Agenda item

To receive an update on GP contracts 2023-24.

The Committee were updated on GP Contracts 2023-24 by Sarah Webster, Executive Director for Berkshire West Place, Abid Irfan, Director of Primary Care, ICB, and Helen Clark, Head of Primary Care, BOB ICB.

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

·       Members were updated on the GP 2023/24 contracts and what this meant for Wokingham Borough residents.

·       The contract was the last of a five-year agreement.  There were several changes.

·       Key changes related to improving access for residents.  There was a focus on assessing the need or signposting at first contact.  There was also a focus on a same day assessment of need if there was an urgent need, and an appointment within 2 weeks for non-urgent primary care situations.

·       Wokingham was already in a strong position with regards to appointments within 2 weeks, with 86% of appointments being offered within 2 weeks.  Just over 50% of these were same day appointments.

·       Other areas of focus included improving Telephony in all practices.  Online platforms were also under consideration, although the continued importance of face-to-face appointments where required, was appreciated.

·       Recruitment was a key area of focus.  The contract allowed for flexibility in the range of roles which could be recruited into primary care.  Members were reminded of the Additional Roles Reimbursement Scheme (ARRS), under which funds were available for practices to be reimbursed for a range of clinical roles.  The contract gave further flexibility on how the fund could be deployed.  There had been successful use of the fund to date within the Borough.

·       The National Workforce Plan and pension reforms would help considerations on retaining the existing workforce.   Further information was anticipated from the National Workforce Plan.

·       There would be a big focus on removing the non-value adding steps which currently used a lot of primary care colleagues’ time.  Examples of how this could be achieved included greater use of other appropriate settings such as community pharmacy and improved self-referral pathways.

·       Better coordination with local authority planning departments, particularly as they produced their Local Plans, would also be a focus to ensure that the health needs of residents in new developments were taken into account.  It was noted that existing relationships were strong.

·       Each of the GP practices would be developing an access improvement plan and the ICB would be developing an overarching access recovery plan, which would be taken to the ICB in the autumn.  Sarah Webster offered to update the Committee further later in the year with regards to progress.

·       Members expressed concern about access to health facilities for residents in new estates.  One Member commented that the possibility of satellite sites to a large practice in central Wokingham had been raised, to facilitate seeing a GP for those in some of the new estates in the area.  He queried at what point consideration was given to creating new facilities for those who had to travel some distance to access a GP.  Helen Clark stated that this issue had been discussed over a number of years.  The CCG Estates Strategy had previously highlighted capacity for residents moving into new estates.  There were a number of premises developments undertaken through National Capital Funding that had become available to support practices to accommodate those patients.  As the Council reviewed its Local Plan, health colleagues needed to work with planning to refresh assumptions and population growth, and the situation with existing primary care capacity.  Regular discussions were held with the planning leads. 

·       Abid Irfan emphasised the need for better planning between health and the local authorities.  Workforce challenges needed to be addressed.  He went on to state that new surgeries were not always the answer and that there was a need to work smartly to deliver health services to residents.

·       Helen Clark stated that the Primary Care Networks had engaged in the Estates Toolkit which was looking at existing capacity and new ways of working.  This would help to inform discussions on what would be required.

·       Alice Kunjappy-Clifton commented that GP access and quality was part of the Healthwatch work programme.  She was of the view that many patients did not understand or know about the new ways of working and that communication could be improved.  Sarah Webster indicated that NHS England was working on a national communication campaign and consideration was being given as to how this could be supplemented locally. 

·       A Member referred to the new estates in Arborfield which were lacking infrastructure and where a new GP surgery had been planned but not yet delivered. 

·       A Member expressed concern regarding increased use of pharmacies as alternatives to visiting a GP as some had closed or were closing.  They went on to highlight the increasing local population levels.

·       Members asked about the recruitment of GPs.  The Committee was informed that the registrar posts were full.  BOB performed well in comparison to the South East with regards to the recruitment of GPs.  However, there was a large cohort of GPs that were likely to retire within the next 5-10 years and this needed to be taken into account.  Retaining and maintaining junior GPs was vital.  Lots of junior GPs wanted to work more flexibility and this needed to be catered to.  The job and workload needed to be attractive.

·       Helen Clark stated that GP numbers in Wokingham benchmarked well in terms of the region and BOB.  The ARRS workforce was a focus in terms of building capacity.  She went on to highlight some of the work being undertaken around recruitment and retention.

·       A Member commented that residents often raised concerns regarding access to GPs, having to hold on the telephone for long periods of time, and issues such as patients not being asked to attend a face to face diabetes review.  Abid Irfan stated that it was a challenged situation.  However, there were a number of initiatives in place which would help to make improvements.  This was a key priority both locally and nationally.  He went on to refer to urgent access on the day. 

·       Members commented that patients often had to wait for long periods of time when contacting NHS 111 and were informed that it was hoped that this would be commissioned in a more clinical way.

·       With regards to funding for recruitment, Helen Clark emphasised that the ARRS investment was recurrent.

·       A Member asked about the budgets for the different Primary Care Networks. 

·       With regards to the health needs of residents on new estates, a Member queried whether Committee members could be invited to meetings between the planners and health colleagues regarding health needs of new residents or be informed of the outcome.  He referred to a proposed site for a GP surgery in Montague Park which had not been progressed. 

·       The Chair indicated that Members had received concerns from residents regarding access to appointments at Woosehill Surgery and Wokingham Medical Centre, and questioned whether their patient populations were becoming overly large.

RESOLVED:  That the update on GP contracts 2023-24 be noted and that Sarah Webster, Abid Irfan and Helen Clark be thanked for their presentation.