+ Annual Report 02
2005 | 2006
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05-06 07-10 11 12 13 13 14 14 15 16 17 18 19 20-29 30
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Introduction - Chief Executive Who we are and what we do Our aims and objectives
Improvements we’ve made during the year Improvement Partnership in Health
Improvements we’ve made in the past FIVE years Public involvement Our Staff
Communications Complaints
Developments since the year-end Who’s who
Finance Director’s report
Remuneration Committee: constitution and operation Independent Auditors’ report to the West Norfolk Primary Care Trust Board on the Summary Financial Statements Financial summary & annual accounts Links
Index 02
This is the last annual report for West Norfolk PCT, as it is abolished at the end of September and becomes part of Norfolk PCT. The PCT was established in October 2000 with the aim of improving health care for the people of West Norfolk, involving them in the decisions made and improving their health. As the PCT comes to an end this is an opportunity to look back and review whether we have been successful. What have we done to improve health care for the people of West Norfolk?
Waiting times for treatment at the Hospital have reduced significantly. No one now waits for longer than 13 weeks for an out patient appointment or 26 weeks for an operation. For mental health users, the services provided have changed considerably. The services are now jointly provided with adult Social Services with a single management structure. More people are supported in the community and fewer people are admitted to hospital. Patients are now seen, diagnosed or treated in a range of facilities across the PCT, rather than automatically in hospital. In addition we have developed a number of specialist services such as the COPD team or the specialist diabetes nurse for children. Have we involved patients, users and carers?
Yes. West Norfolk PCT is seen as an exemplar in the work it has done on Patient and Public Involvement. There are patient representatives on many of the working groups looking at how we improve services. The PCT was asked to be a pilot area for the Expert Patient Programme. This is about encouraging patients to be involved in their healthcare as an equal partner with the professionals. This was very successful project that has continued within the PCT.
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Introduction
Have we improved the health of the population?
The PCT has concentrated a lot of its effort on prevention. We have worked in collaboration with local authority and other partners to develop a number of projects. An excellent example of this is in falls prevention, where a very small team has worked closely with a range of agencies to reduce the number of falls and thus the number of admissions to hospital. The effect of this is that West Norfolk has one of the lowest levels of admissions to hospital for broken neck of femur. Overall opinion?
The PCT has achieved a lot, and leaves the health services in West Norfolk in a better position than in October 2000, with a strong legacy for the future. I would like to finish by giving my personal thanks to everyone who has been involved in the work of the PCT: Board, staff, partners and patients. It has been a pleasure to work with you all. I believe we have achieved a lot and that has been down to the involvement of you all and your commitment to the aims of the PCT.
I do believe that West Norfolk will be a strong influence in the Norfolk PCT and that a lot of the excellent ways of working will continue into the future.
Hilary Daniels Chief Executive
Since 2000 West Norfolk Primary Care Trust (PCT) has been responsible for ensuring healthcare is available for a population of almost 160,000 across 750 square miles of West Norfolk and part of neighbouring Breckland. In partnership with our NHS colleagues at The Queen Elizabeth Hospital King's Lynn, local GPs, dental practices and pharmacies, we have made sure that a consistently high standard of healthcare is on hand for you and your family.
PCTs were set up by the Government to focus on delivering good quality health services at local level, and having local health experts and lay people to run them.
However, Government thinking has now moved on, so this is the final full-year report on health activities in West Norfolk. Later this year West Norfolk PCT will become part of a larger, county-wide Primary Care Trust (with the exception of Great Yarmouth). The new changes to the management and control structure are already being put in hand. As a patient you should see little difference in the way services are provided where they matter most, at your GP surgery, in your community and at your local hospital. In this report we intend to explain not just 'who we are and what we do', but 'who we are and what we have done.' Because we have achieved a great deal during the lifetime of West Norfolk PCT. This has brought us national recognition in many fields, because we have always tried our very best to lead the way in modern healthcare.
The following pages will give you a flavour of the way we have influenced healthcare for the better over the past year and during the preceding years. At all times we have worked for the greater good of you, the patient. We are proud of the legacy the new PCT will inherit from us because it forms a sound basis for even better things to come.
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Our original vision
When we were set up we defined our aim as:
Our vision is the delivery of appropriate services at the appropriate time and place, to the people of West Norfolk. We defined our purpose as:
West Norfolk Primary Care Trust is a local organisation, delivering health improvement to the local population by responding to local needs as expressed by the local people.
That has continued to be our goal and in the following pages you'll find out what's been going on in the past financial year, plus a look-back at some of the achievements of previous years.
During the financial year 2005-6 the outstanding contribution made towards the NHS in West Norfolk by the then Chair of the PCT, Sheila Childerhouse, led to her being asked to take over as Chair of The Queen Elizabeth Hospital King's Lynn NHS Trust Board, following the resignation of the former Chair.
Although Sheila's contribution to the life of the PCT has been greatly missed, we were fortunate to have as our Vice Chair Margaret Cook, an experienced former local government officer. Margaret was able to provide a seamless transition and has ensured that the good work of the PCT has continued. Also during the year - while day-to-day business continued with the care of our population - the NHS was undergoing radical change on a number of fronts. Work on these had to be carried out in addition to the 'day' job of staff, meeting demanding deadlines. But more on that later.
Who we are and what we do 04
So what does the PCT do? In brief, Primary Care is the first point of contact most people have with the National Health Service (NHS) on a regular basis. The PCT's job is to 'commission' - in other words buyin - the services normally provided by your family doctor at the 23 local General Practice surgeries in our area. In addition, the PCT has to commission all other community-based services. These include: ■ District Nursing.
■ Child Health services.
■ Contraceptive advice (the former Family Planning service). ■ School health advisers.
■ Speech and language therapy.
