Preventative and Proactive Care (PPC) Programme Board minutes : 9 September 2024

Attendees and apologies

• Donna Bell (DB), Director for Social Care and National Care Service (NCS) Development, Co-Chair PPCPB, Scottish Government
• Karen Duffy (KD), Delivery Director, PPC, Deputy Chair, Scottish Government
• Angella Fulton (AF), Associate Director, Social Care, NHS Education for Scotland (NES)
• Craig Tomlinson (CT), Engagement Lead for Person-Centred Care, Scottish Government
• Eddie Follan (EF), Chief Officer, Health and Social Care for Convention of Scottish Local Authorities (COSLA), Scottish Government
• Ellie Crawford (EC), Unit Head leading for Primary Care link with PPC, Scottish Government
• Fiona Wright (FW), Clinical Priorities, Scottish Government
• Gregor Boyd (GB), Senior Statistician in Health and Social Care Analysis (HSCA), Scottish Government
• Jennifer Champion (JC), Acting Director of Public Health Scotland (PHS), NHS Forth Valley
• Joanna Macdonald (JM), Deputy Chief Social Worker Advisor, Social Work, Scottish Government
• Kathy Kenmuir (KK), Professional Nurse Advisor Primary Care, Scottish Government
• Katie Morris (KM), Getting it Right for Everyone (GIRFE) Lead, Scottish Government
• Laura Kerr (LaK), Head of Policy and Workforce, Social Work Scotland
• Lorna Kelly (LoK), National Lead, Primary Care for HSCS, HSCS
• Malcolm Summers (MS), Head of Strategic Reform, Scottish Government
• Manira Ahmad (MA), Chief Officer (PHS), Public Health Scotland
• Rishma Maini (RM), Consultant Public Health Medicine (PHS), Public Health Scotland
• Sara Redmond (SR), Chief Officer, ALLIANCE Scotland

 

Apologies

• Alison Byrne (AB), Deputy Director Drugs Policy, Scottish Government
• Anita Morrison (AM), Head of Health and Social Care Analysis, Scottish Government
• Ann Gow (AG), Health Improvement Scotland (HIS) Director of Nursing and Deputy Chief Executive, HIS 
• Professor Carolyn McDonald (CMcD), Chief Allied Health Professions Officer, Scottish Government
• Cat Macaulay (CM), Chief Design Officer, Scottish Government
• Catherine Labinjoh (CL) National Clinical Advisor for Realistic Medicine, Scottish Government
• Julie Murray (JM), Chief Officer, East Renfrewshire, HSCP Representative
• Karen Reid (KR) Chief Executive, NHS Education for Scotland (NES) / NHS Board Chief Executives (BCE)
• Kim Walker (KW), Programme Director, Care and Wellbeing Portfolio (CWB), NHS NSS
• Lynn MacMillan (LMac), Head of Health Inequalities Unit, Health Improvement Division, Scottish Government
• Nicola Edge (NE), Head of Health and Social Care Analysis (HSCA), Scottish Government, Scottish Government
• Niamh O’Connor (NOC), Deputy Director, Population Health Strategy and Improvement, Scottish Government
• Stuart Reary (SRe), GP Lead, Primary Care, Scottish Government
• Susan Gallacher (SG), Deputy Director, Primary Care Strategy and Capability, Scottish Government
• Tim McDonnell (TM), Director of Primary Care (PC), Co-Chair PPCPB, Scottish Government 
   

Items and actions

Welcome and apologies – Donna Bell (DB) 

Donna Bell, Director for Social Care and NCS Development, welcomed all to the meeting and noted apologies received. 
The minutes from the previous meeting on 24 June 2024 were approved subject to the following amendments and will be published on the Scottish Government website. 
Jennifer Champion and Laura Kerr job titles to be updated to Acting Director of Public Health, NHS Forth Valley and Head of Policy and Workforce at Social Work Scotland respectively. 
Updates to outstanding actions were discussed and recorded in the action log.

