1. No category

Mike Kelly FCIOB MCIM
Chief Executive
Our Ref
Your Ref
Date
Please ask for
Direct Line
Direct Fax
E-mail
TO:
JG
HSC/JG
11 March 2015
Julie Gallagher
0161 253 6640
[email protected]
Legal & Democratic Services
Division
Jayne Hammond LLB (Hons)
Solicitor
Assistant Director of Legal &
Democratic Services
All Members of Health Scrutiny Committee
Councillors : P Adams, P Bury (Chair), E Fitzgerald, L Fitzwalter,
J Grimshaw, S Haroon, K Hussain, Kerrison, Mallon, T Pickstone, S Smith
and R Walker
Dear Member/Colleague
Health Scrutiny Committee
You are invited to attend a meeting of the Health Scrutiny Committee which will be
held as follows:Date:
Thursday, 19 March 2015
Place:
Peel Room (Elizabethan Suite), Town Hall,
Knowsley Street, Bury
Time:
7.00 pm
Briefing
Facilities:
Notes:
If Opposition Members and Co-opted Members
require briefing on any particular item on the
Agenda, the appropriate Director/Senior Officer
originating the related report should be
contacted.
*** please note there will be a briefing for
elected members only commencing at 6pm
in the Lancashire Fusiliers Room
AGENDA
The Agenda for the meeting is attached.
Reports are enclosed only for those attending the meeting and for those without access
to the Council’s Intranet or Website.
Electronic service of legal
documents accepted only
at:
E-mail:
[email protected]
Town Hall
Knowsley Street
Bury BL9 0SW
www.bury.gov.uk
The Agenda and Reports are available on the Council's Intranet for Councillors and
Officers and also on the Council’s Website at www.bury.gov.uk – click on Agendas,
Minutes and Forward Plan.
Copies of printed reports can also be obtained on request by contacting the Democratic
Services Officer named above.
Yours sincerely
Chief Executive
AGENDA
1
APOLOGIES FOR ABSENCE
2
DECLARATIONS OF INTEREST
Members of Health Scrutiny Committee are asked to consider whether they have an
interest in any of the matters on the agenda and if so, to formally declare that
interest.
3
PUBLIC QUESTION TIME
Questions are invited from members of the public present at the meeting on any
matters for which this Committee is responsible.
4
MINUTES OF THE LAST MEETING (Pages 1 - 6)
The minutes of the last meeting held on 10th February 2015 are attached.
5
MATTERS ARISING
6
DRUG AND ALCOHOL SERVICES UPDATE (Pages 7 - 26)
Tracy Minshall, Strategic Lead, Strategy and Development, Department of
Communities and Wellbeing will report at the meeting. Presentation attached.
Others officers in attendance will include - Ann Norleigh Noi (Senior Partnership
Implementation Officer); Pam Lievesley - One Recovery Bury (Service Delivery
Director for Bury); Anita McWilliam One Recovery Bury (Team manager); Debbie
Chadwick – Sodexo Justice Services/One Recovery Bury (Drug & Alcohol Strategy
Lead Forest Bank).
7
INTRODUCTION FROM THE CHIEF EXECUTIVE OF THE PENNINE ACUTE NHS
TRUST
The Chief Executive of the Pennine Acute NHS Trust, Dr Gillian Fairfield will report
at the meeting.
8
HEALTH SCRUTINY EVENT UPDATE (Pages 27 - 30)
A copy of an Evaluation report from Jane Scullion, Centre for Public Scrutiny advisor
is attached.
9
URGENT BUSINESS
Any other business which by reason of special circumstances the Chair agrees may
be considered as a matter of urgency.
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Agenda Item 4
Minutes of:
HEALTH SCRUTINY COMMITTEE
Date of Meeting:
10 February 2015
Present:
Councillor P Bury (in the Chair)
Councillors P Adams, E FitzGerald, L Fitzwalter, J Grimshaw,
S Haroon, K Hussain, S Kerrison, J Mallon, T Pickstone,
S Smith and R Walker
Also in
attendance:
John Boyington - Chairman - Bury GP Federation
Linda Jackson - Assistant Director – Adult Care Services
Public Attendance: There was 1 member of the public present at the meeting.
