On July 19th I went along to a meeting of the Clinical Commissioning Gloucestershire (CCG) shadow board, the second one I’ve been to. This time there were six of us public observers at the back, and this time I hadn’t submitted any question for the board to answer.
As before, the meeting was conducted briskly and the issues would have been difficult to follow without having read the papers beforehand. The papers had been published in advance here: Papers for July 19th (PDF, 128 pages)
It was good to see that the minutes of the previous meeting included my written question about psychological therapies, and the reply, and disappointing to see that the two indicators that commissioners use to track the performance of psychological therapies in Gloucestershire are both below target for the first quarter, April – June (PDF pages 99–100, and 112).
The indicator for the number of people receiving treatment is rated amber at 1.7% (roughly 1,200 people) against a target of 2.2% (roughly 1,500 people), and the indicator for the number of people recovering is rated red at 41.4% (very roughly 500 people) against a target of 50% (very roughly 600 people). The indicators ignore some people who drop out, otherwise the percentage would be much lower. Exact figures will be published nationally in a few months.
Dispensing by GP practices
There was a discussion about the dispensing of medicines by GP practices. It was explained that although there are no issues to investigate, there is to be an investigation into some dispensing practices just in case there might be issues, although there are definitely no issues.
“We’ll do a proper root cause analysis.”
The outcome may be that some dispensing practices will require “support, encouragement and information” in relation to the dispensing quality scheme that they’ve all signed up to anyway.
Although there are no issues, an issue that there might be if there were any issues, is that the dispensing side of the practice could influence the prescribing side of the practice and make money through bulk discounts. Not that making money is an issue, because a dispensing service has to make money or wouldn’t be provided at all. But influencing prescribing would be an issue if there actually were any issues.
I suppose that as CCG board members gain experience they’ll learn to spin announcements like this without sounding quite so mealy-mouthed.
Children in care
A nurse who has been designated, but seemingly not yet actually appointed, as the Designated Nurse for Children in Care attended the meeting to answer questions. A 2010 Ofsted report on children in care in Gloucestershire had said some unfavourable things and noted three particular issues. All three issues had been addressed…
…except the issue of links to mental health, that is. Although all three issues had been addressed, there is still work to be done on that issue. This, too, sounded mealy-mouthed.
Some Gloucestershire children are placed in care out of Gloucestershire, while some children from elsewhere are in care in Gloucestershire. No precise figures were available, but it was thought that there are around 50 out-of-county placements. It didn’t seem likely to me that there really are no figures, but that’s what the meeting was told.
A discussion on NHS dentistry revealed that Gloucestershire had met the target it had set itself of having access to NHS dentistry for 60% of the population. Patient numbers had to be estimated based on an average of 2.9 treatments a year, because patients no longer register.
People have not been attending for follow-up appointments nearly as much as they once used to, and this is especially true of appointments for children. (No one seemed to notice that this means the figure 2.9 used in the estimates is no longer valid.)
One reason for falling follow-ups might be the cost. For example, even a check-up and polish costs £17.50. One GP compared this to the costs of fizzy drinks, but it was generally agreed that dental treatment is seen as expensive by some people.
All this means that some capacity in the system is under-used. For example, dentists engaged for the out-of-hours service at weekends are sometimes idle. A publicity drive would be needed to improve uptake, although it was noted that this might not be easy. For example, a new NHS dentistry service in Tewkesbury had taken three years to get established.
A non-executive director made a very weird statement alleging that the Government’s free schools programme will have a bad effect on children’s teeth, and another board member countered by pointing out that free schools tend to be run by very enlightened people. I didn’t think this showed the non-executive in a good light. He had previously declared an interest relating to some charity or other, so I wonder whether perhaps his charity is involved in education in some way.
The performance report shows A&E green against the target, and it was noted that this is unusual:
“That’s something that we haven’t seen for quite a number of months.”
A board member asked whether the improvement was a fluke, and was given reassurance that it’s thought to be sustainable. (A&E had previously caused so much concern that a special Department of Health team had been brought in to fix it, and it’s only as a result of their work that it has at last met a target.)
Trauma, orthopaedics and diagnostics (for example, endoscopy and breast cancer) were areas of ongoing concern.
There was a discussion about the facilities offered by UK Specialist Hospitals (UKSH), which people do not choose as much as they could. It was felt that GPs should do more to promote available capacity.
There was a brief discussion about finance. The planned savings are currently £4 million “behind trajectory” and so there will be a revised plan.
Again this was an interesting and revealing meeting, but I thought I detected a lack of openness at times (and that might just be the tip of an iceberg). It would be good to have more involvement from members of the public to counter that.