Windsor Ascot & Patient Networking Group Meeting

Thursday 17 October 2019

MINUTES Item Action In Attendance: Barbara Gallagher BG Nisha Duggal - CCG ND Sandy Slattely – Claremont & SS Peter Slattely – Claremont & Holyport PS Duncan Johnston – Cedars DJ John Harvey - Claremont & Holyport JH Amanda Button – Claremont & Holyport AB Judith Littlewood – Claremont & Holyport JL Mary Lou Kellaway - Cookham MK Sue Williams – Rosemead Surgery SW George Notley – Runnymede GN Stephen Isaia – Ascot Medical Centre SI Sue Williams – Rosemead Surgery SW

Apologies: Michael Shefras David Pugh David De Bromhead - Claremont & Holyport Audrey Cutting Anne Hackett Sarah - Runnymede Sharon Crossley – Redwood House Audrey Ward - Cookham Graham Pedersen - Cedars 1 Welcome, Apologies and Introductions ND welcomed everyone to the meeting. ND informed the group MS was unable to attend the meeting, and therefore ND will be chairing the meeting. 1.1 The group sent best wishes to MS. 2 Actions from Last Meeting All actions from last meeting were complete WAM Lay member for patient and public involvement 3. Barbara Gallagher was introduced as the new WAM Lay Member for Patient and Public Involvement. BG presented about her role, responsibilities and future plans. SI asked how many hours a month will BG work for the CCG? BG said her contract is for 15 hours per month. SI commented BG’s predecessor Robert struggled with hours. BG said she will have regular liaison with her line manager to manage tasks between her and CCG.

Integrated Care Decision Making Across the Frimley Integrated Care 4 System Dee Parker (Senior Project Manager) and Jenny Plummer (Community Integration Manager Windsor and Maidenhead). Different organisations need to work together to give people the best chance to stay healthy. People are getting older and we need to normalise getting older in the community. To do this care has to be very well co-ordinated and suited to each individual need. Frimley Health and Care Integrated Care System (which includes East CCG, North East Hants and Farnham CCG and Surrey Heath CCG) is one of 5 of the most established by NHS . Primary Care Networks (PCNs) are new this year and aligns to the Long Term Plan. PCNs are responsible for GP practices to deliver comprehensive model of integrated care and in a co-ordinated way. Integrated Care Decision Making (ICDM) is about delivering an integrated model and key to this is how decisions are made. The ICDM work stream underpins the ethos of the ICS system. Integrated Care Decision Making enables people to benefit from continuity of care that is person-centred and well-co-ordinated across local health and social care services. Integrated Care Decision Making is built upon 5 pillars:

1. Anticipatory Care Planning – GPs identifying patients who may have a

need earlier so they don’t end up in hospital. Anticipating future needs and intervene earlier in an integrated way. 2. Locality Access Points – A point where there will be people from different areas – social care, mental health, GP, community nurses etc – in the same room looking at an individual’s needs and assess jointly. 3. Co-located community teams – teams that deliver care siting together in the community 4. MDT Cluster teams: People with complex needs are directed to clusters. Clusters will agree integrated action plans that are shared with people who are important to you. 5. Hospital in-reach approach – good communication between the community and the hospital. Support people who have been admitted to hospital by proactively working to get them back home.

5 Open Discussion SI: How does PCN fit with CCG? DP the CCG role is changing – will commission but PCNs are responsible for health and care of patients. PCNs will dictate what is required for their population. CCG will work closely with PCNs to make sure commissioning choices and plans are joined up. SI – are we better being associated with PCNs or with the CCG? DP: PCNs wider network with opportunity to reach social service user groups, voluntary sector for that population. SI said in Ascot PCN the 4 PPGs are being asked to create a network. DP said some networks still new and finding feet. Integrated care – aligning with PCNs and their residents GN: Who controls the money ultimately? DP: Different pots of money, biggest amount allocated to primary care. CCG supporting the PCNs. JL: Money gets in the way of working together – no-one willing to give up their share of money. DP: The long-term plan is not a quick fix and needs to be sustained. Plan is to gradually integrate budgets. DP: Ambition is to co-ordinate plans in East Berkshire, across the ICS and nationally – overview of plans, make sure they’re integrated SS: Knows an MS patient and they can’t talk to council about the support they need – how can people get into the Integrated Care system? DP: A person with complex needs is referred into Integrated Care. SS: This individual doesn’t see GP. DP: Ambition for this work stream is that members of public will be able to refer someone into Integrated Care. GN: The Integrated Care team is made up of multiple disciplines. How many people are involved in setting up this Integrated Care Decision Making for Maidenhead and what’s the budget? It’s nice to hear but want more facts about timescale and how many people involved. DP: It’s a gradual process; some people have left big organisations to join local team. Supported by Better Care Fund (BCF). Money set aside to support the next step in Integrated Care. Identifying need and making case to BCF board who hold budget. Want more money into community based care over time. JP added- it’s not about where money comes from, it’s more about integration and about coordinating services and sharing care. QS: Do patients attend the Locality Access Points? JP: no, but the patient has given consent for discussion to take place and they will receive the feedback. QS: What if the patient is a child? JP: This programme is only for adults. A new work stream has been launched for children and young people. QS: there is always lots of talk about when things happen but what about preventative care? How to break out of firefighting? JP: anticipatory care identifies patients before they come to the GP with a problem. Currently focussing on people likely to be in need in the next few years but hope is to broaden.

6 Has this meeting worked Everyone agreed that the meeting had been informative.

7 Agenda Items for Next/Future Meeting • Compile list of things GPs have to do – lack of confidence among PPG members about what they can ask GPs to get involved with • Getting patients interested in practice and own health • Virtual PPG/email list that complies with GDPR MS/ND/BG

7 Any other business and dates of next meeting

Date of next meeting: 16 January 2020