Apologies for Absence: Michelle Armstrong - Chief Officer - Bury GP Federation
HSC.687 DECLARATIONS OF INTEREST
Councillor Walker declared a personal interest in any item relating to the Radcliffe Pilot
as the medical centre he was registered with fell within that pilot.
Councillor Grimshaw declared a personal interest in any item relating the CCG as she
was a member of the Patients' Cabinet.
HSC.688 MINUTES OF THE LAST MEETING
It was agreed:
That the Minutes of the Last Meeting held on 27 January 2015 be approved as a
correct record and signed by the Chair.
HSC.689 MATTERS ARISING
1.
Councillor Walker referred to Minute HSC.645 – Better Care Fund Submission
and referred to the resolution that an update would be brought to a future
meeting of the Health Scrutiny Committee. Councillor Walker asked if a more
specific timeframe could be given so that it was ensured that the action was
followed up.
Councillor Bury explained that the forward plan of the Committee would be the first
item that the new Committee would discuss at the first meeting of the 2015/2016
Municipal Year.
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Linda Jackson, Assistant Director explained that the Better Care fund would
commence in April 2015 and it would be likely that a report be brought to this
Committee around October 2015.
HSC.690 BURY GP FEDERATION UPDATE - PRIME MINISTER'S CHALLENGE FUND
John Boyington, Chair of the Bury GP Federation presented members with an update
on the work of the GP Federation and focussing on the successful Prime Minister's
Challenge Fund bid.
It was explained that the GP Federation was a company Limited by shares which was
incorporated in November 2103. There were originally 26 GP practice members who
jointly invested £250 000 to establish the federation and a further 4 had since joined.
It was explained that the GP Federation had been commissioned to work with the
Radcliffe GP practices to help set up and operate the Healthier Radcliffe Pilot.
Work had also been carried out to assist with the winter pressures that GP surgeries
were under during the winter season and had seen surgeries providing extra hours to
assist with this.
The objective of the Prime Minister's Challenge Fund had been to:•
•
•
•
•
•
Pilot improvements in access to appointments;
Promote innovation, share learning and deliver benefits to patients;
Explore a variety of ways to extend access including:
- Longer opening hours
- Greater flexibility of access - e.g. multiple site access
- Greater use of
Technology
Online services
Telehealth
The GP federation had submitted the 'Bury Easy-GP' bid which was presented as a
document setting out vision and ambition and included:
•
•
•
•
Extended working hours 6.30 - 8pm Monday to Friday
8am - 6pm Saturday and Sunday
Increasing the number of patients registered for online access
Offering telephone consultations to all patients instead of face to face
Developing a comparison style website.
John reported that the proposed models for service delivery had been accepted by all
members who are collaborating to increase online registration, a telephone
consultation option and to deliver extended working hours.
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The extended working hours model was based on having 5 sites strategically placed
around the borough with a planned offering of 1420 extra appointments per week. It
was explained that currently all partner GPs were being given the option to work
extended hours at a rate of £80 ph. Those GPs offering the extended hours would have
read and write access to all Bury patients' medical records which would allow for a
bury patient to access any of the sites across the borough.
It was explained that the service was just ramping up to capacity and there had been
issues with IT.
The extended working hours was currently at 50% of the expected capacity providing
an extra 700 appointment per week.
There was currently no prescription printing solution available.
GPs had been slow to come forward but recruitment was now picking up.
John reported that the initial funding from the Challenge Fund would deliver services
to May 2015. Additional funds had however been allocated which would extend
services to November 2015 and allow for further evaluation
The Clinical Commissioning Group were committed to funding an Extended Working
Hours service but were waiting for the evaluation feedback before determining how
the service would be delivered.
Those present were given the opportunity to ask questions and make comments and
the following points were raised:•
Councillor Fitzwalter referred to the 5 sites across the borough that had been
identified to provide the extended working hours. Tottington Medical Centre
had been identified as the site for the north of the Borough but it was barely up
and running due to issues with access to rooms and GPs from Ramsbottom not
having capacity to provide extra hours. Councillor Fitzwalter explained that the
service was currently only offering 2 hours on a Saturday and 2 hours on a
Sunday.
John explained that the GP Federation were aware that access to practices in
Tottington had been difficult but they were committed to ensure that full capacity was
provided. The Federation were recruiting GPs and the issue of rooms was being
addressed. It was explained that the evaluation of the uptake of the use of extended
hours services would be based on the capacity available.
