Sue Fogden gave a verbal update;
‘The CCG does not have any access to capital which needs to be put into context first. GP premises are funded and regulated by NHS England and the CCG has accepted the delegation of that function. NHS launched a fund programme called Estates Technology Transformation Fund ETTF and that comes with a set of regulations about how much money you can spend and how you spend it. What happened with Gossoms End and a number of national projects is the rules needed to change to meet the new ways of working the agenda and we have been waiting two years for those regulations to change and to be published and we are still waiting. CCG had a number of meetings with the national team to try and look at how this could work and we could unblock some of these things and initially it looked positive in July whilst the new rules hadn’t come out we are working behind the scenes to find ways of unblocking it. There was a consultation regarding Gossoms End in September 2016 that completed about not supporting the intermediate beds and that was the decision from that consultation, which left a huge void. We already have one GP working there at Gossoms End Surgery and we still have three other surgeries in Berkhamsted and all four practises got together to think about how they could work together as we are looking at workforce issues as well as capital issues and how we can offer some resilience to those practises in terms of workforce and GP’s. Those talks meant that one practise decided not to partake which was their decision to make, so we were left with two town centre plus the surgery that is already based at Gossoms End. The CCG supported a project through this fund to relocate two of the town centre practises to the void area at Gossoms End following the closure of the beds. We haven’t got the revised rules issued so we are still tied in that respect so we have tried to find ways around this and we have looked to see if we can apply exceptionality status to some of these projects and we have met with the council and various other developers to look at how we could alternatively fund those projects. So with Gossoms End we think we have found a way with NHS England through exceptionality, we have funded a paper to be written by a specialist on business cases to try and get this exceptionality passed, and we are on track to get this to NHS England within the next two weeks.’
Cllr Taylor said Due to the retirement of current GP’s in Berkhamsted the CCG highlighted an issue with the provision of GP premises in Gossoms End,the complexity of health funding makes it difficult for Health Bodies to find the investment required to resolve the problem – consequently the CCG has approached the Council to see if we can facilitate provision of the service through investing in the site and leasing back to the GP’s/CCG. The response to this which was attended by Sue and the Chief Executive and the Assistant finance Director Nigel put a paper forward to say that we would be interested in finding out more on investing, sharing and funding. So there is at the moment a negotiation between the CCG and the Council to find out if we would be in a position to participate with the CCG. We are now waiting for a response.
Sue explained that there has been an update and that when the CCG met with the council they did not just discuss Gossoms End but also other projects in Dacorum and the outcome is that they will probably not be pursuing Gossoms End through local authority funding. However, the council have been invited to make a presentation to another practise. They started with three projects and the Council have been helpful on the other two.
Cllr Birnie said that he wanted to know more about the step down beds and whether the decision to ‘axe’ them at Gossoms End was taken before the problem arose with the GP’s and using it as a solution for that problem.
Sue explained that there were issues with the service and the decision was made in 2016. It was only when the step down decision was made and the void became available that Gossoms End was considered.
Cllr Birnie remarked that step down beds on the east side of the county are more available than they are on this side and he is surprised the CCG are sanquine about this in terms of people being released from hospital earlier etc.
David responded that this area has more community beds than east and north Herts CCG.The challenge for the CCG is to keep the flow moving and make sure they are as operational as possible. There has to be a balance between health and social care.
Cllr Birnie expressed his surprise that the provision at Gossoms End was closed as there is a paucity in that particular area. David explained that there were many factors affecting that closure, including safety.
Cllr Hicks said he was hoping for an update on where people would go as he was concerned that the elderly may be placed in homes, as if one of the problems was a lack of specialist nurses for step down, how would those nurses be provided for the old people’s homes?
David replied that he agreed it was preferable not to place people in residential or old people’s homes as usually they would not return home from there, and that the CCG aim was to get people home as soon as possible whichever path that took.
Cllr Hicks asked whether there was only one Dr’s Surgery at the moment based in Gossoms End, but that once the money becomes available there will be a second and third Dr’s surgery moved there – and if all the Dr’s are located there how do the residents from the other end of Berkhamsted with no transport, get there?
Susan confirmed that there is a single Dr at the moment and the other two surgeries have formally merged contracts and they will move there and work together. Manor surgery is staying where it is so there will be coverage across the town.
Cllr Guest asked whether a further update of Gossoms End would be available for the December meeting, and Susan confirmed that there would be.
Cllr Guest requested Gossoms End be added to the agenda for December’s meeting, she also asked that a presentation on step-down care be given in December.
David agreed that there should be a presentation and Gossoms End and step down care should be treated as different items for clarity.
Item 9 Marlowes Health and Wellbeing Centre
Cllr Guest asked which date Cllrs were able to attend and the 19th September was decided on.
Action point: Add step down care to the December agenda. SB
CCG left the meeting at this point.