OLD COLWYN EAST RESIDENTS ASSOCIATION
Address by Mr Wyn Thomas Conwy Local Health Board
11th Feb 2004
11th Feb 2004
Minute of an Address by Mr Wyn Thomas, Chief Executive of the Conwy
Local Health Board
Mr Thomas introduced himself as a resident of Colwyn Bay who had
worked for 22 years in the NHS as an accountant, including being
Director of Finance of the North Wales Ambulance NHS Trust.
82% of the total 111,900 resident population of Conwy lives along
the coastal strip in the towns of Abergele, Colwyn Bay and Llandudno.
The role of the Conwy Local Health Board is to assess the health
needs of the population:
To ensure that services meet needs.
To improve quality and clinical excellence.
To make sure the staff is trained properly.
To insure the best practice is disseminated.
To insure that mistakes are all learned from.
To work with the local authority.
To work closely with general practitioners.
A network of primary care contractors, two local NHS Trusts and
some tertiary care in England mainly in Liverpool and Manchester
provide the Health Services in Conwy.
The local primary care network comprises of: 19 GP practices:
23 Dental practices: 28 Pharmacies and 15 Opticians.
The secondary care is mainly provided by the following local hospitals
Ysbyty Glan Clwyd
Ysbyty Gwynedd
Llandudno Hospital
Colwyn Bay Hospital
Abergele Hospital
HM Stanley Hospital
GPs are independent contractors whose services are paid for by the
National Health Service under a contract agreed in the early 90s,
where technically the contract is between individual GPs and the
Secretary of State. The current contract was established in 1991 and
was aimed at quantity not quality. The doctor is paid for the number
of people on the list and prescribed services provided.
The present LHB budget is £110,000,000.
£ 80,000,000 goes to NHS Trust hospitals to provide emergency, elective
and community care.
£20,000,000 is the cost of providing prescriptions via primary care.
The local health board is responsible for all this.
There is a requirement for a new contract. There are difficulties
presently in recruiting and retaining staff under the current system.
General practice is not attractive with out of hour’s services having
to be provided; less GP’s want to be on call.
From April 1st 2004, there will be a contract between the practice
and the Local Health Board. This contract will specify services to be
provided, quality requirements and also any additional services and
enhanced services which the doctor agrees to carry out on behalf of
the LHB.
There will be a new quality and outcomes framework where practices
will be rewarded for demonstrating improvements against national
standards over the next three years.
The contract will enable more services to be undertaken in practices,
as the LHB will be able to pay for them. For example, skin complaints,
under the new system the LHB will be able to ask the G. P’s to carry
out the work and pay them to do it, reducing pressures on hospitals
such as Glan Clwyd. The contract will also allow the practice nurses
and physiotherapist’s role to develop in support of GPs as under the
present system if a practice has a GP vacancy, the practice loses the
related income until there is a replacement.
The new system will allow doctors to have more control over what
they do in their practices.
They must provide services :
1. Where they have patients who are ill and recovery is expected, to
manage that recovery.
2. Manage patients with terminal conditions.
3. Manage chronic disease.
They will not have to do a number of additional services such as
child health immunisation and cervical screening, however the
expectation is that they will. If they choose not to do these
additional tasks they may opt out and will get less income as a
result. Control of their workload allows flexibility to deal with
local circumstances.
In Conwy, no practice has refused additional work so far.
With enhanced services the Local Health Board can ask if practices
wish to deal with such issues as patients who are recognised as
violent.They won’t have to do so.The L.H.B. will have to find
alternative resources to cope with the problem.
The Local Health Board has to provide improved access to a doctor.
The target of the National Assembly is to provide access to a GP
within 24 hours of the appointment being made.
It is intended by the Local Health Board to put systems into effect
to support practices do more work with regard to immunisation and
minor surgery. Practices will be paid to do work to a national
standard.
Also enhanced services for the needs of the locality may include
dealing with homelessness and possibly extra services for persons
suffering from depression. This gives the Local Health Board
flexibility to provide services for the public.
With out of hour’s services at present, each general practitioner
has 24 hour responsibility for those on his or her list. There
are arrangements made with cooperatives but legally it is the
responsibility of the general practitioner.
Out of hours and weekend cover is a big issue for general
practitioners and can be an obstacle to recruitment. As a
concession for G Ps in the new contract the Practice will cover
the hours 08:00 to 18:30 Monday to Friday. The Local Health Board
will be responsible for the emergency G P cover outside those hours.
In reality while the GPs will not be responsible for managing and
organizing arrangements during the out of hour periods, a number
will be willing to assist.
