Report of the Clinical Commissioning Group (CCG)
Minutes:
The Committee received a report and presentation from the Director Family Care and Medicines Optimisation Strategy and Deputy Director of Primary Care to consider access to General Practice (GP) and respond to concerns in relation to access to GP surgeries. The presentation provided context, activities and actions put in place during the pandemic to support general practice, key activities in June 2021 and a detailed action plan for general practice access updated on 1 July 2021.
It was reported that GP surgeries had remained open 08:00 – 18:30 during the pandemic and that business continuity plans were upgraded during pandemic to include extended hours and total triage. Total triage was introduced to assess, using clinical criteria, if a face to face consultation was required or whether the issue could be addressed remotely.
At the peak of the pandemic 80% of consultations had been held remotelyand it was noted that the ratio between telephone and face to face appointments at that time 20-80 was being addressed, and currently in the region of 50-55% of consultations were face to face. It was reported that there had been a variety of public responses to the use of telephone consultations and remote access to services, some patients had expressed a preference for telephone consultations. Members raised issues and concerns relating to equity of remote access for some people, the cost of long waits on telephone calls and that that many people wanted a face to face appointment with a GP.
In response to concerns raised, members were informed that practices in Staffordshire were currently dealing with a substantial increase in demand caused by a variety of issues, such as delayed demand for services and people contacting the GP when they were not able to get through to other services such as 111. The increased demand had led to an additional 100,000 phone calls a week and an additional 15,500 appointments per week across Staffordshire. The increased numbers had left some practices struggling to meet demand.
It was considered that public expectation was for access to be ‘back to normal’ on 19 July in terms of people receiving same day appointments and access to practices. It was reported that many GPs wanted to do more face to face consultations but there were constraints and different issues for each practice to address, such as the time taken to clean and change PPE between consultations which limited the number of consultations per day and the size of rooms when socially distancing. Members were advised that some remote access measures would remain,additional telephone lines were being added and some surgeries were moving to cloud based solutions to reduce call waiting times.
It was explained that there were a range of healthcare professionals available at practices, other than GPs, who may better suit the needs of patients. In the last 12-18 months an additional 225 healthcare professionals had been recruited into practices in Staffordshire and patients could contact a clinical pharmacist for advice, however people preferred to see a GP. A training programme for reception staff was progressing to advise patients who was available and how to access services. There was concern that the variability in GP practices had worsened during the pandemic and that health inequalities could be widening as a result.
The Deputy Director presented the action plans detailing the action areas to develop relating to: communications, access improvement programme (Time for Care), record keeping, digital solutions, quality, variation and resilience, training and development, workload and the need to ensure progress is monitored and the data is measured but also checking against patient feedback. Work was ongoing with the communication team and information was feeding back into the action plans.
It was highlighted that there was a need to promote the NHS APP, check record keeping and guidance and to look at population size and to ensure there was not unwarranted variation across practices. There would also be engagement around patient participation, reception training and call handling, and work with local pharmacies relating to GP referral service.
The following comments and responses were noted in response to questions:
Members highlighted the need to develop GP practice sites to reflect the growth of housing development in the County. The Director Family Care and Medicines Optimisation Strategy advised that there was a lot of housing being built in Staffordshire CCG had recently undertaken a utilisation study of all GP practices, to look at where levels of demand did not match practice facilities. The estates function had been taken back by NHS England and this had impacted on ability to match local capacity needs to demand. CCG were now working with the Local Authorities to develop practice sites which was something they planned to do more work on. Members highlighted that the Council Strategic Infrastructure Plan (SIP) should ensure that developers contribute to infrastructure including doctors’ surgeries.
The Chair encouraged all District and Borough Members to ensure local plans included a clear statement in local plans and neighbourhood plans regarding section 106 needing to support healthcare. The Director Family Care and Medicines Optimisation Strategy gave a commitment from the CCG to respond to consultations where more than 250 homes were being proposed, to be engaged and ensure the right capacity and access to primary care. It was confirmed that the NHS was appointing to a planning officer role to lead on s106 negotiations for the CCG. The Chair requested that when available CCG provide a briefing note to advise of the process to engage and be involved with the s106 process re healthcare, in order that Members could feed back into District Planning process.
The Director Family Care and Medicines Optimisation Strategy advised that CCG was at the beginning of developing community healthcare, 26 Primary care networks had been developed and more information on this could be presented at a future meeting. It was considered by members that the wider model of care with voluntary sector and social prescribing could be integrated into future access to services in the community.
It was explained that there was a care training programme which trained receptionists to refer the patient to the right place first time, however this had paused during the pandemic. The receptionists would have to refresh the training and evaluation of that training could take place.
It was confirmed that a review of the public estate would take place to ensure that where more services were in the community CCG maximised use of the public estate.
The Committee welcomed the NHS App and other ways of introducing technical solutions, such as appointment booking on line and cloud based solutions to resolve some of the issues relating to incoming calls. The NHS App could be used as a mechanism for individuals to look at personal medical records and to make GP appointments.
In terms of population growth in Staffordshire the Primary Care Strategy had reduced the number of practices but increased the practice footprint to around 10,000 patients per list, this made practices more resilient and data could be accessed around number of patients each GP has on its list against doctor numbers.
The Chair welcomed an opportunity to meet with officers to consider the data available in the CCG dashboards which had been developed to consider holistic system approach and regional practices in Staffordshire to be able to see diagnosis levels across different areas. The Director Family Care and Medicines Optimisation Strategy indicated that this related to health outcomes and health inequalities. She advised that there was a programme of work in primary care variation and inequality to look at where the were poorer outcomes and why, whether it was a deprivation issue, an access issue or potentially an issue with a GP, and a programme of work was being developed.
The Chair thanked officers for the comprehensive update on GP Access.
RESOLVED:
a) That the report be noted, and further information be circulated to members in relation to the following:
· CCG provide a briefing note to advise members of the process to engage and be involved with the s106 process relating to healthcare.
· CCG provide feedback from Healthwatch work with residents and general practices on ‘what patients prefer - perceptions, challenges and barriers’.
· Chair to meet with officers to consider dashboards and data.
Supporting documents: