· CAMHS update – Presented by Joella Scott
· Primary Healthcare Update – Presented by Michelle Campbell
· Integrated Care System – Presented by David Evans
· Population Health Management in the Primary Care Networks – Presented by Charlotte Mullins
Minutes:
CAMHS (Child and Adolescent Mental Health Services)
DEvans introduced JScott Foster, Programme Manager for CAMHS Redesign and Implementation, who presented an update on CAMHS.
· CAMHS had seen a huge rise in demand in the past 6-8 months, pressuring the service delivery. Responses had to be sustainable.
· More young people presented in a state of crisis than at an earlier stage. They invested significant money for a 24/7 crisis support offer, in both acute hospitals, and 8am-8pm Crisis in the Community. If a young person presented at risk at a placement breakdown, or a family breakdown, Social Care would attend such an assessment. If a young person presented with challenging behaviour, the Positive Autism service would attend the assessment.
· Residential strategies looked across Health and Social Care to create a better system, increase therapeutic support, better training for social care staff, and more mental health training.
· Developing to recognise trigger points for crisis and up-skilling was taking place.
· They were seeing unprecedented demand on Eating Disorder Services, nationwide, in all ages. The amount of young people presenting with eating disorder concerns had grown 127%.
· They were looking at Early Help Eating Disorders services for parents and a home treatment team to support young people within the family to instil change and grow better outcomes.
· A positive from Covid was how they responded digitally, and understanding they could deliver services at scale to young people, recognising they did not want to create digital poverty. Large numbers of young people did not have access to digital platforms, although many young people preferred digital services. Having a robust hybrid offer was moving forward. Digital advice and guidance was being developed to increase relevancy and self-help in a digital environment.
KMinier reported low percentages of young people who preferred digital to face-to-face and asked what they were doing in schools regards mental health. JScott did not have a percentage breakdown of digital versus face-to-face. She relayed many young people disliked being on camera initially, and concerns from young people whose home environments were not private enough for a conversation. She noted that professionals understood the importance of hybrid models.
Jane requested that acronyms were explained in parenthesis for public presentations. Jane praised the team’s work, and enquired about prevention. JScott relayed she worked closely with Public Health who owned preventative information, and detailed safe navigation of social media, body positivity, and Just Talk, for preventative information. JScott confirmed prevention was a CAMHS priority and all agencies recognised their role in prevention.
Cllr Bhinder was pleased to hear the team effort.
TFernandez echoed the increase in demand, 20% above pre-Covid levels and the limited capacity in primary care. TFernandez observed areas for work including access and prompt response, which led to repeat consultations in primary care if nothing was happening. He noted paperwork involved could be lengthy especially for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder and GPs felt like the conduit because they were getting information from parents and schools. TFernandez noted the movement between different services did not always work well and bounced back to primary care. TFernandez queried staffing, as GPs were off sick with stress and anxiety and there were also recruitment issues. JScott assured they had developed a Universal Gold Standard referral form for CAMHS for ASD and ADHD, agreeing that GPs should not do referrals. The automated referral form should be available to schools. JScott explained communication should enable patients to know where their referral was in the system, and was being developed. JScott noted the work progressing on a more accessible system across a continuum of need. JScott acknowledged staffing was their greatest barrier to success nationally. An Agile Task and Finish Group was set up to look at the issues in retention, and recruitment.
Cllr Allen raised an email from Signpost who were struggling to cope with the demand from young people since Covid, and were currently funded 1,500 by CAMHS when their demand was in excess of 4,000. JScott confirmed they were committed to investing in the voluntary sector and would provide increased funding within their contracts. She noted there was not a huge pool of money but they had increased 20%, to start April 1st.
Cllr Adeleke enquired about walk-in centres for young people to visit. JScott answered they did not have a walk-in centre although there were other walk-in centres who would signpost to mental health provision. She noted that a Social Prescriber might support a young person to seek out a new service, or help take them there. JScott detailed parental programmes as part of Early Help. She relayed they did not yet have a telephone number but there was a digital website where young people and professionals could access help and guidance.
KMinier enquired about additional roles for investment and psychiatrist nurses in primary and asked if they were qualified to support children. JScott explained they were Mental Health Practitioners and once the investment came through in April contracts could be purposed into Mental Health Practitioners for young people. They were in conversations about what this would look like and if it fitted with GP-led clinics as young people had better outcomes with support based around the familiar.
Cllr Beauchamp asked if the information they provided was available in programme form within schools that children could access as they may not be aware of CAMHS. JScott noted it was normally through professional newsletters, using co-production with young people for redesign. JScott would ask the Chair of this group to ask how they would like to access information.
· CAMHS explained they were trying to rebalance financial distribution to ensure services available across need, and not purely in crisis to prevent a system that was only built to address crisis.
· Communication and engagement was key, they had to ensure information was accessible amongst young people, parents, and agencies. Delivering and developing a set of partnership principles and outcome data would form the framework.
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JScott offered to change the slide adding acronyms.
DEvans congratulated JScott for articulating the plan well. He felt the key element was the 100% increase in demand during Covid. He would update in the future.
Primary Care Update
MCampbell, Assistant Director of Primary Care in CCG, presented the Primary Care update.
· Across the CCG, as of March 21st, 54 GP practices, 15 for Dacorum. There was a merger of 2 practices in Tring following a patient consultation, making Rothschild House the largest GP surgery with 40,700 patients. They operated 4 branch surgeries and a main site in Tring. The practices were in the Primary Care Network so this did not affect primary care provision.
· Due to system pressures, an additional 11,500 GP appointments were commissioned through Extended Access with a 13% increase compared to pre-Covid.
