Agenda item

To receive updates relating to Health in Melksham from the following speakers:

·       Health Provision in Melksham

·       Spa Medical Centre – Roland Teare GP

·       Giffords Surgery – Dr Abby Burgess

To receive an update on the new Family Hub Model from Carl Houghton (Spurgeons).

To receive an update from the Melksham Health & Wellbeing Group.

As councillor representative for the priority of Older People; Health and Wellbeing, Cllr Jack Oatley introduced this item as well as the respective speakers.

Emma Higgins (Associate Director – Wiltshire Integrated Care Alliance Programme and Delivery Lead NHS Bath and Northeast Somerset, Swindon and Wiltshire Integrated Care Board) provided a presentation (attached to the minutes) on health provision in Melksham, which covered the following points:

·         An overview of the demographic and GP practices included within the Primary Care Network (PCN) and its respective catchment areas was provided.

·         Details of the PCN estate of Bradford on Avon and Melksham was covered, with it noted that there were three main GP premises and 2 branch sites. It was noted that the estate would need to support the expected demand from the increase in population from housing growth by 2032.

·         The Primary Care Network Workforce currently employs 28 staff recruited through the Additional Roles Reimbursement Scheme, with a strong emphasis on personalised care roles which support the living well and frailty teams.

·         Details of the community pharmacies in Melksham were provided, with it noted that the ICB has now began to commission services such as dentistry at a local level.

·         Details were provided as to how the Melksham population was accessing NHS dentistry, with children accessing NHS dental care at a higher proportion than the rest of Wiltshire and Nationally.

·         An overview of the BSW Connect Service was provided, which would go live on 1 July 2024 and would be aimed to support individuals who have needed to use emergency services multiple times over the last five years.

·         It was noted that the Wiltshire average time to discharge from Acute Trusts had reduced, with further work taking place to continue to support this process.

·         An update was provided on Learning Disability and Autism, with work being completed across Melksham including screening practitioner work to ensure that individuals are receiving physical care.

·         Melksham has a higher compliance rate than the Wiltshire average for Severe Mental Illness Annual Health Checks (SMI AHC.

·         It was noted that a new service named NHS 111-2 had gone live and would provide a pathway for urgent and emergency mental health care.

·         An overview of the Melksham and Bradford on Avon Collaborative was provided, which had been set up in early 2023 as a “Pathfinder” test and learn site to provide insights for future collaboratives.

·         Objectives for the Collaborative were outlined as well as how some of these had been achieved, in particular a piece of work which involved a group of people who experienced significant falls.

·         The next steps for the Collaborative were outlined as well as reflections on the work so far.

After the presentations, there was time for the following questions to be received:

·         A question was asked regarding how the NHS planned to deliver services in the community and what plans there were for Melksham Hospital and the surrounding land. A response was provided that currently the NHS is working through a strategic and then clinical plan, in which the estates plan would follow on from.

·         A point was raised that currently in Melksham there was some nurse’s accommodation, which 16 years ago were in working order, but have now been left to degrade, it was questioned why these weren’t being used when there was homelessness in Wiltshire. In response it was stated that these were likely to be owned by an organisation called NHS Property Services, however this organisation did not own or control all NHS property and it was unclear whether these properties were under NHS control. It was agreed that this point would be taken away for a further response, to which the following was provided the buildings are two former houses at the entrance to the hospital site. They are not used for storage but are boarded up and dilapidated. Additionally, the ICB have no plans for these houses yet but they are being held as any changes to the site are likely to require improved road access provision and therefore the houses are being held until the future needs of the NHS are understood and any future plans for the hospital site in relation to the delivery of services.

·         A query was raised regarding what someone would have to do to get onto the NHS dental waiting list. It was recommended that people could visit the following website, which would provide a list of NHS dentists locally and their waiting lists: How to find an NHS dentist - NHS (www.nhs.uk). In addition, individuals could contact individual practices to ask if their list was open or could also contact 111 for emergencies.

·         In Melksham 1,000 homes had been built with Section 106 funding agreed, it was therefore wondered what the plan was for where this money would go and to who it would benefit? It was agreed that this would be taken away and investigated for a response to which it was later clarified that the section 106 funding is available but is yet to be drawn down. When it is, it will support developments across primary care in line with the developing estates strategy and plans for Melksham following confirmation of what and where the need is.

·         Clarity was provided on the 111-2 service, which had launched following a national campaign on social media channels. It was expressed that the ICB would like to use local community media pages more to communicate through already active channels.

·         It was also suggested that should people struggle with the 111-2 number, if this number was to be input wrong, people would still get through and be redirected to 111. Concern was also raised around people accidentally calling 999 in an attempt to reach this service. A further response was provided to this that, service users are actually being directed to call 111 then selection option 2 – therefore Service users will hear the following when they ring 111 (and after pressing 9 to continue):

o   if your call is about physical health press 1,  

o   if you are in mental health crisis press 2,    

o   if you are a health care professional or lab technician press 3.

It’s on the press 2 that they will be asked the question again to double check they have selected the right pathway before being transferred to AWP. This then minimises the risk around the police being called (112 is the ‘non urgent’ police line)

·         The difficulty of being able to access services in Melksham and Bradford on Avon without the use of a car was raised, to which it was stated that there was an awareness that across Wiltshire, transport was an issue and that any collaborative work would need to ensure that it was accessible for the community.

