Last summer, when Councillor Philip Whitehead took over from Baroness Scott as leader of Wiltshire Council, he inherited the position of joint chairman of the county’s Health and Wellbeing Board (HWB).
The HWB has been overseeing Wiltshire’s health services since the coalition government’s 2012 Health & Social Care Act. It is a statutory committee of Wiltshire Council made up relevant leaders from the Council, the CCG and related services like the police and fire service.
This year the HWBs across England will be faced with a series of fundamental changes to the way the NHS works. Some people have wondered whether HWBs will have a useful role in the new hierarchy of organisations.
Councillor Whitehead has told marlborough.news that the Wiltshire HWB still has a valuable job to do and plenty of changes to oversee. Health Secretary Matt Hancock has said that HWBs need to be ’empowered’ – though it was unclear whether he wanted them to have executive powers.
Councillor Whitehead believes they already are empowered: “What empowerment means in reality is something different. It is having us all in the room together – talking together chatting with each other – seeing how to get things done better.”
However, HWBs are not, he insists, merely forums: “If they’d called it a forum no one would have come to it!”
He says that Dr Richard Standford-Hill, who has been the Wiltshire CCG’s Chairman and joint-chairman of the HWB, will, as Wiltshire CCG vanishes, continue in his HWB role.
From April health commissioning for Wiltshire – that’s dividing up its annual NHS budget – becomes less localised as three Clinical Commissioning Groups (CCGs) merge into one organisation – called BSW CCG. It will be interesting to see who the new enlarged CCG sends to Wiltshire’s HWB meetings.
The CCGs for Wiltshire, Swindon and Bath & Northeast Somerset have been serving their local areas since April 2013. In Wiltshire the CCG worked partly at an even more local level with the county divided into three ‘localities’ – Marlborough was in the North and East Wiltshire (NEW) locality.
Newly agreed changes to maternity services across the three CCGs have already brought accusations from campaigners that Wiltshire is being short-changed. But Councillor Whitehead takes an optimistic view of the new wider CCG: “I understand the concerns – so far I’m happy – as an outsider looking in. And because we’re the dominant one – as regards size – I’m less worried.”
One of the changes that will need careful scrutiny and support, is the introduction of Primary Care Networks (PCNs). The one for our area is the East Kennet PCN.
The national cost of these collaborative networks of family doctors – about 1,250 of them across England – is £1.8bn. Setting up Wiltshire’s PCNs cost £500,000 in consultancy fees.
Now many GPs in England are questioning the scheme’s viability – citing the shortage of GPs. It is widely reported that some surgeries will decide to leave the PCN scheme unless it is rethought.
From April, PCNs call on GPs to accept five new duties of care – including reviews of prescribed drugs and regular visits to care homes. The £1.8bn includes new hirings for GP practices – for example pharmacists to carry out the drug reviews.
The Kennet & Avon Medical Practice has already added a clinical pharmacist to its staff. But it still declares on its website’s home page: “Please be aware, primary care is in crisis; GPs are in very short supply in Wiltshire as they are across the country.”
If anyone thinks the Pewsey and Marlborough merger was something unusual that should not have happened, figures from GPonline (21 January) show that in England one in six GP practices covering 5,400,000 patients have closed or merged since April 2013.
Or to put it another way, of the 8,106 GP practices listed in April 2013, 1,284 have closed or merged – that is 16 per cent of the total.
One difficulty of the new wider commissioning area is that people with important jobs to do will have to travel further for meetings. Some of them will be doctors whose replacement is costly and difficult for a day-long CCG meeting – or a half-day committee meeting.
Before I talked with Councillor Whitehead, he had been taking part in a regional meeting of local authority leaders. The meeting was in Cardiff and he had decided not to travel there from Trowbridge, but to join the meeting by phone.
This he said had been perfectly all right. It is, of course, technically feasible to have good sound and vision from all those who are taking part from their offices or homes. He says as the technology is available so we should ‘get clever’ and go for ‘virtual meetings’ – saving time and money and also reducing the NHS’ carbon footprint.