· Primary care networks had risen from 16-17. 4 of the Primary Care Networks were in Dacorum plus an additional Primary Care Network, not geographically aligned but with similar values and patient demographics.
· Since inception in 2019, Primary Care Networks have funding enabling them to recruit additional roles so patients can see different clinicians. Recruited roles include Clinical Pharmacists, Social Prescribing Link workers, Care Coordinators, First Contact Physiotherapists, and Health and Wellbeing coaches. The Primary Care Network can recruit to other roles such as Paramedics, Mental Health Practitioners, and Physician Associates.
· Since 2019, the National Enhanced Service commissioned by NHS England provides a number of clinical services including enhanced health in care homes, with post hospital discharge, advanced care planning, and medication reviews. The Primary Care Networks also deliver medication reviews, using Clinical Pharmacists.
· Early Cancer Diagnosis is a relatively new service. During Covid they have been implemented in a phased approach. There are further iterations going into April 2022.
· The last service delivered is Extended Hours, additional appointments early morning, evening, and Saturday morning.
· Direct Enhanced Service runs to 2024. Developing in April 2022, Extended Access and Extended Services will be merged from October 2022.
· Population Health Management reviewed linked data from acute services, primary care, and voluntary sector where available to ensure care is meeting the needs of the population.
· The model of care for general practice changed during Covid with rapid deployment of video consultations and only bringing in patients where it was necessary to have a face-to-face consultation. Primary care repository hubs were implemented to see patients with suspect or Covid-positive status separate to other populations. A paper was being entered to extend this further.
· During Covid, the Oximetry @home pathway was introduced, delivered by the voluntary sector to patients at home.
· 1.26 million vaccinations had been delivered, 63% by primary care. Primary care remained open during Covid despite media reports. Many consultations were done remotely with patients being seen face-to-face where clinically necessary.
· Since Covid, primary care backlog of care shows an increase of 20% with demand outstripping supply throughout the NHS.
· NHS England and Improvement announced additional funding to support Improvement to Primary Care. To utilise this funding, integrated care system Hertfordshire CCG and West Essex CCG submitted a plan to support patients. Providing funding to practices to upgrade telephony systems, as a big complaint is not getting through on the telephone. Additional appointments are available and commissioned through Additional Access Services.
· There has been investment in engagement. Patients have registered and shared their stories and experiences so they can help support patients and primary care to help improve.
Cllr Hollinghurst suggested the problem was not telephony but difficulties making non-urgent routine appointments in advance. MCampbell confirmed that telephony systems were extremely antiquated, and the majority of complaints were around not getting through on the telephone rather than not being able to make appointments. She noted they were reporting well on making appointments. MCampbell asked Cllr Hollinghurst to forward any particular incidents to her. Cllr Maddern thanked MCampbell for the updated telephony systems and relayed an extremely excited GP who was getting the new system.
Cllr Beauchamp asked if the practices were aware that from 2025 the PSTN and ISTN services would be terminated. MCampbell replied by the time they finished this programme all surgeries would have a new telephony system with a preferred provider. The Digital First programme and Future Digital Strategy would develop this.
TFernandez relayed that demand had increased by 19% and telephony systems had to be updated accordingly. Regards demand, TFernandez noted all available appointments got booked up and there were fewer available because on-the-day demand used resources. TFernandez reported difficulties recruiting. He advised a triage telephone service was vital.
Cllr Adeleke felt there was no measurement to check that the new telephony technology was yielding results. MCampbell relayed that it would take time to identify improvements but getting the newly available call log data would help them assess success.
Cllr Hollinghurst suggested OAPs needing non-urgent review appointments ended up filling emergency appointments. He suggested a mechanism for non-urgent review appointments, seeing a practice nurse where possible. TFernandez felt this would become less of a problem with new services such as Contact Physiotherapists but reported that many patients were adamant about seeing GPs.
KMinier asked how Patient Participation Groups helped involvement. TFernandez noted they got information from patients to develop the services, and helped with ‘flu campaigns. TFernandez reported having BP monitors in the Reception area, using Twitter and their website, and telephone triage as useful strategies. He suggested they use their resources wisely and provide services that worked.
Jane was Chair of a PPG and felt they were a good way to liaise with patients. Jane noted a number of their patients did not access modern media and many practices did not provide accessible communication. Jane asked who triaged patients on the phone, if the community pharmacy was linked to the practice. Jane asked when patient data would be put into a general system.
TFernandez relayed that receptionists received training on which cases were appropriate to go direct to a physiotherapist, a nurse, or a pharmacist without seeing a GP. This training was on-going within most practices. The community pharmacy recently received training. Not all practices had in-house pharmacies so it only affected pharmacies taking part in the scheme. Regards data, there was a limited amount of data available already so drug lists were available in A&E. Jane relayed there was a date for data sharing, and a deferral, and asked if it had gone ahead. Jane queried receptionist triage as this was unwelcome from patients as patients felt a doctor should make the decision, although not necessarily to see a doctor. TFernandez reported they used a doctor-led triage. Jane felt there was an issue with non-clinical receptionists making decisions. TFernandez emphasised Reception staff were trained to consult with a doctor for urgent issues. TFernandez stated they could have continuity or quick access, but it was difficult to have both.
Cllr Hollinghurst felt GPs were a scarce and expensive resource and their skills should be put to best effect. Cllr Hollinghurst asked if there were plans to use distributed ledger technology. MCampbell had not heard of this.
KMinier raised that primary care was more than GP services and asked for an update on community nursing, dentistry, allied health professionals, and other areas of primary care. MCampbell resolved to bring appropriate professionals to provide updates.