Care Closer to Home questions for #Calderdale & #Kirklees Health Scrutiny Committee

Deputation questions 14 June 2016 JHSC

  1. From Jenny Shepherd

These are questions about Care Closer to Home that I would appreciate answers to from this JHSC meeting.

  1. Why haven’t the LMCs ballotted all GPs working in Greater Huddersfield and Calderdale, about their views on the Right Care Right Time Right Place proposals – particularly the Care Closer to Home proposals and primary care strategies?
  2. What are the top 5 high impact deliverables for GPs that the CCGs have set up to date?
  3. Shropshire CCG Governing Body recently voted against the recommendation of its Chair and Chief Executive to support a proposal to close one of the A&Es in the Shropshire and Telford areas – largely because of the Royal College of Emergency Medicine position statement on A&E closures. Are the LMCs aware of this highly critical position statement? Are they advising GPs on the CCGs Governing Bodies to follow the example of the GPs on the Shropshire CCG Governing Body?
  4. Are the LMCs satisfied that GPs have the capacity to deliver key aspects of Care Closer to Home that they will be responsible for? Eg: GP follow ups that will be required by the YAS See and Treat element of the proposed urgent care scheme? And the proposal that post-hospital discharge appointments would be referred to GPs? And how will the CCGs fund these additional GP tasks and build GP capacity if needed?
  5. A Dorset GP has written to his LMC that the GP federation process is clustering GPs into manageable groups in line with future Kaiser permanente type models – an aim now openly voiced by Jeremy Hunt. And that Doctors will lose their autonomy and freedoms, though working on short term salaried contracts within strict guidelines, with the result that many will opt for a private service in order to retain their independence. Do the LMCs share this view?
  6. What does the Pre Consultation Business Plan mean by saying that the aim is to enhance generalist and collaborative skills for the Trust’s workforce across primary and secondary care to support delivery of the Commissioners’ QIPP requirements? And what impact will this have on GPs?
  7. This is a question for Calderdale Council, the CCGs and LMCs. How are you going to resist the Care Closer to Home scheme’s inbuilt incentives to cherry pick patients who will improve the scheme’s outcome of reducing unplanned hospital admissions and its wider QIPP (efficiency cuts) outcome? Two examples of these incentives:

First: The Calderdale Vanguard scheme aims to use capitation payments for Care Closer to Home. This is one of the Kaiser Permanente practices referred to by the Dorset GP and it means the CCGs will pay what they think is the percapita cost across the population for providing CC2H services according to managed care pathways. A rationale is that that this drives efficiencies because if the provider can find a way to deliver the service more cheaply they can make a profit. The downside is that the easiest way to deliver the service more cheaply is to cherry pick patients and deny care.

Second, at least one of the Better Care Fund Phase 1 Care Closer to Home schemes that “integrate” social care and NHS care already seems to be cherry picking patients on the basis of whether they will improve the outcome of reducing unplanned hospital admissions – which bring financial rewards from NHS England – and also save the Council money.

The Calderdale Support and Independence Teams 2015 Report shows that their ‘integration’ of health and social care has resulted in them cherry picking patients who receive the NHS-funded reablement service, on the basis of whether they will bring financial rewards from NHS England for reduced hospital admissions; and they are also funnelling patients as quickly as possible from NHS-funded reablement to means-tested social care. The Report states:

“The targetting of Reablement resource to people who are more likely to benefit … is seen as highly beneficial to the outcomes achieved.” (ie reduced hospital admissions)

The Teams have put more staff to work on services that patients have to pay for – “post-reablement home care waiting” and “rapid access homecare for people who would not be appropriate referrals to reablement” – so that by moving more patients quickly from reablement to an independent-sector provider, the Council saves more money..

Jenny Shepherd 14.6.2016

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