•
Councillor Pickstone asked how much funding had and would be received.
John reported that the initial Challenge Fund amount had been £2.7m and an extra
£600,000 had been secured from April 2015.
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•
Councillor Mallon asked what reassurances were in place in relation to patients'
records if sharing these across the borough.
John explained that the IT systems in use were national systems and security was of
the utmost importance. There were issues with the systems allowing the sharing of
files and these were being worked through.
•
Councillor Mallon asked whether there was a shortage of GPs in Bury and
whether this was having an impact on recruitment.
John explained that he wasn't aware of any shortfall across the borough but the
Federation were relying on the existing stock of GPs to provide the service and not all
of them wanted to take up the offer.
•
•
Councillor Adams stated that the online registration needed to be made easier
as at the moment it was quite difficult to do and would put some people off.
Councillor Walker asked when it was likely that the out of hours service would
have full access to medical records.
John stated that he wasn't sure of the timescale but it was being worked on and the
issue would be solved.
•
Councillor Grimshaw referred to the way that access was spread across the
borough and asked whether this would be changed as some areas may require
more access due to logistics.
John stated that this was the model that had been agreed on for the pilot but this could
change after the evaluation exercise was completed.
•
Councillor Kerrison asked how the extended hours would work for GPs. Would
they be extra hours or a change to their working week.
John explained that it would be up to the GP how they worked but all GPs working
hours would be monitored.
It was agreed
1. That John be thanked for his presentation
2. That a progress report be brought to the Committee once the evaluation had been
carried out.
HSC.691 BURY GP FEDERATION - HEALTHIER RADCLIFFE EVALUATION REPORT
John Boyington, Chair of the Bury GP Federation gave a presentation explaining the
background, objectives and progress of the Healthier Radcliffe pilot and the initial
results and feedback following 12 months operation of the scheme.
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It was explained that the objectives of Healthier Radcliffe were:1.
•
•
•
2.
•
•
Extend access to local GP and primary care services at one point of access
Access to local GP s 8 am - 8pm Monday to Friday and 8am - 6pm Saturday
and Sunday
Patients will be seen by a local clinician who has access to their health records
Integrating other providers and partners such as hospitals, commuity and
social services to provide better joined up care in the community at one point of
contact
Health education and information programmes.
The progress made was explained:1.
•
•
•
2.
•
•
•
•
•
Planning carried out between July and September 2013
Design, agreement, IT enablement, mobilisation and communication delivered
over 3 months enabling governance structures
Successful service went live 2 December 2013 providing 1000 appointments
each month
Two integrated workshops held October 2013 and February 2014
Provider bids invited and submitted during June/July 2914
'Well being' commissioners review of bids feeding into GP Federation approval
on 3 August 2014
Enhanced project management August 2014
Services mobilised between October 2014 and January 2015.
John reported that four projects had been added to Healthier Radcliffe and these
were:•
North West Ambulance Service - "Green Car" Paramedic which had seen a 60%
deflection of 999 calls
•
Multi disciplinary Team and Reablement
•
Domiciliary Medication Optimisation - targeting the 200 patients with the most
complex medication needs
•
Targeted Early Intervention
There had been significant media coverage of Healthier Radcliife and all attendances
of Radcliffe patients at hospital had reduced in all 4 areas. It was also reported that
walk in centre activity had reduced and patient feedback was positive.
It was explained that the first draft of the evaluation report was due to be received by
the GP Federation in mid February 2015.
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John also reported that Healthier Radcliffe had been nominated for a British Medical
Journal Award and some of the staff working on the scheme were attending a
parliamentary event in London to celebrate good working practices.
Those present were given the opportunity to ask questions and make comments and
the following points were raised:•
Councillor FitzGerald asked whether there were any indications that new
patients were now attending as appointment times were more accessible.
John stated that he was not aware of this but it could be a possibility.
•
Councillor Walker referred to the fact that Mile Lane Surgery was included
within the scheme even though it was located in Bury and asked whether the
figures would include the Mile Lane Surgery patients.
It was explained that if they had attended the services provided then they would be
included in the figures.
It was agreed:
1. That the information be noted
2. That the outcome of the evaluation be reported to the Committee when it had been
finalised.
