Agenda item

To receive an update on the Primary Care Networks.

The Committee received an update on a number of the Wokingham Primary Care Networks from the following Clinical Directors – Dr Rachel Thomas (Twyford Surgery, Phoenix PCN), Dr Rupa Joshi (Woodley Surgery, Wokingham North PCN), Dr Jim Kennedy (Wargrave Surgery, Wokingham North PCN) and Dr Amit Sharma (Brookside Surgery, Earley + PCN).

 

The Committee had requested information on the challenges that the different surgeries and areas were facing.

 

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

 

Dr Thomas:

 

·       Dr Thomas indicated that she was a GP and partner for Twyford Surgery and one of the Clinical Directors for the Phoenix PCN which included Twyford and Loddon Vale surgeries.

·       It was a difficult time for General Practice and there was a lot of dissatisfaction in the press.  Dr Thomas emphasised that GPs were working harder than ever, and offering more appointments, with reducing workforces.

·       Dr Thomas indicated that there had been difficulties in retaining and recruiting staff.  Work was being undertaken creatively.  Through the PCN and ICB new Additional Roles Reimbursement Scheme roles had been created such as First Contact Physio and Pharmacists.  It was important to get the message out to patients around these roles.

·       With regards to the Phoenix PCN, one of the surgeries had lost a long term partner, who had not yet been replaced.  The other surgery had lost their Pharmacy Technician. 

·       A new telephone system had been implemented to make the process more user friendly for patients and to improve the patient journey.  Feedback so far had been positive.

 

Dr Joshi:

 

·       Dr Joshi indicated that she was a Managing Partner at Woodley Surgery and joint Clinical Director of Wokingham North Primary Care Network.  She also worked at NHS England helping and supporting practices with access issues.  In addition, she was chairing a Workforce and Estates Group for NHS Confederation, focusing on GP retention, and burnout mid-career for GPs.

·       Dr Joshi highlighted several current projects in the Wokingham North PCN around preventative measures, long term conditions and acute care.  The Council was offering its support on many of these projects. Using Population Health Management, information was being sought on the prevalence of certain illnesses and the population make up, in order to tailor resources accordingly, specifically for those in real need.

·       Demand and complexity of conditions was increasing.

·       Members received information regarding the three surgeries in the PCN, including the number of incoming telephone calls on a sample Monday/per week, and the average number of GP consults per session (half day). 

·       More phone calls than ever were being received.  At Parkside, the largest practice, 1,277 calls were received on a Monday and over the week 2,950.  The new Telephony System showed how many patients were waiting and for how long and how many calls were dropped.  At Woodley 931 calls were received on a Monday with 2,598 across the week.  There were four receptionists at Woodley taking calls.  Patients who did not require urgent on the day appointments were encouraged to use the online request system to put their queries in writing.  Active signposting was then used.

·       Care home residents were also part of the surgeries’ patient bases.

·       Members were informed that there were very few partners and that the number of locums was increasing.  Less GPs were willing to become partners.

·       The Committee noted how the Additional Role Reimbursement Scheme was being used in the Wokingham North PCN.

Ø  GPs, Nurses, Health Care Assistants, GP Trainees

Ø  Health and Wellbeing Team

o   3 Care Coordinators, Social Prescribing Link Worker through ‘Involve’, Health and Wellbeing Coach, Mental Health Practitioner, Health and wellbeing worker through MIND, Physical health check worker through MIND

Ø  Pharmacy Team

o   Senior Pharmacist, 3 Pharmacists, 4 Pharmacy Technicians

Ø  Acute Care Teams

o   Physicians associates, Paramedics, Physiotherapists

Ø  Trainees

o   Nursing Associate - a number of nursing staff were nearing retirement age and succession planning was required.

·       The surgeries faced many challenges including:

Ø  Large numbers of telephone /on-line/ face to face/ Visits /Nursing Home consults;

Ø  Increase in workload over last few years- demand and complexity;

Ø  Recruitment difficulties- both clinical and non-clinical staff;

Ø  Pensions and loss of seniors;

Ø  Staff exhaustion / burnout;

Ø  Public expectations / self-care;

Ø  Effect of secondary care delays, ambulance, NHS 111;

Ø  Carers overstretched;

Ø  Social care staffing shortages;

Ø  Community and mental health services and workload;

Ø  CAMHS;

Ø  Many children with minor illnesses;

Ø  No Winter Access funding -this had been provided via the Government and locally in previous years;

Ø  Ceiling for ARRS recruitment- wish list- GPs, Nurses, Data and Digital lead, GP Assistants, Occupational Therapist for frailty, Physicians associates/ Paramedics;

Ø  Cost of living crisis- administration staff leaving;

Ø  Estates – lack of space for additional roles.

·       Work being undertaken to improve access included streamlining urgent care/ preventative care/ Long term condition management, upskilling admin staff to deal with queries, streamlining processes, and joint working with the Council and the Voluntary Sector.

