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Annual Report 2005 | 2006

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05-06

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20-29

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Index

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 NorfolkPrimary Care Trust Board on the SummaryFinancial Statements

Financial summary & annual accounts

Links

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This is the last annual report for West Norfolk PCT, as it is abolished at the end of September and becomespart of Norfolk PCT. The PCT was established inOctober 2000 with the aim of improving health care forthe people of West Norfolk, involving them in thedecisions made and improving their health. As the PCT comes to an end this is an opportunity tolook back and review whether we have been successful.

What have we done to improve health care forthe people of West Norfolk?

Waiting times for treatment at the Hospital havereduced significantly. No one now waits for longer than13 weeks for an out patient appointment or 26 weeksfor an operation. For mental health users, the servicesprovided have changed considerably. The services arenow jointly provided with adult Social Services with asingle management structure. More people aresupported in the community and fewer people areadmitted to hospital.

Patients are now seen, diagnosed or treated in a rangeof facilities across the PCT, rather than automatically inhospital. In addition we have developed a number ofspecialist services such as the COPD team or thespecialist diabetes nurse for children.

Have we involved patients, users and carers?

Yes. West Norfolk PCT is seen as an exemplar in thework it has done on Patient and Public Involvement.There are patient representatives on many of theworking groups looking at how we improve services.The PCT was asked to be a pilot area for the ExpertPatient Programme. This is about encouraging patientsto be involved in their healthcare as an equal partnerwith the professionals. This was very successful projectthat has continued within the PCT.

Have we improved the health of the population?

The PCT has concentrated a lot of its effort onprevention. We have worked in collaboration withlocal authority and other partners to develop a numberof projects. An excellent example of this is in fallsprevention, where a very small team has worked closelywith a range of agencies to reduce the number of fallsand thus the number of admissions to hospital. The effect of this is that West Norfolk has one of thelowest levels of admissions to hospital for broken neckof femur.

Overall opinion?

The PCT has achieved a lot, and leaves the healthservices in West Norfolk in a better position than inOctober 2000, with a strong legacy for the future. I would like to finish by giving my personal thanks toeveryone who has been involved in the work of thePCT: Board, staff, partners and patients. It has been apleasure to work with you all. I believe we haveachieved a lot and that has been down to theinvolvement of you all and your commitment to theaims of the PCT.

I do believe that West Norfolk will be a stronginfluence in the Norfolk PCT and that a lot of theexcellent ways of working will continue into the future.

+ Introduction

Hilary DanielsChief Executive

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Since 2000 West Norfolk Primary Care Trust (PCT) hasbeen responsible for ensuring healthcare is available fora population of almost 160,000 across 750 square milesof West Norfolk and part of neighbouring Breckland.

In partnership with our NHS colleagues at The QueenElizabeth Hospital King's Lynn, local GPs, dentalpractices and pharmacies, we have made sure that aconsistently high standard of healthcare is on hand foryou and your family.

PCTs were set up by the Government to focus ondelivering good quality health services at local level, andhaving local health experts and lay people to run them.

However, Government thinking has now moved on, sothis is the final full-year report on health activities inWest Norfolk. Later this year West Norfolk PCT willbecome part of a larger, county-wide Primary CareTrust (with the exception of Great Yarmouth). The newchanges to the management and control structure arealready being put in hand. As a patient you should seelittle difference in the way services are provided wherethey matter most, at your GP surgery, in yourcommunity and at your local hospital.

In this report we intend to explain not just 'who weare and what we do', but 'who we are and what wehave done.' Because we have achieved a great dealduring the lifetime of West Norfolk PCT. This hasbrought us national recognition in many fields, becausewe have always tried our very best to lead the way inmodern healthcare.

The following pages will give you a flavour of the waywe have influenced healthcare for the better over thepast year and during the preceding years. At all timeswe have worked for the greater good of you, thepatient. We are proud of the legacy the new PCT willinherit from us because it forms a sound basis for evenbetter things to come.

Our original vision

When we were set up we defined our aim as:

Our vision is the delivery of appropriate services at theappropriate 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 byresponding to local needs as expressed by the local people.

That has continued to be our goal and in the followingpages you'll find out what's been going on in the pastfinancial year, plus a look-back at some of theachievements of previous years.

During the financial year 2005-6 the outstandingcontribution made towards the NHS in West Norfolkby the then Chair of the PCT, Sheila Childerhouse, ledto her being asked to take over as Chair of The QueenElizabeth Hospital King's Lynn NHS Trust Board,following the resignation of the former Chair.

Although Sheila's contribution to the life of the PCT hasbeen greatly missed, we were fortunate to have as ourVice Chair Margaret Cook, an experienced former localgovernment officer. Margaret was able to provide aseamless transition and has ensured that the good workof the PCT has continued.

Also during the year - while day-to-day businesscontinued with the care of our population - the NHSwas 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. Butmore on that later.

+Who we are and what we do

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So what does the PCT do? In brief, Primary Care is thefirst point of contact most people have with theNational Health Service (NHS) on a regular basis.The PCT's job is to 'commission' - in other words buy-in - the services normally provided by your familydoctor at the 23 local General Practice surgeriesin our area.

In addition, the PCT has to commission all othercommunity-based services. These include:

n District Nursing.

n Child Health services.

n Contraceptive advice (the former FamilyPlanning service).

n School health advisers.

n Speech and language therapy.

n Drugs and Alcohol treatment and advice.

n Podiatry services (this includes chiropody and allother foot/mobility problems).

n Psychological therapies.

n Community dental services, including our twolocal NHS Dental Access Centres, in Wisbechand King's Lynn.

