Agenda item

The report provides an update on the development of Primary Care in Medway.

Discussion

The Committee was advised that the report had been written before publication of the NHS Long Term Plan. However, the Medway Model and method of running primary care at scale fitted with the proposal in the long term plan. There were 49 GP practices in Medway, which ranged in size from 1,700 to 25,000 patients. Delivery of services at scale would enable more services to be provided locally with this concept being embodied in the Medway Model. This necessitated bringing services together, serving populations of 30,000 to 50,000. Data in relation to primary care was poor. NHS England, which had previously been responsible for commissioning primary care, had not collected data and there were not established systems in place for such collection. GP Practices were independent businesses who were not obliged to share data in relation to workforce, capacity and demand. This situation was changing with many practices now agreeing to share data. A NHS Digital workforce tool was due to go live in the current month with GP practices having signed up. This would improve the provision of data.

33% of GPs in Medway were already at a stage where they could chose to retire and there was a 10% vacancy rate. Workforce was the most significant risk to GP provision in Medway. There were two types of GP contracts. General Medical Services (GMS) contracts were lifelong contracts which could change hands between GPs, while Alternative Provider Medical Services (APMS) contracts enabled the CCG to purchase extra capacity in a particular area. This could be considered on the Hoo Peninsular to meet demand if existing practices were not able to expand to meet capacity.

The Local GP Federation had been awarded the Improving Access contract and it had been successfully implemented in three localities with feedback having been positive. Rollout was due to be extended which would include the Hoo Peninsular. A GP care home service had also been rolled out for GPs to work with specific care homes. December 2018 figures showed that there had been an 18% decrease in ambulance service attendance at care homes since implementation of this change.

There were currently six Primary Care Networks in Medway. A seventh would be added in view of growth on the Hoo Peninsular. An Estates Strategy was being developed which was due to be published in March or April 2019. This included a systemic review of all primary care estate. While workforce and estate challenges remained, positive changes had included the implementation of improved access, development of clinical leadership and the extension of capacity across Medway during the previous six months.

Committee Members raised a number of questions which were responded to as follows:

Healthy Living Centre Occupancy – It was confirmed that Healthy Living Centres were currently 40% to 50% utilised and that there was a cost for this estate whether or not it was occupied. The Community Health Services review and co-location of community services at Healthy Living Centres would help to address low occupancy as would increasing the amount of general practice provided at certain locations. In relation to the Lordswood and Rochester Healthy Living Centres, business cases would be produced to improve patient flows and make them clinically more attractive.

Work with Pharmacies – The Committee was advised that NHS England currently commissioned pharmacy services although this was expected to change in the next year. The CCG had engaged with local pharmacists in relation to data sharing with GPs but there were associated data protection issues. Patients attending pharmacies would not necessarily consent to their information being shared with a GP.

Reprocurement of Community Health Services, data sharing and Care Navigators – A Committee Member asked why the CCG was continuing in its plans to re-procure community health services. She considered that procurement should be paused while work was undertaken to implement the seven key changes. The Member also asked how problematic difficulties in sharing of data were and expressed concern that the recently commissioned Care Navigators would not provide the extensive service originally envisioned.

The Committee was advised that there were two levels of GP performance data. One of these was commercial data which included information relating to workforce, capacity and demand. GPs were not under any obligation to share this data. However, work was being undertaken with practices to address this. The legal challenge of data sharing between organisations was recognised with work taking place to address this. Within the Approved Access scheme, patients could go to any GP surgery or hub within the scheme to see a GP. With patient consent, their medical record could be viewed and updated. Care Navigation was a face-to-face locally based service provided at Medway Hospital and in GP surgeries. Work was taking place with Medway’s Public Health team in relation to a bid for funding for social prescribing. This would complement the Care Navigators. A database was being developed to use for social prescribing with the voluntary sector having direct input into this. GPs would have access to the database, enabling them to make referrals. In relation to the reprocurment of community health services there had not yet been any change in legislation and the CCG’s legal advice was that services had to be reprocured.

GP availability – A Member expressed concern about availability of GP appointments on the Hoo Peninsular and the difficulty practices were facing in recruiting GPs. When there were no appointments available locally patients were being sent to Gillingham, which was costly, took significant time to reach and could result in them having to wait for significant time upon arrival before being seen.

The CCG Director of Primary Care Transformation advised that a meeting with GPs on the Peninsular was due to take place in the next week. Projected population increases were not yet available but it was expected that Medway Council would be able to provide these in the next one to two weeks. Discussions with Public Health had been taking place over the last year. Once the population growth figures had been provided, more detailed planning could be undertaken to ensure adequate GP provision over the next three to five years. Improved access to GPs on the Peninsular had been secured to eliminate the need for patients to be sent to GPs further afield.

Care Navigation and IT Provision and collaborative working – A Member hoped that Care Navigation would not place constraints on GPs in terms of who they could refer to the service and emphasised the need for GP practices to work with each other. The Member also highlighted the importance of IT systems being able to effectively interface with each other for the service to work effectively. Investment from the CCG to help ensure this would be welcome.

The Director of Primary Care Transformation said work had been undertaken to improve connectivity between GP services and functionality. Medway now had better connectivity between GPs than anywhere in Kent. Improved access arrangements giving GPs instant access to notes of patients who normally saw other GPs and these could be updated immediately. CCG representatives attended Local Care Team meetings. These meetings, which were chaired by a Clinical Body governing member were strengthening links between GPs. The local GP Federation in Medway now had 36 associate directors drawn from the 49 practices in Medway. It was confirmed that there would be no constraints placed on GPs in relation to Care Navigation referrals. A Kent and Medway GP online service was being procured with it being envisioned that all GP practices would be able to offer this service. Rollout was due at the end of 2019.

Contract Model – A Committee Member asked how big a task it was to get the contract model into place to enable delivery of the CCGs plans. The Committee was advised that the CCG was clear about the model required and that appropriate guidance would be provided to GPs. There would be opportunities to create other models within the plan.

GP Care Home Provision – GPs working with care homes had previously covered multiple homes. Patients were being encouraged to transfer to the dedicated GP but were not obliged to do so. The CCG was responsible for ensuring that patients who chose to remain with their existing GP were not disadvantaged as a result.

Decision

The Committee noted and commented on the update provided.