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Public health authority backs out of plan to scrap infection control service

Exclusive A county council has rolled back on plans to scrap the local infection control service for GPs, amid risks ’of avoidable disability and death of residents’.

Under Nottinghamshire County Council’s original plans, the council was planning to stop providing an infection control service to GPs, instead focusing on residential and care homes.

While the plan was to save £31,000, the risks associated with the cut included being unable to provide ‘proactive audit and prevention work’ or respond to new infection threats.

However, the council told Pulse that the plan changed after the CCGs agreed to increase their contribution.

Meanwhile, the council is currently consulting on plans to ‘bundle’ several public health services, including smoking cessation, in an effort to save £950,000.

The plans, outlined in committee papers, formed part of the council’s proposed commissioning intentions for 2018/19.

Under the original plans, the Community Infection Prevention and Control service, which audits infection prevention in practices and manages outbreaks, was to see it’s budget cut by from £91,000 to £60,000 by 2020/21. 

The committee papers said this would mean a ‘reduction to service with focus on residential and care home settings’.

It added that risks to cutting the service would include:

  • Management of outbreaks may absorb all available resource leaving no opportunity for proactive audit and prevention work.
  • May not be able to respond to new community infection threats as they arise (e.g Anti Microbial resistance to antibiotics).
  • Failure to address healthcare associated infections in services commissioned by the LA (and other commissioners) carries risk of avoidable disability and death of residents and/or loss of independence.

However, the local council told Pulse that it was decided the budget and service provision would remain the same after six CCGs in Nottinghamshire committed to providing additional funding to keep the current service afloat.

Dr Kate Allen, public health consultant at Nottinghamshire County Council, said in a joint statement with the CCG: ‘The overall budget remains the same until 31 March 2021 - but there are different proportions being contributed by the county council and the CCGs, the latter who will be increasing their contribution to the contract to ensure service delivery remains the same for the three years of the contract - with no anticipated changes to service provision. 

‘Through close collaboration with the CCGs we have identified a way to manage the reduction in investment from the council in a way which sustains this important service, by the CCGs increasing their contribution.

‘The council will continue to fund elements of the Community Infection and Prevention Control including what it provides to its commissioned care homes.’

A spokesperson for NHS Nottingham City CCG added: 'Our infection prevention and control service has had an enhanced team funded by Nottinghamshire County Council for the last three years, and this has supported care homes and GPs locally.

'In that time we have seen a reduction in all infections in healthcare settings, more robust investigations of outbreaks in care homes and a reduction in E.coli.

'We were therefore keen to continue this enhanced team in 2018/19 and beyond, recognising the valuable contribution the team have made to the local health economy.'

Meanwhile, the council is currently consulting on plans to offer a ‘bundled lifestyle/wellbeing service’ to include smoking cessation, weight management, workplace health and mental health services, cutting a collective £950,000 from the budget.

This approach would see a single provider commissioned to offer all four services.

However, the committee papers said: ‘Early evidence suggests that this model is less effective for some lifestyle change programmes particularly smoking cessation therefore performance could fall.’ 

Rebecca Atchinson, senior public health and commissioning manager at the council, said: ‘Rather than people going to multiple wellbeing services and sharing their story many times, this idea is to enable them just to explain their story once and get the support they need from one team.

She added: ‘Our intention is to have new services in place from April 2020 which will contribute £950,000 to wider savings the Council is required to make as the grant it receives from the government reduces.’

Local GPs said the plan to combine services should work, 'if done properly'.

Dr Steve Kell, a GP in Nottingham, said: 'If done properly I don't think this will impact GP workload to be honest. It does make sense to have single services as long as they are located in urban and rural areas.'

Michael Kell, chief executive of Nottinghamshire LMCs, said: 'The consultation seems a little short on detail of how this change will be undertaken. When you look at the consultation survey you see that traditional ‘GP provided’ services are included with wider wellbeing services that have not been part of the GP offer and so there is a danger around how well resourced such services become.

'This mirrors, to some degree, the harmonising exercise around locally commissioned - enhanced - services that we’re seeing in our CCGs across mid-Notts and Greater Nottingham where the goal is to have one packaged offer covering a selection of services to provide.'

Government announced plans earlier this year to cut public health funding by £170m over two years, with GP leaders saying at the time that reducing funding for smoking cessation and weight management services ‘is ridiculous’ and ‘will undoubtedly lead to more public ill health’.

A continued decline in public health resources

The Government announced a major cut to public health budgets in 2015, when it was slashed by £200m amid a raft of measures to ‘bring down public debt’.

Recent research found that the 2015/16 cuts would cost around £1.6bn in the long run, because of the expected rise in teenage pregnancy rates, sexually transmitted infections, homelessness and suicide.

It immediately resulted in cuts to GP services, including six councils cutting their smoking cessation budgets by hundreds of thousands of pounds.

In the East Midlands, Lincolnshire County Council completely axed GP referral services for weight management and exercise as a result of Government cuts to public health spending. In Devon, the cuts led to some practices having to drop contraceptive services.

Following the cuts to the public health budget Dr Richard Vautrey, then-GPC deputy chair said GPs ‘would struggle to cope with any further cuts’.

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