COUNCILLOR P BURY
Chair
(Note: The meeting started at 6.00 pm and ended at 7.30pm)
474
Tracy Minshull
Agenda Item 6
Strategic Lead
Strategy & Development
Communities & Well Being
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Introduction
JSNA
Joint Strategic
Needs
Assessment
List of Deficits
•Long waiting times for access
•No Interventions for stimulant
users
Public Service
Commissioning
Plans
DAAT Treatment
Plans
List of Services
•Introduced Initial Triage
•Commissioned Stimulant worker
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As it was: a time of plenty
• Deficits
• Public
Services
• Treatment
MID
POINT
ALLEGIANCE
Recovery
Community
Organisations
• Assets
• Community
• Recovery
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As it is: a Time of Austerity
5 Ways to Well Being:
1. Connect
2. Keep Learning
3. Take Notice
4. Give
5. Be Active
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Solution is in the Community
Senior Partnership Implementation
Officer
Communities & Well Being
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Ann Norleigh Noi
Needs Assessment
Large scale Consultation – Service Users & Providers
Strategic Pathway Events (included wider stakeholder
input)
Evidence from the above processes informed the
partnership decision to go out to tender........
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Service Review
Strengths:
Good at getting people into treatment
Accessible to both criminal justice and non-criminal justice clients
Co-located drug and alcohol treatment service
Waiting time for treatment access is short
Weakness:
Clients are recycled within the treatment system with 63% of individuals
representing
Evidenced lack of focus on outcomes – service users retained
Lack of aftercare provision
Little or no internal challenge, this makes it difficult to ‘modernise’
service
An apparent ‘fear’ of change
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Service review 2011/12: findings
Education: lack of a structured programme on the risks
associated with consumption of alcohol/drugs;
Early interventions: lack of structured provision to reduce
problematic use of alcohol and drugs;
Outreach: lack of outreach to increase treatment uptake
among harder to reach populations;
Low numbers of stimulant users engaging;
Lack of aftercare
Lack of a tangible recovery community
Lack of movement of service users through the treatment
system
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Needs Assessment: gaps identified
Gaps identified:
Outreach opportunities;
Aftercare opportunities;
Better geographical spread of services/support;
A responsive weekend service;
Effective links with prisons;
Interventions for stimulant users;
Effective transition for young people aged 18 years and
over;
A visual recovery community.
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Stakeholder input two events
Our vision is to commission a drug and alcohol service
which is based on local need; adopts a whole system
approach to provision; is outcome focused and recovery
orientated; and, is responsive to both the needs of
individual service users and emerging local trends.
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The Service Specification: our vision
Service: the provision of drug and alcohol service for
adults in Bury
Age range: 18 years and over
Substances:
Drugs: including ‘legal highs’, over the counter/
prescribed medications
Alcohol
Contract duration: 3 years (with the provision to
extend for further 12 months)
Procurement process from: July 2012 to April 2014
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The specification: service overview
Unique working collaboration
Whole systems approach
Recovery focused & community based
Innovative way of working with the prison
Gateways Project
Reduced Crime
Freedom from dependency
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Service fit for the future...
BURY
Pam Lievesley
(RMN, Bsc Hons, MA,Msc, PGCE)
Service Delivery Director for Bury
However, most importantly..
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ONERECOVERY
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INTRODUCTION
This presentation will discuss the challenges, the
successes during the first twelve months and the future
aims for One Recovery Bury.
Managing the changes:
- Service staff
- Service User
-
Other Professionals
-
Electronic systems: paper to paperless
Implementing the New Model:
- Reviewing and Adjusting the Model.
Establishing New Partnerships within One Recovery Bury:
- Communication between partners.
- Understanding each others roles and responsibilities
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CHALLENGES
•
“End to End” Integrated recovery focused service.
•
Bridging The Gap – Graduation Event
•
Volunteers
•
BEST - Welly Project
•
D2 (ORBIT) Project
•
Benzodiazepine Worker
•
All prescribed service users reviewed by the Medical Team.
•
Gateway – Addullam Housing & Families (Early Break)
•
Sodexo – continuity for prisoners.
