Agenda item

To receive an update on GP practices and GP services.

The Committee received an update on GP Practice provision and GP services from Katie Summers, Berkshire West CCG.

During the discussion of this item, the following points were made:

·       Unfortunately, Dr Milligan and Dr Sharma had been unable to attend the meeting to provide the views of a GP.  Katie Summers read out a statement from Dr Sharma which highlighted some of the difficulties that GPs were facing.  GPs were providing more appointments than ever, with demand up 30-40% from 2019.   A lack of ambulance services, district nursing and rapid response exacerbated issues.  Dr Sharma encouraged Members to promote the NHS.uk website, which was a good source of information and promoted community pharmacy as a point of contact.  He would be producing a video on this in the near future. 

·       Katie Summers outlined some of the challenges that Dr Sharma had faced recently.  For example, he had been unable to get an ambulance for a potentially sceptic 80-year-old and had had to transport the patient to the hospital himself to be assessed.  Another patient, a 20-year-old, had been visited twice in a week by the paramedics for a urinary tract infection and separately, for a headache, which was not an appropriate use of resources.  20–40-year-olds in particular needed to be educated about the appropriate use of services.

·       Demand had increased with the easing of restrictions across the health service including primary care.  The Committee noted activity in the Primary Care Networks. 

·       The pressure was linked to a backlog in demand and extra secondary care work.

·       The percentage increase in consultation activity across PCNs had varied during July 2019 –July 2021 - ranging from 17% - 155% (Wokingham West PCN) increase.

·       Across Berkshire West there had been a 76% increase in consultations in their various forms.

·       Face2face / telephone consultation data showed a decline in these types of contacts in some PCNs, although a 5% increase overall.  This decline was a likely consequence of national SOP changes at the start of the pandemic introducing total triage model that ensued GP services were sustainable and safe.

·       It was noted that activity might not reflect true demand or activity, i.e. online requests (emails, practice website requests, text consultations) which had become vital tools in communication and consulting with patients, although there had been a national drive to map all appointment types and improved data is expected.  Pre Covid the majority of patients would phone for an appointment.  Now there was a greater use of online appointments and phone triage.

·       Face2face consultations were taking longer due to Covid infection control measures, at an average of 20 minutes.  Telephone consultations were a lot shorter, leaving more time for GPs to spend with the most vulnerable patients, in a Face2face appointment.

·       Although some patients wished to return to face2face consultations, the new, flexible ways of consulting had been appreciated and taken up by many including those who preferred not to attend the surgery for work or health reasons unless it was necessary for them to do so.

·       Housebound patients and those with transport difficulties had more access than before.

·       It was likely that there would continue to be mixed model going forward but with greater emphasis on offering face2face in response to patient preference as well as clinical need.

·       Katie Summers outlined the recovery plans.  The Respiratory Hub had been stepped down with all patients now managed within the practices.  Suspected Covid patients were now seen by practices, and safe hot / cold streaming arrangements were established.

·       Further work would be undertaken to embed new models of access to primary care and to support patients to engage with these.  Members were informed of communication sent out by the CCG and also adopted by the Council, about how the public should be accessing primary care in the future.

·       The backlog of routine appointments was being addressed and the focus was on ensuring that chronic diseases were appropriately managed.

·       Funding had been made available to increase GP capacity, oximetry @home arrangements, long Covid management, clinically extremely vulnerable patient management, chronic disease management, routine vaccinations and immunisations and health checks for learning disability patients.

·       A system wide workshop had been held in May to agree remedial actions to address primary care demand.  Katie Summers took the Committee through these actions.  These included:

Ø  Building intelligence about activity in primary care, including predictive modelling – this was being worked up through the BOB ICS.

Ø  111 call handlers now able to book into primary care

Ø  Standardised telephone message for GP Practices – currently they were very varied

Ø  Maximising GP call handling / workflow management capabilities – training of receptionists to ensure a better utilisation of workflow management

Ø  Additional 170 appointments per day across the CCG being commissioned to increase capacity until end of March 2022.  NHS England had informed the CCG that day of the Winter Access Fund.  For the BOB ICS this amounted to £7.5million.

Ø  Piloting how Royal Berkshire Foundation Trust’s Emergency Department could book patients into GP appointments

Ø  Practices now had ‘front doors’ open so patients can book in person

Ø  Establishing a Community Pharmacy Consultation Service as an alternative to the GP practice

Ø  Exploring the potential to enhance the telephony systems used by GP Practices.

