Agenda item

This report aims to provide the Committee with an overview of Improving Access to General Practice and the mandated requirements from NHS England. It provides an update on the progress on its implementation.

Discussion

Improving Access to General Practice was a nationally mandated scheme. It included clear requirements from NHS England for Medway NHS Clinical Commissioning Group to ensure that additional capacity was provided for general practice. The programme was a key element of the Medway Model and would put general practice at the centre of local care ambitions.

Requirements of the scheme included providing access to GP appointments seven days a week, including during evenings and increasing capacity by 100% by October 2018. This had been brought forward from April 2019.  Consultation capacity would have to increase by 30 minutes per 1,000 of population per week (this was expected to increase to 45 minutes in the future). This equated to 150 additional hours in Medway. The CCG was working on an interim scheme with the local GP Federation and Medway Practices Alliance ahead of a full procurement process taking place by April 2020.

Other requirements included providing a mixture of pre-bookable and same day appointments, ensuring that patients would be able to make bookings through existing channels and ensuring that digital options, such as e-consultations were fully considered. The scheme also required the needs of the local population to be taken into account and did not allow there to be a focus on particular groups of patients. Effective access and links to urgent care and NHS 111 would also need to be ensured.

There was a significant amount of local flexibility in terms of service design and not all GP practices would be required to open late or at the weekend. Consideration was currently being given as to how to deliver the increased provision. Options under consideration included delivering the extra six appointments through three or six hubs or via something between three and six hubs. Staffing, such as utilising nurses and pharmacists to staff the extra provision was also being considered as was which buildings and rooms to use.

A Communications and Engagement Strategy was currently being developed to set out how patients would be informed about the changes. An engagement event would be held on 18 July to test the planned delivery model with Patient Participation Groups. Following this, communications with patients would take place between August and October with the CCG targeting hard to reach groups.

A Committee Member was concerned about the capacity to deliver additional GP appointments in view of there currently being a shortage of GPs locally and the increasing population.

The Committee was advised that there were challenges in relation to the workforce and general practice capacity in Medway and that this was a more significant problem in Medway than in many other areas. It was hoped that part time GPs and older GPs may be attracted by the new provision but it was acknowledged that the programme was ambitious in nature.

A Member was concerned that the amount of funding available appeared to be significantly less than what would be required to fund the increased availability of appointments. She was also concerned that the nationally mandated requirements took no account of the significant existing challenges in general practice or of the local situation. The Members noted that satisfaction rates in Medway in relation to being able to obtain a GP appointment were already around 10% below the national average and that the mandated increase in appointment availability would only make the situation worse.

The Director of Primary Care at Medway NHS CCG acknowledged the local challenges, explaining that GP funding in Medway had previously been relatively low compared to Kent. However, there would be £2million of funding available for the increased provision. This would be spent on GP commissioning and there was flexibility regarding exactly how it would be spent.

The CCG had already been encouraging groups of GPs to work together in order to make general practice more sustainable in Medway. There were currently 49 practices in Medway with the number of patients per practice and availability of appointments varying widely.

It was anticipated that GP practices working together would help to address these issues. It would also make it more practical for pharmacists, paramedics and nurse practitioners to work out of GP surgeries, which would help to increase GP capacity. The new  medical school due to open in Kent would also help to increase the number of GPs in Medway and there was already starting to be an increasing number of new GPs choosing to stay in Medway.

Another Committee Member shared the concerns previously raised that it would not be possible to staff increasing access to General Practice, particularly as some practices were already operating with just a nurse practitioner on duty rather than a GP. The Medway CCG representatives acknowledged that small standalone practices were not popular amongst younger GPs but it was hoped that encouraging groups of GPs to work together would help to address this as working as part of a large team with more complex specialities would be more appealing to this group.

Decision

The Committee noted and commented on the report and agreed that a further update should be presented to a future meeting of the Committee and for this to include statistics, such as average age, number of GPs and the number leaving the profession, in relation to GP provision in Medway.