Minutes:
The lead for the Prime Minister’s Challenge Fund across Havering, Barking & Dagenham and Redbridge explained that the three local CCGs had won £5.6 million from the fund in order to improve services.
There were a total of 48 GP practices in Havering. Havering’s current population was 237,000 and this was expected to reach 250,000 by 2016. Havering also had the largest older population in London. It was felt that there was a need to improve primary care and the Primary Care Transformation Programme sought to use the monies from the Prime Minister’s Challenge Fund to do this. The funding would be used for three areas – improving GP access, supporting people requiring complex care and the introduction of shared IT systems.
It was planned to improve patient experience in primary care and to introduce more GP appointments available in the evenings and at weekends.
The complex care workstream focussed on the 1,000 most vulnerable patients in Havering. A team had been set up including GPs, social care specialists, nurses and consultants with the aim of reducing the reliance on hospital care for this group of patients. A treatment centre was available at King George Hospital but it was explained that this would only be needed for diagnostics with most treatment taking place in a person’s home.
Care would be tailored to each patient, taking into account their goals and what they wished to accomplish. It was planned that this programme would increase primary care capacity for other patients, in addition to reducing admissions to hospital. There would be quicker decision making for the 1,000 patients under the scheme with consultants undertaking home visits. The Complex Care 1,000 team would also have access to all notes for patients using improved IT systems. This would allow better decision making for patients. Patients could choose to leave their GP to transfer to the new programme but would be free to return to their old GP if they wished.
Havering GPs were committed to the Complex Care 1000 project for two years and patient experience would be analysed by Nuffield Health. It was agreed that the patient experience analysis by Nuffield Health should be brought to a future meeting of the Committee.
GPs wished to undertake more telehealth with for example remote blood pressures teats and consultations by Skype introduced. It was accepted that the sharing of notes was an issue and that not all patients were happy for their notes to be shared within doctors. It was hoped to move to I-Pads to allow the inputting of notes directly onto all relevant systems. Following the introduction of the new IT system from February 2015, care providers and Council staff would be trained on the new procedures.
Recruitment to the new scheme had been good although and the number of GPs reaching retirement remained an issue for the health economy. GPs were aiming to encourage the training of new recruits. GPs recruited to the Complex Care 1,000 programme were very experienced and not currently employed. There was a high level of commitment to the project. It was confirmed that the project was supported by GPs who wished to refer patients to the service.
It was felt that the complex care scheme was innovative and would be positive for both primary and secondary care. Direct publicity of the service was being considered but it was hoped that GPs would in any case refer patients themselves. Referrals could be made by a GP in conjunction with a patient’s family but it was not possible for patients to self-refer. A health analytics system would indicate if patients suffered from five or more co-morbidities and hence were eligible for the complex care 1,000 programme.
There was currently one full-time consultant (seconded from Barts Health) as well as three GPs working on the complex care programme. Further recruitment would take place as demand increased. There were around 30 people in the team overall. It was noted that three GPs for the 1,000 patients compared favourably with the national average of one GP for 1,800 patients.
Work was under way with BHRUT to ensure adequate access to hospital tests etc for the 1,000 patients as this was likely to reduce the need for A & E services for this group.
The Committee NOTED the position.