•
Service User Involvement
•
Maintaining stability – dedicated and professional Team
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SUCCESSES
Service Manager – Anita McWilliam
Deputy Manager
Healthcare Team:
Doctors – Dr Kaushal (Lead Consultant) Dr Husain, Dr Jackson,
Nurses:
Laura Walker, Mark Hinchliffe
Criminal Justice Practitioners
Karen Harrison – Team Manager
Don Green, Paul Curran, Caroline Woods
Senior Practitioners
Elsie Rushworth, Angie Boast
Recovery Practitioners
Trish Sweatman, Kai Lievesley, Rod Birtles,
Emma Ward, Iain Grey, Vacant
Shared Care
Amy Scott
Lisa Lightbown,
Administrators
Debbie Simpson – Senior Administrator
Julie Walker, Jackie Millward
Recovery Hub Co-ordinator
Jenny Coulson
Recovery Support Worker
Lis Ashton
Bridging the Gap Co-ordinator
Nikki Allison
Needle Exchange
Scott Walker
ADS Co-ordinator – Alcohol
Community Volunteers
Debra Lamb
Volunteers
Benzos & Z Drugs
Janet Hartley
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Service Delivery Director – Pam Lievesley
• Recovery Hub - ORB
• Recovery Spokes – Townships
• Increased Visible Recovery/Recovery in Communities.
• More volunteers & Peer Mentors.
• Increased numbers leaving Prison Drug Free.
• Increased numbers leaving prison with accommodation and continued
support
• Support for offenders and their families
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FUTURE
FROM
TO:
Competition
Partnership
Independence
Collaboration
Outputs
Outcomes
Process driven
Evidence
Sometime disjointed Care
Fully integrated Service
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CONCLUSION
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Agenda Item 8
Taking stock of health scrutiny in Bury Council
This report is written just as health scrutiny in Bury is about to enter a new era with the recent
announcement of plans to devolve responsibility for health and social care to statutory organisations
in Greater Manchester. That background provides a useful opportunity to take stock of the work of
Bury Council’s Health Overview and Scrutiny Committee. Although it is to be expected that
arrangements will change in future, given devolution, there are still many useful lessons to be gained
from taking stock of current and recent experience in this area.
The report aims to summarise the strengths of practices in Bury, to outline the issues that emerged
from councillors, officers and other stakeholders during a developmental session led by the Centre
for Public Scrutiny in February 2015 and to outline areas for further consideration.
Overview and Scrutiny in Bury: the strengths
Trust and joint working
Scrutiny in Bury Council benefits from good relationships with external organisations such as the
Clinical Commissioning Group, Pennine Care and the local Healthwatch. There is ongoing dialogue
between those external organisations and the council and some recognition of the respective roles
that each play in the local health landscape. There is evidence of willingness to engage and the
difficulties of information sharing, particularly about finance, are not shied away from, but treated
with some frankness about what is possible. The scrutiny of the large reconfigurations had gone
well in Bury as a result. External organisations appear to accept the legitimacy of the scrutiny and
overview process and are therefore prepared to participate and engage in debate. Generally joint
working with external organisations is working well for Bury Council.
Continuity
One explanation for the strengths of those external relations is the continuity provided by the chair
of Bury Council’s Overview and Scrutiny Committee also fulfilling that role for the Joint Health
Overview and Scrutiny Committee(for the Pennine Care NHS Trust) and the Greater Manchester
Joint Health Scrutiny Committee. This enabled links to be made and relationships to be developed
over a period of time and increased the chair’s overall understanding of the overall health economy
and the key players within it. It is to be hoped that this kind of continuity will continue to operate in
the new arrangements, with scrutiny chairs as ‘hubs’, enabling information to flow in both directions
between the Greater Manchester level and the local level. It is important that the ‘overview’
function is kept in sight, as well as the scrutiny of individual decisions.
Focussed topic choice
Bury has also used ‘task and finish’ groups on specific health topics very well. The topics of diabetes
and also of dentistry were quoted as particularly successful examples of successful scrutiny projects
where councillors, officers and partners all agreed that there had been real impact. Clearly bounded
topics, good performance data on service delivery and strong engagement from all stakeholders
were cited as key to success, as was the role of the scrutiny officers in supporting the reviews. It was
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also agreed that the pre-meeting briefing was essential in providing additional relevant information
and giving a focus to the questioning within limited time constraints.