During the 2005-6 financial year work progressedbehind-the-scenes to commission NHS dentistry inWest Norfolk, ready for a major change that took placein April 2006, when PCTs across England becameresponsible for NHS dentistry for the first time.

Our principal role after commissioning these services isto assist the professionals in ensuring that a consistentlyhigh 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

n All the hospital-based treatments you are likely toneed at your local district general hospital.

n Specialist services you may need elsewhere - such asheart treatment at Papworth hospital or specialistservices at the Norfolk & Norwich hospital,Addenbrookes or further afield.

We also have to commission

n Ambulance services. In addition, in our area EastAnglian Ambulance Trust, through its subsidiaryAnglian Medical Care, provides emergency GP 'out ofhours' cover for the times when your local surgery isclosed, such as evenings and weekends.

West Norfolk PCT also operates and manages its own18-bed community hospital in Swaffham, used largelyfor rehabilitation.

One of our largest commitments is to provide mentalhealth services in West Norfolk. This is achieved by avariety of specialist services including communitypsychiatry, a Child and Adolescent Mental HealthService; the specialist Fermoy Unit for psychiatric in-patients, attached to the Queen Elizabeth Hospital; andChatterton House, a dedicated unit for older patientswith problems such as dementia.

+ Our aims and objectives

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We work closely with neighbouring PCTs, ambulance,hospital and mental health trusts and also with socialservices, local authorities, the emergency services andvoluntary services, to ensure patients have a relatively'seamless' system of care in our area. During the 2005-6financial year our budget was nearly £170 million, ofwhich 98% was spent on patient care. Only 2% of ourbudget was spent on administration, which comparesvery favourably with private sector businesses in theUK and health services in other countries.

Overall, we are within the area covered by theEast of England Strategic Health Authority, formerlythe Norfolk, Suffolk and Cambridgeshire StrategicHealth Authority.

During the course of the year an immense amount ofpreparatory work has been in progress ready for majorchanges that will affect all PCTs and Strategic HealthAuthorities later in 2006. Having set up PCTs toprovide local-based health services, the Government'scurrent thinking is that health services should beorganised where possible on a county-wide basis, co-terminus with the local authority.

After public consultation, it has been decided that thenew PCT for Norfolk will incorporate five of the sixcounty PCTs. Great Yarmouth will form a separatecross-border PCT, along with the current PCT coveringthe Waveney district in Suffolk. These changes are dueto take place in October 2006.

During the year West Norfolk PCT lost one of itstwo stars awarded the previous year, out of a possiblethree stars, by the Healthcare Commission and wasassessed as a one-star PCT. This was as a result ofsome key access time targets being missed by somelocal GP practices. Our Mental Health service wasassessed separately, retaining their rating as aone-star organisation.

+ Improvements we’ve made during the year

Two phrases came to dominate the NHS at locallevel during the year: 'Patient Choice' and 'The Patient-led NHS'.

n Choice: Under new arrangements, patients do nothave to follow the traditional path for a hospitalprocedure of being referred by their GP to aspecialist at their local hospital. They now have achoice of 'providers' which may include their localhospital. But it will also give them a choice of severalother hospitals within the region, or alternative'providers' where a particular treatment may beavailable - for example at a local GP surgery whereminor procedures such as cataracts, hernia repairs orcarpal tunnel surgery, are carried out.

n Part of this process now involves 'Choose and Book',in which a patient and his or her GP can choose ahospital and specialist, and book an appointment on-line from the comfort of the GP's consulting room ata time and place to suit the patient. West NorfolkPCT and The Queen Elizabeth Hospital have beenleading the way in this process and were chosen bythe Department of Health as an 'early implementer'.This means that extra resources and expertise werechannelled into West Norfolk to help us introducethe system locally, and to enable the lessons welearned to be passed on to other NHS organisations.

Practice Based Commissioning

National reorganisation of the NHS means that moreday-to-day responsibility for planning local healthservices is being given to GP practices. They will bedeciding what services ought to be provided to meetthe needs of their own patients. When local PrimaryCare Trusts are amalgamated into county-wide PCTs inlate 2006, Practice Based Commissioning consortia willremain in place to ensure that decisions relating to thecommissioning of health services in this area remain inthe hands of local professionals. During 2005-6 our localGP practices formed themselves into a consortium andbegan planning the framework to enable their newworking group to function efficiently. Their workinvolves extensive patient involvement to ensure care'pathways' are suitably mapped and developed.

Patient-led NHS:

West Norfolk has also led the way in publicinvolvement, and representatives of patient groups areincluded in all our health service planning, to ensurethat patients have a real 'voice' in new developments.During the year members of our Patient Forum played akey role in planning for future NHS provision under thenew county-wide PCT and were represented on thePCT's Reconfiguration Board.

New contracts:

One of the biggest undertakings during the year wasthe local negotiation for the new NHS dental contract.This involved marketing the new contract to local dentalpractices, encouraging them to sign-up to the newPersonal Dental Service (PDS) contract and maintainNHS dental cover across West Norfolk. During thecourse of these negotiations, the opportunity was takento expand the cover provided in some areas, making useof the opportunity to bring-in a number of fully-qualifieddentists from Poland. A new dental practice was set-upto cover the coastal area, based at Snettisham, toprovide continuing cover following the decision of asingle-handed dental practitioner nearby to retire.

Since the year-end further developments are under waythat could see additional capacity for NHS dentalpatients being provided in King's Lynn town centre.

Waiting times

Improvements have been made both in access times forGPs and at The Queen Elizabeth Hospital.

The target for seeing and treatment, or referring,Accident and Emergency patients within four hours atThe Queen Elizabeth Hospital remains consistently highat between 98 and 100 per cent.

