Agenda and minutes

Health Scrutiny Committee
Thursday, 21st February, 2019 1.30 pm

Venue: Ground Floor Committee Room - Loxley House, Station Street, Nottingham, NG2 3NG. View directions

Contact: Zena West  Senior Governance Officer

No. Item


Apologies for absence


Councillor Merlita Bryan  -  personal

Councillor Eunice Campbell-Clark  -  personal

Councillor Andrew Rule  -  work commitments

Councillor Chris Tansley  -  unwell

Councillor Cate Woodward  -  unwell


Declarations of interest




Minutes pdf icon PDF 222 KB

Minutes of the meeting held 24 January 2019 (for confirmation)


The minutes of the meeting held on 24 January 2019 were confirmed as a true record and signed by the Chair.


General Practice Services in Nottingham pdf icon PDF 126 KB

Report of the Head of Legal and Governance

Additional documents:


Hazel Buchanan and Dr Hugh Porter, from the Nottingham City Clinical Commissioning Group (CCG), attended to update the Committee on the work taking place to ensure that all citizens had access to good quality General Practice (GP) services now and in the future.


Hazel Buchanan reported that there were 53 GP practices in the City of Nottingham of a mix of sizes, but that the number of practices with only 1 GP had reduced to 9 following a scheme of mergers. While 1 practice had closed in the last 12 months, this was due to its joining with another practice.


The following points on the circulated Nottingham City CCG Primary Care update were highlighted:


(a)  section 3 set out the extra funding going into Primary Care, with a focus on improving access to GPs. As part of this, the GP Alliance was identified as a group of practices that had come together in the City to provide good collective support. The Alliance was providing extended hours (representing 700 additional appointments per week), which had been well-booked and attended, and opened an additional 700 appointments for December 2018 and January 2019 during normal opening hours, which relieved pressure on hospital Accident and Emergency units. The Alliance aimed to establish a multi-disciplinary team (including pharmacists and healthy lifestyle specialists) to find the right skills mix to give the right service to patients;


(b)  the Primary Care Patient Offer launched in 2016 focused on increasing access to GPs, with more same-day urgent appointments, bookings for nurse appointments available 4 weeks in advance and more GPs available for video consultations. Longer, interpreter-assisted appointments are available at 13 practices, to better support the City’s diverse population;


(c)  in the City, there have been 2 boundary reductions to improve access and 1 practice list has been closed (with permission from the CCG), for a 6-month period;


(d)  the Care Quality Commission (CQC) has inspected all 53 GP practices, with 4 rated ‘outstanding’, 42 ‘good’, 6 ‘requires improvement’ and 1 ‘inadequate’. The 6 practices requiring improvement have been re-inspected and the majority are progressing to ‘good’, with the CQC offering support in the delivery of action plans for improvement;


(e)  the GP Alliance will be taking over the ‘inadequate’ Bilborough practice from 1 April 2019 as the contractors, as they have done before at South Lake, where the practice was turned around within 6 months;


(f)  there is variation in the workload between practices, with extra funding injected to bolster reception and clerical staff, with more active signposting of patients towards other services that they might need. Workforce numbers are a serious concern at both the local and national level and the international recruitment drive resulted in only 1 applicant for the area. However, there has been an increase in GPs coming into Nottingham to train and there are opportunities to keep these people and their skills, as well as introducing pharmacists into GP practices;


(g)  Dr Hugh Porter reported that the GP Forward View seeks to  ...  view the full minutes text for item 62.


NHS Long Term Plan pdf icon PDF 128 KB

Report of the Head of Legal and Governance

Additional documents:


Colin Monckton, Director of Strategy and Policy, attended to brief Councillors on the implications of the NHS Long Term Plan for Nottingham, highlighting the following points:


(a)  the Plan was published on 7 January 2019 and sets out the NHS direction over the next 10 years, with £20.5bn to be spent over 5 years with the priorities of better integration of health and social care, improving prevention and early intervention, and addressing health inequalities. There will be a commitment to mental health, children and young people, with changes to make procurement processes more efficient and further investment in community teams, to help Local Authorities (LAs) take on more responsibility for good performance;


(b)  as part of the plan, systems will be:


(i)  restructured, with the clear expectation that LAs will aim to participate in their local Integrated Care Systems (ICS). ICSs will have partnership boards to include LAs with accountability and performance frameworks. There will be a stronger role for the NHS in commissioning preventative health services and the NHS will support local approaches to blending health and social care budgets where councils and CCGs agree;


(ii)  redesigned, with a comprehensive rollout of personalised care and personal health budgets. Where outpatients and testing move from acute into community care, LAs will work in partnership with hospitals with major Accident & Emergency departments to reduce delayed transfers of care. New commitments will be in place for reablement and community care to an age-appropriate model;


