To receive a presentation and update on the primary care strategy for Outer North East London.
Minutes:
The Medical Director of NHS NELC thanked the Committee for the invitation to attend. The primary care strategy had been consulted on between November 2011 and February 2012. All responses from stakeholders had been collated and presented to the cluster Primary Care Trust Board. The strategy had now been further developed with local stakeholders and partners via the CCGs. Ninety per cent of health care contacts were through GPs and so the strategy aimed for as high a quality of GP care as possible. There was also a need to reduce health inequalities via the strategy.
The Primary Care Strategy was based on three key principles – ensuring the best outcomes for patients, achieving value for money in primary care provision and that services are provided from fit for purpose premises. The strategy also sought to take into account the increasing number and diversity of population in North East London and the variation of health outcomes across the different boroughs.
Key recommendations of the primary care strategy included a sustained focus on improving quality and the establishment of an integrated network of primary care providers. This was already seen with a group of GPs in Chingford who had established links with health and social care and community pharmacies in order to attain a level of critical mass for treatments. The strategy also sought to ensure a suitable workforce to provide care both now and in the future and effective IT to support the health system.
The Medical Director added that a number of very useful suggestions had been made during the consultation and individual CCGs were now working with partners to develop their own local primary care strategies. CCGs would be expected to have dialogue with overview and scrutiny committees and other stakeholders concerning the strategy over the coming months. The key personnel in each borough at this stage and the main contacts would be the CCG Chair and the NHS NELC borough director.
The Medical Director recognised there was a rising prevalence of TB in certain areas. It remained a priority under the primary care strategy to seek to prevent TB in North East London. The recognition of the relevant symptoms was important and best practice would be followed in terms of advertising of TB examinations etc.
It was the case that there were very significant undiagnosed long term conditions in the local area and the Medical Director wished to ensure that patients went to their GP at an earlier stage. GPs wished to support patient engagement and would work with CCGs on how this can happen in practice. This could potentially include allowing space for self-help groups etc. to meet in surgeries, where this was practicable.
CCGs were organised to cater for specific, differing needs in each borough and to obtain the best health outcomes for the local population. There would not be a standard size of practice set as the Medical Director felt that service quality did not correlate with the size of a practice. A hub practice could be used for services that a smaller surgery could not provide. There were also issues to be considered around ensuring disabled access to surgeries.
The Medical Director emphasised that he felt patient experience was crucial. Dialogue would be needed at a local level to establish why patient experiences differed. Patient experience could be measured and it was essential to be able to show that this had improved over time. It helped that North East London health services were more advanced in IT than other areas. The strategy would also seek to make the best use of very large premises as, if patients could receive treatment more locally, they would not need to attend hospital to receive these services.
Members from several boroughs reported problems encountered by residents in getting GP appointments. The Medical Director felt that appointment availability varied by surgery and that patient participation groups should have dialogue with their surgeries on this. Drop in clinics etc. were not suitable for all surgeries since they could lead to long waits if many patients arrived at the same time. The Medical Director’s view was that all surgeries should be able to offer emergency on the day appointments for patients.
Implementation of the primary care strategy would be at borough level, led by the CCGs. Members raised the issue of premium rate phone numbers bring used by GPs and the Medical Director confirmed this was the subject of national guidance. He felt there were now fewer cases of surgeries using these numbers but any specific cases should be taken up with the relevant CCGs.
It was accepted that some patients were not comfortable with making complaints to GPs but support could be given to patients by the surgery’s patient participation group. It was clarified that patient participation groups were not mandatory for surgeries but having clear patient engagement was a requirement of GPs. Surgeries that were not engaging sufficiently should be reported to their CCG.
The expectation of health officers was that patients diagnosed with long-term conditions would receive follow up appointments from their GP. For example patients with diabetes should be monitored at least annually and have access available to a specialist diabetes nurse.
The Medical Director agreed that broader primary care should also encompass mental health. He agreed that the role of carers should be covered far more explicitly in the primary care strategy. He also accepted that there could be communication difficulties between consultants and GPs and felt that more seamless care was needed in the future to enable the sharing of for example medication details between professionals.
As regards cancer survival rates, early diagnosis was key. The most important factors in ensuring early diagnosis were patients presenting early enough and GPs making the appropriate referrals. This was linked to efforts to improve primary care outcomes and would reduce the need for patients to go into hospital. A key objective of the strategy was the achieving of high quality, consistent care. The precise strategy for achieving earlier interventions would be included in the detailed implementation plan which would be developed with CCGs.
Members felt it would be important to compare progress and improvements across the four boroughs and therefore agreed to take an update of progress with the primary care strategy at every other meeting of the Joint Committee. The Medical Director suggested that CCG Chairs and borough directors could give updates on progress in each borough.
The Committee noted the presentation and thanked the Medical Director for his attendance at the meeting.