A significant contribution towards meeting Governmenttargets and, more importantly, providing prompttreatment for our patients, has followed the co-locationof the GP emergency 'Out Of Hours' service for theKing's Lynn area adjacent to the A&E department at thehospital. Patients with relatively minor, or easily-treatable conditions are seen swiftly without having toface triage and a subsequent wait in A&E.

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LIFT

Our involvement as a key player in Norfolk LIFT (LocalImprovement Finance Trust) was marked by the successof our first design-and-new-build project, the PlowrightMedical Centre, close to the Eco Tech Centre inSwaffham. The new surgery, for the Plowright MedicalPractice, opened its doors to patients during 2005 andwas the first project to be completed by any LIFT teamin the East of England. An official opening ceremony,performed by former Chair of the PCT, Mrs SheilaChilderhouse, was held in March.

Wells Cottage Hospital

A debate over the future of North Norfolk PCT'sWells Cottage Hospital was led largely by the WestNorfolk PCT Public Involvement Manager, acting inconjunction with senior managers from the two PCTsand a local 'Save Wells Hospital' action group. Localdiscussions, in view of West Norfolk PCT's 'stake' inthe future of intermediate facilities in this part ofNorfolk, included GPs and nursing staff from our area.

Following a period of public consultation and aninitiative by local campaigners, the hospital is set to re-open in the near future under the patronage of a localcharitable trust, formed specifically for this purpose.

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NHS Dentistry

Major changes have taken place in recent monthsrelating to the provision of NHS dentistry across thecountry. From 1 April 2006, PCTs became responsiblefor provision and management of NHS dental services intheir area. Much of the work of the Primary Care teamduring 2005-6 was taken up with planning for the future,working closely with local dental practices to encouragethem to sign the new NHS contract, and ensuring thatadequate provision was made for NHS cover acrossour area.

During the financial year the team:

n Achieved the 25% Personal Dental Service target setby the Department of Health in advance of the 1stApril 2005 deadline. This brought us an additional£900,000 of Government funding.

n Successfully recruited and retained eight Polishdentists during the summer of 2005.

n Opened a new dental surgery in Snettisham inSeptember 2005.

n Led the formation of a Norfolk Dental Consortiumto co-ordinate management effort across the county,the led negotiations with the Department of Healthfor an additional £500,000 of funding for NHSdentistry in our area.

n Successfully implemented the new dental contractduring the last quarter of the financial year.

Pharmacies

A new contract was also introduced during the year forpharmacists, who are playing an increasingly importantrole in the Government's health strategy. During theyear our Primary Care and Pharmaceutical teams

n Published the Pharmaceutical Needs Analysis andimplemented the new Pharmacy Contract.

n Secured arrangements to provide patients withoxygen assessments and made sure that themaximum benefit is obtained from the new nationaloxygen supplies contract.

n Led the formation of the Pan-Norfolk PharmacyGroup to co-ordinate efforts across Norfolk.

n Successfully applied for membership of the PharmacyCollaborative for Effective Use of Medicines.

n Completed pharmacy inspections and visits for thenew contract and completed feedback reports forthe pharmacies.

n Completed new out-of-hours rotas for pharmacists,with new on-call arrangements.

Detailed work was undertaken by a number of specialistteams to improve the quality of life for patients withlife-limiting conditions. Here are some examples:

Heart

A Cardiac Assessment Service was established, followinga successful one-year pilot scheme. The nurse-ledservice is based within the Queen Elizabeth Hospital.Our Cardiac Assessment Nurse, Lucy Daly, seespatients admitted to hospital with chest pain andfacilitates early diagnosis, evidence-based treatmentoptions and early referral to the specialist unit atPapworth Hospital where appropriate.

One-stop heart function clinic: In partnership with theCardioRespiratory Department at the Queen ElizabethHospital we piloted a 'One Stop Heart Function Clinic'.Patients referred to the clinic had an echocardiogramfollowed by a consultation with a 'GP with a SpecialInterest' in heart failure where in most cases thediagnosis was confirmed or refuted. Patients then saw acardiac specialist nurse to clarify any queries andprovide lifestyle advice. Results were sent back to theirown GP. Funding is currently being sought to developthe clinic in a community setting.

BNP: Following pilot studies carried out in partnershipwith the Chemical Pathology Department at the QueenElizabeth Hospital the B-type Natiuretic Peptide bloodtest will shortly be available to GPs to use as a 'rule out'test in diagnosing heart failure.

Heart failure specialist nurse: During the yeardevelopment work took place to build a business casefor funding a Heart Failure Specialist Nurse. Working inthe community the nurse would support GP practices inmanaging heart failure patients and also to provide abeta-blocker titration service. Subsequent to the yearend, the specialist nurse has now been appointed.

Diabetes

West Norfolk PCT has always been at the forefrontof diabetes education, support and nursing. Oureducation and support events have continued to remainpopular dates on the calendar and to ensure wecontinue to 'hit the right mark', our service was auditedin March 2006. In a survey of our workshops, 96 percent of patients said they found presenters 'spoke in away that was clear, easy to understand and hear.' Alldelegates felt they had learned a great deal in a 'relaxed,informal atmosphere'.

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District Nursing

Close collaboration between District Nurses, PracticeNurses and colleagues at The Queen Elizabeth Hospitalled to a new system of leg ulcer assessment andtreatment documentation. This shared knowledge isnow available for reference wherever the patient istreated. In addition, District Nurses have establishedregular leg ulcer clinics, to allow them to see and treata greater number of patients.

