Sara Lingard, NHS England, presented the report that provided members with an update on the action plan to improve delivery of the enhanced service agreement with General Practitioners in Thurrock who deliver Learning Disability Health Checks.

Although the Appendix to the report showed a considerable improvement and activity undertaken in Quarter 3, uptake of Learning Disability Health Checks still remains unacceptably poor within Thurrock.

The report showed an increase of 2% up on 2014/15, Quarter 3 performance.

A further report will be available at the end of the financial year to identify activity undertaken in Quarter 4 and will be presented to the Health Overview and Scrutiny Committee.

NHS England reissued the Enhanced Service to all practices in December 2015 to clarify how practices should be recording their health checks on their systems. In some instances the wrong READ codes had been used on clinical systems which had resulted in some completed health checks not being identified by the payment system. At present, there is no facility for GPs to re-code manually. Any discrepancies therefore had to be undertaken by NHS England.

Even in some instances practices were not declaring the activity on the payment system which had resulted in a nil return.

Sara Lingard confirmed that these issues were being addressed as a matter of urgency.

South Essex Partnership NHS Trust (SEPT) were commissioned as an alternative provider to deliver health checks for this year only. SEPT were also providing training to practices where required. Currently they were providing support to 8 named practices in Thurrock. Sara Lingard confirmed that they were confident that SEPT would reach as many patients as possible.

It was confirmed that clear and concise letters had been sent to those patients that have not responded to previous letters and to those that do not attend (DNA) pre-booked appointments.

Sara Lingard also stated that there were discrepancies between patient lists held by practices and those held by social services and that further investigation into list validation was currently being undertaken by NHS England.

It was agreed by all members and co-optee members that the figures were disappointing and unacceptable. It was questioned by all how come year on year practices sign up to do the Enhanced Service but do not actually provide the service.

A debate between Members and NHS England took place and it was agreed that GPs should be encouraged not to sign up to the Enhanced Service if there was no intention of carrying out these health checks.

Sara Lingard stated that Service Level Agreement contained KPIs which were in place at practices and that penalties were issued.

The Chair stated that the problem of using the wrong codes was not consistent in the report figures as some practices had proved that they had completed checks successfully with no problems with coding.

Sara Lingard confirmed this was a training issue that depended on the level of training received at certain practices.

Councillor Halden stated his concerns regarding those practices in the report that had a 0% result. Yet still, year after year, that same practice applied to undertake the Enhanced Service and receive payment for this.

Sara Lingard confirmed that in the Service Level Agreement it stated that payment was not received upfront and was based on activity undertaken only.

Councillor Gupta commented that a health check had recently been undertaken on a family member and questioned how useful the health checks were and the quality of them. As a carer to that individual he felt carers should have a better understanding of the checks before they were carried out.

Councillor Liddiard stated that it was a good idea that carers were supplied with information regarding the health checks and to ensure that any extra checks were carried out.

Councillor Halden commented that how members were expected to have confidence in the system when a similar report had been brought to the Corporate Parenting Committee in December 2015 highlighting delays of Health Checks of Looked After Children undertaken by NHS England.

The Chair asked Sara Lingard to forward a copy of the Service Level Agreement to all members of the Health Overview & Scrutiny Committee members.

Les Billingham stated that this item had also been discussed at the Disability Partnership Board.

Mandy Ansell stated that the solution going forward was that CCG will have delegated authority to take control of commissioning an alternative provider to undertake the health checks. CCG had a track record of undertaking this commissioning for one year with good results.

Jane Itangata stated that support will be provided to CCG to ensure checks were carried out, ensure the quality of the checks is satisfactory and monitor any aftercare checks.

There will be a designated team in CCG who will be closer to the day to day responsibilities of practices and will be able to monitor performance issues.

The CCG Constitution will also be updated to reflect this change.

As of 1 April 2016 they would monitor those that have signed up for the Enhanced Service, commission the procurement provision and give patients the option on where the health check is undertaken. CCG would work in partnership with NHS England; be closer to the delivery to the areas of where the checks were being undertaken and then re-charge NHS England for those checks completed.

Sara Lingard commented that it was key for the CCG to negotiate with practices and encourage them not to sign up if they are not going to able to deliver the Enhanced Service.

At 8.12pm Councillor Halden left the Committee Room.

Ian Evans requested that a report on Learning Disability Health Checks is provided by the middle of next year to Health Overview & Scrutiny Committee members.

It was agreed by all Members that the Chair of the CCG was one of the practices signing up to the Enhanced Service year on year, but not undertaking any checks. Members agreed that this should be highlighted and looked into.

The Chair requested final outcome figures for 2015/16 from NHS England. Sara Lingard agreed to send these to the Chair.

RESOLVED

1.         That the Health Overview and Scrutiny Committee were asked to note the progress with the Learning Disability Health Checks by Thurrock General Practitioner Practices and future commissioning plans.

2.         That the item be added to the work programme for the 2016/17 municipal work programme.