Mr Luke March has been appointed as chair of the Western Berkshire Accountable Care System - a collaboration of the principal NHS organisations in Western Berkshire. We are facing a period of several years in which NHS funding growth will be around 1% per year on average - hardly enough to keep up with population growth, let alone the ageing of the population, increasing living standards or advances in medicine. In Western Berkshire the strategy for the NHS five-year forward view has been to bring together the principal parts of the NHS in the area into a place-based collaboration known as an Accountable Care System (ACS) which will seek ways of working together by agreement to improve health care and health system efficiency. The initial ACS will be formed by agreement between the Royal Berkshire Hospital Foundation Trust, the Berkshire Healthcare Foundation Trust and the four CCGs of Western Berkshire. The collaboration will be able to change pathways for patient treatment, change payment procedures and incentives between the partners, move activity from one site to another, perhaps from hospital to community but only by agreement, however hardly reached, between the partners. Mr March has been a non-executive director in the NHS since 1998. He was Chair of Salisbury NHS Foundation Trust from 2005 to 2013 and of the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust from 2013 to 2015. In addition he has also chaired the Audit Committee of the Financial Services Compensation Scheme and worked as Group Company Secretary and Compliance Director of the TSB Group, Corporate Governance Director of the BT Group, Chief Executive of the mortgage industry regulator and most recently Group Compliance Director of the Royal Mail Group. He is also currently Chairman of the National Churches Trust and the Building Societies Trust and serves as Lay Canon on the Chapter of Salisbury Cathedral. Price Waterhouse Cooper consultants have been tasked with creating the new system of payments by the members of the ACS. It is hoped that the three local authorities of Western Berkshire will be able to join the ACS eventually as may the South Central Ambulance Foundation Trust.

The British Medical Association (BMA), the doctors' trade union, has announced that doctors in training ("junior doctors" - who can be any grade below consultant and may be in their mid-thirties) will hold 5-day all-out strikes in October, November and December but the strike announced for December has been called off. The strike threats come after the BMA junior doctor membership rejected the official BMA recommendation to accept the proposed new contract as the best available in a ballot and the Health Secretary stated the intention of the NHS employers (he has no power to do this) to impose the proposed contract. It can be expected that consultants will step in to maintain services but this will mean their abandoning their normal clinics and procedures so that many operations and appointments will be cancelled. The BMA has issued a statement on the proposed strike in which they describe the main issues as the effects of the proposed new contract on part-time doctors and the effect of the new contract on those junior doctors working the most weekends. Junior doctors already work shifts and on-call sessions at night and at weekends, but the Health Secretary claims that the new contract, which reduces extra payment for working out of normal hours, is necessary to provide the 7-day NHS which was one of the Government's election promises. The cancellation will undoubtedly be upsetting and possibly damaging for some patients. But another danger is that the demoralisation of the junior doctors will result in more junior doctors either leaving the profession altogether or emigrating to a country where conditions are more attractive. As we already have a big shortfall in doctors, with specialisms such as Emergency Medicine, General Practice and Anaesthetics very short of trainees, this is a serious problem which the Government and NHS employers must try to avoid. One of the aggravating factors in the discussion has been the Health Secretary's manipulative approach to the question of whether people who fall ill at the weekend are at greater risk than those fall ill in the week. His approach has been strongly criticised by several doctor MPs in various parties, including his own. This has contributed to demoralisation of the junior doctors whose training is strongly oriented to evidence-based medicine. The Health Secretary has proposed a helpful review of issues outside the contract that affect junior doctors training and that could be changed to improve their working lives, but it has not yet come to any conclusion and indeed may not yet have started.

The Government's plan for reducing childhood obesity was published on 18th August 2016 (see attached file). Most reviews were unfavourable. The King's Fund has published an analysis and a comparison of the plan with the recommendations of the Health Select Committee of the House of Commons . The Government's plan has no definite objective but expects to significantly reduce England's rate of childhood obesity within the next ten years. It includes the promised tax on sugary drinks and measures to reduce childrens' sugar intake and increase activity and sport in primary schools, but avoids consideration of advertising or promotions. This report can be set in the wider context of the Government's reluctance to act on public health. Simon Steven's five-year forward view was predicated on progress in public health, but with no action on a minimum price for alcohol, cuts to public health funding, little action on air pollution and this disappointing childhood obesity plan, the Government can be judged not to have played its part.

South Reading CCG Governing Body meets in public and holds its annual meeting on Wednesday 7th September, 2016 at the Museum Of English Rural Life, Redlands Road, RG1 5EX. 

Governing Body Meeting in Public - 9.30am - 11.45am

Questions for the Governing Body (taken at the end of the meeting) should be sent to ppiteam.berkshirewest@nhs.net or given by phone at 0118 982 2709 before noon on 6th September.

Annual Meeting - 12.00 noon - 1.30pm

At the end of the presentation, there will be an opportunity to ask our Governing Body members questions about the Annual Report and Accounts outcomes and our future plans for 2016/17.

How To Register

Register for one or both meetings by following this link and then following instsructions or by calling 0118 982 2709, before noon on 6th September.

