·       To consider progress and plans with the Shrewsbury Health and Well-being Hub in Shrewsbury including outputs from focus group work, what has happened so far, and next steps along the project timeline.

Presentation from Emma Pyrah, Associate Director Primary Care and Tracey Jones, Deputy Director Partnerships - NHS Shropshire Telford and Wrekin    

Tracey Jones, Deputy Director Partnerships and Emma Pyrah, Associate Director Primary Care, NHS Shropshire and Telford and Wrekin, delivered a presentation providing an update on Shrewsbury Health and Wellbeing Hub on behalf of Edna Boamapong, Director of Communications and Engagement.  Members were reminded of the phases of the work as outlined at the May Committee meeting and updated on the engagement timeline so far. The presentation is attached to the web page for the meeting:  Health & Wellbeing Hub Presentation 

Members heard about the second phase of engagement including identification of key findings from six focus group meetings – the case for change was understood but there were concerns around travel, transport and traffic congestion issues; continuity of care; fears around impersonal experience; and the impact of the travel concerns on older people and people with disabilities.  The Groups had also contributed to identification of essential and desirable criteria.

Members also heard how the Equalities Impact Assessment would build into the iterative Integrated Impact Assessment (IIA) process and that proactive work was underway to engage with seldom heard groups. 

The continued process of engagement would be open, with additional focus groups targeted at harder to reach audiences, and local councillors.   A stakeholder reference group had been established, with membership including Healthwatch, Patient Participation Groups, Members, and practice representatives and would help to determine the weighting for evaluation criteria once feedback from focus groups was finalised.  This group would also feedback on communications and engagement activity.  A leaflet for practices would be developed to aid patient engagement and to outline why practices have decided to be a part of the programme - these include rent/maintenance/space/extra services.

Members noted that the presentation slide on ‘engagement roadmap 2022 – 2024’.  should also include an update on the July Health and Wellbeing Board meeting. 

The following acronyms used within the presentation were explained:

AIC Assurance Involvement Committee – constituted of members of public representing different aspects of patient groups, who receive reports on engagement and communications activity; PCC Primary Care Commissioning Committee,

IIA – Integrated Impact Assessment; PCBC – pre-consultation business case – the business case that will be consulted on; OBC – outline business case

It was intended to return to the Committee ahead of the next formal phase to share findings to date, ahead of consultation with the public which was planned to take place between October and December and was likely to last 8 – 12 weeks.

Following the presentation members of the Committee raised concerns around the following issues:

·         The real upset for people who were worrying about how they would travel to the hub and about losing regular contact with their GP and primary care staff;

·         The hub appeared to being presented as the only option available, an experiment being directed by NHSE, without a ‘plan B’, and it did not appear that other solutions had been considered.  For example, ideas put forward in the Fuller Report included the joining up of estates across health and social care, perhaps even between primary and secondary care – Bishops Castle Community Hospital was cited as a potential example;

·         The proposal would result in a massive number of additional journeys and appeared to clash with a desire to reduce impact of travel on the climate;

·         It appeared that the ICS Board thought that Shropshire Council would supply new bus routes to service the hub, when that would be at a massive cost – was that the council’s understanding of the situation?

·         The Meole Brace area was already subject to difficult driving and congested conditions with two secondary schools and a retail park in the locale;

·         Difficulty travelling to access primary health care was likely to increase barriers to those who were less likely to seek help, increasing inequalities in health care;

·         Concerns that GPs might retire once their practice buildings were sold or sell practices leading to privatisation;

·         Weighting of deliverability was very important and the public consultation must contain affordable and deliverable solutions only;

Members asked for the following information:

·         Where had the 6 recently held focus groups been advertised, who had attended and where had the face to face ones been held?

·         When would the location for the site be known and how could an impact assessment be made when the location was not finalised?

·         Could the Committee see the Integrated Impact Assessment of Jan - March 2022?

·         Had any examples of delivering primary care overseas been taken into account?

·         What was the maximum distance considered acceptable for a patient to travel to access primary care?

·         Was the location of the hub in the middle of the area covered by the practices who would move into it?

In response to the concerns raised and requests for information, Emma Pyrah and Tracey Jones explained that it was intended to gather and present to the public a number of deliverable options.  Other options had been identified during the engagement period and desirable criteria would be weighted and applied to these to produce a short list for consultation.  It would not be possible to meet the needs of every person and mitigations to address issues identified would be considered

It was recognised that a number of factors needed to be known before a full IIA could be undertaken and it was therefore an iterative process.  It was not known exactly when a site would be finally identified but hopefully this would be within the next month or so. Proximity in relation to practices involved was being taken into consideration and it was known that transport was a major impact and concern for people.

In terms of concerns around privatisation of services, all GP practices were independent businesses and would make always their own decisions. 

Tracey and Emma said they would take the following questions back to Edna:

·         Whether it was possible to supply the IIA to the Committee in its current and earlier forms;

·         Where focus groups had been advertised and who had attended;

·         The distance it was deemed acceptable for a person to travel to access primary care;

·         Whether overseas examples of primary health care provision had been taken into account;

·         Whether weightings of criteria could be supplied once agreed.

The Executive Director for Health and Wellbeing confirmed that the council was working with the ICS team to understand the transport issues linked to the impact assessment. 

The Chair thanked Emma and Tracey for attending the meeting and the Committee looked forward to another update at its next meeting.