Rebecca Champion, Engagement Manager for North Norfolk Clinical Commissioning Group and Christine Walton

Rebecca Champion, Engagement Manager for North Norfolk Clinical Commissioning Group and Christine Walton

Our Group was delighted to welcome back both Rebecca and Christine on 25th June particularly to learn more of the CCG’s progress over the last year.

For those new to the CCG’s work Rebecca summarised their challenges in North Norfolk and adjacent rural Broadland with its combined 168,000 population and 19 GP Practices that are spread over this vast rural area, which also has the oldest demographic profile of any CCG. The current year (15/16) financial allocation for this area is £225,922,000, which works out at £1345 per person, but this year the worsened financial health of the NHS requires £14 million to be saved by our CCG. To achieve this saving whilst continuing to improve services will require some considerable restructuring of services.

From our CCG’s overall budget some 51% currently goes to Acute Care (mainly the N&NUH) with 16% allocated to Primary Care and 14% to Community Care with some 2% covering running costs. The CCG’s role in this includes strategic planning and ensuring consistency of services through yearly contract negotiation set against careful yearly planning for activities. The CCG decisions are project-based and take account of past performance with the aim of solving rather than passing on problems whilst also avoiding any destabilisation of services to ensure local health is protected.

Rebecca also outlined the work of the new Community Engagement Panel that involves representatives from area interest groups, such as our own DUK Group, who meet regularly with CCG representatives to ensure two-way communication on changes and problems. The intention is for representatives to feed back information on CCG activities to their members whilst advising the CCG of any issues they raise.

Diabetes care is currently under review, using a process known by the acronym QIPP (Quality, Innovation, Productivity & Prevention) which essentially focuses on what we have now, identifies any gaps and then seeks to get the best value from these services. Self-care is a vitally important aspect of diabetes management of which, self-help, peer support, and accessing services including technology are under consideration. Currently this review is at the scoping stage, that is gathering information from practice staff and patients with some of the highlighted issues being; on-going diabetes care needs, healthy eating advice and mental well being.

Discussion At this point several members raised the issue of the very poor diabetes care experienced when admitted to the N&NUH for operations, and the lack of any co-ordinated supporting contact from diabetes specialist nurses in the Elsie Bertram Centre. It was felt that there was a need for a more responsive system of care. Rebecca said she would bring this concern to the CCG’s attention.

Christine Walton, North Norfolk Prescribing Advisor, NEL Commissioning Support Unit

Christine’s talk focussed on the huge savings that could be achieved by reducing the high wastage of prescribed medicines. Of nationally wasted medicines that cannot be re-issued and have to be sent for disposal, pharmacies receive about £300 million of returned drugs, with around £90 million of unused prescriptions stored in homes and some £50 million’s worth disposed of by Care Homes.

Medicine waste occurs in many ways, one is where the patient does not take the prescribed medicine because it upsets them but is hesitant to tell their doctor and the prescription is repeated. Another occurred where the now restricted 3-monthly repeat prescriptions were issued. It was also found that Care Workers generally did not check to ensure patients were using and not just storing their medicines. Similarly care homes are being better guided on the shelf life of medicines as many were being routinely disposed of before their expiry date. Returns for disposal are also now being monitored.

There is an intention now to encourage pharmacists to ask patients about their taking of prescribed medicines and there are medicine reviews being undertaken in both community pharmacies and GP practices. To highlight the need, last February waste medicines sent for disposal in Norfolk amounted to 13.2 tons with an annual cost of some £4.9 million. Thus for patients their priorities must be to: check before you order, order only what you need, and ask GPs and Pharmacies for advice.

The Group expressed their grateful thanks to Rebecca and Christine for taking the time from their demanding working lives to explain how our essential medical services are determined and delivered.