Minutes:
The Principal Overview and Scrutiny Officer provided the Committee with a presentation of the following press articles which related to the remit of the Adults, Wellbeing and Health Overview and Scrutiny Committee;
· NHS waits for cancer care, A&E and ops worsen across UK – BBC Online 18 October 2017
The performance of hospitals across the UK had slumped with targets for cancer, A&E and planned operations now being missed en masse, BBC research shows.
· Region's NHS trusts among the best in country for meeting key patient wait targets – Northern Echo 18 October 2017
Nationally England, Wales and Northern Ireland had not hit one of their three key targets for 18 months.
Only Scotland had had any success in the past 12 months - hitting its A&E target three times.
Ministers accepted growing demand had left the NHS struggling to keep up as doctors warned patients were suffering.
Using BBC Online Guide – CDDFT results 96.8% (Target 95%) 4 Hour waits for A&E; Cancer Care 88.8% within 62 days (85% Target) and Planned ops 92.6% within 18 Weeks (Target 92%)
· £85m cost for North-East NHS as number of elderly people falling increases – Northern Echo 11 October 2017
THE cost of emergency hospital admissions connected to falls and fractures among older people in the North-East had been revealed.
An Academic Health Science Network for the North-East and North Cumbria (AHSN NENC) commissioned report found that in 2014 to 2015, there were 12,654 fall-related admissions in the North-East and North Cumbria, costing an estimated £84,973,249 to the region’s NHS.
The figures have been released by the AHSN NENC in a bid to raise awareness of preventable falls
· GP service launched at A&Es at Darlington Memorial Hospital and the University Hospital of North Durham – Northern Echo 03/11/17
A GP service had been launched at A&Es in the region in a bid to ease pressures on the service this winter.
The extra doctors started working in A&Es in Durham and Darlington last month.
Patients cannot make appointments with the doctors and are urged to attend their own GP surgery if they do not need emergency care.
The "primary care streaming" was aimed at assessing patients quicker and helping the departments at Darlington Memorial and the University Hospital of North Durham meet their targets during the winter months.
· Staff shortages blamed for St John's Chapel dispensary closure – Northern Echo 18 October 2017
SAFETY grounds are being given as the reason why a village dispensary was facing closure, according to bosses.
Patients using the service in St John’s Chapel, in Upper Weardale, would have to travel up to 22 miles for their prescriptions when it shuts on Friday, October 27.
The Weardale Practice, which runs the service, said a lack of qualified dispensers was the reason for the closure.
The Chairman welcomed Dr B Rowley and Miss V Watson from The Weardale Practice and Ms W Stephens, Primary Care Contracts Manager, NHS England to the meeting.
Dr Rowley gave a presentation (for copy see file of Minutes) that highlighted the following:-
· Process and difficulties
· Measures taken to mitigate the impact: Improved Service
· Engagement
· Summary
Ms Stephens commented that NHS England were responsible for ensuring dispensary services. They had written to the Health and Wellbeing Board and this would be covered in recent developments in the pharmaceutical needs assessment. The Chairman of the Health and Wellbeing Board confirmed that Pharmacy Service reports were included as an exempt item on the Health and Wellbeing Board agenda.
Councillor Crathorne expressed concerns about people being cut off especially in the poor weather, and she also had concerns about how people would get to the nearest dispensary or pharmacy.
Councillor Laing picked up on a point Dr Rowley raised about extending the prescription for more than the usual prescribed 28 days. Joseph Chandy, Director of Primary Care and Engagement DDES CCG, explained that it was usually practice policy to reduce the amount of days for a prescription to 1 month for safety reasons and so that there was less wastage should someone’s medication change. Dr David Richardson added that there was clear evidence that prescriptions over 28 days do result in wastage and lost money for the service. Joseph Chandy said that in this case the frail and elderly would be monitored with them living in such rural communities.
Councillor Patterson referred to the comment made that the practice no longer wish to provide the service and felt that this was more about cost cutting rather than providing a safe service. She asked if there were any alternative options as the decision had been made in such a short space of time. She also echoed Councillor Crathorne’s concerns about the accessibility for residents of Stanhope and how they would get to an alternative dispensary. She said that most people need a prescription there and then and that people could not always rely on transport to get them to the nearest dispensary or chemist. She felt that residents health should come first.
Referring to the rural area, Councillor Kay was also concerned about the local people. He said that often in poor weather residents could not get out of Upper Weardale, so asked how drivers would get into villages to deliver medication. He also picked up on the point about increasing a prescription from 28 days and asked if this would also increase the cost of the prescription charge so that people would have to pay double the amount. He added that not everyone would be able to use system online and even if they could the area was not reliable in terms of a good broadband connection.
