Agenda item

This report sets out the current challenges facing GP services in Medway and outlines both national and local initiatives to address these challenges and to develop services in a way that provides improved care and access for local patients.

Discussion

In relation to the Risk Management section of the report, the Chairman advised that although there were no direct risks to the Council arising from the contents of the report, he considered that the Council would be potentially exposed to risk in the event that declining GP numbers made it increasingly difficult for residents to get an appointment or care from their GP.

The Senior Contracts Manager, Primary Care Commissioning at NHS England South (South East) and The Accountable Officer at Medway Clinical Commissioning Group, introduced the report. The report set out the challenges facing GP services in Medway and outlined both national and local initiatives to address these challenges and to develop services in a way that provided improved care and access for local patients.

There were around 600 local GP practices in Kent, Surrey and Sussex. General Practice was facing unprecedented challenges, both nationally and locally. These challenges included increasing workloads, recruitment and retention challenges, which was partly due to an increasing number of GPs being aged over 60 and therefore, approaching retirement. Within Medway, 38.6% of GPs were aged over 60. There were 51 practices in Medway and of these, 13 were run by ‘single-handed’ GPs. The age of some practice buildings was also a challenge.

Some practices had needed to close their lists to new patients for a year, while others had placed a cap on the number of new patients for a period of time. There had also been cases of some practices with multiple branches closing a branch, while other practices had merged with a neighbouring practice and a few had resigned their contracts completely. Rising operating costs were problematic, particularly for smaller practices that could face the same operating costs as a larger practice. There was an increasing reliance on locums due to difficulty in filling vacancies. While the use of locums enabled patients to be seen, locums cost more than their partner or employee counterparts and did not undertake other work associated with the running of a practice.

More positively, it was noted that of 45 GP practices in Medway visited by the Care Quality Commission, 82% had received a good rating.

Following the publication of the General Practice Forward View and the Five Year Forward View, there would be a review of General Practice contracts to ensure consistent funding for all practices. Development of local primary care services would be supported through a National Estates and Technology Transformation Fund. There would also be pilots in relation to new models of care with a better integration of primary care with other local health services.

Nationally, there was due to be £2.4 billion of investment in general practice by 2020/21, a 14% real terms increase. A £500 million national sustainability and transformation package would support GP practices. It had been determined that 18% of the current level of GP appointments would not be needed if care provision was structured in a different way. Over £900 million of capital investment was due to be made in estates and technology infrastructure. Three practices in Medway were set to benefit from improvement grants allocated from this funding. Work was taking place to migrate GP practices to a new computer system that would facilitate information being shared more easily between GPs and other health providers. An increase in communication with patients via, for example, text message and e-mail was also envisaged.

NHS England (South East) would be looking to support the expansion of local GP practices. The aim was to support practices to increase to a size of 8,000 patients or above, as practices of this size were the most sustainable. Discussions were also taking place with practices in relation to how they could work together with Local Care Teams, which between them would care for between 30,000 and 50,000 patients.

A number of Clinical Commissioning Groups were now taking the lead for commissioning local GP services under delegated commissioning arrangements. NHS Medway CCG was intending to apply to take on this responsibility from April 2017. The CCG had established a Primary Care Commissioning Committee to oversee the associated work and the CCG was pleased that the Medway Health and Wellbeing Board had agreed that the Director of Children and Adult Services should attend meetings of the new Committee in a non-voting capacity.

It was not yet clear exactly how much of the agreed investment would be available for primary care in Medway. However, funding would be allocated for the establishment of a community hub in Chatham and an associated feasibility study.

The Committee raised a number of points and questions as follows:

Appointment Availability and Delays: A Member explained the difficulty that they had had in trying to obtain an appointment with a specialist doctor. This had taken four weeks and it had been suggested that the Member could have a consultation by e-mail or text message, which they did not want. Another Committee Member spoke of a case that she knew of where significant delays that had been experienced in providing a child with essential medication. There had been a ten day delay in providing medication and three medical providers had been involved. The CCG Accountable Officer said that these delays were unacceptable and noted that missed appointments put pressure on the provision of services. The use of technologies, such as e-mail and Skype, had a part to play in patient care, particularly where a complex case had a good care plan in place. With regard to the delay in providing medication to a child, the Accountable Officer encouraged the submission of a complaint so that the issue could be fully investigated.

GP Support: It was anticipated that the use of non-GP staff and pharmacists to see some patients in the future would help to alleviate resource pressures. A Member mentioned that there was also a shortage of pharmacists. The CCG Accountable Officer advised that a range of measures would be required, particularly as the average age of GPs running single handed practices was increasing and patient demands were changing. The General Practice Resilience Programme would support GPs over the next three years. One aspect of this was looking at diagnostic services in order to quickly identify areas for improvement support. The new GP contract would aim to make general practice more appealing. Difficulties included that younger GPs often favoured being employees rather than a practice partner and that other areas of healthcare provision could be more attractive to doctors than general practice. There was also an increasing demand for part time working and a better work-life balance. It was anticipated that the development of other specialisms and enhanced healthcare services, to be delivered via general practice, would help to increase its appeal to those starting their medical careers. The Healthwatch representative advised that Healtwatch was aware that some GPs encountered difficulties in accessing support and that they were working with some surgeries to undertake strategic reviews, a process that included interviewing the practice manager.

Medway Model: The local strategy for the transformation of primary care services set out a programme for the provision of primary and community hubs, which were known locally as the ‘Medway Model’. In response to a Member question that asked whether the new model would attract more people into general practice, the CCG Accountable Officer advised that the new contracts would provide increased flexibility and encourage specialisation.

Allocation of Funding: Practices would be supported based upon their individual needs and prioritisation given accordingly in order to ensure that resources were allocated where they were needed the most. Practices with concerns were encouraged to engage with the CCG.

Decision

The Committee:

a)    Commented on the report provided and on the implications and issues raised relating to Medway.

b)    Recommended that Cabinet notes the risks that falling GP numbers will present to Medway residents and the implications for Adult Social Care.