The battle against privatisation of Brent GP practices is going on right now

Brent CCG is discussing the takeover of two Brent practices t and appears unlikely to oppose. Join HERE

Nan Tewari has put this forward to the meeting which has just  started:

The PCCC of Brent CCG wishes to NOTE that in ratifying the consent as recommended by Officers of the North West London Collaboration, a number of events have occurred since the PCCC gave its in principle consent to the change of control of AT Medics Ltd in its Part 2 meeting in late 2020.

(a)   The 18 Feb 2021 letter confirming ‘change of control’ letter is written by Samantha Jones [CEO, President and Director of MH Services International Holdings (UK) Ltd] who became the new CEO, President and Director of AT Medics on 10 Feb 2021.

(b)   Samantha Jones’ statement that <the existing AT Medics GP directors remain actively involved at an executive level in the business> may give rise to adverse inference in its inaccuracy, and for the avoidance of doubt should be amended to correctly refer to 'the former AT Medics GP directors..........'. 

(c)   All the AT Medics GP directors resigned their directorships on 10 Feb 2021.

(d)   The AT Medics assurance questionnaire answer on 3 Dec 2020 on the question of staffing or management changes that may take place as a result of change of control, is a straightforward description of the standard TUPE status of the former GP directors and cannot be represented as being a specific ‘assurance’ of any other nature.

(e)   Information of public interest relating to Operose Health Ltd and MH Services International Holdings (UK) Ltd, deriving from Companies House financial records, that has come to the attention of the PCCC and its non-voting, Brent Council representatives, is summarised below.

 

As at 31 December 2019, the holding company for the UK group which Operose Health Ltd is part of, MH Services International Holdings (UK) Ltd, had creditors falling due within one year of nearly £49m (£48,999k).

It owed Centene Corporation £37.8m at the end of 2019, and then notes that it received a further £13m in 2020.  These debts are unsecured, but repayable on demand.

Its accounts (audited by KPMG) have been prepared on the basis that the UK group is a "going concern".  This is because Centene has advised “that it does not intend to seek repayment of the amounts due at the balance sheet date, for the period covered by the forecasts.”  Those financial forecasts only go up to 31 December 2021, and the accounts note that there is a risk that those forecasts may not be met.

The Director who made all the statements in connection with the holding company accounts to 32 December 2019, and signed them off, is not one of the company's UK resident directors, but Tricia Dinkelman.  Her address is given as Centene Plaza, 7700 Forsyth Blvd., St Louis, Missouri, MO-63105.

That is also the address of Centene Corporation, which is a US company registered on the New York Stock Exchange, reg. 42-1406317.

The money which the UK group owes to Centene Corporation has not come directly from Centene, but via its Delaware registered "affiliate", MHS Consulting International Inc.

The business model policies that are set in the accounts of the group holding company, MH Services International Holdings (UK) Ltd, indicate an intention to close non-profitable parts of its business.

From We Own IT

Nearly 50,000 from all across the UK have signed the petition asking health chiefs to kick Centene out of NHS GP practices - amazing! Will you join us for an hour tomorrow to take the next steps to win this campaign to protect our NHS? We've got a plan - now we just need your help to make it happen! Please join us whether or not your GP surgery is directly affected. Can you join the online organising meeting at 6:30pm on Thursday, 18th March?

Sign up for the organising meeting

A US healthcare profiteer, Centene, has recently taken over 49 NHS GP practices. This is terrible news for the NHS. Millions of Pounds will be syphoned out of those GP practices in shareholder profits and the care people receive will suffer greatly as a result.  The pay and conditions of GP surgery staff (including GPs) could likewise suffer, which would affect morale and therefore patient care. And, this could lead to more of our local GP practices being closed down for not being profitable. Wherever you live and whether you are currently affected, this matters to you because Centene could be coming to your neck of the woods soon. Local health authorities (CCGs) have the power to terminate Centene's primary care contracts and kick them out. We need to force the authorities to take that step.

Brent Scrutiny Task Group set up on GP services and accessibility

It is about 5 years since Scrutiny has looked at GP services in Brent and there have been many changes since then as well as current issues around accessibility during the Covid pandemic. A quick glance at locally based Facebook sites will demonstrate there are issues around accessiblity to face to face appointments, difficulties in making contact via the telephone and differences between surgeries regarding email contact and on-line consultations.