■ Drugs and Alcohol treatment and advice.
■ Podiatry services (this includes chiropody and all other foot/mobility problems). ■ Psychological therapies.
■ Community dental services, including our two local NHS Dental Access Centres, in Wisbech and King's Lynn.
During the 2005-6 financial year work progressed behind-the-scenes to commission NHS dentistry in West Norfolk, ready for a major change that took place in April 2006, when PCTs across England became responsible for NHS dentistry for the first time.
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Our principal role after commissioning these services is to assist the professionals in ensuring that a consistently high standard of service is provided and developed. However, the work of the PCT as local NHS 'buyer' also includes commissioning secondary care in the area. This covers ■ All the hospital-based treatments you are likely to need at your local district general hospital.
■ Specialist services you may need elsewhere - such as heart treatment at Papworth hospital or specialist services at the Norfolk & Norwich hospital, Addenbrookes or further afield. We also have to commission
■ Ambulance services. In addition, in our area East Anglian Ambulance Trust, through its subsidiary Anglian Medical Care, provides emergency GP 'out of hours' cover for the times when your local surgery is closed, such as evenings and weekends. West Norfolk PCT also operates and manages its own 18-bed community hospital in Swaffham, used largely for rehabilitation.
One of our largest commitments is to provide mental health services in West Norfolk. This is achieved by a variety of specialist services including community psychiatry, a Child and Adolescent Mental Health Service; the specialist Fermoy Unit for psychiatric inpatients, attached to the Queen Elizabeth Hospital; and Chatterton House, a dedicated unit for older patients with problems such as dementia.
Our aims and objectives
We work closely with neighbouring PCTs, ambulance, hospital and mental health trusts and also with social services, local authorities, the emergency services and voluntary services, to ensure patients have a relatively 'seamless' system of care in our area. During the 2005-6 financial year our budget was nearly ÂŁ170 million, of which 98% was spent on patient care. Only 2% of our budget was spent on administration, which compares very favourably with private sector businesses in the UK and health services in other countries. Overall, we are within the area covered by the East of England Strategic Health Authority, formerly the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority.
During the course of the year an immense amount of preparatory work has been in progress ready for major changes that will affect all PCTs and Strategic Health Authorities later in 2006. Having set up PCTs to provide local-based health services, the Government's current thinking is that health services should be organised where possible on a county-wide basis, coterminus with the local authority.
After public consultation, it has been decided that the new PCT for Norfolk will incorporate five of the six county PCTs. Great Yarmouth will form a separate cross-border PCT, along with the current PCT covering the Waveney district in Suffolk. These changes are due to take place in October 2006. During the year West Norfolk PCT lost one of its two stars awarded the previous year, out of a possible three stars, by the Healthcare Commission and was assessed as a one-star PCT. This was as a result of some key access time targets being missed by some local GP practices. Our Mental Health service was assessed separately, retaining their rating as a one-star organisation.
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Two phrases came to dominate the NHS at local level during the year: 'Patient Choice' and 'The Patient-led NHS'.
â– Choice: Under new arrangements, patients do not have to follow the traditional path for a hospital procedure of being referred by their GP to a specialist at their local hospital. They now have a choice of 'providers' which may include their local hospital. But it will also give them a choice of several other hospitals within the region, or alternative 'providers' where a particular treatment may be available - for example at a local GP surgery where minor procedures such as cataracts, hernia repairs or carpal tunnel surgery, are carried out. â– Part of this process now involves 'Choose and Book', in which a patient and his or her GP can choose a hospital and specialist, and book an appointment online from the comfort of the GP's consulting room at a time and place to suit the patient. West Norfolk PCT and The Queen Elizabeth Hospital have been leading the way in this process and were chosen by the Department of Health as an 'early implementer'. This means that extra resources and expertise were channelled into West Norfolk to help us introduce the system locally, and to enable the lessons we learned to be passed on to other NHS organisations.
Practice Based Commissioning
National reorganisation of the NHS means that more day-to-day responsibility for planning local health services is being given to GP practices. They will be deciding what services ought to be provided to meet the needs of their own patients. When local Primary Care Trusts are amalgamated into county-wide PCTs in late 2006, Practice Based Commissioning consortia will remain in place to ensure that decisions relating to the commissioning of health services in this area remain in the hands of local professionals. During 2005-6 our local GP practices formed themselves into a consortium and began planning the framework to enable their new working group to function efficiently. Their work involves extensive patient involvement to ensure care 'pathways' are suitably mapped and developed. Patient-led NHS:
West Norfolk has also led the way in public involvement, and representatives of patient groups are included in all our health service planning, to ensure that patients have a real 'voice' in new developments. During the year members of our Patient Forum played a key role in planning for future NHS provision under the new county-wide PCT and were represented on the PCT's Reconfiguration Board. New contracts:
One of the biggest undertakings during the year was the local negotiation for the new NHS dental contract. This involved marketing the new contract to local dental practices, encouraging them to sign-up to the new Personal Dental Service (PDS) contract and maintain NHS dental cover across West Norfolk. During the course of these negotiations, the opportunity was taken to expand the cover provided in some areas, making use of the opportunity to bring-in a number of fully-qualified dentists from Poland. A new dental practice was set-up to cover the coastal area, based at Snettisham, to provide continuing cover following the decision of a single-handed dental practitioner nearby to retire.
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Since the year-end further developments are under way that could see additional capacity for NHS dental patients being provided in King's Lynn town centre. Waiting times
Improvements have been made both in access times for GPs and at The Queen Elizabeth Hospital. The target for seeing and treatment, or referring, Accident and Emergency patients within four hours at The Queen Elizabeth Hospital remains consistently high at between 98 and 100 per cent.
