BPV and Commissioning Intentions for 2016/17

On 5 October 2015 Brent CCG published on its website a 66-page document setting out draft plans for funding healthcare for Brent residents in 2016/17. In the jargon this is called “Commissioning Intentions”. You can find the full text on the Brent CCG website. The public are invited to comment.

To help those who attended the Health Partners Forum (public event) yesterday 7th October BPV prepared a set of questions on each of the 8 topics to be presented. These were our questions:

BPV briefing for Health Partners Forum 7th October 2015

Commissioning Intentions 2016/17 consultation event 

Suggested questions for the 8 topics for which table discussions are being arranged (NB. These do not cover all topics in the main Commissioning Intentions document of 05.10.15)

Urgent care

Where is the survey evidence to indicate that significant numbers of patients are wrongly referring themselves to A&E or that the problem is getting worse?

Why is there a diagram indicating that under the Current System patients can only refer themselves to A&E via an Urgent Care Centre?

What is the proposed timescale for designing, finding premises for and setting up the proposed “Primary Care Centres” or Hubs, staffed by multi-disciplinary teams? Are these polyclinics by another name? How many will there be?

What justification can there be for suggesting that A&Es are for life threatening emergencies only? Surely most fractures, facial, head or eye injuries, and saddle paresthesia are examples of cases where A&E attendance is fully justified?

Primary care

Where is the JSNA evidence relating to the relative performance of GP practices in Brent?

Are patients complaining that practices are of different size and that this restricts their treatment?

What evidence is there to suggest that larger practices or providing services via Networks of GPs will improve the quality of care?

Why is it necessary to wait until April 2016 to review the working of the GP Access Hubs when attendance and satisfaction data are available now on a monthly basis?

Why does this section ignore the fact that what patients want most of all is ready access to a face to face appointment with a GP they know and trust?


Community care/long term conditions

Is not the title here misconceived, since patients with long term conditions need a mix of secondary care and community/primary care? Is there an implication that hospital consultants and GPs can be extracted from the care package?

What is meant by the “success of the new services for diabetes and CHD patients”? Is the CCG not aware of the major shortcomings of the Royal Free Community Cardiology clinics in Brent?

What is the incidence of Parkinson’s in Brent? Does “nurse-led” mean that no doctors are involved?

What is wrong with the existing community respiratory service?


Planned care

Can the DXS referrals optimisation system be explained? Is this obtained from a commercial provider? How does it differ from the Referrals Facilitation Service Processes V4 software provided by the US Minnesota United Healthcare corporation through Harness GP co-operative discontinued by Brent CCG in 2014 at a cost of about £350,000?

Now that the proposal is to jointly design clinical care pathways in collaboration between the CCG’s clinical directors and hospital consultants does this mean that the 2012 Planned Care Business Case for a further 11 specialist community services commissioned out of hospital has been abandoned by Brent CCG?

Please explain the ways in which the Brent Community Cardiology Service provided by the Royal Free Trust is at present not being delivered up to full contract specification. How many patients are currently waiting more than the contract 14 days for urgent cases and 28 days for non-urgent cases?

Brent CCG at the Governing Body meeting on 2 September 2015 expressed concern that the Ophthalmology Community service provided by BMI Healthcare Limited has been ‘over-performing’. Does this mean that it has been seeing too many patients or carrying out more procedures that anticipated for the contract so that it is costing the CCG more than planned? Please explain the extent of this over-performance and what it means for patients.


Mental Health

How does the CCG make appropriate impact assessments on its MH policy for black and ethnic minority patients and how have they been factored in?

Why are chronic mental health conditions treated differently from chronic physical health conditions? In the case of chronic patients (who require medication and long term management) is it sensible to put the onus on them to stabilise themselves and to self care, when this may reinforce a sense of failure, anxiety and social isolation? If a care plan is not put in place how can the patient access the system or secure monitoring and change in medication if discharged from the service?

Do the plans recognise that you need the care in the community to be in place and clearly signposted and actually accessible to and trusted by patients before you change a care setting? How will the CCG/providers monitor patients in the community, bearing in mind that not all have support of family or friends? Are there undue pressures on patients to discharge themselves from continuing care?

Is Belvedere House Day Hospital in Harlesden being closed?

Learning disabilities

How are local arrangements for advocacy proposed to be updated?

In relation to integrated care planning and joint commissioning with Brent, what is the current statutory division of responsibilities between the CCG and Brent?

What is meant by a self supported assessment and support plan?

Who will carry out the proposed annual health checks for people with learning disabilities?

Has any equalities assessment been made to see whether people with learning disabilities find it difficult to access general healthcare facilities?

Children’s services

What is being done to meet current needs of the five categories of children mentioned while long term unified CAMHS and commissioning arrangements are designed?

How long are children waiting for counselling and SEN assessments?

Why is it desirable to devise an approach covering all NW London CCGs?

Are there currently any personal health budgets for children in the categories identified?

What action is being taken, presumably via the Health and Wellbeing Board, to improve children’s dental health?



Can this whole area be clarified to indicate that it refers to measures which are being devised to help “people with complex or long-term conditions who need joined-up support”?

Why is there no reference to the pilot projects for Whole Systems Integrated Care Phase 2 (WSIC2) which are currently being set up with 1,200 patients over 65 with one or more long term conditions who are registered with 10 selected practices in the Kilburn and Harness Localities?

Are members of the multi-disciplinary teams who are to provide joined-up support for these vulnerable patients going to have access to their medical records and if so will patient consent be obtained?

Why cannot the STARRS scheme, which aims to prevent unnecessary hospitalisation and facilitate early discharge, be expanded as an alternative to the expensive and bureaucratic approach of WSIC phases 1 and 2?


To follow up please contact info@bpv.org.uk . 7th October 2015

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