It is welcome then that a strong General Practioner and Primary Care Accessibility Group has been formed consisiting of  Cllr Mary Daly as Chair plus Cllr Abdi Aden, Cllr Tony Ethapemi,  Cllr Claudia Hector, Cllr Gaynor Lloyd and Cllr Ahmad Shahzad.

 

The scope of the Task Force will be discussed at 5pm on Monday at a meeting that is available to watch on Zoom. 

The Task 

i) To gather findings based on quantitative data and information about GP accessibility based on face-to-face appointments, physical and digital access, and qualitative information from patients’ experiences with particular reference to those who are older, have mental health needs or a disability, and who have long-term health conditions.

ii) To review the overall local offer of GP services, including the extended GP access hub service, and evaluate any variation in accessibility by practice and the underlying reasons for any variation with particular reference to clinical capacity and nursing.

iii) To evaluate the local demand to access primary care, changes in demand during the Covid 19 pandemic and changes in access to GP services during the pandemic with particular reference to digital accessibility and face-to-face appointments.

iv) To understand the role of primary care in addressing health inequalities by gathering findings on population health, deprivation and demographic trends in the borough with particular reference to Black and Minority Ethnic (BAME) patients.

v) To develop a report and recommendations for local NHS organisations and the local authority’s Cabinet based on the findings and evidence gathered during the review.

It is suggested that there are five evidence sessions for this task group. The proposed structure for the meetings will be meetings with representatives from NHS organisations and GPs for evidence session 1 and evidence session 2, meetings with Healthwatch Brent and patient advocacy groups for evidence session 3, and a meeting with the voluntary sector and other relevant community organisations for evidence session 4. There will be a meeting with community organisations for evidence session 5.

Key Lines of Enquiry

To structure the evidence sessions, the scrutiny task group will focus on particular key lines of enquiry to ensure there is accountability about local primary care services.

These will include, but not be limited to, the following suggested key lines of enquiry.

1. What is the local demand for GP services and what are the particular needs of Brent residents, including vulnerable patient groups, in relation to accessing GP care?

2. Is there sufficient provision of GP services in the London Borough of Brent based on local population health needs and the growing population in the borough and is there a difference in provision or accessibility between the north and south of Brent?

3. What has been the long-term trend in how GP services are accessed and what has been happening during the Covid 19 pandemic in terms of the balance between remote appointments using digital technology and face-to-face appointments?

4. Is there a danger of exclusion from primary care services for those patients who are not able to use the digital or online options and rely on face-to-face appointments?

5. What strategy is needed to address variation and ensure that there is fair and equitable access to GP services available to Brent residents across the borough?

6. What does benchmarking data show about primary care and GP performance in Brent compared with the other clinical commissioning groups in North West London?

7. What is the role of Patient Participation Groups in addressing accessibility issues? 

 MORE DETAILS

Dedicated borough-based Covid-19 clinics to be established by NW London CCGs

Responding to Saturday's tweet (above) by Cllr Ketan Sheth (Chair of Brent Council's Commnity and Wellbeing Scrutiny Committee) a spokesperson for the MedianWL North West London Collaboration of Clinical Commissioning Groups, said:

The eight CCGs in North West London are establishing a joint primary care response to COVID-19. This will include patients being managed both remotely and face to face by GPs. Face to face management will require dedicated clinics and we are establishing these in each borough. Patients will access the clinic through referral by the NHS 111 service or their practice.’​

Palliative care services under scrutiny tomorrow

Proposals to address short-comings in palliative care in North West London will be interrogated by the Community and Wellbeing Scrutiny Committee tomorrow (Tuesday March 3rd, 6pm Brent Civic Centre). AGENDA

A well as Brent other CCGs involved are Central, Hammersmith and Fulham and West. There has been an in-depth involvement of patients and carers to address the problems and 4 scenarios have been put forward.

The main report sets out the context:

Access to services -only 48% of people with a palliative care need are accessing services when they need them. Reaching only 48% of patients is not good enough. It is paramount that we increase the reach of palliative care services to all patients who need it, regardless of their condition.

Inconsistency between services–depending on where you live you will have more or less access to specialist palliative care services and this is not acceptable. For example, while some hospices can support people to die at home if they wish, others do not. There is also variation in what services can be accessed out of hours and how quickly, for example in the middle of the night or at the weekends.