Woundcare and nutritional guidelines have beencompiled in conjunction with nursing colleagues inGP practices and The Queen Elizabeth Hospital.The guidelines are now in general use at the hospital,GP practices and in local nursing homes.

We have also worked closely with the local FireService. Nurses are asked to give a pre-paid postcard topatients they think might benefit from a home riskassessmentby Fire officers. Free smoke alarms are available tothose in need.

All trained District Nurses in West Norfolk attendeda five day course during the year on advancednursing skills.

Rapid Assessment Team

One of the continuing problems for the healthcommunity is the number of emergency hospitaladmissions, principally of older patients, that mightotherwise be avoided. In October 2005, in conjunctionwith The Queen Elizabeth Hospital King's Lynn andNorfolk Social Services, we established a RapidAssessment Team, with the initial target of reducing thistype of hospital admission by 150 cases a year.

The team operates on weekdays, Monday to Friday,from 8.30am to 4pm, and comprises a specialist nurse, aphysiotherapist, an occupational therapist and a socialworker. Incoming patients are assessed promptly andwhere appropriate, are given the right treatment orhelp for their condition via other healthcare 'pathways'.This avoids the necessity for what can be a stressfulhospital admission for the patient, and ensures that allthe local 'help' agencies are involved in assisting thepatient to make a recovery.

So successful was the project that within the first fivemonths the team had achieved their target. As a result,extra funding has now been allocated to expand theservice into a seven-day-a-week service, operating until8pm each day.

Starfish

West Norfolk PCT's pioneering Starfish projectcontinued to bridge the gap in services available tofamilies of young people with complex learning andbehavioural conditions. The basis of Starfish is to ensurethat children and young people with 'challenging' needscan be given help and assistance within their familygroup, rather than being sent away to special schools inother parts of the country.

As part of Starfish's groundbreaking work in this area,the National Autistic Society EarlyBird Plus course washeld in King's Lynn - the first time the course has beenheld in this area. It is a course designed to help thecarers of children aged from four to eight with adiagnosis of autism. Feedback from those on the coursewas 'very positive.' A number of other training coursesdesigned to help carers of children with learningdifficulties were arranged by the team.

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+ Improvement Partnership in Health

IPH was an 18-month programme, funded bythe Department of Health, aimed at encouragingand facilitating partnership working across localhealth economies.

A joint team drawn from West Norfolk PCT, EastCambridgeshire & Fenland PCT and The QueenElizabeth Hospital King's Lynn studied a variety of areasof work to find ways of improving services for patients,streamlining management - and obtaining better valuefor money. These included:

n Transport: a specially-appointed transport co-ordinator ensures that the provision of hospitaltransport is run on a rational and cost-effectivebasis between GP surgeries, patients homes andthe hospital.

n Operations Centre: the latest computer technology isemployed to collect all relevant data relating to bedoccupation, incoming ambulances, patient dischargesand staff availability to give an 'at a glance' picture ofhospital usage at any given time.

n Rehabilitation: redesign of the area's rehabilitationservices, involving the PCT, the local acute hospital,community hospital, nursing homes, residential homesand social services facilities, has allowed hospital in-patient times and acute hospital bed useage to bereduced. This improves care services for patients andallows better use to be made of facilities for thosewho need specialist care.

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+ Improvements we’ve made in the past FIVE years

This is the final annual report of West Norfolk PCT, sowe took the opportunity to ask a few of our key staffwhat they considered to be the highlights of their timewith the PCT, and what they are proud of achieving.Here's what they said:

Nigel Day, Head of Primary Care

“In the past five years we've been responsible for:

n Forming Clinical Liaison groups to bring-together cliniciansfrom primary, secondary and community care. This sowedthe seeds of Practice Based Commissioning.

n Initiating a Specialist Nurse servicefor respiratory conditions. As aresult we now have the lowestadmission rate for COPD (ChronicObstructive Pulmonary Disease)patients in the East of England.

n Opening-up closed GP listsby recruiting doctors from overseas.

n Opening a new nurse-led GPsurgery in Downham Market.

n Recruiting up to six GPs in what was then a uniquetripartite scheme with the Queen Elizabeth Hospital andthe University of East Anglia called 'Supporting SpecialismsWith Primary Care.'

n Opening a new dental practice in West Norfolk andincreasing, by international recruitment, the number ofdentists. We also managed to obtain an extra £500,000from the Department of Health to help pay for developingNHS dentistry in this area.”

“I hope West Norfolk PCT will be remembered for being anorganisation that 'got there first' on many issues and as aresult helped other PCTs in their learning process.”

James Fisher, Head of Podiatry Services

“Since the PCT was set-up we have:

n Set up a foot-screening programmefor people with diabetes, leading toa significant reduction inamputations.

n We now have input to theOrthopaedic Triage.

n We're developing input to theVascular Multi-Disciplinary team.

n We now have sophisticated targeting of resources toachieve maximum impact. This leads to hospital admissionsavoidance and allows patients to maintain theirindependence.

n We've developed our Biomechanics 'wing' to the pointwhere it's now one of the best in the UK. ”

Samantha Oughton, COPD Nurse

The 'COPD team' comprises nurses specialising in ChronicObstructive Pulmonary Disease, and the Respiratory NurseSpecialist at The Queen Elizabeth Hospital King's Lynn.

“We're proud of two achievementsin particular:

n Our team won the QEH MichaelBastow Audit Prize for our workon long-term oxygen therapy.Our work resulted in cost savingsby conducting reassessments in apatient's home, and allowed usto save hospital 'bed days'.

n We successfully launchedBreathe Easy West Norfolk, a support group for patientsand their carers living with respiratory disease. It's apatient-led group supported by respiratory nurses.”