Overview and Scrutiny in Bury: areas for further consideration
External versus internal facing scrutiny
Bury Council’s scrutiny councillors, like many others elsewhere in the country, noted that it
sometimes seems easier to scrutinise the provision of services provided by external bodies than
those provided by the council itself. There are, it might be speculated, several possible explanations
for this general problem. The role of ‘critical friend’ is sometimes hard to get right within a council
setting. There might be a shared understanding within the council that times are hard and budgets
are tight, which leads to a feeling of sympathy and a reluctance to engage in a more rigorous
questioning of decision-makers and senior officers. There might be a culture amongst some officers
that scrutiny is not particularly highly valued and that therefore information provision is not
prioritised. It may be that a particular council’s political or management culture sees problems with
performance as a matter for blame rather than legitimate enquiry. It is not suggested that any of
these explanations describes the situation in Bury, but rather it is proposed that the council guards
against this by continuing to strengthen its existing support for the challenge of overview and
scrutiny as a legitimate part of the checks and balances in the democratic process.
Entry points for scrutiny
Scrutiny councillors also noted that there were some very practical areas that could be improved in
order to enhance health scrutiny. The first of these was the difficult question of the ‘entry’ point for
a scrutiny committee. In an increasingly plural service delivery environment, with services being
provided at arm’s length through a variety of vehicles, councillors were unsure about the role of the
committee in, for example, pre-contract specification, where there might be commercial
confidentiality. It may be that some involvement at the pre-contract specification stage might be
useful, to harness the knowledge of the scrutiny committee and also to assist in setting up what the
scrutiny arrangements should be after the contracts are let. Councillors, in general, do not
extinguish their responsibilities and accountabilities for functions even if the service provider is
external to the council and it may be that building scrutiny into the process at an early stage would
help to provide an additional accountability mechanism. Bury Council may wish to engage in further
debate about appropriate entry points for scrutiny committees as the terrain of service provision
becomes more diverse.
Site visits
The next area for consideration that emerged was the very practical desire to make more site visits
as part of overview and scrutiny. It was agreed by councillors and stakeholders that this type of
experiential learning and the information gained from talking to service managers and users in the
work setting had often proved invaluable and it was felt that this should be planned into task and
finish group work programmes in the future.
Rules for closure
The question of the ‘rules for ‘closure’ was also one that continued to exercise members. Following
each review there was a period of time when the recommendations were regularly monitored and
reported upon and this could, in some cases, lead to agendas being clogged up with ‘old’ items. It
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was agreed that it would be more effective to reduce agendas to enable in depth discussion and that
the committee should give consideration to shorter monitoring schedules and have a cut-off point.
Questioning
The issue of how to offer robust challenge to decision makers while remaining a ‘critical friend’ is
one which is common to scrutiny councillors across the country and Bury is no exception.
Councillors spoke of feeling bamboozled at times by slick presentations from skilled officers and of
the continued need to dig down into performance reports in order to understand the whole picture.
Scrutiny councillors are reminded that they are ‘lay’ members who cannot have the expertise in
every specialist area; their job is to ask the questions that the public, the service users, would expect
them to ask – the who, what, how, why and when questions.
Conclusion
The confidence that Bury Council displays in its management of its health scrutiny functions is
demonstrated by its commitment to training (in new health legislation, for example), but also in its
determination to make the time for learning and reflection, even when things seem to be going well.
Councils are sometimes criticised for only engaging in taking stock of their democratic processes
when things have gone wrong and there is a crisis; Bury is an exception with regard to its health
scrutiny function.
The Health Overview and Scrutiny Committee has tried to learn from good practice elsewhere using
the Centre for Public Scrutiny material and support, it has explored the lessons to be learned from
the Francis and the Casey reports and it has sought to make sure that it is kept up to date with
changing legislation. The Bury Health Overview and Scrutiny Committee, by engaging in regular
evaluation of its own effectiveness and refreshing members’ skills is taking measures to guard
against complacency and drift and is setting an example to other councils.
Report of Jane Scullion, Expert Advisor, Centre for Public Scrutiny, March 2015. Email:
[email protected] Website: http://www.cfps.org.uk
Supporting information:
Publications on questioning skills:
http://www.cfps.org.uk/domains/cfps.org.uk/local/media/uploads/060711questioningskillsf
inal.pdf
http://www.cfps.org.uk/publications?item=213&offset=150
Casey Report:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/401125/4
6966_Report_of_Inspection_of_Rotherham_WEB.pdf
Practice guides:
http://cfps.org.uk/practice-guides
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