Underinvestment in community services contributes to differences in what services are available for people to access. Our vision is that everyone gets the palliative care that they need. We aim to increase this number up to a minimum of 75%initially. Investing in community services will enable us to reach more people in their last phase of life. A lack of co-ordination between services can result in care being delayed or interrupted which causes anxiety and stress for patients, carers and families and unnecessary discomfort to the patient.

National staff shortages in palliative care specialists -this has been a challenge locally and due to a specialist palliative consultant not being available led to the suspension of the in-patient unit at the Pembridge palliative care centre, highlighting the fragility of our local system.

The scenarios:

Currently spending by Brent CCG is split into three areas.

Councillors will be keen to see how the three areas cited by patients and carers are being addressed. Of particular interest are the issues around 'talking about death', access for different ethnic/cultural communities and the seemingly mundane but vital issue of travel cost and convenience for carers' travelling to a hospice.

Brent's independent voice for the disabled silenced

No longer able to afford the market rent demanded by the NHS  for its premises in Willesden Hospital Brent Advocacy Concerns has closed its doors today and will vacate tomorrow.

Last week I received this message from John Healy, one of the volunteers (there are no paid workers):

I know you are very busy with the election and climate change, not forgetting Brent's pavement's as well but I am just letting you know that we will be leaving our office this Friday, the 29th November 2019 (on the same site for over 31 years) where we have been continuously providing advocacy to the disabled community in Brent during all that time.

We are not closing down (yet) as we will still be available online but without seeing people in person, I think it will only be a matter of time before we close the charity down completely.

Through Wembley Matters, could you ask both the council and Brent CCG who will take over from us by  seeing disabled people face to face in an office, when we are no longer there.

With a nice bit of irony--A Clinical Psychologist from Northwick Park Hospital has asked us (21/11/19) to provide him with an advocate for one of his stroke patients, who can no longer access his kitchen & bathroom.  I have sent him two emails offering to advocate for him but as yet, he has not replied.

John got in touch again this evening to say:

Hi Martin, I had three disabled people contact me on my last day.

Including:-

A lady with Autism who had been turned down by PowHer, Voiceability and Brent CAB who all said she did not meet their eligibility criteria.  Even the council turned her away, saying she was not entitled to a needs assessment.  Under The Care Act, 2014, the council have a statutory duty to carry out an assessment for anyone who asks for one.

So with us gone after today, who will help disabled people in Brent?

 

Best wishes

I hope the the Council and Brent CCG will respond but I don't think it right not to finish without thanking John and his colleagues, past and present, for what they have done for Brent people with a disability over the past three decades.

Thank you.

Scrutiny ask for Urgent Care Centre reduction in hours to be reviewed and put out to public consultation

Brent Community and Wellbeing Scrutiny Committee tonight asked Brent Clinical Commissioning Group (CCG) to use its statutory right to ask North West London NHS to reconsider the abolition of overnight hours at Central Middlesex Hospital Urgent Care Centre and to put the issue out to public consultation.

The decision was one of several made after an exhaustive discussion of the North West London NHS Recovery Plan and the proposal to merge the various CCGs in North West London into one 'Super CCG'.

Dawn Butler MP was unable to attend the Committee due to pressing duties in the House of Commons but her speech was read out for her by Cllr Colacicco. Butler said that the Recovery Plan was coded language for cuts in NHS services.  She said that the cuts fell disproportionately on the south of Brent affecting the poorest areas  in Stonebridge and Harlesden where life expectancy was 13 years lower than in the north of the borough.

When the A& E at Central Middlesex was closed it was on the basis that the Urgent Care Centre at the hospital would be provided on a 24 hour basis. It had now been shut at night with no public consultation. She said that a whistle blower had informed her that this was a 'closure by design' and was part of a plan that could lead to eventual closure of the hospital.

I understand that Dawn Butler and Barry Gardiner MP will meet the CCG tomorrow to discuss their concerns.

Addressing the Committee Cllr Mary Daly refuted claims that the Recovery Plan did not relate to patient care. It aimed to cut referrals to consultants by GPs - 'there was not enough money to treat Brent patients' - by scaring them.  GPs would not be allowed to refer patients more than once and if a consultant decided a patient needed to be referred to a consultant in a different discipline the request would first have to go back to the GP. Emergency A&E patients would not be admitted to hospital and patients would have to pay for over the counter medicines themselves.

