The self-proclaimed “grandest wedding venue” in the South West was the venue for the Bristol, North Somerset and South Gloucestershire primary care trust cluster’s board meeting.

Unable to fit into NHS North Somerset’s offices, the expanded board opted to meet in the “magnificent” (yet reasonably priced) Victorian mansion Clevedon Hall near Bristol.

There was little love in the air, however, when discussion turned to the commissioning support service the cluster is working with NHS Somerset to develop.

Non-executives complained they had not been involved in developing the plans, with vice chair Melanie Gibbs warning she did not want to be presented with a “fait accompli” when the proposals came to March’s board meeting for approval.

North Bristol Trust featured heavily on the agenda due to its declining accident and emergency performance and the continuing disruption of outpatient appointments following the introduction of Cerner Millennium software in January. Although implementation had been successful for inpatient data, the outpatient system required a complete rebuild.

The problems meant data for the four-hour A&E standard was not available in December. But the cluster’s director of commissioning delivery, Louise Tranmer, told the board it was believed the trust had missed the target for the fourth consecutive month. Figures from November showed North Bristol saw only 91.7 per cent of patients within the time limit.

The NHS Interim Management and Support intensive support team for urgent care has visited the trust and is working with the local health economy to diagnose the problem.