 
PPC Status Report – Katie Clayton (KC)

Katie Clayton, Programme Manager for PPC, reported that the overall RAG status for the programme is Green for this reporting period July to September. All workstreams are also reporting Green and progressing with their agreed deliverables. One high level risk at programme level has been reported relating to workforce capacity and pressures within Getting it Right for Everyone (GIRFE), Primary Care and cardiovascular disease (CVD). Controls are in place for these workstreams and at a programme level to ensure workstreams are on track with their deliverables and there is continued collaboration with workstream leads to focus on deliverable phasing.  
Once the revised PPC Charter is approved, reporting will be updated to reflect revised workstreams and contributions to Care and Wellbeing Portfolio (CWB) and the overall Health and Social Care Vision for Scotland. 
High level dependencies have been identified through the workstreams and more detailed work is now required to map these out. This will be part of status reporting brought to the next Programme Board. 
The very high risk on the Community Glaucoma Service (CGS) reported at the last Programme Board meeting has now been reduced, due to 10 out of 14 Boards now on track to complete rollout by April 2025. There are ongoing discussions with remaining boards who are still to progress the roll out of CGS. 
The next PPC Newsletter is due to be issued late September, with planning for a virtual stakeholder event in November. 

 

PPC Delivery Director’s Update, Karen Duffy (KD) 

Karen Duffy, Delivery Director for PPC, provided an overview of the revised programme charter outlining the landscape of PPC and Governance Reporting. This included why we need to change and focus on reform, the challenges currently faced within the system and referred to the Population Health Framework through the lens of the four primary drivers for population health with change ideas and priorities for each. Our focus within the PPC Programme is on prevention and early intervention for better outcomes for people which is most cost effective. 
The four quadrants of the reform vision are focused on access, prevention, quality, and people and place, with PPC contributing to all four areas. Our programme mission is to transfer our models of care to be more preventative, proactive and focused on early intervention, with our specific aims (strategic objectives) for 2024 to 2026 identified. 
The revised governance for the PPC Programme was laid out. There will now be four proposed workstreams composed of; GIRFE, Primary Care (PC) and Community Healthcare Reform, Secondary Prevention (Cardiovascular Disease and Waiting Well), with the fourth a proposed joint workstream with the Population Health Programme that will dual report to Population Health and PPC. 
Summary of board discussion on this item: 

• there was a discussion around the four quadrants in the charter with the suggestion that there could be a 5th quadrant, focused on how the Board and programme itself could facilitate the strategic levers towards prevention. This would of course need to be done in partnership with Population Health Framework colleagues (Place and Wellbeing Programme Board) and Primary Care Reform (Primary and Community Health Steering Group) to avoid any duplication in preventative approaches covered by both
• there was a suggestion on the need to reflect on our lessons to date from the programme elements we have been introducing and consider how we can support the system to implement learning into business as usual – thus helping to root preventative and proactive care deeply into whole system culture
• it was noted that there is a lot of onus on Primary Care and Community Healthcare Reform and that we need to be realistic about what can be delivered, by focusing on statutory delivery and being mindful of the challenges and barriers. In order to achieve systemic change to prevention, it would be beneficial to reflect on things that are barriers to making a shift to prevention e.g. short-term lens and financial systems
• overall, there are barriers to implementation of preventative and proactive system, such as the macro issues of workforce and finance. These are challenges for all and impact the system wider than within the PPC Programme. There was a suggestion to prepare a draft paper for the CWB Portfolio with a view from PPC members on these macro issues and barriers and where they are owned in relation to enabling PPC to implement real system change  
• Donna Bell suggested that the board members calling for this action be involved in the drafting (this would include Manira Ahmad, Jennifer Champion, Sara Redmond and Lorna Kelly). First stage would be for Karen Duffy to cross reference PHS draft when received from Jennifer Champion as referred to in Public Health in Action Teams (PHAcT) section below

Actions: 

• KD to explore creating a paper for either the new Care and Wellbeing Executive or Advisory Group – setting out practical solutions around barriers, opportunities and enablers to set out prevention as the root to reform activity  
• KD to review the PHS and PHAcT conceptual paper ‘Population Health Organisation’ when received from Jennifer Champion 
• KD to involve a small group of board members who have expressed interest in supporting drafting the paper relating to macro issues and barriers to PPC implementation to the new Care and Wellbeing Portfolio Executive/Advisory Group (MA, JC, SR and LoK) 