Cllr Nerva introduced himself as a former non-Executive Director in the NHS and said that as things had developed there was now a lack of democratic accountability in the NHS. The proposal that patients should choose hospitals within The NW London NHS Trust, in order for it to enjoy the 30% in-house cost reduction, would provide an incentive to limit choice. These were toxic cuts and there should have been officer input to the Committee for members to consider.

Cllr Colacicco and Cllr Ann Clarke (Labour, Barnet, Childs Hill ward) both concentrated on the proposed closure of the walk-in Cricklewood Health Centre. Colacicco criticised the consultation for not enabling people to state that they wanted the Centre kept open. Clarke said the Centre had been under threat before, in 2014, and had been saved then. New developments, including that at Brent Cross, meant there would be many new homes in the area in the future and the Centre would be needed. She was also concerned with the suggestion that extended GP hours would increase local capacity when the Centre closed.

Cllr Thomas Stephens proved to be the most incisive and persistent member of the Committee when cross examining NHS and CCG officers. Most questions were fielded by Mark Easton, Accountable Officer for the NHS North West London Collaboration of Clinical Commissioning Groups (the shadow Super CCG),  He attributed the financial crisis to population increase, an ageing population, cost increases caused by new treatments with costs going up 18% and population 5%.  Units costs were increasing faster than numbers treated.  Regulators recognised that the planned deficit could not be wiped out in one year so a three year programme had been introduced.

He said patients would be allowed to go into hospital but that some GPs were not aware of community services that would keep patients out of hospital. The CCG were visiting GPs who may have referred more than 3 times as many patients as other GPs to make them aware of community services.

He said that hospitals inside the NW London NHS area were as good as those outside and had the advantage of being 30% cheaper, although patients could still choose to go outside.

Patients paying for over the counter medicines rather than through prescriptions was already policy and it was just a matter of ensuring compliance by GPs.  Eligibility criteria were based on evidence from NICE.

Adherence to the NHS Constitution would ensure that the changes would not affect the quality and safety of health services.

Scrutiny adopted a number of recommendations including that the NHS should ensure that local services were sufficient for the needs of local residents, there should be a full Equality  Impact Assessment of proposed changes in referral behaviour, review the impact on Primary Care which is already low quality in comparison with the rest of London, review the impact of changes after the Winter.

Regarding the merger of local CCGs into one NW London body Scrutiny recommended that the CCG guarantee that the new structure will include local government representatives and lay people, before a final decision is made on the super CCG that they should come back to Scrutiny with the full financial implications and assessment of the shadow structure currently in operation, if a single CCG is formed it should more adequately integrate medical and social care.

Proposal to reduce hours at Central Middlesex Urgent Care Centre by closing it overnight

Brent NHS Clinical Commissioning Group  is proposing to close the Central Middlesex Hospital Urgent Care Centre, presently available 24/7, from midnight to 8am, saving £450,000 annually in what they admit are financially challenging circumstances.

The service is currently provided by Greenbrooks and the CCG says the provider agrees with the proposal. The CCG health, rather than financial case, is based on low usage and availability of alternative provision:

The data analysis based on “reasons for attendance” showed that from the average of ten (10) patients attending per night, the following would be the appropriate course of action if CMH UCC were to close overnight: 


o Less than 1 per night would continue to require ED either urgent treatment or referral to specialty review

o One(1)per night would need to attend an alternative UCC such as Charing Cross, St Mary’s, Ealing or Northwick Park

o Four (4) per night could access an alternative night service such as GP out of hours

o Four (4) per night could access alternative provision, including their own GP, the next day

The UCC was set up in 2014 when the Accident and Emergency service was closed at  Central Middlesex Hospital, despite widespread opposition, which included rather belated opposition from Brent Council.  The overnight closure of the UCC represents a further deterioration of the service currently offered to residents in Harlesden, Park Royal and Stonebridge.

Transport difficulties to alternative A&Es was always a factor in the original campaign against the A&E closure was a major factor so the CCG puts forward the transport timings for residents seeking overnight treatment:

The CCG argue that the change would mean a 'safer urgent and emergency offer by reducing entry points to out of hours services':

The alternative offering being implemented by the CCG will aim to drive down [] inappropriate attendances, helping to provide choice and direction to those seeking advice and care. The majority of attendees overnight are between 20 and 44, the age group most likely to have internet access at home, or own a smartphone, and therefore be best place to benefit from digital signposting.

People arriving out of hours at Central Middlesex will be advised to dial 111.

The report will be considered by Scrutiny Committee at its meeting on July 9th. The full document is HERE