·         A point was raised that recently in Melksham two 70 bed care homes had received planning permission with another pending and that the GP practices had stated that in 2022, in of support of an application to amend a S106 agreement at Verbena court, that the surgeries in Melksham had enough capacity to meet population needs for the next 5 years. In response, clarity was provided that Giffords Surgery had enough capacity to absorb such a population expansion and that any increase would also bring extra funding.

·         The recruitment of GPs was discussed, with it stated that there were no concerns for recruitment currently and that locally a resilient structure had been built.

Roland Teare GP, provided an update on behalf of Spa Medical Centre, which covered the following points:

·         Roland was a GP Surgeon who had been working in Melksham for 10 years.

·         Recently things had changed, with the parameters of the Primary Care Network (PCN) changing to join up Spa Medical Centre with Bradford on Avon Surgery and Giffords Surgery. This change has had both positive and negative aspects, such as working collaboratively however there has also been geographical impacts.

·         An example of a challenge experienced by the PCN was that during lockdown, very few Covid Vaccines had been delivered to Bradford on Avon, meaning that the rollout took place for both sets of patients at Spencer’s Club in Melksham.

·         Housing is currently being built in Melksham with patient numbers expected to rise, however it could be argued that in PCNs, money follows the patients. For example, the three proposed new care homes in Melksham would attract more funding for the increased patients and would require further staff recruitment.

·         There has been changes within Spa with Senior GPs retiring and the surgery has started to employ other health care professionals as not all patients require the attention of a GP.

·         In January an E-Consult online system was brought in to take away waiting times on the phone, with it stated that this had to be turned off last week due to circumstances.

Dr Abby Burgess provided an update on behalf of Giffords Surgery which covered the following points:

·         Abby was a Senior Partner at Giffords Surgery and had worked there for 13 years.

·         The Surgery currently had 61 staff, however there had been Doctor challenges with two currently off on maternity leave. These roles were being covered and a current trainee was set to be taken on as a Doctor in August. In addition, the Partnership had recently expanded and consisted of young individuals for resilience and succession planning.

·         A Friends of Giffords charity had recently been set up with an uptake of 40 people, which would enable the surgery to link up with the third sector in a better way.

·         The E-Consult system has changed the way which Giffords has operated and has improved getting patients to the right service, though it was still possible to come into the Surgery to book appointments or via phone.

·         It was hoped regarding the building lease that the building could be developed for more space which could be recruited into.

·         Difficulties such as some of the team having long term sickness leave and the impact of contracts with inflation was cited.

·         Difficult decisions were being made regarding services which were not proving to be profitable.

After the presentations, there was time for the following questions to be received:

·         When the E-Consult online system had been launched there had been very good comms, however when the system was turned off last week, this had not been communicated as well and had led to confused patients. Clarity was provided that the system had to be turned off due to a shortage in doctors, meaning that there had not been enough staff to run the system. It was acknowledged that when launched there had been comms and that when the urgent decision had been taken to turn off the system this had only been communicated by a phone message and that it was appreciated that this could have been done better. It was expressed that if comms had been sent out regarding the system being turned on and off, this might have caused further confusion.

·         It was stated that a relative of a member of the public had recently called Giffords Surgery, however the Doctor who answered ended the call and informed the caller that they would have to make another appointment to continue, which had happened twice. In response, the member of the public was encouraged to email the surgery to contact the complaints lead as this is not something which would be expected. Assurance was also provided that the system in place would allow for patients with complex needs to have longer time slots and was flexible.

·         A question was asked regarding if additional facilities were to be built, whether this would have to be in Holt, to which it was stated that any changes to the investment of estates would have to be considered from a PCN level. Currently Bradford on Avon was judged to have a higher level of need than Melksham, therefore any development likely to happen would be there. Further clarity was provided that to have its own PCN, Melksham would have to have 30,000 patients.

Carl Houghton (Spurgeons), provided an update on the new Family Hub Model, which covered the following points:

·         Carl provided an overview of his role as a Family Navigator for the new Family Hubs which had been set up in April to support children 0-19 and from 0-25 with SEND.

·         Flagship hubs had been set up in County Hall, Bourne Hill and Five Rivers, with an Admin Navigator based in each for support.

·         The team had also branched out to the Community Campus and Library to speak to families and to try and support them in the best way possible.

·         The team consisted of Family Practitioners who would provide a deeper level of support in the home and Navigators who would provide support with everyday tasks such as filling out forms and signposting to agencies.

·         The main mission of the model was to get out into communities to build a link with families and build stronger communities by bridging gaps with agencies.

Cllr Oatley provided an update from the Melksham Health & Wellbeing Group, which included the following points, but was not limited to:

·         The full updated would be provided to Democratic Services to be attached to the minutes.

·         The Health and Wellbeing Group is a sub-group of the Area Board and brings together partners to share information and support older and vulnerable people within the neighbourhood. The sub-group is not a decision-making body but is able to comment on funding bids.

·         The most recent meeting of the group took place last week, which was Mental Health Week.

·         In February, the group looked at the CJSNA data and decided that mental health would be a focus for this year. As a result, the group is looking to set up an Andy’s Man Club which is a recognised mental health support group as well as looking at funding mental health first aid training for groups in Melksham.

·         The group has also worked closely with other partners and organisations with Community Support 2.0, this has included providing drop-in sessions, providing slow cookers, and ensuring that the foodbank receives regular funding.

·         The grant funding pot for the year would be £7,500 which could be awarded to applicants to support the older and vulnerable.

·         Cllr Oatley thanked those involved with the group and stated how it had been an honour to chair the group over the past year.