It was suggested that consideration should be given to including racialised health inequalities and equity of access which at the moment appears to be missing from the charter. Whilst the work currently underway by the programme does portray a story and talks to a certain extent about a level of intersectionality, it could be framed more clearly in the charter to elevate its position. This is at the forefront of work within the CVD workstream already but can be expanded within the charter to reflect its importance within the programme as a whole.  

Action: KD to cross-reference the wordings in the charter to include consideration of racialised health inequalities and equity of access to reflect its importance within the programme as a whole (This is at the forefront of work within the CVD workstream already but can be expanded within the charter) 

 

Care and Wellbeing (CWB) Portfolio Update – Malcolm Summers (MS) 

Malcolm Summers, Head of Strategic Reform, provided the CWB Portfolio update around governance, decision making and the scope of the vision of Health and Social Care reform. 
There is a need to increase coherence and integration of how we are approaching reform within a complex landscape and how to achieve better clarity around the parts that are not formally within scope of CWB Portfolio. Discussions have taken place around the best governance model to support this and the CWB Portfolio Board is expected to be formalised as an Advisory Board to advise a SG Reform Executive. This executive will be set up under the Health and Social Care Management Board (HSCMB) to manage SG policy input into reform.  
There will also be an Expert Reference Group led by the Chief Medical Officer and a Stakeholder Advisory Group is to be established to be attended by cross-sector professional associations. 
A single integrated method of reporting for all the major reform programmes will be developed to improve visibility, coherence of reforms and to ensure reform activity continues within existing governance activity and coordinating dependencies.  
A small working group will be set up to include a wide range of representatives to look at consistent reporting with representatives from NCS, Mental Health, Primary Care and Community Health, Acute Reform and Population Health. 
The scope under the HSC reform is continuing to be reviewed to better understand where good progress is being made and identify any gaps in order to scale the work. There is a potential for a fourth programme under CWB Portfolio looking across integrated services and where we need to work jointly across NCS, Acute Care, Population Health, etc. 
Summary of board discussion on this item: 

• discussion to take place around touch points between local Government and governance and what our role is at the government level and statutory service responsibility level. A visual representation will be worked up showing how this will look. In addition, it would be beneficial to have a discussion with COSLA around individual and collective responsibilities 
• there is opportunity under Value Based Health and Care programme and within the current fiscal position to look at things we should stop doing and to capitalise and focus on the most impactful activities to bring increased attention to collective areas of work. On preventative spend, where budgets are siloed and may be holding a systemic problem in place, we should have some financial interrogation of budget lines. Members are asked to consider how we move from where we are now to how we get to the changes needed, and a deep dive may be valuable in defining this. This may indeed be linked to call for a paper to be drafted (as above) 
• it was advised that the NHS Scotland Strategic Planning Board (which deals with nationally commissioned elements of NHS care such as national networks, or acute national or regional services) and NHS NSS (NSD section that deals with these national commissions) have developed a draft prioritisation framework (to help make clear and justifiable decisions about NHS resources and funding that should be prioritised). This draft framework is exploring prioritisation based on several factors, including clinical need and effectiveness, affordability, impact on health inequalities, strategic fit, and anticipated health gain. This tool is still to be live tested. To note this is a tool for the central NHS (mostly acute) to help it prioritise money already allocated from SG to NHS. This is not a SG tool for deciding on new investment or a tool used in the wider NHS settings such as Primary and Community Health 

Action:  

• MS to share a visual representation of the new CWB Portfolio governance structure once ready  
• a deep dive session is to be arranged to identify if we are focusing on the right things and to tease out ideas around implementation challenges and opportunities. As this links to the drafting of the paper suggested above, it is suggested that the planning of any deep dive session is held off until the above paper writing action is underway (as a session may be needed to inform the content or alternatively sense check once the paper is drafted)

