones explained that between 15% and 18% were registered with a dentist privately Carl Bickler asked about the standard and statutory requirements for dental services. Colwyn Jones commented that it was not an NHS statutory requirement to ensure that general dental services were provided to everyone but that appropriate access should be made available to emergency dental services. It was noted that the Chalmers Dental Centre provided emergency treatment to patients who were not registered with an NHS dentist. Colwyn Jones explained that if a patient had not attended their dentist in the last 36 months their registration would elapse Ian McKay referred to oral health programmes within local nurseries and was concerned that there was a lack if involvement by some nurseries. Colwyn Jones commented that the problem was small and nurseries were encouraged to participate in programmes and the care commission has been involved with this piece of work. Kingsley Thomas commented that given the close relationship with the local authority this should be picked up Dental Access - A copy of a paper on Dental Access was circulated to members. Alison McNeillage introduced the paper and explained that a more detailed paper would be circulated to the Edinburgh CHP Committee in 6 months time. The CHP Sub-Committee were asked to note the progress to date and the options for improving access to NHS Dentistry. Alison McNeillage explained that there was a short list of 2

3 NHS Dentists taking on patients and that this list changed on a regular basis. It was noted that there were no Dental Practices in East and Midlothian currently taking on NHS patients Alison McNeillage explained that there was a growing number of dentists from England and overseas looking to set up practice in Scotland and that there was ongoing work to encourage dentists to open premises within areas of greater need. Alison McNeillage commented that there were ongoing discussions on the development of new premises and how dental services might be based in the same premises as general practices Sandy Reid referred to the Glennie report and the need to improve decontamination within Dental Practices. Colwyn Jones explained that funding had been made available to Dental Practices for improving facilities for decontamination, however, some practices were unable to develop this within existing premises and are now having to look at relocating their practice Ian Clement referred to the use of dentists from England and overseas and asked if there were any quality checks carried out. Alison McNeillage explained that through the application process to the Scottish Executive issues around standards of practice would be picked up and appropriate checks made with registered bodies Ian Clement asked whether consideration would be given to reestablishing the dental school. Colwyn Jones commented that it was not proposed to open a dental school at present David Jack suggested that it might be helpful to consider a more flexible service for the working population. Colwyn Jones commented that this does happen in some large organisations, however, this is usually carried out on a private basis. He explained that some Dental Practices are now open in the evenings and at weekends to accommodate patients who work during the day The CHP Sub-Committee noted the report. 95. Fire Safety and Discharge Planning 95.1 Sally Lee commented that Fiona Murphy who had been invited to provide a presentation was unable to attend due to a change in job. It was therefore agreed to postpone the presentation until the April meeting of the Edinburgh CHP Committee. Sally Lee referred to fire safety and commented that this had been an initiative raised by the North PPF and involved incorporating the promotion of fire safety checks into the discharge planning process. It was also noted that Stay Safe Scheme leaflets were circulated to parents with young children. 3

4 96. Primary Care Modernisation Strategy 96.1 Paul Currie attended the meeting to provide a presentation on the consultation process on the Primary Care Modernisation Strategy Paul Currie explained that the consultation was completed on 11 February 2007 and that work was underway to revise the draft strategy in light of the comments received. It was noted that there had been 43 individual responses to the consultation and that 25 groups/committees had been involved in the consultation process. Paul Currie explained that 283 people attended public meetings and that the overall consensus was positive. He explained that participants were supportive of the strategy and members of the public were keen to become involved in the implementation process Paul Currie commented that the draft strategy would be submitted to the NHS Lothian Board on 28 March 2007 for approval and that, following approval, discussions would take place with CHPs on the recommendations and how the strategy would be implemented. It was agreed that a copy of the finalised strategy would be circulated to the CHP Sub-Committee members once it had been approved by NHS Lothian Board. PC/LM 96.4 Angela Lindsay asked about supported self-care and whether there had been any feedback. Paul Currie commented that patients were looking for support on points of contact, taking medication etc In response to a question about linking other key strategies, Paul Currie commented that it was recognised that the Review of Community Nursing was underway and that it was also important to ensure that other strategies were linked in to the Primary Care Modernisation Strategy. Sally Lee commented that a paper on the Review of Community Nursing would be circulated at a future meeting of the CHP Sub-Committee Ian Clement asked about minor surgery service for lumps and bumps. Paul Currie explained that there would be specialist trained GPs to carry out minor procedures. Graham Paxton referred to diagnostic services and commented that Primary Care and Acute Imaging Service would be merging and that this would provide the opportunity to look at access arrangements. He added that this would help improve the patient journey. 97. Child Protection Update 97.1 Sally Lee provided a brief update on Child Protection Inspection and commented a sample of 67 cases had been considered by the Inspection Team. It was noted that 50% of these case would be audited further and depending on the nature of the case the Inspection Team will determine who will be interviewed. It was noted that 7 Health Visitors had been invited for follow-up interviews. 4