A significant contribution towards meeting Government targets and, more importantly, providing prompt treatment for our patients, has followed the co-location of the GP emergency 'Out Of Hours' service for the King's Lynn area adjacent to the A&E department at the hospital. Patients with relatively minor, or easilytreatable conditions are seen swiftly without having to face triage and a subsequent wait in A&E.
Improvements we’ve made during the year
LIFT
Our involvement as a key player in Norfolk LIFT (Local Improvement Finance Trust) was marked by the success of our first design-and-new-build project, the Plowright Medical Centre, close to the Eco Tech Centre in Swaffham. The new surgery, for the Plowright Medical Practice, opened its doors to patients during 2005 and was the first project to be completed by any LIFT team in the East of England. An official opening ceremony, performed by former Chair of the PCT, Mrs Sheila Childerhouse, was held in March. Wells Cottage Hospital
A debate over the future of North Norfolk PCT's Wells Cottage Hospital was led largely by the West Norfolk PCT Public Involvement Manager, acting in conjunction with senior managers from the two PCTs and a local 'Save Wells Hospital' action group. Local discussions, in view of West Norfolk PCT's 'stake' in the future of intermediate facilities in this part of Norfolk, included GPs and nursing staff from our area.
Following a period of public consultation and an initiative by local campaigners, the hospital is set to reopen in the near future under the patronage of a local charitable trust, formed specifically for this purpose.
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NHS Dentistry
Major changes have taken place in recent months relating to the provision of NHS dentistry across the country. From 1 April 2006, PCTs became responsible for provision and management of NHS dental services in their area. Much of the work of the Primary Care team during 2005-6 was taken up with planning for the future, working closely with local dental practices to encourage them to sign the new NHS contract, and ensuring that adequate provision was made for NHS cover across our area. During the financial year the team:
■ Achieved the 25% Personal Dental Service target set by the Department of Health in advance of the 1st April 2005 deadline. This brought us an additional £900,000 of Government funding.
■ Successfully recruited and retained eight Polish dentists during the summer of 2005. ■ Opened a new dental surgery in Snettisham in September 2005.
■ Led the formation of a Norfolk Dental Consortium to co-ordinate management effort across the county, the led negotiations with the Department of Health for an additional £500,000 of funding for NHS dentistry in our area. ■ Successfully implemented the new dental contract during the last quarter of the financial year. Pharmacies
A new contract was also introduced during the year for pharmacists, who are playing an increasingly important role in the Government's health strategy. During the year our Primary Care and Pharmaceutical teams ■ Published the Pharmaceutical Needs Analysis and implemented the new Pharmacy Contract.
■ Secured arrangements to provide patients with oxygen assessments and made sure that the maximum benefit is obtained from the new national oxygen supplies contract. ■ Led the formation of the Pan-Norfolk Pharmacy Group to co-ordinate efforts across Norfolk. 09
■ Successfully applied for membership of the Pharmacy Collaborative for Effective Use of Medicines. ■ Completed pharmacy inspections and visits for the new contract and completed feedback reports for the pharmacies.
■ Completed new out-of-hours rotas for pharmacists, with new on-call arrangements. Detailed work was undertaken by a number of specialist teams to improve the quality of life for patients with life-limiting conditions. Here are some examples:
Heart
A Cardiac Assessment Service was established, following a successful one-year pilot scheme. The nurse-led service is based within the Queen Elizabeth Hospital. Our Cardiac Assessment Nurse, Lucy Daly, sees patients admitted to hospital with chest pain and facilitates early diagnosis, evidence-based treatment options and early referral to the specialist unit at Papworth Hospital where appropriate. One-stop heart function clinic: In partnership with the CardioRespiratory Department at the Queen Elizabeth Hospital we piloted a 'One Stop Heart Function Clinic'. Patients referred to the clinic had an echocardiogram followed by a consultation with a 'GP with a Special Interest' in heart failure where in most cases the diagnosis was confirmed or refuted. Patients then saw a cardiac specialist nurse to clarify any queries and provide lifestyle advice. Results were sent back to their own GP. Funding is currently being sought to develop the clinic in a community setting.
BNP: Following pilot studies carried out in partnership with the Chemical Pathology Department at the Queen Elizabeth Hospital the B-type Natiuretic Peptide blood test will shortly be available to GPs to use as a 'rule out' test in diagnosing heart failure.
Heart failure specialist nurse: During the year development work took place to build a business case for funding a Heart Failure Specialist Nurse. Working in the community the nurse would support GP practices in managing heart failure patients and also to provide a beta-blocker titration service. Subsequent to the year end, the specialist nurse has now been appointed. Diabetes
West Norfolk PCT has always been at the forefront of diabetes education, support and nursing. Our education and support events have continued to remain popular dates on the calendar and to ensure we continue to 'hit the right mark', our service was audited in March 2006. In a survey of our workshops, 96 per cent of patients said they found presenters 'spoke in a way that was clear, easy to understand and hear.' All delegates felt they had learned a great deal in a 'relaxed, informal atmosphere'.
District Nursing
Rapid Assessment Team
Woundcare and nutritional guidelines have been compiled in conjunction with nursing colleagues in GP practices and The Queen Elizabeth Hospital. The guidelines are now in general use at the hospital, GP practices and in local nursing homes.
The team operates on weekdays, Monday to Friday, from 8.30am to 4pm, and comprises a specialist nurse, a physiotherapist, an occupational therapist and a social worker. Incoming patients are assessed promptly and where appropriate, are given the right treatment or help for their condition via other healthcare 'pathways'. This avoids the necessity for what can be a stressful hospital admission for the patient, and ensures that all the local 'help' agencies are involved in assisting the patient to make a recovery.