·       More information messaging via newsletters and social media, was required around topics such as when to go to A&E or the pharmacy or to call NHS 111, and self-care, was required.  The Council’s support on this would be appreciated.

·       Support in digital and data would also be appreciated and would help improve websites and online signposting, improving the patient experience.

·       Work would be undertaken with nurseries and schools regarding how to cope with fevers and temperatures in young children.

 

Dr Jim Kennedy:

 

·       The average number of daily contacts for a GP across the European Union was 25-30, whereas the average number locally and the UK was 65-75 contacts a day. 

·       The GP funding model had historically been based on 3-4 patient contacts with a GP per head of patient population, per year.  Locally it was currently 11.5-13.5 contacts.

·       The GP working day was at least 12-14 hours.

·       The increase in demand was the result of many different factors.  The pandemic had delayed access to care, meaning that people were often becoming sicker, and consulting their GP more often whilst they waited to access secondary care.  Mental health and people’s resilience had also decreased as a result of the pandemic.  Clinical standards were increasing.  The ageing population and the impact of the cost of living crisis was also helping to drive up demand.

·       The number of GPs in the UK had steadily declined.

·       Issues around pensions were causing many primary and secondary clinicians to leave or retire earlier.  Punitive tax implications of working beyond once your pension pot was full, meant that continuing to work in the profession was considered not financially viable by many.

 

Dr Sharma:

 

·       As a practice Brookside had received over 1300 calls that day.

·       Dr Sharma believed that the Council could assist more with getting the message out to those patients who had minor illnesses such as coughs or colds, that could be best dealt with by other means, about the best options available to them.  This would help to free up GP appointments for those that really needed them.

·       With regards to consultation rates, the highest growth areas during the pandemic were amongst 20-40 year olds, and under 5’s.

·       Dr Sharma requested support with communications around self-care.

 

·       A Member questioned who would produce the communications messages to pass on to residents.  Dr Sharma indicated that these could be quickly produced.  In the past videos had been found to be particularly helpful. 

·       A Member asked how NHS 111 assisted primary care.  Dr Kennedy emphasised that the system had both its positives and negatives.  Whilst it could take large volumes of public enquiries, some its algorithms were very risk adverse which could increase the number of patients then going to A&E or primary care.  Where algorithms had been refined secondary dispersal had decreased.  Dr Kennedy added that there was also heightened societal expectations regarding the speed of response, which was not sustainable or appropriate for non serious issues.

·       In response to a question as to whether there was an additional top up support available from external providers such as Westcall that could be drawn on, Members were informed that Westcall were facing similar issues, in that there was a national shortage of clinicians, particularly GP clinicians.  In addition, this year there was not access to national and local funding that had been previously available.  The previous year additional appointments and locums had been provided using this funding.

·       Ingrid Slade assured the Committee that the Council worked closely with GP colleagues through the Wokingham Integrated Partnership Board and had received the message around communication support required.  A specific Health and Wellbeing Communications post within the Council was currently being recruited to.  Dr Sharma emphasised the need for swift action.  Demand for services had spiked in the past three weeks.

·       Dr Joshi welcomed the support received so far from the Council.

·       Councillor Margetts asked whether waiting lists were starting to decrease.  Dr Kennedy praised the approach taken by the Royal Berkshire Hospital but also highlighted that they too faced issues around demand and workforce.  Whilst on the whole joint working locally was good, the system as a whole was vulnerable due to the lack of spare capacity.

·       Sarah Webster offered the support of the ICB Communications Team.  She also informed the Committee that the Royal Berkshire Hospital was looking at waiting lists at a patient level, based on the level of risk for each patient, to understand how this risk could be managed whilst they remained on the waiting list.  A focus of the ICB was how working with colleagues across BOB, on how access to elective services could be improved.

·       Dr Joshi informed the Committee of pilots to tackle waiting lists.  Group clinic support had been provided to patients on the waiting list for knee operations, long Covid, and a pilot was also due to begin on orthopaedic wait lists.  A link officer was in place and some clinical staff were shared with the Royal Berkshire Hospital.

·       It was noted that the Royal Berkshire Hospital was bringing in a system which would allow patients to see indicative waiting times for each speciality, and clearer messaging about what action to take if the patient’s situation worsened in the meantime.

·       With regards to the number of GP contacts per day, a Member questioned if the figure for the South East and England was known.  Dr Kennedy commented that the European comparator figures were from the European Association of General Practice.  A survey had been carried out several months ago by one of the UK representatives.  The figures across BOB had been collected over the last 18 months by the Local Medical Committee, which had analysed ongoing consultation data from the practices and found that GPs were undertaking between 65-75 consultations daily.  Consultations included face to face appointments, phone calls, and video appointments, home and nursing home visits. Figures were similar in other areas of the country such as Cambridge.

·       In response to a Member question, Dr Kennedy indicated that many patients preferred video or telephone appointments.  These could be quickly converted to face to face appointments if deemed necessary. 

 

RESOLVED:  That the presentations on the Primary Care Networks be noted and that the Clinical Directors be thanked for their presentations.