Question 1 – Michael Payne, Cruse Bereavement

I am very impressed with everything heard today.  I am impressed as a member of an organisation and as a local patient.  When talking about MDTs looking after patients, implies that there are going to have to be a specific number of case conferences.  We are all aware of how busy clinicians are.  How realistic is it in the extensive care pilot when you require six or seven people dealing with one patient?

Tony Naughton: Everyone recognises that primary care is under a great deal of strain. We do recognise that the middle section of people (those with one or more long-term health condition) who lay within primary care’s gift to sort out but are not as well looked after as they should be.  The idea is to look at the top group of people who currently take up a lot of primary care’s workload but their care is not well organised, and a lot of time is spent reacting to their situations rather than proactively managing them.

So the plan is to look after these people in the top group within the community. We are bringing a hospital consultant out into the community to care for these people meaning they are not cared for directly by primary care anymore but more by secondary care relieving some of the pressures in primary care.

The bottom – episodic care – a lot of these people I currently seen in my practice and they don’t need to be seen by doctor. They could be looked after by other professional i.e. Pharmacist, which will free up primary care to support enhanced primary care.  So we are looking at skills that we have that are mainly under-utilised i.e. pharmacist and re-directing to clinical care.

We also recognise that we have workforce issues and therefore are working with NHS England and Health Education North West to find new trainees and working with hospitals to set up new training schools.  There are short, medium and long term plans to address these issues.

Question 2

With regard to someone that may not fall into the last two groups, for example someone with diabetes who goes once a year for a blood check-up, the results are okay and there is nothing to trigger support in lower group.  This system does not pick up people with disability as an extra condition.

Tony Naughton: The key to this is for clinicians to ask questions.  One thing we are doing and need to continue to do is to give clinicians the tools to ask the right questions.  There are lots of other organisations out there (400 or so) who are keen to work with us and have lots of skills and attributes.  We need to make sure we can use these and have accurate directories of services.  Need to allow our teams to ask the right questions give and make sure they can solve any issues raised.

Question 3 – Edward Nash, Fylde Borough Council

What specific measure have you taken to implement the Armed Forces Covenant and Community Services Covenant and would you be prepared to engage with the Armed Forces Champion to make this into a partnership.

Tony Naughton: We are already engaged.  Nick Medway, one of the CCG team, is activity engaged.  There are statutory requirements that we need to give priority to ex-servicemen and we are complying with these requirements.  This is known by all our Practices and when a referral is made to Hospital this is recorded.  We are always happy to engage with anyone in this regard.

Peter Tinson: All the providers we commission services from, are required to adhere to this Covenant and we would be happy to follow-up any instances where this has not happened.

Question 4

400 organisations working across Fylde and Wyre and you have done a lot of Focus Groups with Providers.  Are you planning on doing any more events with providers to shape this?

Jennifer Aldridge: Yes, engagement is extremely important to the CCG .We already have a comprehensive engagement programme in place and this year it is our intention to hold two additional workshops specifically aimed at wider stakeholders to share what we are doing and look at how this compliments other organisational plans as appropriate.  All our engagement efforts are aimed at helping develop local, future health care services influenced and shaped by the population and clinicians together.

Question 5

Are you able to carry forward any underspend into a future year?

David Walsh: Yes.  The reason why surpluses are allowed is to enable flexibility for future years and to plan on a long term basis and enable re-design of services.  This is done via the Department of Health and NHS England.  It allows us to be sustainable, to be sure we can deliver our plans over a number of years and work with our community to make sure they are deliverable.