Primary and Community Health Steering Group: terms of reference

Purpose of the group

The mandate letter from the First Minister to the Cabinet Secretary for NHS Recovery, Health and Social Care made clear the commitment to ‘Set out a common approach for the reform of the NHS to improve population health and system sustainability to meet the needs of our diverse population of Scotland,’ and the Cabinet Secretary has expressed a desire to set out plans for longer-term reform. Primary and community health will be a core part of this, and the Cabinet Secretary has repeatedly made it clear that the sector is of critical importance to health system sustainability and reform. 

The Scottish Government wish to bring together key strategic level delivery partners across primary care and community health (as defined in annex A) to form a Primary and Community Health Steering Group to discuss a number of primary care and community health strategic issues in the context of wider reform. 

The group’s focus will be on primary care and community health services. Currently the membership is more weighted towards primary care but the membership endeavours to include community health interests as far as possible recognising the importance of an integrated and community-based perspective in developing strategic advice. The existing published definition of primary care refers to the community health services currently within scope (see annex A), although it is recognised this may not be exhaustive. The relevant community health services will be scoped further through the work of this group. This will include consideration of acute-based services that are based in the community.

The group provides an opportunity for a broad cross-section of the primary care and community health sector to collaborate and collectively provide advice for the strategic policy direction of the Scottish Government, with the ultimate aim of improving population health, reducing inequalities and the promoting the sustainability of the health and social care system, in keeping with the three missions of the care and wellbeing portfolio. 

The group will have a focus on shifting the balance of care into the community, driving a proactive approach of early intervention and prevention, and promoting value for money in primary care and community health, as part of an integrated and collaborative health and social care system. The group will be closely involved in work on integrated long-term reform and will be the main advisory body for developing primary care specific advice into that process and a core advisory body for developing community health specific advice, as well as inputting into broader areas outlined below.

This will not be a formal decision making forum but focus on advice to steer policy development and delivery.

Key areas of focus

The group will focus on bringing together stakeholders across the primary care and community health sector to holistically consider strategic reform issues and provide advice in the following key areas:

• the role of primary care (in particular) and community health as part of a wider system aimed at improving population health, the sustainability of the health and social care system, and reducing health inequalities, including the consideration of wider (non-health and social care) services and support
• how reforms within primary care and community health that are currently underway (or planned) can be achieved, and where further reform is required to meet health outcomes
• how National Care Service (NCS) reform can best support and enable primary care and community health to improve outcomes for people, and how the sector can support the delivery of the NCS
• how wider NHS reform proposals can work best to support and enable primary care and community health to improve outcomes for people, and how the sector can best support wider reform
• the group will give their views and advice on other emerging national policies relevant to the sector (including Getting It Right For Everyone - GIRFE) and the evidence to support them, taking account of existing reforms, broader health and social care reform, and the diversity of delivery partners/agents of change within primary care and community health

Scope and dependencies

This group is centred on primary care and community health. Given the wide definition of community health, the group will focus on the parts of this that are most related to primary care, and this will be scoped through the work of the group. Scottish Government definitions for primary care and community health are set out in annex A.

The group will provide advice over the duration of the programme for long-term health and social care reform, from 2024 to its completion (yet TBD).

The group will be a key anchor for primary care and community health into wider health and social care reform.

Whilst the membership of this group will necessarily be focussed on a comprehensive but limited cross-section of primary care and community health, any gaps will be managed by strong governance connections across policy areas within the Scottish Government and by inviting relevant guests to attend meetings of the group as required.

The group is part of wider governance across health and social care policy and delivery within Scottish Government, which is evolving. As recognised above, the group will maintain a strong anchor into wider reform architecture as this emerges. The membership and purpose of this group may fluctuate to take account of these shifts. Existing/planned governance in specific delivery partner spaces (e.g. general practice, out of hours, dentistry) will continue and views can be fed into this group where appropriate. 

Patient voice and lived and living experience

Public opinion and lived and living experience are of critical importance to the work of this group. The group will utilise outputs from prior engagement and consultation with the public to support their work, recognising the wealth of evidence available. Where additional evidence on the views of the public and patients is required, the group will rely on the communications and engagement work being progressed within the Scottish Government’s long-term health and social care reform programme to ensure a joined up and person-centred approach.

Roles and responsibilities

Steering group members:

• have responsibility for providing advice to the Scottish Government on the key areas outlined above
• are expected to have delegated authority on behalf of their respective organisation to provide advice to the Scottish Government on the key areas outlined above
• are expected to consult within their organisation to enable them to provide and represent the views of their respective organisation and stakeholders
• are responsible for cascading information effectively from the Steering Group to their organisation to keep them informed
• will progress actions assigned to them by the Group, with the agreement of the member in question

Membership

Members will be asked to represent their organisation in serving on this group. Members are leaders across primary care and community care. The steering group will be co-chaired Tim McDonnell, Director of Primary Care Directorate and Graham Ellis, Deputy Chief Medical Officer. Secretariat support will be provided by the Primary Care Directorate within the Scottish Government. The proposed membership list can be found in annex B.

Members are asked to identify a substitute who can attend if they are unable to, with the understanding that the substitute is able to represent the organisation’s views on behalf of the member and is adequately briefed to support the work of the group.

