Agenda item

At the November 2016 meeting of the Health and Wellbeing Board, it was agreed, following a request made by representatives of NHS Medway Clinical Commissioning Group that the Medway Primary Care Development Plan would be presented to the Board at its next meeting. The Plan, which is entitled “General Practice Forward View” was due to be submitted to NHS England in December 2016.

Discussion

The General Practice Forward View was introduced by the Programme Director of Primary Care Transformation at Medway NHS Clinical Commissioning Group.

A national General Practice Forward View document had been published in July 2016. All Clinical Commissioning Groups had been asked to respond to NHS England to set out plans for local implementation in relation to general practice. This had included details of how the plans would align with the General Practice Forward View and with Sustainability and Transformation Plans. Medway CCG had made its submission to NHS England in December 2016.

At a national level, Primary Care had been in decline, with there being particular difficulty in recruiting and retaining GPs. There were 51 practices in Medway, with the majority of these being either single handed practices or practices where GPs were approaching retirement age. The General Practice Forward View was directly linked to the STP and to the Medway model. In order to increase resilience, consideration was being given with regard to how GP practices could work collaboratively to cover populations of around 30,000, or even up to 100,000.

There were three key elements to the Forward View:

1.    Rollout of the ten high Impact Changes – These are evidence based and nationally proven. Some local GP practices have already started implementing and sharing changes. A key aim is to promote self-care and reduce impact on other services, particularly acute services.

2.    Extended access – The intention was to start piloting extended access to GP Services in Medway, with the move to services being provided 8am to 8pm seven days a week. This would be piloted in one area in the first year, with the aim being to cover 50% of Medway after two years and 100% after three years.

3.    Workforce – Work was being undertaken to recruit and retain GPs. In order to achieve this, General Practice needed to be vibrant, modern and forward thinking. Newly qualified GPs tend to be drawn towards larger practices that had extended services rather than to smaller surgeries.

Two estates enabling programmes would facilitate the effective use of GP estates locally. Funding had been provided by the Central Estates Transformation Fund to enable the possibility to be explored of creating two additional GP hubs in Chatham and Strood. Expanding the use of IT would also be important. This would include collaboration between practices and interaction with patients.

Work was taking place to implement the Forward View with small collaborative working groups having been established. These would be developed further.

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

Difficulty obtaining GP appointments: A Board Member spoke of their personal difficulty in getting a GP appointment, which they had been told would be a three week wait. They had also had difficulty in obtaining a consultation for a family member. However, the care itself had been of particularly good quality. A Member of the Board, who was also a GP said that patients booking appointments and not turning up was an issue that resulted in a time equivalent to the work of one GP being lost each month. It was noted that the CCG now had a policy in place to address the issue. The need to make use of multi-disciplinary teams in order to increase the capacity of General Practice was highlighted. This would enable some patients to be seen by alternative processionals, such as pharmacists. The Accountable Officer of the Medway CCG said that there was a need to make general practice more attractive. A single point of access to services was needed for existing patients to enable their care to be effectively managed. There were currently 15 single points of access in Medway. A single point of access would enable patients, practitioners and social workers to contact a single place to access services. There was also a need to work with the voluntary sector to empower local communities.

Another Member of the Board had not personally experienced difficulty in getting a GP appointment but was a Councillor for a ward that contained many residents who had. He felt that Medway had a lot to offer and that more needed to be done to promote the area as a place to work. There was also a need to challenge the trivial reasons for which some people visited their GP or hospital.

Housing Demand:  According to figures contained in General Practice Forward View document, 3,370 houses were planned to be built in Medway over the next five years. However, the figure contained in the Local Plan was 1,200 a year. In response to Member concerns that demand for services would therefore be higher than the assumptions that the Forward Plan had been based upon, the Chairman of the Board said that the reason for the discrepancy was likely to be that the figure used in the Forward View would be the number of dwellings that planning consent had already been provided for.

General Comments on the Forward View: A Member considered that the Health and Wellbeing Board provided a useful mechanism through which key information messages could be disseminated to partner organisations and via these organisations to the public. Key challenges to be addressed included making the best possible use of estates, including ensuring that facilities were fit for purpose and the different challenges faced by urban and rural parts of Medway. The linkages between the General Practice Forward View, the STP and the Local Plan were also important considerations. There was a general need to ensure that facilities were fit for purpose. The Member also asked what work was being undertaken to ensure that Healthy Living Centres were being utilised effectively.

The Programme Director advised that work was being undertaken with landlords to review use of Healthy Living Centres to ensure that assets were being used effectively. A range of GP services and community services could be encouraged to relocate to healthy living centres to maximise the use of estate. The Accountable Officer said that work to encourage use of Healthy Living Centres needed the support of the Council and local Councillors in order to be effective.

Role of Healthwatch: The Healthwatch representative advised that Healthwatch Medway was familiar with local General Practice developments and that a group of Healthwatch Members were undertaking enter and view visits to doctor surgeries.

Number of GPs over Retirement Age: In response to a Member question, the Chair of Medway CCG advised that 38% of the 136 Whole Time Equivalent GPs in Medway were over 60 years of age.

Decision

The Board noted the content of the presentation and agreed that the CCG commissioning intentions reflected the local priorities in the Joint Health and Wellbeing Strategy agreed by the Health and Wellbeing Board.