Representatives of NHS England will present to the Committee on plans and strategies for GP services in the areas covered by the Committee.
Minutes:
It was explained by the Deputy Head of Primary Care (London) at NHS England that this was a national organisation that had commenced in April 2013 with a very broad role. NHS England was responsible for commissioning services directly and for assuring the work of Clinical Commissioning Groups (CCGs).
Core GP services i.e. those operating from 8 am – 6.30 pm were commissioned by NHS England which also commissioned community pharmacies, optometry and dental care. NHS England procured, monitored and performance managed contracts and sought to raise the quality of primary care and poorly performing GPs. NHS England was also responsible for GP premises.
CCGs commissioned secondary care such as hospital care as well as non-core primary care e.g. special GP services. The NHS 111 service was also commissioned by CCGs.
There were however a number of overlaps between the two roles such as the estate strategy which was likely to see more services located on the same sites. NHS England and the CCGs also had to agree the primary care strategy together. The primary care strategy had a number of priorities including empowering patients and the public, publishing clear quality outcomes, and developing the workforce, GP premises and IT.
NHS England expected to see GP practices working together on a bigger scale in order to achieve economies of scale. This would see more extended opening hours and the officer felt that some GP surgeries would be open until 10 pm very shortly. GP practices would also make more use of text messaging and virtual consultations. More hospital-based services would move into the community although the position would be different in each borough.
It was explained that there were a lot of part-time GPs in the sector. As more practice nurses etc were introduced, the size of a practice list normally went up. Appointments at GPs were organised by the individual practice rather than NHS England and there were no targets for numbers of appointments in the current GP contracts. Patients should make complaints initially to the GP practice. NHS England received information annually concerning the number of GP complaints but not on specific issues.
Population information was held by the public health team in each borough and was also contained in the Joint Strategic Needs Assessment for each borough. This was the same for Essex and Epping Forest and it was agreed that the clerk to the Committee should ask NHS England for the GP statistics for the Essex area.
It was explained that NHS England arranged premises development but that NHS Property Services managed the buildings themselves and associated phone and IT systems. Many GPs had currently bought their own buildings. NHS England’s view was that many GPs could not give a full service to patients due to poor premises and it was therefore better to have groups of clinicians working together. The issue should be the quality of care and health outcomes rather than the number of practices. Comments on NHS Choices and reports from Healthwatch were considered but it was difficult to performance manage under the existing GP contracts.
The NHS England representative felt that GP appointments should be able to be obtained in 24-48 hours. There were however large variations in this and it was accepted that delays in appointments had to be addressed. Details of a practice in Havering with a one-month wait for a GP appointment would be passed to NHS England by the Healthwatch Havering representative outside of the meeting. The total list sizes given by NHS England appeared to be larger than relevant borough populations and this may have been due to GPs having incentives to keep patients on their lists if they move out of the area. The list management work undertaken by NHS England was expected to have an impact on this in the next quarter. It was agreed that revised figures and a report on GP list sizes should be taken at a future meeting of the Committee.
If an individual GP was exhibiting poor performance, NHS England would seek to address this by drawing up an informal remedial action plan or issuing a breach notice against that contract. Cases of across the board poor performance would be worked on with the General and Local Medical Councils as well as with the Care Quality Commission. Issues such as diabetes and TB targets for GPs would be worked on jointly with the CCGs. GPs working with other practices would also influence this. It remained the choice of the GP whether to employ e.g. practice nurses.
NHS England remained unhappy that practices were not open long enough and CCGs would now commission an extra half hour of appointments for each 1,000 patients. This would aim to save patients from attending A&E if they were unable to get a GP appointment.
The NHS England officer felt that, of the for example 52 GP surgeries in Havering, this should be reduced by one third. She felt that too many Havering practices were open too few hours and that there were too many with less then 3,000 patients on their list.
NHS England hoped that the new GP contract would specify minimum standards. Members were concerned that NHS England should advise the local population of any GP closures and ensure that elderly people had a surgery nearby. There were for example two wards in Redbridge that did not contain a single GP practice. Pharmacies were commissioned by NHS England and there was sometimes a difficult relationship between pharmacists and GPs. CCGs should be asked why GPs were not using local pharmacies. Essex pharmacies had developed a reporting scheme to improve working with GPs and it was agreed that more details of this scheme should be taken at a future meeting of the Committee.
Cases of duplicate registration should not occur although it was noted that, under a new scheme to be introduced from October 2014, patients would be able to register in two places. It was confirmed that primary care services were free to all at the point of contact and that overseas visitors could access primary care services without the need for a visa etc.
Patient Participation Groups were paid for by the respective practices and NHS England felt it was important that these groups continued to have an influence. It was agreed that a recent Waltham Forest scrutiny report on GPs would be circulated to the Committee.
The Committee noted the presentation.