Close collaboration between District Nurses, Practice Nurses and colleagues at The Queen Elizabeth Hospital led to a new system of leg ulcer assessment and treatment documentation. This shared knowledge is now available for reference wherever the patient is treated. In addition, District Nurses have established regular leg ulcer clinics, to allow them to see and treat a greater number of patients.
We have also worked closely with the local Fire Service. Nurses are asked to give a pre-paid postcard to patients they think might benefit from a home risk assessment by Fire officers. Free smoke alarms are available to those in need. All trained District Nurses in West Norfolk attended a five day course during the year on advanced nursing skills.
One of the continuing problems for the health community is the number of emergency hospital admissions, principally of older patients, that might otherwise be avoided. In October 2005, in conjunction with The Queen Elizabeth Hospital King's Lynn and Norfolk Social Services, we established a Rapid Assessment Team, with the initial target of reducing this type of hospital admission by 150 cases a year.
So successful was the project that within the first five months the team had achieved their target. As a result, extra funding has now been allocated to expand the service into a seven-day-a-week service, operating until 8pm each day. Starfish
West Norfolk PCT's pioneering Starfish project continued to bridge the gap in services available to families of young people with complex learning and behavioural conditions. The basis of Starfish is to ensure that children and young people with 'challenging' needs can be given help and assistance within their family group, rather than being sent away to special schools in other parts of the country. As part of Starfish's groundbreaking work in this area, the National Autistic Society EarlyBird Plus course was held in King's Lynn - the first time the course has been held in this area. It is a course designed to help the carers of children aged from four to eight with a diagnosis of autism. Feedback from those on the course was 'very positive.' A number of other training courses designed to help carers of children with learning difficulties were arranged by the team.
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Improvement Partnership in Health
IPH was an 18-month programme, funded by the Department of Health, aimed at encouraging and facilitating partnership working across local health economies.
A joint team drawn from West Norfolk PCT, East Cambridgeshire & Fenland PCT and The Queen Elizabeth Hospital King's Lynn studied a variety of areas of work to find ways of improving services for patients, streamlining management - and obtaining better value for money. These included: â– Transport: a specially-appointed transport coordinator ensures that the provision of hospital transport is run on a rational and cost-effective basis between GP surgeries, patients homes and the hospital.
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â– Operations Centre: the latest computer technology is employed to collect all relevant data relating to bed occupation, incoming ambulances, patient discharges and staff availability to give an 'at a glance' picture of hospital usage at any given time.
â– Rehabilitation: redesign of the area's rehabilitation services, involving the PCT, the local acute hospital, community hospital, nursing homes, residential homes and social services facilities, has allowed hospital inpatient times and acute hospital bed useage to be reduced. This improves care services for patients and allows better use to be made of facilities for those who need specialist care.
This is the final annual report of West Norfolk PCT, so we took the opportunity to ask a few of our key staff what they considered to be the highlights of their time with the PCT, and what they are proud of achieving. Here's what they said:
James Fisher, Head of Podiatry Services
“Since the PCT was set-up we have:
■ Set up a foot-screening programme for people with diabetes, leading to a significant reduction in amputations.
Nigel Day, Head of Primary Care
■ We now have input to the Orthopaedic Triage.
“In the past five years we've been responsible for:
■ Forming Clinical Liaison groups to bring-together clinicians from primary, secondary and community care. This sowed the seeds of Practice Based Commissioning.
■ Initiating a Specialist Nurse service for respiratory conditions. As a result we now have the lowest admission rate for COPD (Chronic Obstructive Pulmonary Disease) patients in the East of England.
■ Opening-up closed GP lists by recruiting doctors from overseas. ■ Opening a new nurse-led GP surgery in Downham Market.
■ Recruiting up to six GPs in what was then a unique tripartite scheme with the Queen Elizabeth Hospital and the University of East Anglia called 'Supporting Specialisms With Primary Care.'
■ Opening a new dental practice in West Norfolk and increasing, by international recruitment, the number of dentists. We also managed to obtain an extra £500,000 from the Department of Health to help pay for developing NHS dentistry in this area.” “I hope West Norfolk PCT will be remembered for being an organisation that 'got there first' on many issues and as a result helped other PCTs in their learning process.”
■ We're developing input to the Vascular Multi-Disciplinary team.
■ We now have sophisticated targeting of resources to achieve maximum impact. This leads to hospital admissions avoidance and allows patients to maintain their independence. ■ We've developed our Biomechanics 'wing' to the point where it's now one of the best in the UK. ” Samantha Oughton, COPD Nurse
The 'COPD team' comprises nurses specialising in Chronic Obstructive Pulmonary Disease, and the Respiratory Nurse Specialist at The Queen Elizabeth Hospital King's Lynn.
Mavis White, Matron, Swaffham Community hospital
“I think our main achievements at the hospital have been:
■ Working together with the Radiology Department at the Queen Elizabeth Hospital and, with the help of our League of Friends, our new X-ray equipment and the increase in our ultrasound clinics. ■ Intravenous therapy and the continuation of blood transfusions for primary care patients. ■ Piloting the Palliative Care 'pathway'.
■ The anti-coagulant clinic here, and at Heacham and Dersingham. ■ Our Phlebotomy Clinic, taking patients from the three GP practices in Swaffham.
■ but most of all the ongoing good quality care we've given to our patients.”
“We're proud of two achievements in particular:
■ Our team won the QEH Michael Bastow Audit Prize for our work on long-term oxygen therapy. Our work resulted in cost savings by conducting reassessments in a patient's home, and allowed us to save hospital 'bed days'.
■ We successfully launched Breathe Easy West Norfolk, a support group for patients and their carers living with respiratory disease. It's a patient-led group supported by respiratory nurses.”
