Agenda item

The report provides an update on proposals, previously considered by the Committee, to reconfigure GP services provided at some Gillingham and Chatham GP surgeries. NHS Medway CCG has advised that this proposal is no longer under consideration.

This report also advises the Committee of action taken by the CCG, in collaboration with DMC Healthcare, in response to patient concerns raised in relation to GP access, telephone access and prescriptions.

Discussion

The report included a summary of patient concerns that had been sent to the Chairman of the Committee by Ms Zi Fincham. These related to GP Services provided by DMC Healthcare at Medway GP surgeries the Sunlight Centre, Balmoral Gardens, the Pentagon, St Mary’s Island, Twydall and Kings Family Practice. It was explained that the Committee could not consider individual patient complaints and that these should be submitted to the provider or NHS Medway Clinical Commissioning Group (CCG). The Committee was, however, able to ask the CCG for a response if patient experience suggested that acceptable standards of patient care may not be being met.

The Director of Primary Care Transformation at the CCG reminded the Committee that it had previously been advised that the CCG was considering the rationalisation of five GP surgery sites to three as part of a contract review. It had since been agreed that the five sites would be maintained. The Committee had considered that the proposals amounted to a substantial variation to the health service in Medway, therefore any further review of the configuration would be presented to the Committee. There were currently no plans for any such reconfiguration.

Since Ms Fincham had submitted complaints in August 2019, the CCG had received a further eight complaints about services at these surgeries. The complaints related to GP access, telephone access, repeat prescriptions and prescription reviews. The response to these was managed in line with CCG and NHS England complaints policies. All patient complaints had been considered as part of an action plan agreed with the provider, DMC Healthcare and progress was monitored via KPIs. DMC had been asked to undertake audits in relation to referrals, access to GPs, length of time to answer phones and prescriptions. DMC had been asked to undertake further public engagement and work with Patient Participation Groups (PPGs).

Ms Fincham addressed the Committee. She asked for an apology from the Chairman of the Committee and from the Clinical Chair of the CCG for the way in which her complaints had been dealt with. Miss Fincham said she had been advised that the CCG was not responsible and told to complain to NHS England who had advised her to complain to the CCG. She said that patients were still waiting two weeks for appointments and that it was very difficult to get an appointment. There were still difficulties relating to prescription processing and repeat prescriptions. Ms Fincham was concerned that her patient records were being centralised without her permission and that unauthorised persons would be able to access them. She also considered that public engagement had not been transparent. Ms Fincham then left the meeting and did not return.

Maggie Cane from Healthwatch Medway addressed the Committee. Healthwatch had received some complaints that related to the issues outlined by the CCG. GP access was still a concern and some apps were not currently allowing patients to make GP appointment bookings. There had been an improvement in comments made on NHS choices and in friends and family tests in relation to the surgeries. Ms Cane was the Independent Chair of the Patient Participation Group for the five surgeries. Additional Members were being recruited and meetings held across all surgery locations.

The Director said that outstanding issues were being addressed. It was recognised that DMC had taken on demanding surgeries. Ms Fincham had been advised that she should refer back to the CCG or escalate to the Ombudsman if she remained concerned but to date, this had not happened.

DMC representatives stated that they did not sell patient data. No data was shared outside the NHS and appropriate data sharing arrangements were in place. DMC had taken over the five sites on 1 April 2019 and had recognised that they would be challenging, with it being anticipated that sustained improvement would take two to three years. It had successfully turned around another practice that it had previously taken over, resulting in a good Care Quality Commission (CQC) rating. A recent visit by the CQC had recognised that medicines management was being dealt with effectively. Only one negative comment had been received in relation to this visit to the Sunlight Centre.

DMC currently had dependency on locum GPs and had a clear strategy to recruit locally to address this. DMC was appointing community psychiatric nurses. This was not required but it had taken the decision to invest in this area. An issue with how medicines had been dispensed by a local pharmacy had been addressed.

Members of the Committee made comments and asked questions as follows:

Visit to DMC – Some Councillors had met DMC management and staff in November. This had been positive and the Councillors had felt listened to. Poor communication was the main concern identified with ward Councillors having not previously been told about developments. It was suggested that the surgeries consider production of a monthly newsletter and that it would also have been helpful for details of performance auditing undertaken to have been included in the report. The Committee was advised that the PPG had agreed that a newsletter would be produced and displayed in each surgery. Performance data was available and would be shared with the Committee. Only two people had attended a recent meeting of the PPG. Work was being undertaken to increase future attendance and ensure that meetings were fully accessible.

Patient Participation Groups – It was asked whether each surgery had an independent PPG and how the PPGs considered complaints. The Committee was advised that each of the surgeries had a PPG Chair. There were plans to hold meetings at a range of times and locations and that the possibility of video conferencing would be explored. The groups were actively trying to recruit new members.Further details on the PPGs would be provided to the Committee.

Gillingham North surgeries – It was sometimes necessary for patients to attend another practice but local transport limitations could make this difficult. DMC had produced a leaflet to advise about local transport to get to their surgeries but the Sunlight Centre had not been included. The reliance on locum GPs and workforce issues were also highlighted. The Deputy Managing Director of the CCG had made some trial bus trips to and from Gillingham to see how good local transport links were. Results of this had been variable with there being a need to improve some local links. DMC had been able to recruit a physician associate.

Healthy lifestyles – In response to a question about how patients were encouraged to adopt healthy lifestyles, the Committee was advised that social prescribing was being developed. There would be significant links to interventions to address negative lifestyles and providing advice to patients. This would require reviewing data and considering how to target and engage particular groups. It was acknowledged that there was a need to undertake more prevention work in primary care.

Physician Associates – It was asked how more people would be encouraged to undertake the Physician Associate programme available at local universities and how it was funded. The CCG was working with local organisations through a group led by the Council. This was looking at how to target schools and industry to encourage participation in the programme as well as promoting other routes of entry into the medical profession. The Associate programme was university based with students undertaking rotating GP placements. The programme was self-funded by students. DMC had taken on four students from the programme and was developing strong links with the local universities, such as working with the Parkinson’s Association and research groups.

Decision

The Committee considered the update provided and thanked Ms Fincham for highlighting her concerns.