Mavis White, Matron, SwaffhamCommunity hospital

“I think our main achievements at the hospital have been:

n Working together with the Radiology Department at theQueen Elizabeth Hospital and, with the help of our Leagueof Friends, our new X-ray equipment and the increase inour ultrasound clinics.

n Intravenous therapy and the continuation of bloodtransfusions for primary care patients.

n Piloting the Palliative Care'pathway'.

n The anti-coagulant clinic here, andat Heacham and Dersingham.

n Our Phlebotomy Clinic, takingpatients from the three GPpractices in Swaffham.

n but most of all the ongoing goodquality care we've givento our patients.”

Considerable pressure was exerted on the 900 PCTstaff during the course of the year as they wererequired to meet the demands of a number of internalchanges - in particular the new Agenda For Change payand career structure - and begin planning thereconfiguration of PCT responsibilities. This is inpreparation for the new county-wide Primary CareTrust, Norfolk PCT, which comes into being on 1October 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 andstimulating equality of opportunity, and have a'programme of action' of positive measures in place toensure our policies are implemented. Staff are givenevery assistance and encouragement to further theircareers, education and professional status.

Environment

WNPCT sites are 'smoke free' and during the year staffwere encouraged to use the PCT's 'Stop Smoking'service if they required help in quitting. A number ofrecycling initiatives were undertaken during the year inline with the PCT's aim to be environmentally friendlywhere practicable.

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+ Public Involvement

Work on public involvement took West Norfolk PCTinto a number of new dimensions during the year, inline with the shift in Government policy to give patientsand the public a greater say in the way the healthservice is run.

The PCT's Public InvolvementManager led public involvementfor both West Norfolk andNorth Norfolk PCTs on planningfor the future of Wells CottageHospital. Although situated inNorth Norfolk, the hospital hadtraditionally provided cottagehospital bedspace for patientsfrom the northern part of theWest Norfolk PCT catchmentarea. Its closure by NorthNorfolk PCT prompted theformation of a local pressuregroup. A locally-formed charitableTrust is now progressing plans toreopen the hospital.

Also during the yearreconfiguration of Norfolk's sixPrimary Care Trusts involvedextensive consultation withpartner organisations in a processled by Public Involvement leadsfrom across the county.

Detailed consultation also took place with our staff andstakeholders on PCT reconfiguration and the effect onNHS services and jobs.

During the year a number of exercises were held locallyinvolving the NHS, emergency services, voluntaryagencies and local authorities to test our EmergencyPreparedness in the event, for example, of a majoraccident or health incident.

+ Our Staff

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+ GP practices+ Communications + Complaints

During the year 2005-06, the PCT received 31complaints, a decrease of six over the previous year.There were significantly fewer complaints against theMental Health Service - 14 compared to 25 for theprevious year. All complaints involving GeneralPractitioners were resolved within the 20-workingday time limit.

Complaints involving mental health and other PCTactivities took longer to resolve, according to the areaof activity and the nature of the complaint. In MentalHealth, 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 advisedthat the complexity of the complaint will require longerthan the 20 days to investigate, and regular updates aregiven, either in writing or by personal contact.

Communication with the general public, ourstakeholders and partners, has taken place on a varietyof levels.

Externally, the Trust has enjoyed good, professionalrelationships with the local, regional and national mediaand during the year promoted a number of healthinitiatives with media events.

Our website provides easy access for the general publicto information on local health services. A re-vamp ofthe site during the year now allows the public to accesscomprehensive information on health services in theirown locality at the click of a button.

Internally, information continued to be disseminated tostaff via an electronic news bulletin.

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West Norfolk PCT has been working closely with otherNHS organisations within the county and further afieldto ensure that changes to the management structure ofthe NHS locally will not impair delivery of services tothe patients.

Our GP practices, in conjunction with the PCT, havebeen developing a Practice Based Commissioningconsortium, and the PCT's executive function hasdivided into 'commissioner' and 'provider' arms inpreparation for the new NHS structure due to comeinto effect in October.

No new health projects have been undertaken duringthe final six months of West Norfolk PCT.

Instead, emphasis has been placed on consolidation ofthe PCT's healthcare achievements. This will ensure thatthe very best of our work is carried forward into thenew organisation to provide a seamless transition ofcare for our population and to influence others inmaking improvements to overall healthcare standards.

+ Developments since the year end

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Who's who on the Board?

Sheila Childerhouse: (to Nov) Chair

Margaret Cook: Vice-Chair (Chair as from Nov 05)

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 PatientInvolvement Forum

Changes during the year:

Sheila Childerhouse was seconded by the NHSAppointments Commission to the Board of The QueenElizabeth Hospital King's Lynn following the resignationof the QEH Chair

Kate Gordon resigned in December 2005, onappointment to the Board of The Queen ElizabethHospital King's Lynn

Gordon Dawes replaced Dave Routledge as the PPIco-opted member in February 2006

The Professional Executive Committee

Dr Malcolm Skinner: Chair

James Fisher: Vice 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, QueenElizabeth 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 PracticeManagement representative

Sue Gurr: Director of Community Services

Stevie Shepherd: Community nursing representative

In line with the proposed reorganisation of PCTfunctions, the PCT Professional Executive Committeehas subsequently separated into two elements, Providerand 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 theFinance and other departments in an advisory capacity.

Hilary Daniels, Chief Executive Officer, West NorfolkPrimary Care Trust, acts as the Public Sector Directoron the Board of Norlife, the private sector LIFTcompany, of which WNPCT is a shareholder.+Who’s who?

