Agenda item

This report is to introduce Dr Peter Brambleby, Director of Public Health, and Dr David Geddes, Medical Director at North Yorkshire and York Primary Care Trust. They will update members on clinical pathways and guidance for referral to secondary care.

Members considered a report that updated them on North Yorkshire and York Primary Care Trust’s Referral Policies and work for the Individual Case Panel. Dr Brambleby and Dr Geddes of the Primary Care Trust were present at the meeting to provide details to Members.

Dr Brambleby, Director of Public Health at North Yorkshire and York Primary Care Trust confirmed that there were three major programmes in terms of the health budget, these being:

·        Circulation Disorders

·        Cancers

·        Mental Health

Mental Health was the biggest programme in budget terms but the per capita expenditure was lower than the national average even though it was the largest programme. It had always been a large programme that overlapped with social services and there was need for wider community support, especially for the elderly.

The Director of Public Health suggested an informal session where he could talk about ‘Investing in Health in North Yorkshire and York’ which would explore where the PCT spends its money in all the major health programmes. Members agreed that this would be a good idea and the Scrutiny Officer agreed to arrange this.¹

Members discussed whether there may be other efficient but alternative therapies that had not been mentioned in the guide. They felt that the guide focussed on clinical pathways only and did not present evidence from patient forums.

Dr Geddes said that all Primary Care Trusts had responsibilities that were high cost or non-standard and there was opportunity to apply to the Individual Case Panel for extraordinary case funding. The guidance provided a clinical framework which supported the commissioning and provision of local services across the North Yorkshire and York Primary Care Trust and brought together evidence from sources such as NICE, Prodigy, the Cochrane Database, Royal Colleges and local clinical consensus. Health professionals were expected to take the guidance in this document fully into account when exercising their clinical judgement. Where an exceptional clinical need had been identified, which fell outside the scope of these guidelines, the Primary Care Trust considered funding for each request on a case by case basis via an Individual Case Panel. There had been a significant change since last year in order to meet challenging financial restrictions and therefore some treatments were not so available.

Discussions were had regarding GP specialisms and the need to focus hospital treatments on those that really needed it. It was felt that the development of GP expertise was something that needed to be looked and the balance between the need to support hospital consultants and retention of acute services was important in relation to this.

Members felt that, in terms of looking at alternative care pathways, the following services should be looked at in detail:

·        Mental Health (taking a broad scope so social care is looked at as well)

·        Musculo-skeletal services

RESOLVED:             That Members delegate to the Chair, Vice-Chair and one other member of the Committee to do some scoping work around alternative care pathways for mental health and musculo-skeletal services.²

REASON:                  In order to carry out their duty to promote the health needs of the people they represent.