Updates have previously been provided to both the Health and Wellbeing Board and the Health and Adult Social Care Overview and Scrutiny Committee on the development of the Medway and Swale Integrated Care Partnership (ICP). This document sets out the priorities for the ICP and focuses on the proposed Local Care Plan which incorporates primary care.
The Director of ICP Transformation, Medway and Swale ICP briefed the Board on the report, highlighting it was the first step in developing a Local Care Strategy. Access to a sustainable primary care service was one of seven priorities of the ICP road map. Reference was made to the Additional Roles Reimbursement Schemes (ARRS) which was a national scheme providing funding for an additional 26,000 roles to add to multidisciplinary teams. This was the equivalent of 160 clinical patient-facing roles within Medway and Swale primary care. The Medway and Swale Primary Care Network Representative made the point that General Practice had delivered around 75% of COVID vaccinations, along with regular GP services. She added that under ARRS, local collaborative efforts with all Primary Care Networks (PCNs) across the ICP would be made to, among others,
a) pool existing and new resources to create capacity where there was a scarcity in available professions;
b) build a community nursing team in PCNs to provide multidisciplinary support to vulnerable patients in the neighbourhood; and
c) ensure provision of General Practice services by looking at recruitment, retainment, and personal development packages.
As regards the types of access to GPs, in addition to conventional clinical face-to-face services at clinics, other options would include home-visiting for more vulnerable patients, an enhanced service for care home residents as well as the use of digital technologies, including e-consult. An engagement strategy was also being developed to communicate with and gain feedback from the public and other organisations.
Members welcomed the report and raised a number of questions and comments which included:
Local Care Plan and deliverables - questions were asked about measurable targets for the Local Care Plan and the relevant timeline in terms of months. It was explained that the Local Care Plan would form the beginning of a strategy which would set out clear priorities and ambitions for the next 3 years. The strategy would focus on nine priorities that all support improved access to primary care, with clear qualitative and quantitative deliverables worked out together with the patients and other stakeholders, and hence all nine carried equal weightings.
On recruitment of professionals, it was advised that to maximize appointment opportunities, colleagues were being creative in such ways that the PCNs could maximise collaborative working across and localise job descriptions and find system solutions to meet the community needs. It was added that the local authority had a role in developing Medway the place to be somewhere people would choose to live and work.
Access to GPs and performance – reference was made to the difficulties of residents across Medway in accessing GP appointments with some eventually giving up. The issues and frustrations were acknowledged, however, Medway and Swale shared the same national shortage of GPs while the number of cases for primary care, mental health and hospital general care faced unprecedent rise. Patients’ calls were more likely to be dealt with initially by paramedics, pharmacies and nurses who all had clinical backgrounds and could provide initial screening to relieve pressure on GPs and would refer more complex and serious cases to GPs.
As regards performance and access disparity among GP surgeries, it was stressed that efforts had been made to work closely with the clinical directors to find solutions to meet the specific needs of the PCNs and the additional roles that could collectively be played with a view to attaining equity in respect of primary care for local people.
There was a concern about miscommunication between the hospitals and GPs. It was acknowledged that practices in different hospitals did pose a challenge to PCNs, and officer undertook to look into the matter.
Phone systems – many Members referred to the frustration of the public in relation to calling GP surgeries to get an appointment and the long waiting times involved. Addressing the concerns, it was explained that the phone booking systems for GP appointments across Kent and Medway/Swale was being reviewed to be upgraded to become more coordinated and standardised and it was hoped this would be done in the relatively short term.
The Health and Wellbeing Board noted the report.