CCG - Mental Health GP Services closure
- Meeting of Health and Adult Social Care Policy and Scrutiny Committee, Tuesday, 17 December 2019 5.30 pm (Item 48.)
Members will receive a report which provides an explanation of the circumstances regarding the set up and eventual closure of the Primary Care Mental Health team service.
Cllr Melly left the meeting area for consideration of this item.
Members received a report which provided an explanation of the circumstances regarding the set up and eventual closure of the Primary Care Mental Health team service.
The Primary Mental Health Team (PMHT) had been set up by Priory Medical Group (PMG) in January 2019 on behalf of nine Vale of York Practices. The service had been established to support frontline general practitioners by providing additional services to refer patients with mental health issues. The source of funding was from the NHS General Practice Forward View Practice Transformation Support Scheme. The funding source was non-recurrent money. Based on previous funding allocations to the CCG there had been an expectation that this would be maintained. However in 2019/20 the NHS had made significant changes to the GP contract and the fund was re-allocated to fund the establishment of Primary Care Networks (PCN). The re-allocated funds for PCNs have strict instructions on their use and had left no scope to channel these resources to the existing Primary Care Mental Health staff.
The Executive Director for Primary Care and Population Health, NHS Vale of York Clinical Commissioning Group and the Accountable Officer for the NHS Vale of York Clinical Commissioning Group, were in attendance to present the report and to respond to questions.
The following information was provided in response to questions from committee members:
· CCG budgets are committed years in advance. It had therefore not been possible to draw down funds.
· The Financial Plan 2019/20 was for a deficit of £8.8m, a reduction on the previous year. The CCG were under a legal obligation to stick to that. Budget allocation had to be recognisable in terms of waiting times for example children’s waiting times. The CCG went through a process of prioritising what it had to do in terms of its statutory obligation to reduce waiting times.
· The CCG’s Governing Body had prioritised mental health and had committed to the minimum requirement for the next 5 years. In terms of equality of access to services, there are 360,000 people in the city of York, it would not have been fair to put extra resources to one small area.
· Mental health funding for the City of York had increased by £3.5 million of dedicated funding this year compared to 2018/19.
· In response to Members questions on why this service had not been considered to be vital and incorporated in the
additional £3.5 million spent on mental health this year it was explained that the CCG had made budgetary decisions a long time prior to this service being established and was not in a position to draw down committed funds.
· The timeline for closure had been that the CCG were aware at the beginning of the year that the funding had not been recurrent. PMG had approached the CCG in September for financial assistance. The service had closed in October.
· There had been no exit strategy because the intention had been to support the service, unfortunately, that had not been possible.
· A learning point had been not to use non-recurrent funding to launch a new service particularly in relation to those most vulnerable.
· There had not been an evaluation or data analysis undertaken as the service had not been in operation for a full year.
· There had not been a business plan as the decision to establish this service had been made by Healthwatch Members and GP practices. The practices make their own internal business cases.
· The direction that the CCG is going in it will become more of a funder with GP practices tacking commissioning decisions so it is there responsibility to have exit strategies.
· Patients receiving this service had been provided with two further sessions then returned to the care of their GPs to be directed to the most appropriate existing alternative service. (A list of these services can be found within the report at p.16 of the Agenda).
· They were unable to discuss what had happened to some members of staff who had been recruited to this service as they would now be involved in a HR process. A number of staff had been retained by practices or gone on to work for other mental health providers.
· Had the service not been in existence GPs would have directed service users to the most appropriate service as listed in the report (at p.16 of the agenda).
· Following the closure of this service there had been an increase in those accessing the appropriate existing services. Therefore this service is still available.
· Other practices had used the Practice Transformation Support Scheme funding on: complex care teams, care co-ordinators, health care assistants, checks for people with hearing disabilities. Practices to the North used it for mental health assistants, Selby District did not draw down the money.
· Practices are being encouraged to pool resources and work together. PMG had been ambitious and innovative in terms of taking the lead and creating a service on a scale that has not been seen before. It is unfortunate that this service had to close but PMG should be commended for their hard work and forward thinking.
· Plans in regard to mental health spend next year included
Improvement to access of the following services: dementia and autisms services, talking therapies, mental health services for children, eating disorders and personality disorders. There will be significant improvements with recurrent funding to that of the last 2 years and a commitment for the next 5 years.
Resolved: That Members will communicate with each other via
email to agree suitable phrasing of a question that could be put to colleagues in the CCG to ensure further accountability on this matter.
Reason: To ensure that Members are kept informed of changes to services.