Agenda item

General Manager Primary & Community Services

Dr Angus McVean gave an overview of the content of the paper and highlighted: a move to a four cluster approach; demographics; appointment of quality cluster leads; appointment of practice quality leads; and funding of the quality leads.

Dr Stephen Mather enquired how the Practice and Cluster Quality Lead appointments would be resourced.  Dr McVean advised it would be for the Health & Social Care Integration Joint Board to provide the resource.  Mrs Susan Manion commented that the specific decision making was a matter for the Health Board as the contractor for GP services, however resources for primary care funding to support GPs had been provided as part of the functions delegated and therefore sat within the delegated budget.

Dr McVean advised that he understood that the Practice Quality Leads would be funded from the primary care budget however the Quality Cluster Leads might not be. 

Mrs Manion advised that funding currently flowed from the Health Board to GPs through the Health & Social Care Integration Joint Board and the next step would be to identify what was required and what was approved and then understand the implications and whether it could be funded from another source.

Dr Mather commented that it appeared the assumption was that the Health Board would be funding the posts and he asked for assurance that the appointment process would be robust as the posts were essentially becoming lead positions.  He further enquired if the appointees would become Health Board employees.  Mrs Manion responded that she understood that the current process was to employ and then agree how funded and she would continue with that approach.

Dr Mather requested that the recruitment and appointment and funding of the quality lead posts be reviewed and brought back to the Board for further discussion.

Mr Andrew Murray enquired about the next steps.  Dr McVean advised that the legislation passed to GPs was that GP Practices would agree the cluster approach to be taken locally.  Discussion had taken place at the Local Medical Committee (LMC) where the preferred option had been to have 4 locality clusters and the LMC were settled on that position.  In regard to the cluster quality leads the LMC were clear that a robust interview and appointment process was required to ensure the right person was appointed with the right experience and ability to speak for and to the constituent GP practices. 

Mrs Jane Davidson commented that the matter was yet to be discussed by and with the Health Board, including the engagement with the LMC.  She was aware of informal engagement taking place but reminded the Health and Social Care Integration Joint Board that the Health Board was the contractual agent with GPs and required to understand and discuss with the LMC their proposal.

Mrs Manion commented on the need to be supportive and work with GPs and in relation to locality plans.  She suggested it was a good compromise to ensure it was local and offered opportunities to think about across the health and social care system.  She further suggested that at the point when the contractual arrangements were discussed by the Health Board, the mechanics of recruitment and funding would take place to support the process.

Mrs Elaine Torrance enquired if the arrangements could be tweaked if they did not work.  Dr McVean responded that the arrangements would be entirely flexible and he and colleagues were aware that there were possibilities the approach might not work and would need to be relooked at.

Mrs Jenny Smith commented that in terms of locality plans were the localities being asked what they felt would work best for them.  Dr McVean commented that he was keen that the localities were not seen as GP clubs and he was keen to ensure the clusters were seen as whole system clusters encompassing all health and social care agents such as the third sector, allied professions. 

Mrs Jane Robertson advised that the Locality Co-ordinators were in the process of formalising localised working groups to develop the 5 locality plans and sought assurance that whatever the outcome of the 4 GP cluster proposals the locality coordinators were kept informed. 

Mrs Jane Davidson suggested the challenges of several services operating across more than one cluster would need to be thought through. 

Mr David Davidson sought assurance that the delivery of quality would be on an equal basis across the whole of the Borders.  The Chair echoed Mr Davidson’s comment and cited postcode prescribing as a potential challenge in ensuring localities did not just deliver what the local community wished.

Mr John Raine enquired, in recognising primary care was pivotal to the success or otherwise of the Health and Social Care Integration Joint Board (IJB) where the accountability lay, in the sense that GPs had a contract with the Health Board and also a responsibility and accountability to the IJB and he sought the views of Dr McVean and Mrs Manion of how they saw that accountability in order to enable the IJB to monitor progress and how the cluster arrangements would succeed over time.  He questioned it is was a dual accountability? 

Mrs Manion responded that as independent contractors the accountability sat with the individual practices and in terms of the performance of individuals it sat with the Health Board.  Given the locality approach and development of the performance framework around services, ultimately the GP practices would be accountable for themselves.  She advised GPs would report performance to the IJB from their GP practices. 

Dr McVean commented that his contact was with the Health Board and he reported to the Health Board, he did not have a responsibility to the IJB, he had a responsibility to his contract provider and defence organisation but no responsibility to the IJB.  Dr McVean reiterated that as an independent GP working in Practice that was his reporting and responsibility route.

The Chair thanked Dr McVean for providing the first look at what GP practice clusters would look like and noted that further reports would be received and would also clarify some of the issues raised during discussion.  She emphasised that IJB colleagues would be keen to see localities and GP clusters working well together and that there was an expectation that there would be an equality of service across the Borders.   

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted and considered the report and that it would receive further update reports in due course.