Meeting with WHHT at HHGH on Wednesday 30 August 2006 
	
Hi all

Meena and I attended a meeting at HHGH with WHHT and PCT members to discuss the provision of Urgent Care in line with the Financial recovery plan. 
Sam Marchon, Howard Borkett-Jones and Rafat Farag were present as well. 
Obviously the Acute trust see the Urgent care centre as a threat to their income and many avenues were discussed to prevent them "suffering".

The Service Level Agreement (SLA) is set at 52,140 A&E attendances and we are charged with NOT EXCEEDING THAT LEVEL rather than having to make huge reductions in attendances which will compromise the Acute trusts budgets. We also need to try and reduce the non elective activity by 1800 spells.

Having originally been told that we had to set up the Urgent Care Centre for a Go-live date of 1st October 2006, Meena and I were relieved to hear that the Acute Trust cannot work to that date and suggest a start date of April 2007 or possibly October 2007. Both Meena and I felt that October start date was unworkable anyway. The downside of this is that allegedly we have agreed in our business plan to make savings of £499,000 by April 2007 and Christine O'Connor was implying that if we did not, this would be taken from our budget of next financial year. This is not what I had expected - I thought that we had agreed to work WITH the PCT TOWARDS achieving the FRP. Now they are threatening budgetary cuts.
  
Essentially we still have to find a way to reduce emergency admissions and Unscheduled Care Admissions (Frequent Flyers). Pat Reid, Head Nurse(!) mentioned that the majority of costs actually comes from admissions from Nursing and Residential Homes with inadequate care provision in the community for dementia and "end of life / palliative" care, which subsequently blocks beds and costs lots. Further discussions are needed on ways to reduce theses admissions and an improved "end of life" care service was suggested. 

Christine O'Connor mentioned that she could not continue paying twice for the provision of Urgent care in Hours (ie GPs access money and PbR at A&E). Howard Borkett-Jones suggested that GPs should work in an Urgent Care centre or ELSE HAVE THEIR ACCESS MONEY CUT to pay for the service we are allegedly not providing and should be. It was felt that the Urgent Care Centre should be funded from Primary Care. Christine also mentioned putting this UCC out to tender and that the Acute trust would be able to bid for the provision of this service - More cuts from Primary care if we do not watch out. After the meeting she implied that she actually wants us to get our act together and provide this service so I do not know which side she is really supporting. 

She also mentioned that the new Chief Exec Anne Walker(?) allegedly thinks that all local Gps are "incompetent fools" and that no work on the FRP has been done so far - watch out!

The £300,000 set up / management money set aside for the UCC apparently was to be funded from savings so it is not possible to subtract it from the £499,000 target in the FRP. 

In essence we, as GPs, will be expected to be part of this service probably to 8pm either at a centralised UCC or extended practice hours or we will lose money. 

There is an Unscheduled Care Meeting with all the players, venue to be decided (but probably HHGH) on Monday 25th September 2006 2.30pm - 4.30pm. 

Dr Jeremy Cohen
30.08.06