Agenda item

This report provides an update to the Committee on Primary Care provision across Medway. It provides an update on the Kent and Medway Primary care Strategy and describes the local primary care response to COVID.

Discussion

The Executive Director of Health Improvement highlighted that Primary Care Networks were a key element of Integrated Care Partnerships. 47,000 additional primary care appointments would be available each year via improved access. It was highlighted that the DMC Healthcare run St Mary’s Island group of practices and St Werburgh had had their registrations removed and that a handing back of the contracts had been agreed for this and for the Kings Family practice that was also run by DMC Healthcare. An interim service run by Medway Practice Alliance had been put in place while engagement was undertaken with local practices to consider longer term options.

Members raised a number of questions which included:

Issues with GP Services, staffing, data use and DMC Healthcare – there were some issues in relation to the interim GP services, broken ECG machines being highlighted as an example. It was pleasing that there had been recognition that people with learning disabilities needed particular support and also that a multi-disciplinary team had been developed for people with co-ocurring conditions such as drug and alcohol abuse. It was asked whether there were sufficient staff in place to provide services and whether there was the expertise to make effective use of data analytics. In relation to the DMC Healthcare surgeries, it was asked how the situation had been allowed to escalate in view of there having been problems for a significant period of time and why the Committee had not been made aware of issues sooner. There was concern that performance data that had been requested, which was said to have shown improvement, had not been provided and it was questioned whether there had been any such data. It was also suggested that patient concerns and complaints had not been taken seriously and assurance was sought from the CCG that there would not be a similar occurrence in the future.

The Executive Director said that the CCG Governing Body would receive a report in relation to the DMC Healthcare run services and that the findings of this would be shared with the Committee. The CCG had encouraged the CQC to act once the extent of the problems had become clear. There had been some teething problems in relation to the interim service but feedback from patients suggested that they were getting a better service than previously. There was now increased scrutiny of primary care by the CCG nursing team and reports provided to the governing body now contained much more detail on primary care. The Acting Director of Health Improvement said that there had been significant joint working with organisations such as Medway Community Healthcare to ensure continuity of care for patients.

The Chief Nurse said that it was important to ensure that appropriate lessons were learned and that review of performance indicators was part of this processes, with a more sophisticated dashboard of indicators due to be developed. It was envisaged that more targeted support would be put in place when concerns were identified in the future. The CCG had been aware of problems associated with the DMC Healthcare surgeries at an early stage but there was a limited amount of information that could be made public ahead of the CQC publishing its report.

Other GP Surgeries – in response to concern that there were other GP surgeries facing difficulties in Medway, the Executive Director acknowledged that ideally there would be a greater number of GPs available. The development of Primary Care Networks was necessary as primary care was not sustainable without the development of new ways of working, including groups of practices working together. In response to a further question, it was confirmed that the initiative to encourage GPs to come out of retirement during the Covid pandemic had been a national rather than a local initiative that had aimed to ensure that primary care was not overwhelmed and that patient safety was maintained.

Out of hours appointments, home working and workloads – clarification was sought on whether out of hours appointments could be booked outside normal GP practice hours with it also being asked how the increase in homeworking and GP workloads were being managed.

The Kent and Medway CCG Deputy Managing Director (Medway) said that the Medway Foundation Trust Urgent Treatment Centre currently handled calls for its own out of hours walk in service. From October 2020, NHS 111 would handle the calls. Callers would be triaged over the phone to confirm whether they needed an urgent face to face appointment. If an appointment was required a timeslot would be given, minimising waiting at the Urgent Treatment Centre. Appointments would be bookable outside GP working hours.

The Executive Director of Health Improvement said that digital opportunities in Medway had been enhanced over the last couple of years. This included supporting GPs to move to a single software system, enabling them to access patient records more easily and for practices to support each other. The ability of GPs to work remotely had helped general practice to provide many more appointments during the Covid crisis and would otherwise have been possible and there had been positive patient feedback from those who had found it easier to get a GP appointment. GPs were able to access patient records remotely and were able to complete prescriptions electronically. GPs working from home were able to work more flexibly with the total time available for patient appointments increasing as a result.

It was acknowledged that remote appointments were not suitable for everyone but the reduced number of patients attending surgeries made them a safer environment for those who did need to. It was not envisaged that there would be a return to pre Covid levels of face to face appointments. The Acting Director said that the development of primary care networks and multi-disciplinary teams would help GP time to be used more effectively and help manage GP workloads. The Chief Nurse said that a governance review was undertaken ahead of GPs starting to work remotely. This included ensuring that they had a separate private area within their home to work from.

Rainham Healthy Living Centre – it was asked how an effective GP service would be offered at the Centre in view of the number of operational GP suites at the Centre having reduced. The Executive Director said that flexible and remote working arrangements were encouraging many GPs to work extra hours, but it was recognised that Kent and Medway had less GPs than other areas. The Acting Director said that the aim was for Healthy Living Centres to be filled with both primary and community care services for the local population. Work was taking place with GP practices to ensure service availability but some consolidation of services was necessary in view of GP numbers and that relative attractiveness to primary care staff of being part of a multi-disciplinary team.

Remote access concerns and engagement – concern was expressed that many patients would be unable to access remote GP appointments and also that call waiting times had increased at some of the surgeries previously run by DMC Healthcare. It was also asked how public engagement would be undertaken in relation to the contracting of new providers at these surgeries and how feedback would be taken into account during the procurement process.

The Chief Nurse said that many GPs had been concerned by the prospect of undertaking consultations remotely but that they now realised it was a viable option for many appointments. Remote appointments would not replace face-to-face with this option and telephone appointments being available for those unable to attend via video call. The remote triage of patients could be used to assess whether they needed a face-to-face appointment. The Acting Director added that the CCG used mystery shoppers to monitor patient telephone call waiting times and were not aware of any excessively long waits at the former DMC run surgeries.

It was acknowledged that there were lessons to learn from previous engagement in relation to these surgeries. This included that the engagement had not taken place for long enough and had taken place during the summer. An engagement process was being developed and would be reported to the Primary Care Commissioning Committee in September. Ensuring that engagement results were fully considered during the procurement process would be challenging. Feedback would be presented to the Health Scrutiny Committee as part of a future update.

Performance Indicators and independent report – it was suggested that the current set of performance indicators had not been sufficient to identify the DMC Healthcare surgery issues soon enough. It was also asked whether there had been an apology to the patients of the DMC GP surgeries and whether an independent report would be produced in relation to these issues. It was requested that the lead Members of the Committee be provided any such report ahead of publication. The Executive Director said the Chief Nurse’s team was undertaking regular visits to practices and that questions about the process would need to be answered after a report into the events relating to the DMC surgeries had been considered by the CCG Governing Body. The report would not be externally produced but there would be close collaboration with NHS England. An apology had been made to patients via the local press and in a letter sent to patients.

GP Numbers – further concern was expressed about the reducing number of GPs and the difficulties being faced in providing sufficient GPs at healthy Living Centres. In order to assist the Committee in its scrutiny of the matter, it was requested that future reports include a breakdown of GP numbers, to include for example, figures for three years ago, six months ago, the present and next year. It was also asked whether the move towards centralisation of GP services in Healthy Living Centres had been the right one. The Executive Director said that younger GPs tended not to want to work in small practices and that many GPs were also close to retirement age. In view of these constraints the future of general practice was considered to be GPs working in larger multi-disciplinary groups.

Decision

The Committee noted and commented on the report, requested that a future update to the Committee contained the details set out in the minutes and requested that a briefing note be provided containing statistics in relation to telephone appointments for the GP surgeries previously run by DMC Healthcare.