Agenda and minutes

There were no apologies for absence. 

There were no declarations of interest in matters coming before this meeting.

RESOLVED:  That all items of business be considered in public.

RESOLVED:  That the minutes of the meeting held on 27 January 2022 be agreed as a correct record.

The Chairman welcomed those present to the meeting and noted that Ms Caroline Morison, Managing Director at Hillingdon Health and Care Partners (HHCP), and Dr Ritu Prasad, Chair of the Hillingdon GP Confederation, had joined the meeting virtually. 

Ms Morison advised that HHCP was a partnership of organisations that worked across the health and care system in Hillingdon.  It comprised a range of organisations (including The Hillingdon Hospitals NHS Foundation Trust (THH), Hillingdon GP Confederation, Central and North West London NHS Foundation Trust (CNWL) and H4 All) who had been working together for approximately two years under an alliance agreement.  In addition to these partners, HHCP worked very closely with London Borough of Hillingdon (with regard to work such as Joint Health and Wellbeing, older adults and children and young people) and North West London Clinical Commissioning Group (NWL CCG). 

HHCP had developed three strategic aims which had stemmed from the Joint Health and Wellbeing Strategy: improving outcomes for Hillingdon residents; delivery of sustainable, person-centred, joined up models of care aligned to the new hospital plans; and delivery of the NWL Integrated Care System (ICS) priorities through local models. 

Dr Prasad noted that work had been undertaken over the last five years or so to develop more person-centred care.  Six Neighbourhood Teams had been set up which each comprised a group of GP practices that covered approximately 35k-80k patients.  In addition, the Care Connection Teams worked with GPs to provide community based care to those who had been identified by their GP as needing case management as part of their care (based on their physical, mental or social needs).  This work had been joined up with the mental health liaison teams and was helping to provide a model of care without organisational boundaries. 

Increasingly, services were being developed with their delivery being joined up across the Borough.  This had resulted in integrated discharge which had helped to prevent A&E admissions and streamlined the discharge process with improved capacity in the community.  H4All had provided dedicated support to prevent A&E admissions and work had been undertaken with Michael Sobell Hospice and Harlington Hospice in relation to end of life care.

Ms Morison advised that the national health and social care policy was now focussing on integration at ‘place’ level (e.g., Hillingdon borough).  This meant stronger partnerships in local places between the NHS, local government and primary care and the development of strategic commissioning with a focus on outcomes. 

The direction of travel for integrated care had been set out at a system (NWL) and place level.  This would include establishing shared outcomes and priorities at a local level alongside national commitments and effective local leadership with governance in place by spring 2023 with a single individual accountable for shared outcomes working with partners.  HHCP had been working with NWL ICS to shape and align to the governance that would be required for spring 2023. 

During the pandemic, the work that had already been undertaken to achieve these outcomes had  ...  view the full minutes text for item 49.

Mr Richard Ellis, Hillingdon Joint Borough Director at North West London Clinical Commissioning Group (NWL CCG), advised that digital consultations provided an opportunity to reach out to underserved communities.  GPs in NWL and Hillingdon had been using online consultations for 3-4 years following investment from the NHS.  However, during the pandemic, each practice needed to develop and transform its own procedures and online consultation facility. 

Time and money had been invested in providing support to patients to help them engage with online consultations.  As such, digital contact with healthcare was quite well advanced.  Patients were now being asked to provide feedback on their experience of online consultations, both good and bad. 

It was noted that one of the benefits to online consultations was the ability to access their practice at any time of day or night (although there would not necessarily be an immediate response).  GP surgeries had been open throughout the pandemic and Hillingdon had been one of the first areas in the country to get patients doing their own tests and transmitting them to the clinic. 

Mr Ellis recognised that not everyone liked online consultations and that some patients did not like using the telephone to contact their surgery.  NWL CCG had tried to engage with the various patient groups in Hillingdon to solicit feedback in relation to online consultations.  Healthwatch Hillingdon had also been closely involved in this engagement work. 

It was noted that the online consultation system was currently going through the re-procurement process so might change.  Healthcare was being responsive to patient needs and would be able to provide opportunities such as mental health patients being able to have an online consultation quicker than they would if they wanted a face-to-face appointment.  This digital offer would enable the workforce to work differently and would need to incorporate the estate. 

Members queried whether residents would still be able to see a GP face-to-face if requested.  Mr Ellis advised that they would.  The move to digital had enabled additional appointments to be created since the pandemic started with 50% of the total now being online and the other 50% being face-to-face. 

Mr Ellis noted that 34% of the eConsult contact had been in relation to admin assistance.  This would have been in relation to requests for things like letters for passport applications, travel issues or housing. 

It was queried whether, in the future, an online GP surgery would be set up that only did online consultations.  Mr Ellis advised that there were no specific plans for this facility.  In most practices, the day was organised with urgent call backs taking place first thing in the morning and then face-to-face appointments.  The urgent call backs could be undertaken by any clinician so therefore could be made by another practice within the same primary care network (PCN).  However, it would be important to understand the needs of the population in much more detail to be able to address them more effectively. 

Although there seemed to be a larger number  ...  view the full minutes text for item 50.

Mr Richard Ellis, Hillingdon Joint Borough Director at North West London Clinical Commissioning Group (NWL CCG), noted that he had previously spoken to the Committee about the transfer of phlebotomy to general practice.  This had been very well received by residents who were now able to access phlebotomy closer to home as every practice now had a practice-based phlebotomist. 

It was noted that there had been shortage of vacutainers (the vials used to hold drawn blood) which had impacted on performance but that this was now getting back on track.  As there had been a 60% reduction in demand for the service at Mount Vernon Hospital (MVH) Phlebotomy Clinic since the service became available in general practice, it was proposed that all routine blood tests be undertaken in general practice and that MVH concentrate its phlebotomy activity solely on its own outpatient clinics.  It was also proposed that urgent weekday bloods be moved to the community (although the numbers were likely to be small) with back up provided by MVH and Hillingdon Hospital. 

Members noted that Ms Kirstie Neale, Primary Care Delivery Manager (Uxbridge and West Drayton) at NWL CCG, was currently looking at undertaking consultation with the practices and a detailed engagement plan was being finalised.  In July and August 2022, patient feedback would be sought in relation to the benefits and impacts of the service changes.  Once analysed, this feedback could inform any necessary changes needed to improve the service.

RESOLVED:  That:

1.    the options for urgent blood tests to be taken at practices/PCN level rather than Mount Vernon Hospital be noted;

2.    the separate proposals by Mount Vernon Hospital for use of their phlebotomy outpatient estate be noted; and

3.    the report be noted.

The Chairman advised that he had been collecting information from informal meetings with various partners over the last few months about the police and mental health attendance at Hillingdon’s Emergency Department.  Members agreed that a witness session be held at the meeting scheduled in June 2022. 

Ms Vanessa Odlin, Director for Hillingdon and Mental Health Services – Goodall Division at CNWL, advised that she had been setting up meetings with partners (including the police) to discuss this matter.  She would be happy to attend the meeting in June to provide an update. 

RESOLVED:  That a witness session in relation to the police and mental health attendance at A&E be held at the Committee’s meeting in June 2022. 

Consideration was given to the Committee’s Work Programme.

RESOLVED:  That the Work Programme be noted.