Agenda item

Mrs Cathy Wilson provided an overview of the content of the paper and highlighted several key elements including: work on skill mix; scrutiny of workforce to validate the workforce required; £200k savings achieved; future funding envelope insufficient for the development of Memorandum of Understanding (MoU) 2; and recurring funding required to TUPE staff from GP Practices.  Mr Hazel Robertson elaborated on the content of the allocation letter and its implications for the IJB. She advised that the IJB would be required to ensure it fully spent any carry forward balances within its reserves. Then 70% of the allocation would be released to the IJB with the remaining 30% held in abeyance. She further advised that the funding envelope did not give certainty for the next year, but gave some indication of an overall direction of travel.  Dr Kevin Buchan commented that the organisation was in a reasonably good position as it had continued to work on elements of the PCIP through the COVID-19 Pandemic. He advised that the consequences of not delivering the contract were huge and suggested that there would be significant difficulties with GP Practices in the Borders being unable to provide their normal high level of care. Mrs Kathy Steward commented that as the clinical lead for CTAC, explained that there were lots of dependences in the project and in terms of timescales they were already part way through the organisational change process with current staff, vacancies would require to be recruited to as well as the TUPE of staff. There would be pressures to deliver CTAC by the end of March, however she suggested the IJB should consider the risks of non delivery.  Discussion focused on: what was the level resource predicted on a recurrent basis from April 2023; what was the acceptable level of risk given a lack of available funding; supported the direction of travel; Scottish Government had responsibility for financially resourcing the PCIP; escalation of the overall position to the Scottish Government to make them aware of the implications of non delivery of MoU 2; assurance to NHS Borders that the IJB will commission what it has funds to commission to ensure it does not operate an overspend position; sustainability payments; position of ring fenced reserves; any direction should clearly set out the risks and assumptions made by the IJB; and pursue a more robust approach with the Scottish Government on future funding.  Cllr David Parker commented that non recurrent resources should not be used to TUPE staff and clarification of the financial situation was required.  Mr John McLaren enquired about the level of engagement that had taken place with the Scottish Government.  Mr Tris Taylor expressed concern that the IJB did not have clarity on the financial risk and that the operational risks required to be summarised.  In terms of the financial risk, Mr Chris Myers advised that he had written to the Director of Primary Care at the Scottish Government and outlined the situation and advised that there was a risk that the MoU 2 would not be delivered. He had emphasised that the contract was clear that the financial responsibility for resourcing the contract sat with the Scottish Government.  Mr Myers suggest the Chief Financial Officer work with the NHS Borders Director of Finance and the PCIP to draw up a reserves plan and to issue a direction to NHS Borders whilst being clear that the direction would not ask NHS Borders to go beyond the funding made available for delivery.  Dr Buchan commented that he had raised the matter with the BMA and the Scottish Government Practitioners Committee. He spoke of the Action 15 monies that had always been directed to primary care and the disparity of treating GPs differently to other services in health care.  The Chair suggested that as a result of the conversation the IJB required Mr Myers and colleagues to develop a paper to clarify what needed to happen over the following 4 weeks to be able to meet the 16 September 2022 deadline and to understand the deployment of reserves and other funding streams in the short term as well as finance, workforce and other risks in moving forward. She further clarified that the paper should look at how to deliver what was currently planned to be done as safely and prudently as possible. She suggested that the paper could be circulated virtually for the IJB to consider.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the progress made since the last Integration Joint Board.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the risks to non-delivery of the GMS Contract, GP sustainability, workforce, and mental health and wellbeing services.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that the local financial position had been escalated to the Scottish Government Primary Care Directorate, and that the Scottish Government had subsequently issued a national allocation letter and the process to be followed.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that the funding for the Mental Health and Wellbeing in Primary Care Services plan reviewed at the Integration Joint Board in June 2022 had not been released and the plan had not been signed off by Scottish Government.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted that discussions would occur with the Scottish Government about the use of the Mental Health and Wellbeing in Primary Care fund to inform a future paper for the Integration Joint Board.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed that a further paper be worked up and shared with the IJB for consideration.