Our local 111 urgent care and advice telephone service is being recommissioned. You can help shape the future service by taking part in a consultation meeting on 13th September from 9.00am to 1.00pm at the Holiday Inn, Basingstoke Road, Reading, RG2 0SL. At the consultation meeting the preferred provider of the new service - Care UK - will present its vision and take feedback and input from the meeting attendees. Care UK is one of the UK's largest private providers of health care services. They operate 12 contracts for 111 services in places such as Hillingdon, Croydon, Gloucester and Swindon, Kingston and Richmond, Lincolnshire etc. To attend please email joe.winstanley@nhs.net or call 0118 982 2803 to reserve a place.

The NHS is now setting out its plans for the next five years when spending increases will be well below demand. In 44 Sustainability and Transformation Plan "footprints" (areas) CCGs and NHS providers are formulating plans to cope with the stress to come. (We are in the Western Berkshire, Oxfordshire and Buckinghamshire STP area known as BOB/WeBOB/COBWeB). NHS England has ruled that the current draft plans must not be shared with the public as considerable resistance is expected, although they will have been shown to members of the Reading Health and Wellbeing Board in private and confidential session, so Reading Healthwatch and leading councillors will have seen draft plans. (Consulting with representatives of the public is sufficient to satisfy the NHS constitution.) We are told that there will be "consultation" when the final plans are published but as final sign-off is predicted for the end of October there may not be much time for discussion or opportunity for change. The BBC reported early news on these plans under the headline "NHS cuts planned across England" after an investigation funded by campaigning organisation 38 degrees produced details of planned ward closures, A&E closures, hospital downgrades and service transfers from sample areas.

We will be discussing patient engagement in the NHS with the new lay member of the South Reading CCG Governing Body, Wendy Bower and Nikki Malin, in charge of comms support for Berkshire West CCGs. The meeting is from 6.00pm to 7.45 pm on Wednesday, 20th July 2016, at the Reading Community Learning Centre, 94, London Street, RG1 4SJ. There will also be news from PPGs and from the CCG.

Reading Borough Council's Health and Wellbeing Board - which has a remit to bring together the local health and social care economy - is holding an extra meeting at short notice at 6pm on Tuesday, 14th June 2016 in Committee Rooms 4A and 4B at the Civic Offices. The meeting appears to be to review plans which are due to be finalised before the next planned meeting. The final plan for the integrated working of health and social care - the Better Care Fund plan will be reviewed. Plans to move care of people with learning disabilities from hospitals to the community, known as "Transforming Care Plans" will also be reviewed. But the urgent novelty is a report on the development of the draft plan for the new regional "Sustainability and Transformation" unit - known variously as BOB, WeBOB and COBWeB. The region unites Buckinghamshire, Oxfordshire and Western Berkshire and is under the leadership of David Smith, the CEO of the Oxfordshire CCG. Draft five-year plans which should show trusts rapidly returning to financial sustainability and to meeting their targets are due to be lodged with NHS England by 30th June. The responsibilities at the new regional level are likely to cover workforce changes in primary care, IT developments in support and the re-organisation of urgent care and A&E departments where a national programme is under the leadership of Professor Keith Willett of Oxford.

By withdrawing its offer to sell land at 17, Craven Road the Royal Berks Hospital Trust has stopped a project to build a multi-practice, high-facility GP medical centre in south-east Reading. The primary care strategy for South Reading CCG area (most of Reading south of the Thames) envisages collaborations and mergers between GP practices to meet increased demand and patient expectations for services and access. Patients can benefit when doctors specialise and share the responsibilities of running a practice. And patients could use a broader range of services out of hospital. Some of our small practices have been rated "inadequate" by the Care Quallity Commission and put into special measures. Working together with other practices could help to raise standards. Three local practices have been working together since the Royal Berkshire Hospital offered to sell land on the east side of Craven Road in 2011 to develop the plans for a multi-practice GP medical centre. They are believed to be Pembroke Surgery, London Street Surgery and Kennet and Christchurch Surgery. Reputedly, over 100.000 pounds was spent by NHS England (then responsible for GP primary care) on a feasibility study for the new centre. Full architectural plans have been drawn up and granted planning permission recently by Reading Borough Council. But now the project is halted because the hospital trust has withdrawn its offer to sell while it reassesses its options. The four CCGs of Western Berkshire are jointly taking responsibility for GP primary care in their area now. And they provide the bulk of income for the hospital. So can the various parties, and perhaps representatives of the public, not get together with an open mind and a flexible approach and sort this out? Members of South Reading Patient Voice heard a description of the medical centre project and its rationale from Dr Gerard d'Cruz of Pembroke Surgery in March 2016. But apart from that patients are standing on the sidelines wondering exactly what is being proposed and what will happen when.

There will be a discussion about developments in primary care. The set of questions posed as starters is: 

1. Where are we with the new workforce in GP surgeries?
2. What will the new alliances of practices be doing differently?
3. There are practices with closed lists in South Reading CCG area - will we have sufficient primary care capacity?
4. Cancer wait targets are being missed at RBH. What are the effects of this? Can this be put right?
5. What can be done about rising A&E attendances AND admissions?
6. Can we do more for carers at GP surgeries?
7. NHS England is proposing better incident reporting at GP surgeries. How will that work?
8. How well are we doing as regards outcomes? (See attached document taken from the NHS Choices web site.)

There will also be reports from Patient Participation Groups and from recent healthcare planning and consultation meetings held in public. Patients registered with a GP practice in the South Reading CCG area are welcome to attend.