The timing of the Out of hours changes under the new contract is
no later than the 31st of December 2004 but it may be as early as
April 2004, the intention is that it will take place as soon as
practicable after April.
There will probably still be a base service at Glan Clwyd, with
satellites at Llandudno and Ruthin The plan is that the Glan Clwyd
center will operate a triage system.
1. Advice by phone
2. General practitioner to attend
3. Patient to go to a centre in which case they may attend
Llandudno or Glan Clwyd
Any complaints about such things as a patient being required to
attend a centre, instead of a doctor attending will be handled
by the Local Health Board this will be a standardisation of
procedure. The service should not feel any different to the patient.
Complaints will be to the Local Health Board.
There’ll be a contract between the LH.B and out of hours providers
and it should not feel any different to patients except that there
will not be access to a particular doctor. Of the nineteen practices
in Conwy only one has indicated that they will carry on out of
hour’s services managed by them.
Currently the LHB and Council are developing The Health, Social care
and Well- being Strategy that identifies the needs of the County.
The strategy will set out over a three-year period what the priorities
will be. There is a requirement to involve patients in feedback.
In reply to a question about percentages of appointments not being
kept by patients and wastage of prescription drugs seized when patients
have stockpiled them, Mr Thomas told the meeting that currently in the
County six or seven practices were already able to provide same day
appointments and the LHB were supporting remaining practices to achieve
the same over the next 18 months. This should ease the problem of missed
appointments.
On the subject of seized waste drugs, he said that approximately £1m
was handed in to be destroyed in a year. Eighty percent of drugs are
on repeat prescriptions and sometimes people do not tell the doctor
if their prescription is wrong or they no longer want some items. To
improve this there is a move towards twenty-eight day prescribing for
a paying customer and keeping prescribed amounts to a reasonable level.
This obviously costs more to the customer.
In response to a question regarding an impression that the Health
Service is overwhelmed by administration, Mr Thomas said that when
market forces were introduced into the Health Service in the early 90s,
finance and other managers were necessarily involved. With the number
of strategies and developments the Assembly wants in place to improve
health in Wales the demands on management and support staff are growing.
There is also a question of definitions. A number of doctors and nurses
in the NHS are now regarded as managers, and this can sometimes give an
impression of more managers than traditionally people would have considered.
In the Local Health Board there is 30 staff to manage a budget of £120M
and support nineteen Practices and commission services from 2 Trusts.
This creates a significant workload.
In answer to question regarding the percentage of management costs, Mr
Thomas said that there was a target of four and a half to five percent
in the NHS generally. Set against the American system where a 15 percent
level of management cost is seen, that is a reasonable level.
A resident made the point that the French and German health setup
appeared to be streets ahead of this country. Also he said that in earlier
times, the Health Service seemed to be part of the community and people
seemed happier. There seemed to be no administration problems then.
Mr Thomas answered by emphasizing that the main changes in health care
were due to new techniques and drugs. The point was made that with new
technology people are living longer. In response to another question,
Mr Thomas said that the Health Board is required to deliver on 104
objectives in 2004/5, some are sensible, such as waiting lists, coronary
heart disease and so on.
He went on to say that the Local Health Board has access to the Assembly
and civil servants, Ministers and Members and they do listen. In 2004/5
the number of objectives have been reduced as a result of consultation
and feed back.
A resident stated that as a Councilor, he had sympathy with the LH B over
plans and performance indicators but that he had the belief that the needs
of Conwy could not be very different to Gwynedd. He posed the rhetorical
question “Why then did then have to be 22 health boards?”
In reply to a question regarding what would happen where practices chose
to opt out of immunisation programs, Mr Thomas stated that the LHB have
responsibility to look for alternative trusts or another practice to do
it. As part of the work of the LHB, they had a good idea of the intentions
and skills of each practice.
In response to a question regarding a possible shortage of doctors in
Wales Mr Thomas stated that at present in South Wales there are a number
of single-handed G Ps coming up to retirement age. There are a number of
factors, which affect the interest of trainee doctors in an area.It may
be that they are interested in returning, following training, to the areas
where
they did their practice whilst at university. The Medical School in Wales
is in Cardiff. Trainees from Liverpool University come to North Wales.
North Wales needs to tie in to Cardiff University also, to attract students
at the end of their education.
In response to a question over tuition fees and whether it could affect
persons attending University to become doctors, Mr Thomas said that it was
his understanding that persons would not be required to pay after the third
year; therefore it should not disadvantage the medical profession.
