Agenda item

5.1    Mrs Cathy Wilson provided an overview of the content of the proposal and highlighted:a in breach of contract and risk to the delivery of the bundle. Dr Tim Young gave an outline of the situation regarding the GP sustainability position and CTAC.

5.2    Mrs Wilson indicated that the presentation had been received at the Health Board meeting on 29 June 2023 where the proposal had been agreed in principle with certain caveats. She also intimated that a meeting regarding Polypharmacy would be taking place on 20 July 2023.

5.3    Mrs Wilson commented that further discussions would take place at the GP Executive following discussions with GPs regarding the TUPE of staff arrangements.

5.4    Mrs Wilson referred to the reserves from the IJB and noted any offset in savings would come from the Polypharmacy review. It was noted that it was a 3 year plan and an exit strategy was required. It was noted that Mrs Hazel Robertson has also written to the Scottish Government on the issue.

5.5    In response to the caveats referred to above, Mrs Karen Hamilton stressed the need for the recommendations and caveats to be included within the paper to ensure the IJB were fully aware of the position within NHS Borders. In addition, Mrs Hamilton referred to point 5.12 of the paper and the need to ensure the date was added and also raised concern at the use of the word “lucky” at point 5.15.

5.6    In response to a query from Mrs Jenny Smith regarding any benefits and impacts for the third sector, Mrs Wilson confirmed that engagement was underway complete stages 2 and 3.

5.7    Mrs Sarah Horan commented on the purpose & scope “realistic medicine” and intimated she would like to include “values-based care”. It was also noted that paediatrics had not been mentioned within the impact assessment.

5.8    Mrs Jen Holland referred to a social care proposal for pharmacotherapy and home care to reduce the amount of visits and reduce delayed discharges and highlighted the need to be coherent around priorities regarding efficiencies in health as well as health & social care.

5.9    Mrs Fiona Sandford referred to the “fragility of GP services” and noted NHS Borders had the highest vacancy rate for GPs than any other Health Board and commented that it was imperative to highlight that to the Scottish Government.

5.10 Mr Tris Taylor welcomed the approach outlined regarding the delivery of savings and the impact assessment section “improvement to health & equalities......” if there was increased capacity.

5.11 In response to a query from Mr John McLaren regarding GP payments, Mr Ralph Roberts intimated that the details of contractual parties were the responsibility of the Health Board and he was clear that it was not compensation and was paying for a contractual service around Polypharmacy. It was being funded through the funds available within the PCIP as they currently stood and the commitments of savings to fund on an ongoing basis until additional funding was received from the Scottish Government. In addition, and in response to a query regarding how other NHS Boards had delivered PCIP services, Mr Roberts intimated that they had been delivered in different ways by different Boards depending on their identified priorities.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD directed NHS Borders to implement the Bundle Proposal plan to deliver services outlined in PCIP 6 Scottish Government’s direction.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD approved and endorsed the financial model supporting the PCIP Bundle Proposal, including temporary redirection of Polypharmacy efficiency savings to deliver against PCIP 6.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to escalate funding concerns and gaps for PCIP 6 delivery with the Scottish Government which include the financial risk of over and under delivery.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to review the situation at the next meeting and review the delivery in March 2024.