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The PCT overspent £813,000 - just under 0.5% of itsoverall resource limit. Whilst this is an improvementon last years position we still failed to achieve ourstatutory breakeven duty and this has resulted in atechnical qualification of the regularity opinion tothe PCT's accounts. Despite strong local managementof pressures on Out of County Mental Healthplacement we had deficits on these budgets asa result of contributing to countywide riskmanagement arrangements.

It is pleasing to confirm that our provider arm ofCommunity & Mental Health Services achieved financialbalance, which proved particularly challenging for theservices to deliver and required very tight managementof recruitment to vacant posts.

Whilst 2006/7 is another very challenging year the PCThas set a realistic balanced budget and continues to workclosely with The Queen Elizabeth Hospital King's LynnNHS Trust in support of their financial recovery plan.

The PCT met its financial duty of staying within itsannual cash limit.

The PCT invested £495,000 in capital infrastructure.This includes £114,000 in refurbishment costs at theFermoy Mental Health Unit and £190,000 in ITinfrastructure in primary care in order to support fullimplementation of Choose and Book Software.

The PCT is expected, in line with public sector paymentpolicy, to pay all suppliers of goods and services within30 days of goods received or a valid invoice which everis the later. Against a target of 95% compliance the PCTachieved 85.8% by volume and 91.2 % by value.

Management costs increased from £18.30 per head inthe previous year to £19.59 per head of population in2005/6. West Norfolk PCT will be disestablished in2006/7 and form part of new Norfolk PCT, which willresult in management cost saving of at least 15%.

Senior Managers received a pay award of 3.225% in linewith other pay groups. This pay award was agreed bythe Remuneration Committee, which is made up ofthe PCT chair and two Non Executive Board members.

Summary Financial Statements

The following statements are a summary of theinformation contained in the full accounts, whichreceived an unqualified audit opinion from our externalauditors, PriceWaterhouseCoopers. For a copy of thefull accounts please telephone 01553 816207.

+ Finance Director’s report

David StonehouseDirector of Finance

18

n The PCT's Remuneration Committee comprises theBoard Chair and the other Lay Members with officers inattendance as deemed appropriate.

n It meets periodically to agree the pay award for SeniorManagers and other locally agreed pay changes e.g.clinical excellence awards.

Senior Manager Pay

Contractual basis

n All directors are on substantive contracts with a threemonth notice period for both employer and employee.

n There are no Senior Managers within the PCTemployed on fixed term contracts.

Pay structure

n Currently there is no performance related pay forSenior Managers and pay awards have been made in linewith admin and clerical staff.

n Senior Managers have recently been assimilated to theAgenda for Change pay spine in line with other non-medical staff.

n Other than lease car benefits in kind, all otherremuneration relates to cash amounts.

n The tables on pages 26 and 27 provide details of theremuneration and pension entitlements for PCT seniormanagers in 2005/06.

Pay awards

n There have been no significant awards or compensationpayments made to past senior managers in the year(2004/05: nil).

Payments to third parties

n There are no amounts payable to third parties for theservices of senior managers.

+ Remuneration Committee: Constitution and operation

Hilary Daniels

Chief Executive

14 September 2006

David Stonehouse

Director of Finance

14 September 2006

We have examined the summary financial statements forthe year ended 31 March 2006 which comprise theOperating Cost Statement, the Balance Sheet, theStatement of Recognised Gains and Losses, theCashflow Statement and the related notes. We havealso audited the information in the PCT's RemunerationReport that is described as having been audited.

This report, including the opinion, has been preparedfor and only for the Board of West Norfolk PrimaryCare Trust in accordance with Part II of the AuditCommission Act 1998 and for no other purpose, as setout in paragraph 36 of the Statement of Responsibilitiesof Auditors and of Audited Bodies prepared by theAudit Commission. We do not, in giving this opinion,accept or assume responsibility for any other purposeor to any other person to whom this report is shownor into whose hands it may come save where expresslyagreed by our prior consent in writing.

Respective responsibilities of directorsand auditors

The directors are responsible for preparing the AnnualReport, including the Remuneration Report. Ourresponsibility is to audit the part of the RemunerationReport to be audited and to report to you our opinionon the consistency of the summary financial statementswithin the Annual Report with the statutory financialstatements. We also read the other informationcontained in the Annual Report and consider whether itis consistent with the audited summary financialstatements. This other information comprises only theFinance Director's report and the unaudited part of theRemuneration Report. We consider the implicationsfor our report if we become aware of anymisstatements or material inconsistencies with thesummary financial statements. Our responsibilities donot extend to any other information.

Basis of opinion

We conducted our work in accordance withBulletin 1999/6 'The auditors' statement on thesummary financial statement' issued by the AuditingPractices Board.

Opinion

In our opinion:

n the summary financial statements are consistent withthe statutory financial statements of the PCT for theyear ended 31 March 2006; and

n the part of the Remuneration Report to be auditedhas been properly prepared in accordance with theaccounting policies directed by the Secretary of Stateas being relevant to the National Health Service inEngland.

The PCT exceeded the revenue resource limit specifiedby the Secretary of State and consequently our opinionon the financial statements was qualified for non-compliance with governing authorities.

