The North Central London Joint Health Overview and Scrutiny Committee met on Thursday 25 July 2024, discussing significant updates on the 'Start Well' programme, primary care access, and dental services. Key decisions included the re-election of Councillor Pippa Connor as Chair and the agreement to provide formal feedback on the 'Start Well' interim report by 16 August.

Start Well Programme Update

The committee received an update on the 'Start Well' programme, which aims to reform maternity, neonatal, and children's surgery services across North Central London (NCL). Anna Stewart presented an interim report on the public consultation, highlighting that 67% of stakeholders agreed that changes were needed to address current service challenges. There was overall agreement that all neonatal clinics should offer the same minimum level of care (at least Quality Level 2). However, there was less support for consolidating maternity and neonatal services from five to four sites, with concerns raised about increased travel times, potential service pressures, and capacity issues.

The committee was asked to provide formal feedback on the interim report by 16 August. Councillor White questioned the framing of the consultation, suggesting that the proposals appeared to be led by experts rather than stakeholders. Councillor Chakraborty sought clarification on the engagement and representation within the consultation, while Councillor Cohen questioned why the consultation had not directly addressed the closure of a facility. Councillor Revah requested more detailed qualitative feedback and a delay in providing feedback to allow for discussion with Camden's Health Overview and Scrutiny Committee.

The committee also raised questions regarding the children's surgical proposals, requesting written responses on how the views of 'hard to reach' audiences were considered, the inclusion of post-implementation stakeholder follow-up in the business case, and the consideration of knock-on effects on other hospitals. The final report on the 'Start Well' programme is expected in early autumn.

Primary Care Access

An update on primary care access was presented, highlighting that GP services constitute over 90% of all NHS activity in NCL. In the past year, GP services in NCL handled over 800,000 appointments, with 50% of targets met on the day. While GP services are returning to pre-pandemic levels, patient satisfaction has declined nationally. The report emphasised the need for adequate recruitment and retention of GPs and consistent funding to meet increasing demand.

Councillor Connor noted the extensive nature of the report and suggested a summary of key points for consideration. Councillor Clarke highlighted the absence of GP Federations in the paper, and Councillor Revah raised concerns about long waiting times for appointments and patient confidence in remote consultations. Councillor Chowdhury echoed these concerns, noting difficulties with online consultation forms and the accessibility of digital channels for all residents.

The committee requested further details on how the ICB is improving patient experience, decreasing waiting times, and ensuring consistency for patients with chronic conditions. They also requested more information on Physicians Associates, supervision, and the pressures on GPs. A communications plan for pharmacies to increase uptake of expanded services and reduce pressure on GPs was suggested, along with research into smartphone access and inclusion for residents without them.

Dental Services

An update on dental services revealed that Dental, Optometry, and Community Pharmacy Services were brought under ICB management in 2023 and have undergone a transformation programme. An additional £600,000 has been allocated to support vulnerable residents, reduce waiting times for children and young people needing specialist care, and invest in preventative work. Patients in acute pain can access urgent appointments via NHS 111, and the ICB is committed to supporting Looked After Children and developing child-friendly dental practices.

Community Dental Services have been instrumental in reducing the number of patients requiring treatment in specialist centres, with only 8% of referrals resulting in hospital treatment. The ICB's primary focus has been on expanding access to Primary Dental Services, increasing activity to 95% of plan. Future work includes improving oral health for patients with long-term conditions like diabetes, piloting the identification of cardiovascular disease through oral health issues, and developing a new paediatric trauma pathway.

Concerns were raised about the inability of the ICB to change national contractual terms for dentists, the financial disincentive for dentists to see NHS patients compared to private patients, and the cost of NHS dentistry for residents. The committee requested more in-depth details on dental treatment for vulnerable groups and agreed that a specific update on this would be provided. They also requested information on the definition of 'exempt' patients, special provisions for those with diabetes, the ICB's view on preventative schemes, and a communications budget to improve accessibility to dental services.

Work Programme and Terms of Reference

Due to time constraints, the discussion on the work programme and terms of reference was deferred to a later date. However, Councillor White raised questions regarding the committee's resources and finance, suggesting that other boroughs could contribute to resourcing. Councillor Ketan Sheth offered to meet with the Chair to discuss best practices in other boroughs. It was agreed that Haringey's Scrutiny Office would form a working group to draft recommendations for new terms of reference.

The committee also agreed to a formal response on the 'Start Well' interim report by 16 August and requested written responses to various questions raised during the discussions on primary care access and dental services. The dates for future meetings were confirmed.