To receive an update on primary care, including pressure on resources locally. (30 mins)
Members received an update on primary care from Dr Cathy Winfield and Dr Debbie Milligan.
During the discussion of this item the following points were made:
· Members were informed that in the last 5 years, there had been a 15% increase in patient contacts. People were living longer and the number of those with multiple long terms conditions was increasing.
· From October 2018, the Clinical Commissioning Group had been providing access to GP appointments from 8.00 am to 8.00 pm, 7 days a week, in line with national requirements. This was achieved via cluster arrangements.
· Councillor Jones asked how popular weekend appointments were. Dr Winfield commented that Saturday appointments were increasing in popularity but take up of Sunday appointments remained low. The CCG was trying to raise awareness of the weekend appointment option. Dr Milligan stated that patients with ongoing conditions often preferred to wait to see a specific GP. Councillor Jones went on to ask whether weekend appointments were offered by GP receptionists when speaking to patients over the phone and whether they could be booked online. Dr Winfield responded that weekend appointments were not currently bookable online but that the delivery of this was being worked towards. There was common appointment book across the clusters.
· One of the key challenges facing Primary Care locally was the anticipated housing growth, particularly in the Wokingham Borough area.
· There were insufficient numbers of GP trainees. Historically it had not been possible to fill GP training places, although this had improved in 2018.
· Members asked why places had not been filled previously. Dr Winfield indicated that over the last few years approximately 80% of training places had been filled. The Deanery had undertaken a lot of work to encourage undergraduate medics to take up training places to supply Buckinghamshire, Berkshire and Oxfordshire. Dr Milligan emphasised that once trained there was no guarantee that that they would stay in the area or the career.
· There was also a shortage of practice nurses trainees.
· GPs were working less sessions in order to deal with the intensity of the workload and approximately 69% of GPs were working part time.
· In response to a question from Councillor Miall, Dr Milligan indicated that guidance stated that a session was 3 ½ hours (half a day). This did not just entail face to face contact with patients but also matters such as checking results and prescriptions.
· Members asked whether GPs ever took on private work. Dr Milligan stated that they tended not to.
· The practice model was less attractive to many new graduates. Many did not want to stay in one place for their whole career or to buy into a partnership. Councillor Croy questioned whether consideration had been given to other models. Dr Winfield stated that consideration could be given to models such as a salaried model but that different GPs preferred different models.
· Members were informed that investment in Primary Care had lagged behind other NHS sectors. However, £4.5bn of funding nationally had been announced in the NHS long term plan. In response to a question from Councillor Richards, Dr Winfield explained that this would be phased over the next 5 years. Councillor Croy asked what would happen after 5 years and was informed that it was hoped that funding would be recurrent.
· Dr Winfield highlighted some of the work that was being undertaken to meet the challenges to Primary Care.
· The workforce was becoming more diversified and patients may not always see a GP. Other staff included Clinical Pharmacists, Paramedics, First Contact Physiotherapists, Physician Associates and Social Prescribers.
· Members were informed of the paramedic pilot, the GP Consultant Model and the Berkshire West Primary Care Alliance Clinical Pharmacist Scheme.
· Retaining the workforce was a challenge. Work undertaken included offering support for Practice Managers across the CCG area, upskilling administrative staff, mentoring new GPs, providing more varied career options for GPs, offering support for sessional and locum GPs and those returning from a career break and the Paramedic Fellowship programme.
· Dr Winfield commented that the first successful recruit from the international GP recruitment scheme was ready to be placed in a local practice. Councillor Jones asked the cost of the recruitment and was informed that it had been funded by a national programme. The CCG would work with the Deanery to identify a suitable practice for the individual.
· With regards to the impact of population growth, estimated population growth, had been mapped. The CCG was undertaking a 20 week review of population data in Berkshire West.
· The strategy had been to expand existing surgeries to serve the increasing population; Swallowfield, Finchampstead and Brookside and prior to that the building of new capacity at Wokingham Medical Centre and Shinfield. It was noted that Shinfield practice was currently only at 50% capacity.
· Dr Winfield highlighted digital improvement work. It was noted that the CCG had funded enhanced websites for all Wokingham practices.
· Councillor Loyes asked how those who were less technically able were supported. Dr Milligan indicated that support would continue to be offered for these patients.
· Councillor Shepherd-DuBey asked whether appointment letters could be sent via email.
· Dr Milligan explained the timescales around receiving test and x ray results, in response to a question from Councillor Shepherd DuBey.
· Neighbourhood working was discussed. The GP practices were organised into 3 clusters; Wokingham West Wokingham East and Wokingham North.
· Members noted some of the partnership working initiatives. 2019 would be the year in which the CCG worked together with partners to ‘Design our Neighbourhoods’.
1) Dr Milligan and Dr Winfield be thanked for their presentation;
2) the update on primary care be noted.