The Health Overview and Scrutiny Committee met to discuss general practice funding, winter planning, wellbeing support for NHS staff, urgent treatment centres and community service procurement. Councillor Oliver Bradshaw was elected Chair of the committee, and Mr Robert Mayall was elected Vice Chair. The committee agreed to note reports on the Carr-Hill formula, the 2024/25 winter plan review, wellbeing support for NHS staff, the urgent treatment centre review update, and the community services procurement and engagement update.

Election of Chair and Vice Chair

Councillor Oliver Bradshaw was elected as Chair of the Health Overview and Scrutiny Committee, and Mr Robert Mayall was elected as Vice Chair.

Declarations of Interest

Mr Alex Ricketts, a public governor of East Kent Hospitals University Trust, declared an interest in agenda items related to the trust.

Carr-Hill Formula and General Practice Funding

The committee discussed the complexities of general practice funding, focusing on the Carr-Hill formula, with a presentation from Dr Caroline Ricard, Medical Director of the Kent Local Medical Committee. The Carr-Hill formula is used to calculate the global sum, a main source of income for general practices. It adjusts funding based on factors like patient age, sex, and additional needs, but it has been criticised for not adequately adjusting for deprivation.

Dr Caroline Ricard explained that the formula, developed in 2002-2003, does not account for the digitisation of records and a greater understanding of the impact of deprivation on population health. She noted that practices in the most deprived areas receive approximately 9.8% less funding than those in the least deprived areas. She also highlighted that the number of GPs has not kept pace with the increasing population in Kent and Medway, with an average of one full-time equivalent GP to 2,702 patients, and even greater in Medway and Swale, where the ratio is 1:3,833.

Dr Ricard noted that general practice represents excellent value for money, with 95% of NHS activity managed in GP practices. She also noted the value of continuity of care with the same GP, which can reduce acute admissions.

Mr Stuart Jeffery described the situation as a damning indictment on 15 years of austerity and suggested that the committee ask the Integrated Care Board (ICB) to report on the Fuller report¹ and its progress across Kent.

Councillor Kim Tanner asked about encouraging more people to choose general practice as a career. Dr Ricard responded that it still offers variety and impact, but practices are facing financial uncertainty, with some ceasing recruitment.

Mr Terry Mole asked why surrounding practices take on clients when a practice closes, even if they are already struggling. Dr Ricard explained that the ICB provides support to ensure patient needs are met. Edward, the Chief Strategy Officer and interim Chief Commissioning Officer at the ICB, added that procuring a new contract is an option, but it depends on the circumstances of the closure and the ability of other practices to take on the patient list.

The committee noted the report.

Winter Plan Review 2024/25

The committee reviewed the 2024/25 winter plan, presented by Mr Waller and Natalie Davies, Chief of Staff at the ICB. The plan prepares the NHS and wider system in Kent and Medway for increased demand during winter, focusing on avoiding A&E arrivals, managing hospital operations, and ensuring timely discharge for patients.

Mr Waller reported that NHS Kent and Medway's performance was relatively strong on many measures, but that more people waited more than 12 hours in ED departments than was desirable.

Mr Stuart Jeffery asked about the approach to discharge to assess². Mr Waller confirmed that the system is still in operation, with the assessment taking place outside hospitals to speed up the process. He noted that there are challenges in social care and discharge pathways, which are common across England. He also noted the need for health and social care teams to work together in a more integrated way.

The committee noted the report.

Wellbeing Support for NHS Staff During and After Covid

The committee reviewed a written briefing on wellbeing support for NHS staff during and after the COVID-19 pandemic. Mr Alex Ricketts raised concerns about the long-term implications of COVID-19 on NHS staff and how to reduce NHS sickness, referencing the NHS 10-year plan.

The sickness rates in the NHS nationally have fallen since COVID-19, but there are vast differences between hospital trusts. The current sickness rate across the system is 4.6%, which benchmarks relatively well nationally.

Mr R.G. Streetfield, former incident commander for NHS in Kent, expressed concern that the report read like a military report, saying that there was support available if people needed it, but that a more proactive approach was needed to identify those who were likely to have difficulty down the line.

The committee noted the report.

Urgent Treatment Centre Review Update

The committee received an update on the review of urgent treatment centres (UTCs) in Kent and Medway, presented by Mr Waller. The review aims to provide a consistent urgent treatment offering, reduce variation in access and outcomes, support the reduction of emergency department attendances for minor conditions, and deliver effective services to drive value for money.

Mr Waller explained that the review is looking at the provision of UTC capacity in the four parts of Kent and Medway: East Kent, West Kent, Medway and Swale, and North Kent. He noted that one of the things that they are looking at is whether the UTCs, which are co-located next to emergency departments on acute sites, should increase their hours of operation. He also noted that they are looking at the future of minor injuries units and whether they should bring those up to the same specification as the urgent treatment centre specification.

Mr Stuart Jeffery expressed frustration that the work had not moved on since he started it in 2019. He asked when the model would be completed, how much weight was being put on the combination of out-of-hours services with UTCs, and whether the model would include a front-door nurse to direct people who walk up without contacting 111 first.

Mr Waller responded that they were hoping to conclude the review at the beginning of next calendar year, and that they were thinking about the interaction between GP out of hours services and walk-ins as part of the provision.

Dr Caroline Ricard asked about the integration of GP out of hours services with the UTCs and the plan to incorporate this activity into the NHS 111 services as part of the clinical assessment platform. Mr Waller responded that the intention was to streamline things such that people undergo a single triage process.

Mr Alex Ricketts asked whether there was a need for more physical infrastructure and more individual places to provide the need, particularly with the shift into more local care in the future. Mr Waller responded that there was a need to improve the existing infrastructure, but that the general constraint was the amount of capital funding available to the NHS.

The committee noted the report.

Community Services Procurement and Engagement Update

The committee received an update on the community services procurement and engagement, presented by Mr Waller and Ms Natalie Davies. The report provided an update on the Kent and Medway Integrated Care Board (KMICB) Community Services procurement.

The committee noted that the contract sign-off was on hold, subject to NHS England approval.

Mr John Baker asked what improvements would be seen once the contract was signed off. Mr Waller responded that the new provider would be asked to provide a plan for improvements, which would then attract funding for implementation. Ms Davies added that a lot of that would be built up with the patients and service users as well.

The committee noted the report.

Work Programme

The committee discussed the work programme for the next meeting on 9 October, which will include items on the Maidstone and Tunbridge Wells NHS Trust, Fordcombe Hospital, and the Kent and Medway Prosthetics Service.

Mr Alex Ricketts noted that the meeting that was scheduled in June and that every item on the agenda today was requested by members of a previous committee. He said that the committee was way behind and that the next agenda should be looking at the issues that are current and moving into the future, including the NHS 10-year plan.

Mr R.G. Streetfield emailed the operational pressure plan from adult social care in November 2024 and endorsed Mr Ricketts' view that winter pressures was something that needed to be discussed.