Minutes of meeting re Urgent Care at PCT, Watford
Friday 20 October 2006 13.00

Present : Dr J Cohen, Mark Jones, Dee Boardman, Jackie Collett, Toni Legatt

Apologies: Lynn Dalton

JC lead initial discussions around the TPP system one which looks to be a viable proposition for UC service. The PCT have as yet been unable to cost out the MIU model as per SACH.

However a rather large spanner was thrown into the works. Informed by PCT that plan “from above” is to have a “Hertfordshire wide Urgent Care Service” which will definitely be put out to APMS tender. This apparently has something to do with the paper from the DoH regarding the overall strategic view of delivery of Urgent Care, but now they will be looking for an In Hours AND Out of Hours Package. We will have the opportunity of drafting a service specification for the local area though within this overall service. In other words, no matter what we suggest, the plan is already there and will go ahead. I despair! They have also suggested working with Watcom, and StaDoc to get a tender ready to be a provider. What is our role?

Terms bandied about liberally included “Economies of Scale” and “Critical Mass” not to mention “Political Agenda”. PASA (The government Procurement Agency) has decreed that it shall be done this way and who are we to argue?

I asked about the budget available to set up the local service and was told that “there is no budget” until April 07 at least and after that it is not certain. What is required now is for all Local GPs to reduce A&E attendances to keep under the SLA target with no extra funding available for increased practice workload.  A&E attendances in hours at least seem to be related to distance from HHGH but one also has to question the access at the “worst offending practices”. It is obvious that we need to disincentivise A&E attendances rather than promote GP attendance but we first need to find out why people attend A&E in preference to their practice. PCT will do Audit / Survey in A&E in hours. It would also be useful for Practices to look at whatever data is obtained from A&E discharge summaries to see if the attendance was actually appropriate.

I also asked about who has the responsibility for the actual MIU if it goes ahead. It appears that that depends on who provides the service as it will probably be the provider’s responsibility. Again there is no funding for this at present. 

Overall I am extremely unhappy about the current state of affairs. From being told we would have a £300,000 budget to set up an In Hours local service in October 2006, we have now moved to a Hertfordshire wide Urgent Care model comprising In Hours and Out of Hours which will be put out to APMS tender. We have no defined budget and are being threatened with budgetary deficits next year if we exceed the SLA and do not make savings in line with the FRP and our business plan. Again I have to question whether we are commissioners, providers or just pawns in a larger game. We don’t seem to have a clearly defined role. 

ACTIONS ARISING

•	PCT to cost out MIU option as per MIU at SACH (outstanding at present)
•	PCT to undertake survey / audit of A&E attendances from Patients in A&E waiting area.
•	Practices to look at A&E summaries to determine if attendance was appropriate.

Next Meeting : Friday 3rd November 2006 at 13.30 at PCT, Watford. 

Jeremy Cohen
20.10.2006