19

PricewaterhouseCoopers LLPNorwich

14th September 2006

+Independent auditors' report to the

Directors of the Board of WestNorfolk Primary Care Trust

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West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +

2005/06 2004/05£000 £000

Commissioning

Gross Operating Cost 173,074 158,179

Less: Miscellaneous Income (26,511) (22,958)

Net Operating Costs 146,563 135,221

Providing

Gross Operating Costs 26,375 25,736

Less: Miscellaneous Income (3,752) (3,941)

Net Operating Costs 22,623 21,795

Total Net Operating cost for the Financial Year 169,186 157,016

2005/06 2004/05£000 £000

Fixed Asset Impairment Loss (3,711) 0Unrealised surplus (deficit) on fixed asset revaluations/indexation 378 2,795

Increase in the donated asset reserve and government grant reservedue to receipt of donated and government granted assets

Reduction in the donated asset reserve due to depreciation (8) (9)

Gains and (losses) recognised in the financial year (3,341) 2,786

PricewaterhouseCoopers LLP are the PCT's external auditorsand their fees for 2005/06, all of which related to statutoryaudit services, amounted to £115,000 (2004/05: £105,000).

OPERATING COST STATEMENT

STATEMENT OF RECOGNISED GAINS AND LOSSES

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West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +

31st March 2006 31st March 2005

£000 £000

Fixed Assets 13,777 17,369

Current Assets

Stocks and work in progress 7 4Debtors 4,326 2,431Cash at bank and in hand 5 5

4,338 2,440

CREDITORS : Amounts falling due within one year (11,564) (9,161)

NET CURRENT ASSETS (LIABILITIES) (7,226) (6,721)TOTAL ASSETS LESS CURRENT LIABILITIES 6,551 10,648CREDITORS: Amounts falling due after more than one year (299) 0PROVISIONS FOR LIABILITIES AND CHARGES (668) (562)TOTAL ASSETS EMPLOYED 5,584 10,086

FINANCED BY CAPITAL & RESERVES:General Fund 4,288 5,449Revaluation reserve 1,222 4,504Donated asset reserve 74 133

TOTAL CAPITAL AND RESERVES 5,584 10,086

BALANCE SHEET

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CASH FLOW STATEMENT

2005/06 2004/05

£000 £000

OPERATING ACTIVITIES

Net cash outflow from operating activities (167,221) (154,414)

CAPITAL EXPENDITURE

Payments to acquire tangible fixed assets (510) (839)

Receipts from sale of tangible fixed assets 0 100

Payments to acquire fixed asset investments (23) (14)

Net cash inflow/(outflow) from capital expenditure (533) (753)

Net cash inflow/(outflow) before financing (167,754) (155,167)

FINANCING

Net Parliamentary Funding 167,754 155,171

Increase/(decrease) in cash 0 4

West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +

24

West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +

2005/06 2004/05£000 £000

Total net operating cost for the financial year 169,186 157,016Less Non-discretionary Expenditure (2,996) (2,464)Operating Costs less non-discretionary expenditure 166,190 154,552

Revenue Resource Limit 165,377 153,070

(Over)/Under spend against revenue resource limit (813) (1,482)Unplanned brokerage received 0 0Operational Financial Balance (813) (1,482)

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'sshare of the Norfolk-wide Out of County specialist mental health budget and specialist non-commissioned activity.

In 2004-05 the PCT received internally generated financial support of £813,000, relating tocapital to revenue flexibility transferred from Norwich PCT. No appropriate capital schemeswere identified to support the transfer. The PCT was not required to repay this support in2005/06, 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 significantrisks around the achievement of financial balance which the PCT will need to closely manage.

OPERATIONAL FINANCIAL BALANCE

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The PCT is required to recover full costs in relation to its provider functions. The performance is as follows:

2005/06 2004/05

£000 £000

Provider gross operating cost 26,375 25,736

less: Miscellaneous income relating to provider functions (3,752) (3,941)

Net Operating Cost 22,623 21,795

Costs met from PCT's own allocation (22,623) 21,795

(Under)/over recovery of costs 0 0

PROVIDER FULL COST RECOVERY DUTY

West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +

2004/05 2003/04

Non NHS CreditorsBetter Payment Practice Code - measure of compliance Number £000s Number £000s

Total bills paid in the year 7,491 10,927 8,301 12,327

Total bills paid within target 6,428 9,955 6,584 10,388

Percentage of bills paid within target 85.81% 91.10% 79.32% 84.27%

PUBLIC SECTOR PAYMENT POLICY

2005/06

Number £000s

Total bills paid in the year 1,355 130,477

Total bills paid within target 1,159 129,634

Percentage of bills paid within target 85.54% 99.35%

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.

NHS CREDITORS

£000 £000 £000 £000 £000 £000H Daniels Ms Chief Executive 100-105 - 13-14 100-105 - 29-30*J Rees Dr Director of Public Health 110-115 30-35** 9-10 100-105* - 19-20*D Stonehouse Mr Director of Finance and Information 60-65 - - 60-65 - -J Keown Mr Director of Mental Health 70-75 - - 50-55 - -S Gurr Mrs Director of Community Services 65-70 - 17-18 45-50 - 12-13*

M Cook Mrs Chairman of the Trust Board from Nov 05# 10-15 - - 5-10 - -S Childerhouse Mrs Chairman of the Trust Board until Oct 05 10-15 - - 20-25* - -L Collison Mrs Non Executive Board Member 5-10 - - 5-10 - -K Gordon Ms Non Executive Board Member# 5-10 - - 0-5 - -E Pank Dr Non Executive Board Member 5-10 - - 0-5 - -S Roberts Sir Non Executive Board Member# 5-10 - - 5-10 - -

M Skinner Dr Chairman of the Trust Executive 30-35 - - 30-35* - -U Thakaar Mr Executive Member 0-5 - - Nil - -S Barrett Mrs Executive Member 5-10 - - 5-10 - -G Dickerson Mr Executive Member 5-10 - - 5-10 - -Ho Dr Executive Member 5-10 - - - - -J Fisher Mr Executive Member 5-10 - - 5-10 - -I Mack Dr Executive Member 5-10 - - 5-10 - -R Redman Dr Executive Member / Board Member 10-15 - - 10-15 - -S Shepherd Mrs Executive Member 5-10 - - 5-10 - -P Southgate Mrs Executive Member / Board Member 10-15 - - 10-15 - -I Waterson Dr Executive Member 5-10 - - 5-10 - -