Changes to membership (adding and removing members) must be agreed by the Chairs. Changes to membership can be raised by any member. 

Quorum

Where decisions are required, they can be undertaken based on the attendance of at least two-thirds of the members (excluding secretariat) set out in annex B.

Meetings/working methods

The steering group will meet virtually or in person every eight weeks or more frequently if required. 

In person meetings will be scheduled to replace or in addition to a virtual meeting as the group deems appropriate either through a vote or without opposition to a proposal made by the chair.

Members of the group may contribute suggested agenda items and papers for meetings, through the group Secretariat, no later than ten working days in advance of meetings.

The group Secretariat will circulate agendas and papers marking clearly where decisions and/or agreement is required, electronically to each member at least one week before each meeting. However, in extremis, papers may be issued in shorter timeframes. Papers will be agreed with chairs in advance.

Meetings will be minuted. The SG secretariat will produce a draft note of minutes and actions from each meeting within seven working days working days of the meeting taking place. The SG Secretariat will follow up with members on actions that have been assigned to them with their agreement.

The group may, from time to time, invite people to meetings to observe, discuss or present on specific matters. These attendees will not form part of the quorum for decision making purposes and are bound by the same agreements as to confidentiality etc as group members. The secretariat will ensure that, where appropriate, this is made clear to invited attendees.

Where they have been agreed, papers and/or decisions will be seen as collectively owned by the group.

Meetings will be for one to two hours, depending on agenda.

Reimbursement of expenses

Members will be provided with catering at in-person meetings and workshops. It is expected that members’ employers and the organisations that they are representing will reimburse them for costs incurred in the course of their duties for that organisation. Expenses incurred in relation to membership of the Steering Group will not be reimbursed by the Scottish Government.

Processing and storage of members personal information

Scottish Government officials are completing a Data Protection Impact Assessment (DPIA) regarding the processing and storage of members’ email addresses and which will underpin the forward work of the group. Officials will be in contact with members in respect of this.

If any members’ have feedback (including concerns and complaints) regarding the processing and storing of their email addresses, please contact the Secretariat at PCCHSteeringGroup@gov.scot.

Confidentiality

There may be times when group members are given access to sensitive or confidential information. The Chair and/or group secretariat will make it clear when this is the case, and members give an undertaking to not share this information more widely.

Equally, although minutes will be recorded and will be published, at times discussions will be confidential and not included in the public record. The Chair and/or group secretariat will make it clear when this is the case, and members will be instructed to not share this information more widely. 

Governance

Outcomes and actions from the group’s consideration will be taken forward by the Primary Care Directorate, working closely with wider colleagues across community health, NCS, NHS Reform and others.

The Primary Care Directorate will report actions and outcomes onwards to the relevant officials and governance bodies that emerge as part of wider long-term reform governance architecture

Annex A - Scottish Government definitions of primary care and community health

Definition of primary care

Primary care is the first point of contact with the NHS. This includes contact with community-based services provided by general practitioners (GPs), community nurses, dentists, dental nurses, optometrists, dispensing opticians, community pharmacy and GP practice based pharmacists and pharmacy technicians. It can also be with allied health professionals such as physiotherapists and occupational therapists, midwives, and pharmacists. Primary care also encompasses urgent community care including out of hours service provision.

Each week in Scotland, there are on average a total of 680,000 consultations in general practice, 42,000 eye examinations, 56,000 NHS dental exams, 73,000 Pharmacy First consultations and 20,000 OOH consultations. NHS 24 answered just over 166,000 calls and SAS responded to almost 44,000 emergency incidents on average per month in 2021 to 2022. 

Definition of community health

From birth, community health services comprise at least 90% of all our health contacts. Many needs are identified, managed, and resolved within the community, making it one of the largest and most crucial sectors of healthcare.

Community health is primarily relational and person centred, providing access to services in a range of settings, at health and care sites including peoples’ own homes and where appropriate supported by technology.

People access community health for many reasons and care should be proactively provided by a range of professions and services, providing continuity and support throughout their life.

The principles of Getting it Right for Every Child and Getting it Right for Everyone form the core approach for all ages including connecting people to other services and coordination with acute, specialist, independent and third sector services.

Community health encourages shared decision making between communities, individuals and health professionals, combining personal and professional expertise to provide the most appropriate outcome for the person.          

Most services are accessed locally or are based in the community and address the majority of health and wellbeing concerns without escalation, reducing harm by the early identification of need through a coordinated multidisciplinary team approach.

People often need more than one form of support at the same time so there is a significant benefit to everyone from integrating services, ensuring a joined-up experience. This helps teams to support people living in the community with increasingly complex needs at any stage of life including care around death.    

Annex B - steering group membership

Following feedback, and with the agreement of the Co-Chairs we have arrived at this membership, which is broadly representative of NHS Board Directors for the different clinical areas, representation from HSCPs, Special Boards, representative organisations, academia, and the third- and voluntary sectors. 

Policy interests within primary care and community health will be covered by members of the steering group to the maximum extent possible. Where there are gaps of policy or professional representation, the Primary Care Directorate will ensure that advice/outputs from the steering group are communicated onwards to teams and provide teams opportunities to provide feedback and input into the steering group where appropriate.