Dr Rowley referred to the speed at which the decision had been made and explained that the dispenser had left and they were no longer able to provide a service. Referring to concerns over medication he explained that the GP would be able to prescribe from his doctor’s bag should clinical circumstances determine it. He also confirmed that the charge for a prescription would be the same regardless of whether it was for 28 or 56 days. With regards to prescriptions he advised that a GP could send electronically to any pharmacy and that there was a delivery service for housebound patients. Dr Richardson reported that more than 90% of people do not pay for their prescriptions and that if they did pay they could by a season ticket that allowed them to get all prescriptions for a set price. He added that paper prescriptions were rapidly disappearing and that people could go to any pharmacy in the country. He felt that it was important for the committee to understand that GPs provide an excellent service and did have thought and consideration for their patients. County Durham were fortunate enough to have three CCGs but he did recognise that there were pressures facing the whole County.
Dr Rowley advised that the practice would not save any money due to the changes but would remain sustainable, further to a question by Councillor Temple about the financial impact.
Councillor Temple did have sympathy for the practice when he heard that it was impossible for them to recruit and retain another dispenser until he heard that they no longer wished to provide the service. Dr Rowley said that they had tried for a long time to recruit and then it was unsustainable to retain staff in the rural location. It had taken up a lot of practice time and had reached a crisis point. He explained that the dispenser role was unique to the practice and they did not have a member of staff who could give any training.
The Chairman was concerned about how people would access their medication, especially in an emergency, and felt that there would be a delay. He was also mindful of the additional cost in transport for the people living in the Dales.
Dr Rowley informed Members that there were postal pharmacies and that local pharmacists could also be contacted by telephone for advice, something that a dispenser could not give. He added that there were safety and legislative issues with regards to controlled drugs and fridge items but that someone could collect drugs on behalf of the patient. He also pointed out that many medications were on repeat prescriptions and could be ordered in advance.
Mrs Hassoon said that controlled drugs could not leave a pharmacy without a signature and she had concerns for those people who did not have relatives who could collect the prescription on their behalf.
The Chairman invited the local member to speak.
Councillor Shuttleworth reported that on receipt of the letters from the practice he received 11 telephone calls from concerned members of the public. This was a Saturday afternoon. He then wrote to the practice the following Monday asking to meet with them. He did meet with the practice staff the following week and asked them to place an advert in the local paper to recruit more staff but he said that they did not want to do this. He then informed the practice that he knew of two people who were qualified and who could carry out this work in the dispensary. Councillor Shuttleworth expressed his concerns that 1200 people deserved a service and that the nearest services were in Allendale – 18 miles away, Consett – 17 miles away and Barnard Castle – 22 miles away. He had received a complaint from a constituent who had a 95 year old mother and these changes would mean regular 20 mile journeys. He advised the Committee that the Weardale Advertiser had offered to place a free advert in their paper. He believed that people deserved a service and asked if the practice would reconsider appointing someone to the position.
Dr Rowley said that there was a national issue with recruiting staff but confirmed that rurality was a problem with retention at this practice, following a question from Councillor Laing.
The Chairman asked if this was a foregone conclusion given the extremely short notice and if the process could be halted and looked into.
Ms Stephens explained that NHS England could not enforce a practice to reinstate a service if the practice did not feel that they had the capacity of staff. She confirmed that NHS England had liaised with them and that this issue had only been known for a matter of weeks.
The Chairman said that there had been several issues with NHS Commissioners not advising the Council about issues such as the Richardson Hospital, Neonatal care, heart care and felt that the Committee were losing the opportunity to comment. Ms Stephens said that she would take this back to the board of directors.
Joseph Chandy said that the CCG had good working relationships with NHS England and that GPs were in a fragile place. He recognised the frustrations as originally the dispensing service was brought into rural communities when technology was not as advanced as it was now. The shift to electronic prescriptions was available with online ordering and delivery now. He said that practices were not about profit and in this case it was not a profitability issue. Challenges in the workforce were common and in these times we needed to work together.
Councillor Crathorne referred back to the issue of recruiting staff and asked why the two people who could do the job had not been approached.
Councillor Patterson asked if the practice had the capacity to hold a community based pharmacy and felt that there were further options to explore.
With reference to the two people who had offered to carry out the role, Dr Rowley explained that training a dispenser was a very particular role to each dispensary and very different to a pharmacy. He felt that options had been explored and that they were unable to provide a training service regardless of the qualification of an individual. He reiterated that the decision had been triggered by the only dispenser leaving the practice.
The Chairman informed the Committee that given the localised nature of the impact of the decision, it was inappropriate to exercise the power to refer the decision to the Secretary of State and that they could only put their concerns forward.
Councillor Crute asked that Dr Rowley come back to Committee in 3 months time to report on the impact of the community. He said that powers were limited to this Committee and that mechanisms needed to be put in place for any future decisions.
The Chairman thanked everyone for their questions and thanked Dr B Rowley, Miss V Watson and Ms W Stephens for attending.
Resolved that a report be brought back to the Committee in March highlighting the impact of the decision on the local community