26

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# Members of the Remuneration Committee* Restated** Arrears on consultants contractAll 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

Board & Executive Commitee Member Remuneration 2005-06+

£000 £000 £000 £000 £000 £H Daniels Ms 5.0-7.5 155-160 624 567 30 NilJ Rees Dr110-115 15-17.5 150-155 - - - NilD Stonehouse Mr 2.5-5.0 55-60 154 136 10 NilJ Keown Mr 17.5-20 125-130 542 434 68 NilS Gurr Mrs 22.5-25 75-80 327 214 75 Nil

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As Non-Executive members do not receive pensionableremuneration, there are no entries in respect of pensions forNon-Executive members.

Cash Equivalent Transfer Values

A Cash Equivalent Transfer Value (CETV) is the actuariallyassessed capital value of the pension scheme benefits accrued bya member at a particular point in time. The benefits valued arethe members' accrued benefits and any contingent spouse'spension payable from the scheme. A CETV is a payment made bya pension scheme or arrangement to secure pension benefits inanother pension scheme or arrangement when the memberleaves a scheme and chooses to transfer the benefit accrued intheir former scheme. The pension figures shown relate to thebenefits that the individual has accrued as a consequence of theirtotal membership of the pension scheme, not just their service ina 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 orarrangement which the individual has transferred to the NHSpension scheme. They also include any additional pension benefitaccrued to the member as a result of their purchasing additionalyears of pension service in the scheme at their own cost. CETVsare calculated within the guidelines and framework prescribed bythe Institute and Faculty of Actuaries.

Self-employed GPs who are members of the ProfessionalExecutive Committee (PEC) have pension entitlements.However, the proportion of those entitilements that relates totheir membership of the PEC is not significant compared to theproportion that relates to their work as practitionersindependent of the PCT. It is not, therefore, appropriate todisclose their pension entitlements.

Real Increase in CETV

This reflects the increase in CETV effectively funded by theemployer. It takes account of the increase in accrued pensiondue to inflation, contributions paid by the employee (includingthe value of any benefits transferred from another scheme orarrangement) and uses common market valuation factors for thestart and end of period.

Details of the treatment of pension liabilities in the PCT'saccounts are included within the Pensions Costs AccountingPolicy note in the full financial statements

Board & Executive Commitee Member Remuneration 2005-06+

PENSION ENTITLEMENTS

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2005/06 2004/05

Management costs (£000) 2,822 2,632

Weighted Population 144,047 144,047

Management cost per head of weighted population £19.59 £18.27

MANAGEMENT COSTS

West Norfolk Primary Care Trust 2005/06 Summary Financial Statements +

Hilary Daniels

Chief Executive

David Stonehouse

Director of Finance

The PCT is required to keep within its Capital Resource Limit.The performance for 2005/06 is as follows

2005/06 2004/05

£000 £000

Gross Capital Expenditure 495 886

less: Net Book Value of assets disposed of (27) (100)

Charge Against the Capital Resource Limit 468 786

Capital Resource Limit 968 1,225

(Over)/Underspend against Capital Resource Limit 500 439

CAPITAL RESOURCE LIMIT

The Statement on Internal Control can be found in the full accountsavailable from our internet site: www.westnorfolk-pct.nhs.uk

STATEMENT ON INTERNAL CONTROL

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+ Provision Of Primary Healthcare 14.9%

+ Primary Care Prescribing 13.4%

+ Administrative Expenditure 1.8%

+ Secondary Care 69.9%

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+ General and Acute 69.3%

+ Accident and Emergency 1.3%

+ Community Health Services 12.6%

+ Learning Difficulties 3.7%

+ Maternity 2.2%

+ Mental Illness 10.7%

Prim

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lthca

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urch

ased + Ophthalmic Services 1.8%

+ Dental Services 5.8%

+ Pharmaceutical Services 5.3%

+ GMS/PMS 39.1%

+ Prescribing 47.3%

+ Other 0.7%

Within Secondary Healthcare £61,7 million of spend was for services commissioned fromQueen Elizabeth Hospital NHS Trust and £22.6 million for community & mental healthservices directly provided by the Primary Care Trust. All figures are gross of income fromlead commissioning arrangements and services provided to other PCT's.

+ Grants to fund Capital Projects 0.2%

West Norfolk PCTwww.westnorfolk-pct.nhs.uk

Borough Council ofKing’s Lynn and West Norfolkwww.west-norfolk.gov.uk

NHS Directwww.nhsdirect.nhs.uk

Department of Healthwww.doh.gov.uk

Healthcare Commissionwww.healthcarecommission.org.uk

Norfolk County Councilwww.norfolk.gov.uk

Norfolk Suffolk and Cambridgeshire StrategicHealth Authoritywww.nscstha.nhs.uk

West Norfolk Young Peoplewww.youthzone.biz

National Health Servicewww.nhs.uk

Patients Associationwww.patients-association.com

HARP web site for Asylum Seekers health issueswww.harpweb.org.uk

+ Links to other organisations

These are links to the web sites of the organisations who work together in promoting good healthcare in West Norfolk:

30

West Norfolk Primary Care Trust

St JamesExton’s RoadKing’s LynnNorfolkPE30 5NU

Tel: 01553 816200Fax: 01553 761104e-mail: enquiries@westnorfolk-pct.nhs.uk www.westnorfolk-pct.nhs.uk

+