5 98. General Manager s Report 98.1 A copy of the General Manager s Report was circulated to members. David Small introduced the paper and highlighted the following key areas: - Long Term Conditions see minute Premises and Population Growth A draft list of priorities for premises development was considered by the Premises Group today. It was agreed that the list would be revised following the discussions and that this would be circulated at a future meeting. - Care Homes It was noted that this was ongoing and that the CHP Management Team was addressing local issues. - CHP Office The move of the CHP Office to St Roque at the Astley Ainslie Hospital was planned for the end of March Local Health Partnerships An event had taken place on 8 February 2007 to discuss the role of the LHPs. It had been agreed that each LHP would have a local plan and that this would support the CHP Workplan. It was noted that this was being developed for 2007/08. - Move to a Single CHP Sub-Committee It was noted that letters would be sent out shortly requesting nominations for membership on the new CHP Sub-Committee Physiotherapy Direct Access Service A copy of a paper on Direct Access to Out-Patient Physiotherapy Services within Edinburgh CHP was circulated. Angela Lindsay explained that direct referral would improve access to physiotherapy services. It was noted that Angela Lindsay would providing information on the new service to General Practices Colin Murray asked about the timescale for pulling together the CHP and LHP Plan. David Small commented that this would be completed within the next 2 to 3 months. 99. Performance Management 99.1 Performance Management Sub-Group 15 February A copy of the Action Note of the Performance Management Sub-Group 15 February 2007 was circulated to members. The CHP Sub-Committee noted the action note Finance Report as at Month 10 - A copy of the Finance Report as at Month 10 was circulated to members. David Small introduced the paper and commented that the total overspend in January was 404,000 which was a significant improvement on 826,000 overspend for December. It was noted that there had been a significant underspent by 458,000 in the prescribing budget at the end of August David Small commented that he was confident that the CHP would achieve its financial target of breakeven with a 5

6 small underspend. David Small referred to the Joint Equipment Store and commented that the capital grant solution should be resolved by the end of the financial year. Stuart McLauchlan asked if the Joint Equipment Store would have a recurring shortfall of 200,000. Dawn Arundel commented that the Clinical Nurse Managers were finding the information relating to community nursing difficult to understand. Sally Lee commented that there were issues around the supplies budgets and that a significant piece of work was required in this area. Lynne Hollis referred to prescribing and commented that the position was continuing to improve, however, the figure for December 2006 anticipated an underspend of 250,000 but was now looking like an overspend of 200, Budgets 2007/2008 David Small provided a brief outline on the following key areas for proposed funding: - Financial Developments and Pressures; - Locality Drugs Clinics; - Child Protection Advisor; - Physician Assistants; - Nurse Team Leaders; - Management Costs; - Vasectomy Service; - Long Term Conditions David Small explained that the list excluded the Joint Equipment Store as this was an issue for East and Midlothian CHPs to resolve. The total funding required for the above areas was 1.58 million, however, David Small explained that it was unlikely that all would receive funding. It was noted that there would be a meeting next week to discuss this further David Small commented that on top of the funding requirements there was also a CRES target of 1.2 million for 2007/2008. It was noted that a programme for achieving the CRES target was being developed by managers David Small reported that proposals were also being developed on the prescribing budgets and that a paper would be circulated to the CHP Sub-Committee. It was noted that there was an increase of 6.6 million in the NHS Lothian prescribing budget for 2007/2008. David Small commented that he was confident that all CHPs would be able to work within the framework for prescribing. David Small commented that it had been agreed that East and Midlothian CHPs would receive an additional 350,000 at the beginning of the financial year and that their position on prescribing would be reviewed at Month 6. It was noted that East and Midlothian CHPs were working on addressing practices which were prescribing outwith the agreed framework David Small commented that there was a 2.4 million financial gap within GMS. Lynne Hollis explained that NHS Lothian were currently looking at receiving additional funding through population growth and 6