 

Primary Care Reform Update – Ellie Crawford (EC)/Kathy Kenmuir (KK) 

Ellie Crawford, Primary Care Lead, set out the Primary Care reform landscape, how it connects to wider health and social care reform, and a proposal for next steps for collaborative working with the PPC Programme. 
Primary Care and Community Health reform is operating under the joint vision and principles set out by the Chief Medical Officer in the Value Based Health and Care vision. 
Several challenges and issues have been identified as impacting Primary Care, including increasing complexity in patients’ needs, access to services such as GPs and dentistry, a declining number of primary care workforce such as GPs relative to specialist acute staff and related the issue of balance of care. The scale and complexity of challenges will require joint working across and beyond Primary Care. 
The role and characteristics of Primary Care include key evidence-based strengths such as universal contact, critical connector role, person-centred (not condition specific) care, care navigation and the specificities of independent contractors. Primary Care is commonly understood to be the first point of contact for the health service and includes five main types of services; general practice, pharmacy, dentistry, community eyecare and community urgent care with community hearing currently under secondary care but intended to become part of Primary Care. 
The Scottish Government is developing a Route Map to further enhance sustainability of Primary Care, aligned to wider reform of Health and Social Care.  The Route Map will be developed with the person at the centre, drawing on the principles and learnings from GIRFE. The Primary Care Reform team are connecting closely with multiple wider areas of reform to ensure that the delivery of our services is person-centred and that it transforms their experience of Primary Care and their health. 
This work will include a review of the existing Primary Care vision and outcomes to ensure alignment with broader strategic intent.  
Core emerging themes have been identified and include recognising and valuing the role of Primary Care and benefits to the system, sustainable and equitable access and high-quality outcomes and experience for both users of primary care and the workforce. 
Stakeholder engagement is ongoing with wider reform internally and externally. The third meeting of the Primary Care and Community Health Steering Group is scheduled for 26 September where the initial version of the refreshed vision and outcomes and initial version on the integration position to provide framing for enablers will be discussed. 
Deliverables and priorities for 2024/25 have been identified to support how the wider system can contribute and engage. 
Members were asked for their views on the strategic direction for Primary Care reform that have been outlined, the role that Primary Care can play in broader strategic policy and reform, for example improving Population Health and the key things that would help realise this role in practice.   
Summary of board discussion on this item: 

•  it was noted in reference to the specific slide on GIRFE, that the GIRFE focus needs to be on the person placed in and supported to thrive by an enabled community, more than the focus being on health services surrounding the person. The PPC programme has to be about enabling individuals as part of the community, supported through things like social prescribing. The interface between Primary and Secondary Care should be such that there is a seamless understanding of how a person is managed between them through the National Clinical Framework (NCF) and approach to managing chronic conditions 
• in relation to the cogs of wider reform, it was asked if we could include the role of funding and directors of finance under broader reform and also consider how we encourage individuals to take responsibility for management of self-care in a safe and sustainable way. It was noted that Primary Care is in the process of working the issue of self-care into their approach
• relating to vision for change, it was asked if there is an opportunity under equitable services to take a lens of intersectionality to bring protective characteristics to the forefront of conversations  
• there was a reflection on the fit of Primary Care and Prevention; the need to be very clear on how Primary Care can best support prevention, what the role of prevention is and how to assess if the reform programmes will be fit to enable this and understand where the competing priorities exist 
• it was noted that possible opportunities exist regarding linking up around the Interface between secondary and Primary Care and the National Clinical Framework being critical to this. Also, community connections and NCS and broader work around community reform being part of our approach. It was suggested that we weave the ‘how’ we do this into the wider deep dive  

 

Highlight Reports 

Primary Care (PC) – Ellie Crawford (EC) 

Ellie Crawford, Primary Care Lead, gave a brief update on progress. Deliverables overall are reporting green. 
The team are currently looking at the redefinition and refocusing of Primary Care reporting up to PPC with an expected date of 4th October for final confirmation of deliverables. 
Whole Family Support through General Practice – The HSCP has contracted a service provider for new Family Wellbeing Workers expected to start by end of October.  
Inclusion Health Action in General Practice – The year 1 evaluation report published in July 2024 found positive outcomes for both patients and practice teams. A year 2 workshop at the start of September will share examples and learning from year 1; with a series of other events to support practices planned.  

