Agenda item

This report informs Members about a proposed change to the current delivery of the Personal Medical Service (PMS) Homeless Service in York.

Members received a report which provided them with information about a proposed change to the delivery of the Personal Medical Service (PMS) Homeless Service in York.

The Medical Director and Director of Primary Care Services and the Head of Primary Care Governance from NHS North Yorkshire and York attended the meeting along with the Chief Executive of the Vale of York Clinical Commissioning Group to answer Members’ questions.

The Chair allowed for Councillor Jeffries who attended the meeting to make comments in relation to the report, specifically on the role that Equality Impact Assessments (EIA) had played in the proposals. She asked that if no negative impacts had been found on Equalities what were the reasons for carrying out the assessments, and if these were only looking at negative impacts.

It was reported that EIA’s had been carried out in order to examine if there was another way to provide the service. Negative impacts had been closely looked at in order to identify where these might exist and what action could be taken to mitigate this.

Members were informed about the current status of the PMS Homeless Service and the changes that were proposed, in that there would be a primary element to the service to be provided by GP surgeries and a secondary element which would be the responsibility of the Vale of York Clinical Commissioning Group (VOYCC).

It was noted that the recent Joint Strategic Needs Assessment (JSNA) had highlighted that the Traveller community did not regularly use GP practices and that community nurses visited them. In response, it was suggested that future commissioning of services in GP surgeries needed to be flexible, for instance through the input of mental health and drugs service advocacy teams. However, the size of some practices restricted the maintenance and use of specialists in these areas, and that it was often felt to be more practical to have them in bigger practices.

It was underlined that the Traveller community should not be viewed as an homogenous group and that they might have distinct needs from other patients that might not be picked up. It was therefore crucial to engage Travellers themselves and that this be met specifically through the proposed changes.

Some Members asked the representatives from NHS North Yorkshire and York and the Vale of York Clinical Commissioning Group what was meant by the shortfalls in the service in regards to the resilience of its delivery. It was noted that there was a restricted number of staff and for example if the practice nurse was absent, then the patient would not be able to get an appointment. Further to this, back up from voluntary services would not be available as they were not trained to fulfil this role.

Further questions from Members related to a number of issues including;

·        What training would the VOYCC offer to deal with patients who turned up intermittently and who needed longer appointments?

·        How services would diversify to include specific groups and yet remain focused?

·        How mental health services would link in with those people who had originally been engaged within Sure Start centres?

In relation to the question of diversity, Members were informed that the areas where patients came from had been identified and that GP practices had been encouraged to commission services in areas where there was a preponderance of particular problems. It was also reported that the commissioning of a Health Visitor in practices would continue in order to take care of those who had been seen in Sure Start centres.

Members raised further concerns about how they felt that housing and homelessness issues would become more significant in York. They also asked about the timeframe in which the formal transition from the PMS to GPs practices would take place. It was reported that it was hoped that expressions of interest to provide the services would be received from GP practices over the summer. Members asked to receive an update on the progress of the transition at a future meeting in autumn.

RESOLVED:       (i)      That the report be noted.

(ii)      That a further update report on the transition of the PMS services be received by the Committee in the Autumn.

REASON:                     In order to keep the Committee informed of the changes in services for Homeless Patients in York.