Agenda and minutes

There were no apologies.

Deborah Oliver declared these two interests:

Agenda Item 4: patient of the Neaman Practice; and

Agenda Item 7: Governor of Royal Bridewell Hospital (King Edward and Barrow hills Schools).

No other declarations were made.

To agree the minutes of the meeting of 04 October 2023.

RESOLVED – That the minutes of the meeting of 04 October 2023 be agreed as a correct record.

To view the presentation of the Neaman Practice Manager following the improvement plan.

The Committee viewed a presentation updating Members on the Neaman Practice following its improvement plan, noting in particular the following:

-       The overseeing by the Regional Digital First teams (NEL) of a distinct process aimed at identifying practices on analogue telephony systems, with funding allocated to facilitate: i) the buyout of existing contracts if necessary, ii) the procurement of digital/cloud-based telephony licenses, and iii) local implementation support;

-       The introduction of tools to facilitate the transition to Modern General Practice (MGP);

-       Staff training and local improvement support;

-       Means of communication with patients;

-       The consideration of a plan for offering an outcome to patients at first point of contact with a practice via

•       Options for patients to have needs assets via an online consultation through the practice website or using e-Consult,

•       Re-structured appointment system,

•       Fulfilment of contractual obligation by achieving prospective record access for patients, which became active on October 25, 2023 allowing all patients with consent, who have signed up for online access, to remotely review their records,

•       Recognition of significance of participating in the PCN Improvement Leads programme, and

•       Working with the national Digital & Transformation Leads development programme team to receive extended support over a twelve-month period to include action learning set sessions, individual Quality Improvement (QI) coaching sessions, and guidance towards signposting to other learning opportunities such as webinars.

Members asked for more information on performance, measuring and KPIs, and on how issues and concerns were gathered.  The meeting heard that patient feedback was gathered via Patient Participation Groups and feedback forms and that some issues related to patient triage and how patients were signposted to the right support, and that day-to-day capacity was monitored.  Members heard that data was benchmarked against other local practices.

A Member asked whether any

To view the presentation of the Programme Lead – Unplanned Care, City and Hackney NHS North East London.

The Committee viewed a presentation delivered by the Programme Lead – Unplanned Care, City and Hackney NHS North East London setting out updates on virtual wards, noting in particular the following:

-       NHS national priorities and operational planning guidance;

-       delivery of virtual wards now sits with Place teams, with the NEL Urgent and Emergency Care Programme providing overall system oversight;

-       finance allocations for 2023/24;

-       virtual ward referral pathways;

-       impacts and benefits of virtual wards; and

-       next steps.

On sharing best practice and learning, a Member asked for further information on sharing digital tools. The meeting heard that best practices were shared across NEL and that a range of practice communities shared best practice including digital technology tools.

On funding from NHS England, a Member commented that while in theory funding could be diverted from hospital bed use, expansion was such that escalation beds were being used and that hospital wards were not necessarily being shut. Consideration was being given on how more could be done within the community through virtual wards, and that provided appropriate technology was being used virtual wards would be more affordable per bed in the longer term.

On the three categories of patients, a Member commented that most patients would have multiple conditions and asked how these were prioritised and whether co-morbidities might preclude the virtual ward setting. The meeting heard that patients who benefited the most from virtual wards tended to have complex conditions, and would be handled by a lead consultant in the same way as would such a patient in a hospital environment. The meeting also heard that all cases were assessed for suitability to virtual wards.

A Member asked why virtual ward provision had taken so long to roll out given that the technological tools have been

To view the presentation of:

-       Programme manager, Start Well and Age Well, City and Hackney Place-based Partnership, NHS North East London;

-       Joint CEO and Director of Clinical Services, St Joseph’s Hospice; and

-       Joint Director of Operations, City and Hackney GP Confederation.

The Committee viewed a presentation delivered by the Programme Manager at Start Well and Age Well at City & Hackney Place-Based partnership, the joint CEO and Director of Clinical Services at St Joseph’s Hospice, and the Joint Director of Operations and City & Hackney GP Confederation. The presentation set out updates on current end-of-life support and impact and the Committee noted in particular the following:

•       An overview of community and inpatient Palliative and End of Life Care (PEoLC) services in the City of London;

•       A summary of the NHS North East London ICB Palliative and End of Life Care Strategy;

•       Activity and progress on End of Life Care within Primary Care in City & Hackney (with detail from the Neaman Practice);

•       Overview of the Marie Curie Overnight End of Life Care Rapid Response Service; and

•       Report from St Joseph’s Hospice covering key activity, inpatient ward re-development, work to improve links with community services, and achievements.

The Committee noted the PEoLC strategy at the NHS North East London; the 2024/25 priority on embedding activities that focus on practices’ EoL procedures at micro practice level; the Marie Curie Rapid Response Service; and the activities of St Joseph’s Hospice.

A Member congratulated the Hospice for its warmth and friendliness noted during a visit in 2023.

A Member asked for more information on the triage process for patients ending their lives in hospices. Members heard that patients tended to express a preference, and that referrals tended to come from palliative care teams. The meeting noted that many patients would be admitted a few times for symptom management. 

A Member sought further information on hospice capacity and how that related to funding sources. The meeting heard that funding came from a range of sources including grants, and that fundraising was a real challenge

To receive the report of the Executive Director, Community & Children’s Services.

NB: Appendix to this paper is non-public.

The Committee received the report of the Executive Director, Community and Children’s Services on the Children’s Social Care Self-Evaluation Framework.

Members noted that the non-public paper carried an exemption, noting that names had already been redacted (noting also that identification was also possible in theory). Members commented that future such items should be presented as Public items – at least wholly or in part, with appropriate redactions where necessary.

Members noted that the paper was positive for the City of London Corporation, reflecting the Corporation’s policy decisions to boost children’s services and to continual improvement. 

The meeting was extended beyond 1pm with the agreement of all Members.   

The Committee noted that in May, at least these three topics would be covered:

-Self-evaluation of adult social care services

-Evaluation of special educational needs and disability services for children and young people

-Update on low-paid workers/access to healthcare;

and that these topics would be covered in later meetings:

-Patient choice and access to health services (the right to have treatment at the place of choice, including for City workers)

-Clarification of postcode provision to ambulance service following a recent incident at Guildhall in which an ambulance was apparently unable to assist an unwell person due to confusion over the correct postcode, the meeting heard that the matter would be investigated. The meeting noted that the issue had been raised and that a response was awaited and that further information would be circulated to Members within a week.

A Member asked for briefings to presenting officers to highlight discussions of impact and performance.

There was no other business.