Ø  Taking part in the Additional Roles Reimbursement Scheme to create bespoke multi-disciplinary teams

·       Katie Summers highlighted the letter from Dr Richard Wood, of the Local Medical Council, which detailed the benefits of the hybrid model.

·       Members referred to the most recent GP Patient Survey and noted that a number of practices in the Borough had scored within the top 10%.  However, four practices had scored within the bottom 10%.  Members questioned how those practices that had scored less well in the Patient Survey were being supported to improve.  Katie Summers indicated that the CCG had responded to a number of concerns raised about the future delivery of primary care services in the Borough.  Members were informed that the survey looked at one aspect, and the CCG wanted to a gain a clearer picture of performances at those practices.  The national team were working on improving the reporting mechanism, which would enable a better comparison between practices.  The pandemic and vaccination programme had placed additional pressure on primary care; however, practices were still required to meet patients’ needs though the delivery of responsive and planned services.  NHS England had recently committed a Winter Access Fund for Integrated Care Systems, which would be used to increase the number of appointments available to patients and improve access to services.  There would be a focus on those practices which had received a low patient satisfaction rating.  Tailored support would be provided to those practices.  An update on the implementation of this would be provided to the Committee.

·       Out of hours services were experiencing heightened patient contact.  A Member questioned whether funding was sufficient to maintain activity levels.  Katie Summers confirmed that out of hours activity was included in the funding opportunity.  With regards to capacity, several practices had seen GPs retire.  A programme to support returners was in place as was a programme of retention.  Locum cover was used to support the system.  The out of hours service provided by Berkshire Healthcare Trust via Westcall, was under pressure.  Practices had concerns regarding the individual capacity versus individual demand.

·       In response to a question regarding the continuation of training during the pandemic, Katie Summers stated that many of the practices had training facilitators.  There was a programme of Advanced Practitioners in a number of practices such as Brookside and Wokingham Medical Centre.

·       A Member expressed concern that the E Consult app was not very user friendly, and commented that they had had to phone the surgery on several occasions after unsuccessfully using the app.  Katie Summers asked that details of the individual surgery be sent to her so that she could follow up on the matter.

·       A number of Members commented that many patients preferred face2face appointments, and questioned when it was likely that a return to pre pandemic levels would be seen.  Katie Summers indicated that funding would help increase the number of appointments available, depending on GP and other staff practice.  Many patients, particularly those who worked, preferred a hybrid approach to appointments.  Members agreed that the system had to fit patient need.

·       A Member expressed concern regarding the impact on vulnerable patients’ mental wellbeing should services not be delivered in a timely manner.

·       A Member questioned how many GPs there were in the Borough and if this was increasing or decreasing.  Katie Summers agreed to provide the Committee with information regarding the number of GPs, admin staff, nurses, and other staff within the GP practices, pre and during the pandemic.

·       With regards to finances, Katie Summers indicated that what income had come into General Practice across the CCG, could be examined.

·       In response to a question regarding the increasing population in the Borough and whether there were sufficient GP practices to accommodate this, Katie Summers stated that a few years ago the CCG had undertaken work on the forthcoming housing growth.  The Council and CCG had worked with individual practices to assess whether they could absorb the additional population growth.  Some practices had expanded and brought in new staff.  It was potentially time to reassess the picture and to undertake a further examination.  A Member commented that a new surgery had been proposed prior to the construction of Montague Park but that this had not been taken up.  Katie Summers indicated that at the time it was felt that neighbouring practices could accommodate the new residents.

·       Members asked about the impact of the ageing population, who may require more medical appointments.  They went on to ask whether data about the amount of time patients had to wait before they could make an appointment via telephone, by surgery, was available.  Katie Summers commented that population growth data suggested an increase in the working age population.  However, the number of residents living with multiple long-term conditions was increasing.  In the past a mystery shop had been undertaken, phoning individual practices, and hearing how long it took to connect and the messages that patients heard.  It was hoped that telephone messages and processes would become standardised, which would help in the monitoring of wait times and call abandonment rates.

RESOLVED:  That

1)    The update on GP practice provision and GP services be noted and Katie Summers thanked for her presentation.

2)    An update on the targeted support that would be provided to the 4 GP surgeries identified, be requested.