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Improvements we’ve made in the past FIVE years 12
Work on public involvement took West Norfolk PCT into a number of new dimensions during the year, in line with the shift in Government policy to give patients and the public a greater say in the way the health service is run. The PCT's Public Involvement Manager led public involvement for both West Norfolk and North Norfolk PCTs on planning for the future of Wells Cottage Hospital. Although situated in North Norfolk, the hospital had traditionally provided cottage hospital bedspace for patients from the northern part of the West Norfolk PCT catchment area. Its closure by North Norfolk PCT prompted the formation of a local pressure group. A locally-formed charitable Trust is now progressing plans to reopen the hospital. Also during the year reconfiguration of Norfolk's six Primary Care Trusts involved extensive consultation with partner organisations in a process led by Public Involvement leads from across the county.
Considerable pressure was exerted on the 900 PCT staff during the course of the year as they were required to meet the demands of a number of internal changes - in particular the new Agenda For Change pay and career structure - and begin planning the reconfiguration of PCT responsibilities. This is in preparation for the new county-wide Primary Care Trust, Norfolk PCT, which comes into being on 1 October 2006. West Norfolk PCT is an equal opportunities employer, committed to considering all job applicants fairly, regardless of disability, gender orientation or ethnicity. We are committed to preventing discrimination and stimulating equality of opportunity, and have a 'programme of action' of positive measures in place to ensure our policies are implemented. Staff are given every assistance and encouragement to further their careers, education and professional status. Environment
WNPCT sites are 'smoke free' and during the year staff were encouraged to use the PCT's 'Stop Smoking' service if they required help in quitting. A number of recycling initiatives were undertaken during the year in line with the PCT's aim to be environmentally friendly where practicable.
Detailed consultation also took place with our staff and stakeholders on PCT reconfiguration and the effect on NHS services and jobs.
During the year a number of exercises were held locally involving the NHS, emergency services, voluntary agencies and local authorities to test our Emergency Preparedness in the event, for example, of a major accident or health incident.
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Public Involvement
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Our Staff
Communication with the general public, our stakeholders and partners, has taken place on a variety of levels.
Externally, the Trust has enjoyed good, professional relationships with the local, regional and national media and during the year promoted a number of health initiatives with media events.
Our website provides easy access for the general public to information on local health services. A re-vamp of the site during the year now allows the public to access comprehensive information on health services in their own locality at the click of a button. Internally, information continued to be disseminated to staff via an electronic news bulletin.
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Communications
During the year 2005-06, the PCT received 31 complaints, a decrease of six over the previous year. There were significantly fewer complaints against the Mental Health Service - 14 compared to 25 for the previous year. All complaints involving General Practitioners were resolved within the 20-working day time limit.
Complaints involving mental health and other PCT activities took longer to resolve, according to the area of activity and the nature of the complaint. In Mental Health, 55 per cent were resolved within the 20 days; for Clinical Services 71 per cent, and for other areas, 50 per cent. In these cases complainants are advised that the complexity of the complaint will require longer than the 20 days to investigate, and regular updates are given, either in writing or by personal contact.
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Complaints GP practices 14
West Norfolk PCT has been working closely with other NHS organisations within the county and further afield to ensure that changes to the management structure of the NHS locally will not impair delivery of services to the patients. Our GP practices, in conjunction with the PCT, have been developing a Practice Based Commissioning consortium, and the PCT's executive function has divided into 'commissioner' and 'provider' arms in preparation for the new NHS structure due to come into effect in October.
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No new health projects have been undertaken during the final six months of West Norfolk PCT.
Instead, emphasis has been placed on consolidation of the PCT's healthcare achievements. This will ensure that the very best of our work is carried forward into the new organisation to provide a seamless transition of care for our population and to influence others in making improvements to overall healthcare standards.
Developments since the year end
Who's who on the Board?
The Professional Executive Committee
Margaret Cook: Vice-Chair (Chair as from Nov 05)
James Fisher: Vice Chair
Sheila Childerhouse: (to Nov) Chair
Lynn Collison: Non Executive Director
Kate Gordon: (to Dec 05) Non Executive Director Dr Edward Pank: Non Executive Director
Sir Sam Roberts, Bt.: Non Executive Director Hilary Daniels: Chief Executive
Dr Malcolm Skinner: Executive Committee Chair Dr John Rees: Director of Public Health David Stonehouse: Director of Finance Jim Keown: Director of Mental Health
Dr Richard Redman: GP representative
Pat Southgate: Health Visitor - Nurse representative Gordon Dawes: West Norfolk Public and Patient Involvement Forum Changes during the year:
Sheila Childerhouse was seconded by the NHS Appointments Commission to the Board of The Queen Elizabeth Hospital King's Lynn following the resignation of the QEH Chair Kate Gordon resigned in December 2005, on appointment to the Board of The Queen Elizabeth Hospital King's Lynn
Gordon Dawes replaced Dave Routledge as the PPI co-opted member in February 2006
Dr Malcolm Skinner: Chair
Hilary Daniels: PCT Chief Executive
David Stonehouse: PCT Director of Finance Dr John Rees: Director of Public Health
Dr Richard Redman: GP Clinical Governance lead Pat Southgate: Health Visitor Dr Ian Mack: GP
Dr Luk Ho: Mental Health clinician
Dr Rosemary Eames: Consultant, Queen Elizabeth Hospital
Dr Imogen Waterson: Child Health clinician Sir Sam Roberts: Lay member
Sue Barrett: Mental Health specialist, Older People's service
Jim Keown: Director of Mental Health Graham Dickerson: GP Practice Management representative
Sue Gurr: Director of Community Services
Stevie Shepherd: Community nursing representative In line with the proposed reorganisation of PCT functions, the PCT Professional Executive Committee has subsequently separated into two elements, Provider and Commissioner, both of which meet independently. Audit Committee
Members of the Audit Committee during the year were: Margaret Cook, Lynn Collison and Dr Edward Pank. In addition, meetings were attended by members of the Finance and other departments in an advisory capacity.
