To receive a presentation from the Primary Care Improvement Director, BHR Clinical Commissioning Groups on the Primary Care Strategy and GP workforce issues in Havering.
Minutes:
The Director of Primary Care Improvement – BHR CCGs explained that a Programme Board was working in conjunction with Barking, Havering and Redbridge University Hospitals’ NHS Trust and health and social care directorates across the three boroughs. Each borough however had its own primary care strategy.
There were a number of key drivers around the primary care landscape. These included the ageing population, more patients with multiple long-term conditions, IT issues, information sharing, the NHS estate and workforce issues. The Royal College of GPs had also recently issued a blueprint for new GP arrangements. The College wished to have 8,000 more GPs working nationally. It also wanted GPs to be allowed to innovate, have better premises and to have increased time with patients.
There was a total of 47 GP practices in Havering which were now commissioned locally by the CCG. Representatives of the Health and Wellbeing Board and Healthwatch Havering sat on the Commissioning Committee in order to avoid any conflicts of interest. It was clarified that pharmacists, optometrists and NHS dentists were still commissioned by NHS England. The Urgent Care Centre at Queen’s hospital was now managed by the three local GP Federations.
The GP list size in Havering (5,383 patients) was lower than the national average but Havering was also below the national average for the numbers of GPs and Practice Nurses per patient. These combined figures totalled 0.67 medical staff per 1,000 patients compared to a national average of 0.85 staff per 1,000 patients.
It was accepted that it was difficult to recruit GPs in Havering. Around 20% of Havering GPs were aged over 60 and this was expected to rise to 27% in the next 10 years (higher than the national average).
A new GP contract needed to be negotiated nationally which would allow professional barriers to be broken down and GPs to work more closely with Social Care. The GP Federation could be used to provide some services differently and a Programme Board of stakeholders had been established to improve primary care provision. A programme of stakeholder engagement was also under way with regard to this and clinicians, patient groups and pharmacists had been asked to give their input. The CCGs were keen to have further patient and public engagement with regards to primary care provision.
A review of how local NHS properties and estates were being used was in progress and the CCGs wished to ensure that existing spaces were used as effectively as possible. There was a possible £1 billion NHS England investment in premises available nationally over the next four years but it was important that this linked with the CCG Estates Strategy. The Director would confirm when the review of local NHS premises was due to concluded and hence when the Estates Strategy would be available for scrutiny.
The Chair of the Havering GP Federation felt that difficulties in recruiting GPs locally were due to a number of issues. These were mainly related to working conditions and expectations of being based in an outer London location. It was agreed that it would be useful to maximise GPs’ relationships with Queen’s and the Federation Chair felt that, if Queen’s was continue to improve its image, this would be helpful to GP recruitment.
The Estates Strategy would assist with the procedure if GPs wished to move into new premises. It would also be helpful if the estates process could be streamlined as there were currently a lot of different organisations involved.
Most Havering GP practices had signed up to the Federation hub with 80% of practices, covering 89% of the local population now being members. Non-member practices were also kept informed and worked with. The Director of Primary Care Improvement did not feel there needed to be a move away from single handed GPs. While some practices were proposing to merge, the CCGs wished to keep the ‘family doctor’ model. It was though the aim for Practices to work together to provide services in order to meet the demand for planned and unplanned care. It was confirmed that one small GP practice had recently merged with the North Street Medical Centre.
It was clarified that the figure of 148 Havering GPs was based on returns by practices to NHS England. This figure also included part-time doctors. The CCG wished to develop a workforce audit with the Havering Local Medical Committee and the Sub-Committee asked for details of the workforce audit to be provided when these were available.
The targets of seeing GP patients within e.g. 48 hours were no longer in operation. It was accepted that there was not a specific definition of ‘reasonable access’ to a GP. Some practices had begun using phone consultations to manage demand and other models were also being tested. The Federation Chairman reported that only one third of calls in the trials needed to be seen by a GP but felt that the telephone consultation model may not be sustainable in the longer term. The demands on general practice were huge and more GPs were needed in the system. Finding ways to lower Did Not Attend rates was another important issue.
It was confirmed that some pharmacists were able to prescribe a restricted list of medications. Some services were already commissioned from local pharmacies and pharmacists could also bid for e.g. an anti-coagulation contract from the CCG. There was however a lot of regulation and paperwork to be gone through and there was also the issue of insurance for pharmacies. A Pharmacy Federation had recently been formed. Some Public Health services such as smoking cessation were also commissioned from pharmacies by the Council.
Stitches removal was not specified in the current GP contract although the CCG was looking at this. It was clarified however that the budget for this service sat with the Harold Wood and Queen’s Hospital clinics rather than with GPs. GPs would be interested in providing this service, if the budget was available. Most practice nurses were already at full capacity and so were unable to deliver stitch removal. There was also a shortage of practice nurses locally.
The suggestion that nurses in care homes be used to provide more medical services was noted but this would need to be explored with the Council as it may require a change to how care homes were commissioned.
The NHS dentist contract did not include any minimum number of patients that should be on a dental practice’s NHS list. This area was the responsibility of NHS England.
The Sub-Committee NOTED the position.