(iii)  reoriented, to create a service design aim that will avoid preventable hospitalisation and tackle the wider underlying factors of mental and physical ill-health. It will tackle health inequalities and include place-based prevention, early intervention and a focus on wider lifestyle, and facilitate the rollout of social prescribing;


(iv)  refurbished, so that data management will be improved. The property estate will be maximised, teams and targets will change with the new NHS workforce implementation plan later this year, with community two-hour crisis teams, two-day access to reablement and clinical support for care homes; and the improvement of technology over the next 10 years;


(c)  the Plan will be implemented alongside the Adult Social Care Green Paper due in early 2019, the publication of Local Plans for 2019/2020 by April 2019, the publication of local 5-year plans by Autumn 2019, the National Implementation Programme spending review of decisions on social care and Public Health, the Green Paper on prevention and proposed changes to legislation on competition in procurement;


(d)  for funding, every area in England will receive a cash increase of at least 17% over the next 5 years, including a minimum rise of 4.4% in 2019/20, with £1bn a year distributed according to greatest need. NHS England will introduce a more accurate assessment of need to ensure the allocations formulae is more responsive to the greatest health inequalities and unmet need from April 2019;


(e)  the primary risks include:  a potential lack of detail, with the NHS planning guidance still to follow; that the ICS plan will not  ...  view the full minutes text for item 63.


Nottingham City Council's Fulfilment of its Public Health Responsibilities pdf icon PDF 203 KB

Report of the Head of Legal and Governance

Additional documents:


Alison Challenger, Director of Public Health, attended to update Councillors on the progress in implementing the changes to Targeted Intervention services agreed as part of the Council’s budget in March 2018 and on the strategic approach to fulfilling Public Health responsibilities and improving the wellbeing of citizens, highlighting the following points:


(a)  LAs have been given a statutory responsibility for improving the health of the local population and reducing health inequalities for the last 6 years (including delivering the National Child Measurement Programme, universal health visitor reviews, sexual health services, NHS Health checks, drug and alcohol treatment services, health protection and public health advice for NHS commissioners), with the aim of achieving healthier local populations;


(b)  the ring-fenced Public Health Grant for delivery has reduced by 2.6% per year since 2015/16, resulting in a £32,937m budget for 2019/20. As such, ensuring that NHS services are commissioned for best value and delivered to the areas of greatest local need is of primary importance, and it is vital to also invest in other areas to increase the potential for good health, such as parks, good quality safe housing and better air quality. The main health and wellbeing priorities are to engage with obesity, smoking, alcohol related harm, mental health, dementia, loneliness, sexual health and teenage pregnancy, support in the early years, and dental health;


(c)  a system-wide approach (with a major focus on the most vulnerable) is being built, in partnership with the GP Alliance, to help people stop smoking. This includes creating smoke-free hospitals, with specialist advisors and services available on site – particularly to those people most at risk. A weight management app has been developed and a weight-loss programme commissioned from a major provider, but current funding levels are extremely limited. It is hoped that the NHS Long Term Plan will make engaging with these issues much more routine for clinicians;


(d)  NHS Health check invites saw a 64% increase in quarters 1-3 of 2018/19 (compared to the same period in 2017/18). External funding was secured (in conjunction with partners) to reduce physical inactivity, Nottingham’s Time to Change Hub was launched with more than 70 local champions recruited, and arrangements have been made with the CCG to sustain the Knowledge & Resource function;


(e)  the City’s policies aim to maximise the contribution to public health outcomes across its wider services and functions, incorporate health considerations into decision-making across sectors and policy areas, and utilise the unique position of LAs to address the social determinants of health, with an initial focus on training the wider Council workforce to talk to citizens about healthy lifestyle behaviours. This supports the national November 2018 policy context of positive recognition of the importance of prevention, the NHS Long Term Plan and the upcoming Spring 2019 Prevention Green Paper – though further reductions to the Public Health grant will still be implemented.


Some further information was provided, following questions and comments from the Committee:


(f)  the current flu season has not yet concluded, but that there  ...  view the full minutes text for item 64.


Work Programme pdf icon PDF 107 KB

Report of the Head of Legal and Governance

Additional documents:


Zena West, Senior Governance Officer, presented the proposed work programme for the remainder of the municipal year and the Chair confirmed that the upcoming March meeting will take place. The CityCare Quality Accounts will not be in their final form by the March meeting due to the upcoming local elections. A written update on progress concerning the refresh of the Suicide Prevention Plan will come to the March 2019 meeting for information, while the full report on the refreshed Suicide Prevention Plan will be deferred to July 2019.




1)  note the work programme for the remainder of the 2018/19 municipal year.