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Who’s who?
Hilary Daniels, Chief Executive Officer, West Norfolk Primary Care Trust, acts as the Public Sector Director on the Board of Norlife, the private sector LIFT company, of which WNPCT is a shareholder.
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The PCT overspent £813,000 - just under 0.5% of its overall resource limit. Whilst this is an improvement on last years position we still failed to achieve our statutory breakeven duty and this has resulted in a technical qualification of the regularity opinion to the PCT's accounts. Despite strong local management of pressures on Out of County Mental Health placement we had deficits on these budgets as a result of contributing to countywide risk management arrangements.
It is pleasing to confirm that our provider arm of Community & Mental Health Services achieved financial balance, which proved particularly challenging for the services to deliver and required very tight management of recruitment to vacant posts.
Whilst 2006/7 is another very challenging year the PCT has set a realistic balanced budget and continues to work closely with The Queen Elizabeth Hospital King's Lynn NHS Trust in support of their financial recovery plan. The PCT met its financial duty of staying within its annual cash limit.
The PCT invested £495,000 in capital infrastructure. This includes £114,000 in refurbishment costs at the Fermoy Mental Health Unit and £190,000 in IT infrastructure in primary care in order to support full implementation of Choose and Book Software.
The PCT is expected, in line with public sector payment policy, to pay all suppliers of goods and services within 30 days of goods received or a valid invoice which ever is the later. Against a target of 95% compliance the PCT achieved 85.8% by volume and 91.2 % by value. Management costs increased from £18.30 per head in the previous year to £19.59 per head of population in 2005/6. West Norfolk PCT will be disestablished in 2006/7 and form part of new Norfolk PCT, which will result in management cost saving of at least 15%.
Senior Managers received a pay award of 3.225% in line with other pay groups. This pay award was agreed by the Remuneration Committee, which is made up of the PCT chair and two Non Executive Board members. Summary Financial Statements
The following statements are a summary of the information contained in the full accounts, which received an unqualified audit opinion from our external auditors, PriceWaterhouseCoopers. For a copy of the full accounts please telephone 01553 816207.
David Stonehouse Director of Finance
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Finance Director’s report
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Remuneration Committee: Constitution and operation
■ The PCT's Remuneration Committee comprises the Board Chair and the other Lay Members with officers in attendance as deemed appropriate. ■ It meets periodically to agree the pay award for Senior Managers and other locally agreed pay changes e.g. clinical excellence awards. Senior Manager Pay Contractual basis
■ All directors are on substantive contracts with a three month notice period for both employer and employee. ■ There are no Senior Managers within the PCT employed on fixed term contracts.
Pay structure
Pay awards
■ Senior Managers have recently been assimilated to the Agenda for Change pay spine in line with other nonmedical staff.
Payments to third parties
■ Currently there is no performance related pay for Senior Managers and pay awards have been made in line with admin and clerical staff.
■ Other than lease car benefits in kind, all other remuneration relates to cash amounts.
■ The tables on pages 26 and 27 provide details of the remuneration and pension entitlements for PCT senior managers in 2005/06.
■ There have been no significant awards or compensation payments made to past senior managers in the year (2004/05: nil). ■ There are no amounts payable to third parties for the services of senior managers.
Hilary Daniels
David Stonehouse
14 September 2006
14 September 2006
Chief Executive
Director of Finance
18
+ Independent auditors' report to the Directors of the Board of West Norfolk Primary Care Trust We have examined the summary financial statements for the year ended 31 March 2006 which comprise the Operating Cost Statement, the Balance Sheet, the Statement of Recognised Gains and Losses, the Cashflow Statement and the related notes. We have also audited the information in the PCT's Remuneration Report that is described as having been audited. This report, including the opinion, has been prepared for and only for the Board of West Norfolk Primary Care Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission. We do not, in giving this opinion, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.
Respective responsibilities of directors and auditors
The directors are responsible for preparing the Annual Report, including the Remuneration Report. Our responsibility is to audit the part of the Remuneration Report to be audited and to report to you our opinion on the consistency of the summary financial statements within the Annual Report with the statutory financial statements. We also read the other information contained in the Annual Report and consider whether it is consistent with the audited summary financial statements. This other information comprises only the Finance Director's report and the unaudited part of the Remuneration Report. We consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary financial statements. Our responsibilities do not extend to any other information.
In our opinion:
â– the summary financial statements are consistent with the statutory financial statements of the PCT for the year ended 31 March 2006; and
â– the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England.
The PCT exceeded the revenue resource limit specified by the Secretary of State and consequently our opinion on the financial statements was qualified for noncompliance with governing authorities.
Basis of opinion
We conducted our work in accordance with Bulletin 1999/6 'The auditors' statement on the summary financial statement' issued by the Auditing Practices Board.
19
Opinion
PricewaterhouseCoopers LLP Norwich 14th September 2006
20
+ Financial summary & Annual accounts
West Norfolk Primary Care Trust 2005/06 Summary Financial Statements + OPERATING COST STATEMENT
2005/06 £000
2004/05 £000
Gross Operating Cost
173,074
158,179
Less: Miscellaneous Income
(26,511)
(22,958)
+
Financial summary & Annual accounts
Commissioning
21
Net Operating Costs
146,563
135,221
Gross Operating Costs
26,375
25,736
Providing
Less: Miscellaneous Income Net Operating Costs
Total Net Operating cost for the Financial Year
STATEMENT OF RECOGNISED GAINS AND LOSSES Fixed Asset Impairment Loss Unrealised surplus (deficit) on fixed asset revaluations/indexation
Increase in the donated asset reserve and government grant reserve due to receipt of donated and government granted assets Reduction in the donated asset reserve due to depreciation Gains and (losses) recognised in the financial year
PricewaterhouseCoopers LLP are the PCT's external auditors and their fees for 2005/06, all of which related to statutory audit services, amounted to £115,000 (2004/05: £105,000).