7 that it was expected that the GMS would have a balanced position. She added that the GMS allocation was issued in June David Small referred to the Hospital and Community Health Services and commented that the discussions around the financial pressures and developments needed to be finalised. It was noted that the Performance Management Sub-Group would be meeting on 19 March 2007 to go over the draft plan Lynne Hollis commented that there were ongoing discussions between the CHPs and the Primary Care Organisation on the transfer of services. It was agreed that a paper would be submitted to the next meeting of the CHP Sub-Committee detailing the services which have been transferred to the CHP. DS 100. Health Inequalities Update David Jack provided a brief update on Health Inequalities. He explained that the Health Inequalities Sub-Group had now met twice and that both the Public Partnership Forum and the Voluntary Sector were represented on the Group David Jack commented that a paper was being developed on the future of breakfast clubs and whether this should be expanded David Jack commented that it was important to be clear on how business was reported back to the CHP and how this linked with community planning. It was noted that there would be a meeting with Tim Montgomery and Margaret Douglas to discuss this further David Small commented that a detailed report would be submitted to the next meeting of the CHP Sub-Committee. TM 101. Public Partnership Forum Jo Scott referred to the prescribing of generic drugs and pharmacies and commented that it was difficult for patients to understand the differences between generic and branded drugs. It was important that pharmacies provided an explanation to patients in cases were the same drug is prescribed but a different brand provided. Lynne Hollis commented that the roll out of the Pharmacy Contract would hopefully improve the situation. It was suggested that it would be helpful to invite Martin O Dwyer to the wider budget setting meeting to discuss Community Pharmacy issues Any Other Competent Business Long Term Conditions Toolkit - A copy of the Scottish Executive CHP Long Term Conditions Toolkit was circulated to members. Carl Bickler 7

8 introduced the toolkit and provided a brief outline of developments in Long Term Conditions Carl Bickler explained that each CHP was asked to complete the toolkit which provided a list of standards to be assessed. It was noted that there was an NHS Lothian Steering Group established to look at the Lothian-wide issues and that a CHP core group chaired by Craig Beveridge had also been established. Sandy Reid referred to rheumatoid arthritis and asked if consideration had been given to providing resources within this area. Carl Bickler commented that work was mainly being done around Chronic Obstructive Pulmonary Disease cancer and diabetes. David Small commented that discussions had not yet taken place on rheumatoid arthritis. Lynne Hollis agreed to check whether funding was for the current financial year or if this would be carried forward. David Jack suggested that it would be helpful to overlap issues with the Inequalities Sub-Group and that a number of actions could be taken forward. LH South Edinburgh CHP Sub-Committee Peter Gabbitas thanked Kingsley Thomas and members of the CHP Sub-Committee for their work and input to the CHP Date and Time of Next Meeting It was noted that the first meeting of the Edinburgh CHP Committee would take place on Wednesday, 18 April 2007 at 1.00pm in the North Edinburgh Arts Centre, 15a Pennywell Road, Edinburgh. 8

9 NHS LOTHIAN SOUTH EDINBURGH COMMUNITY HEALTH PARTNERSHIP 7 MARCH 2007 ACTION NOTE Topic Decision Action Primary Care Modernisation Strategy PCO Transfer of Services Health Inequalities Long Term Conditions It was agreed that a copy of the finalised strategy would be circulated to the CHP Sub- Committee members once it had been approved by NHS Lothian Board. (para 96.3) It was agreed that a paper would be submitted to the next meeting of the CHP Sub- Committee detailing the services which have been transferred to the CHP. (para ) A detailed report would be submitted to the next meeting of the CHP Sub-Committee. (para 100.4) Lynne Hollis agreed to check whether funding was for the current financial year or if this would be carried forward. (para ) PC/LM DS TM LH 9

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