Getting it Right for Everyone (GIRFE) – Katie Morris (KM)  

Katie Morris, GIRFE Lead, reported GIRFE by exception which has a green RAG status.  
Milestones are on track and the risk around internal resourcing has increased slightly due to the upcoming departure of two members of staff. 
Further updates can be found in the GIRFE highlight report. 

Cardiovascular Disease (CVD) - Karen Duffy (KD) 

Karen Duffy, Delivery Director for PPC, gave an update on CVD which has a green RAG status.  
CVD Proposals were endorsed at the meeting with the Cabinet Secretary for Health and Social Care and Chief Medical Officer Senior Medical Advisory Forum in August 2024. This includes national stretch aims development, the creation of a CVD bundle of 5 risk factors and a 3-horizon plan for transforming models of care from present to future system. 
The CVD Hub on NHS Inform launched on 3 July: Cardiovascular disease | NHS inform. 
The development of ASSIGN v2.0 for launch on the Right Decision Scotland (RDS) platform and across clinical environments and the update to SIGN 149 are currently in progress. 
The creation and early exploration of testing the CVD bundle is underway with 3-4 cluster areas who have expressed interest to drive improvements. 
Engagement is ongoing with Women’s Health team and Primary Care on improving care pathways for women who postnatally will have a higher lifetime risk of CVD. 

Waiting Well (WW) - Karen Duffy (KD) 

Karen Duffy, Delivery Director for PPC, gave an update on WW which has a green RAG status. Most deliverables have been met as we move towards business as usual. 
There are ongoing campaigns of patient validation via SMS including a link directing people to the WW Hub. Steady views and traffic to the site have been seen as a result.  
The WW Learning Network Teams channel has now launched to encourage shared learning amongst WW champions and support respective local areas testing the toolkit. 
The building of a digital version of the National Waiting Well Toolkit on Right Decision Scotland platform has now commenced and the first round of feedback is complete.  
Members were asked to reflect on delivery and success of WW and as the workstream moves towards BaU and consider where resource should be reallocated.  
Reassurance was provided that as WW becomes BaU, we will ensure that activity, learning and monitoring of impact is captured via the PPC led national learning network outcomes; and there will also be metrics available once the national Toolkit for WW is live on the RDS platform later in this year.

Public Health in Action Team (PHAcT) update – Jennifer Champion (JC) 

Jennifer Champion, Acting Director of Public Health, gave a brief update on PHAcT. 
Progress is underway to show how the Public Health in Action team are evolving, and a governance diagram is to be presented at the next meeting 
there are two workstreams; one is responsible for looking at system pressures and drivers to understand how sick people are in the system and the other is embedding prevention to look at smoking cessation, dementia, MSK, preventing hip fractures, and links with CVD, Waiting Well and GIRFE 
Underpinning themes have been identified such as Health Inequalities, AI digital and Climate Sustainability. Supporting Reform is a new underpinning theme to look at how the PHAcT as a group can support the NHS and Primary Care to reform from a population health perspective. A conceptual organisation paper is in development with public health colleagues containing basic concepts on how the NHS is going to change its sense of identity and a toolkit will be available to support this.

The five concepts being explored are: 

• identify the needs of the population
• work collaboratively
• embed primary prevention
• have a Primary Care booklet
• medicine is delivered through a value-based approach 

Actions: 

• JC to share a copy of the conceptual paper on how the NHS is going to change its sense of identity once the toolkit around it is developed
• JC to present a governance diagram at the next meeting to show how PHAcT is evolving

 

Any Other Business 

The PPC Autumn Event 2024 is scheduled for 6 November on MS Teams for one and a half hours.  
Donna Bell thanked PPC Board members for their contributions and comments.   
The next meeting will be held on Monday 2 December and a meeting invite has now been issued.