(3,752)
22,623
(3,941)
21,795
169,186
157,016
2005/06 £000 (3,711) 378
2004/05 £000 0 2,795
(8)
(9)
(3,341)
2,786
West Norfolk Primary Care Trust 2005/06 Summary Financial Statements + BALANCE SHEET
31st March 2006
31st March 2005
13,777
17,369
7 4,326 5 4,338
4 2,431 5 2,440
(11,564)
(9,161)
Fixed Assets
Current Assets
Stocks and work in progress Debtors Cash at bank and in hand CREDITORS : Amounts falling due within one year
NET CURRENT ASSETS (LIABILITIES) TOTAL ASSETS LESS CURRENT LIABILITIES CREDITORS: Amounts falling due after more than one year PROVISIONS FOR LIABILITIES AND CHARGES TOTAL ASSETS EMPLOYED FINANCED BY CAPITAL & RESERVES: General Fund Revaluation reserve Donated asset reserve TOTAL CAPITAL AND RESERVES
£000
(7,226) 6,551 (299) (668) 5,584
(6,721) 10,648 0 (562) 10,086
4,288 1,222 74
5,449 4,504 133
5,584
10,086
+
Financial summary & Annual accounts
£000
22
West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +
+
Financial summary & Annual accounts
CASH FLOW STATEMENT
23
OPERATING ACTIVITIES
Net cash outflow from operating activities CAPITAL EXPENDITURE
Payments to acquire tangible fixed assets
Receipts from sale of tangible fixed assets
Payments to acquire fixed asset investments
Net cash inflow/(outflow) from capital expenditure
Net cash inflow/(outflow) before financing FINANCING
Net Parliamentary Funding
Increase/(decrease) in cash
2005/06
2004/05
(167,221)
(154,414)
(510)
(839)
(23)
(14)
£000
0
(533)
£000
100
(753)
(167,754)
(155,167)
167,754
155,171
0
4
West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +
2005/06 £000
2004/05 £000
Total net operating cost for the financial year Less Non-discretionary Expenditure Operating Costs less non-discretionary expenditure
169,186 (2,996) 166,190
157,016 (2,464) 154,552
Revenue Resource Limit
165,377
153,070
(813) 0 (813)
(1,482) 0 (1,482)
(Over)/Under spend against revenue resource limit Unplanned brokerage received Operational Financial Balance The PCT overspent by £813,000 against its revenue resource limit for 2005/06 (2004/05 £1,482,000 overspent). The deficit position primarily reflects an overspending on the PCT's share of the Norfolk-wide Out of County specialist mental health budget and specialist noncommissioned activity. In 2004-05 the PCT received internally generated financial support of £813,000, relating to capital to revenue flexibility transferred from Norwich PCT. No appropriate capital schemes were identified to support the transfer. The PCT was not required to repay this support in 2005/06, but expects to do so in 2006/07. Nevertheless, the PCT has set a balanced budget and Local Delivery Plan (LDP) for 2006/07, including the repayment of prior year deficits. However there remain a number of significant risks around the achievement of financial balance which the PCT will need to closely manage.
+
Financial summary & Annual accounts
OPERATIONAL FINANCIAL BALANCE
24
West Norfolk Primary Care Trust 2005/06 Summary Financial Statements + The PCT is required to recover full costs in relation to its provider functions. The performance is as follows:
PROVIDER FULL COST RECOVERY DUTY
Financial summary & Annual accounts
+ 25
less: Miscellaneous income relating to provider functions Net Operating Cost
(Under)/over recovery of costs
Percentage of bills paid within target
Total bills paid within target Percentage of bills paid within target
£000
(3,752)
(3,941)
(22,623)
21,795
21,795 0
2004/05 Number
2003/04 £000s
Number
10,927 9,955
6,584
10,388
85.81%
91.10%
79.32%
84.27%
6,428
Number 1,355
2005/06
£000s
130,477
1,159
129,634
85.54%
99.35%
8,301
£000s
7,491
NHS CREDITORS
Total bills paid in the year
25,736
0
PUBLIC SECTOR PAYMENT POLICY
Total bills paid within target
26,375
22,623
Costs met from PCT's own allocation
Total bills paid in the year
2004/05
£000
Provider gross operating cost
Non NHS Creditors Better Payment Practice Code - measure of compliance
2005/06
12,327
The Better Payment Practice Code
requires the PCT to aim to pay all
valid invoices by the due date or
within 30 days of receipt of a valid invoice, whichever is later.
+
H Daniels Ms J Rees Dr D Stonehouse Mr J Keown Mr S Gurr Mrs M Cook Mrs S Childerhouse Mrs L Collison Mrs K Gordon Ms E Pank Dr S Roberts Sir M Skinner Dr U Thakaar Mr S Barrett Mrs G Dickerson Mr Ho Dr J Fisher Mr I Mack Dr R Redman Dr S Shepherd Mrs P Southgate Mrs I Waterson Dr
2004-05 Other Remuneration (bands of £5000) 2004/05
Benefits in kind (bands of £100) 2004/05
Salary (bands of £5,000) 2004/05
Benefits in kind (bands of £100) 2005/06
2005-06 Remuneration (bands of £5000) 2005/06
Salary (bands of £5000) 2005/06
Title
Name
Financial summary & Annual accounts
Board & Executive Commitee Member Remuneration 2005-06+
£000 100-105 110-115 60-65 70-75 65-70
£000 30-35** -
£000 13-14 9-10 17-18
£000 100-105 100-105* 60-65 50-55 45-50
£000 -
£000 29-30* 19-20* 12-13*
Chairman of the Trust Board from Nov 05# Chairman of the Trust Board until Oct 05 Non Executive Board Member Non Executive Board Member# Non Executive Board Member Non Executive Board Member#
10-15 10-15 5-10 5-10 5-10 5-10
-
-
5-10 20-25* 5-10 0-5 0-5 5-10
-
-
Chairman of the Trust Executive Executive Member Executive Member Executive Member Executive Member Executive Member Executive Member Executive Member / Board Member Executive Member Executive Member / Board Member Executive Member
30-35 0-5 5-10 5-10 5-10 5-10 5-10 10-15 5-10 10-15 5-10
-
-
30-35* Nil 5-10 5-10 5-10 5-10 10-15 5-10 10-15 5-10
-
-
Chief Executive Director of Public Health Director of Finance and Information Director of Mental Health Director of Community Services
# Members of the Remuneration Committee * Restated ** Arrears on consultants contract All benefits in kind relate to the provision of lease car. The PCT took the view that consent should be withheld Remuneration waived by directors & allowances paid in lieu.Nil ( 2004-05 Nil) remuneration was waived by directors. Nil (2004-05 Nil ) of allowances were paid in lieu to directors
26
+ 27
Cash equivalent Transfer Value at 31st March 2005
Real increase in cash Equivalent Transfer Value
Employer’s contribution to stakeholder pension (rounded to nearest £00
£000 5.0-7.5 15-17.5 2.5-5.0 17.5-20 22.5-25
Cash equivalent Transfer Value at 31st arch 2006
H Daniels Ms J Rees Dr110-115 D Stonehouse Mr J Keown Mr S Gurr Mrs
Total accrued pension at age 60 & related lump sum at 31st March 2006 (bands of £5,00)
Name and title
Financial summary & Annual accounts
PENSION ENTITLEMENTS
Real increase in pension at age 60 & related lump sum (bands of £2,500)
Board & Executive Commitee Member Remuneration 2005-06+
£000 155-160 150-155 55-60 125-130 75-80
£000 624 154 542 327
£000 567 136 434 214
£000 30 10 68 75
£ Nil Nil Nil Nil Nil
As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members. Cash Equivalent Transfer Values
A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the members' accrued benefits and any contingent spouse's pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefit accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figure, and from 2005-06 the other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.
Self-employed GPs who are members of the Professional Executive Committee (PEC) have pension entitlements. However, the proportion of those entitilements that relates to their membership of the PEC is not significant compared to the proportion that relates to their work as practitioners independent of the PCT. It is not, therefore, appropriate to disclose their pension entitlements. Real Increase in CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of period. Details of the treatment of pension liabilities in the PCT's accounts are included within the Pensions Costs Accounting Policy note in the full financial statements
West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +
MANAGEMENT COSTS
+
Financial summary & Annual accounts
Management costs (£000)
The PCT is required to keep within its Capital Resource Limit. The performance for 2005/06 is as follows
less: Net Book Value of assets disposed of
144,047
£18.27
2005/06
2004/05
495
886
£000
£000
(27)
(100)
968
1,225
Charge Against the Capital Resource Limit
468
(Over)/Underspend against Capital Resource Limit
500
Capital Resource Limit
144,047
2,632
£19.59
Management cost per head of weighted population
Gross Capital Expenditure
2004/05
2,822
Weighted Population
CAPITAL RESOURCE LIMIT
2005/06
786 439
David Stonehouse Director of Finance
Hilary Daniels Chief Executive
STATEMENT ON INTERNAL CONTROL
The Statement on Internal Control can be found in the full accounts available from our internet site: www.westnorfolk-pct.nhs.uk 28
29
+ Administrative Expenditure 1.8% + Secondary Care 69.9%
Within Secondary Healthcare ÂŁ61,7 million of spend was for services commissioned from Queen Elizabeth Hospital NHS Trust and ÂŁ22.6 million for community & mental health services directly provided by the Primary Care Trust. All figures are gross of income from lead commissioning arrangements and services provided to other PCT's.
+ Accident and Emergency 1.3%
+ Community Health Services 12.6% + Learning Difficulties 3.7% + Mental Illness 10.7% + Maternity 2.2%
+ Grants to fund Capital Projects 0.2%
+ Ophthalmic Services 1.8% + Dental Services 5.8%
+ Pharmaceutical Services 5.3% + GMS/PMS 39.1%
+ Prescribing 47.3% + Other 0.7%
Secondary Healthcare Purchased
Gross operating expenditure
+ Primary Care Prescribing 13.4%
+ General and Acute 69.3%
Primary Healthcare Purchased
+
Financial summary & Annual accounts
+ Provision Of Primary Healthcare 14.9%
These are links to the web sites of the organisations who work together in promoting good healthcare in West Norfolk: West Norfolk PCT www.westnorfolk-pct.nhs.uk
Healthcare Commission www.healthcarecommission.org.uk
National Health Service www.nhs.uk
NHS Direct www.nhsdirect.nhs.uk
Norfolk Suffolk and Cambridgeshire Strategic Health Authority www.nscstha.nhs.uk
HARP web site for Asylum Seekers health issues www.harpweb.org.uk
Borough Council of King’s Lynn and West Norfolk www.west-norfolk.gov.uk Department of Health www.doh.gov.uk
+
Norfolk County Council www.norfolk.gov.uk
Patients Association www.patients-association.com
West Norfolk Young People www.youthzone.biz
Links to other organisations 30
+
West Norfolk Primary Care Trust St James Exton’s Road King’s Lynn Norfolk PE30 5NU
Tel: 01553 816200 Fax: 01553 761104 e-mail: enquiries@westnorfolk-pct.nhs.uk
www.westnorfolk-pct.nhs.uk