Agenda item

Attending for this Item were:

Lynda Dando, Director of Primary Care for the Worcestershire Clinical Commissioning Groups (CCGs)

Dr Jonathan Leach, Clinical Lead Redditch and Bromsgrove CCG

Members received a presentation on the General Practice (GP) Forward View which outlined current context, local and national developments and what the future may hold for access to Primary Care, including GPs.

The Committee was reminded that Worcestershire had an increasingly ageing population, many of whom had complex health needs.  Although the overall population was roughly the same as the 2011 census, there had been a 28% increase in those aged over 75.  In addition, as the number of procedures undertaken and conditions that could be treated in a Primary Care setting developed, patient visits to a GP Practice had increased to around 12 to 15 per year, compared to a historical 2 to 3.

Alongside this, there were national recruitment issues for GPs and it was reported that the number of GPs leaving the service was four times as many joining.

Against this backdrop, Worcestershire had 65 General Practices, all of which benchmarked within the top 10% of Practices nationally for patient satisfaction, access and performance.  From a July 2016 national GP Survey, Wyre Forest responses in particular were extremely positive compared with responses nationally.

In April 2016, the General Practice Forward View was published and although there were other developments across the health economy, including the developing Sustainability and Transformation Plan, new ways of working must include GP services as well.  This was aimed at reducing pressure on secondary care.  The development of GP Hubs, whereby Practices work together to ensure access is improved, was seen as a positive way forward.  However, it was noted that patients may have to accept that they would not necessarily see their usual GP. 

In the ensuing discussion, the following main points were made:

·         The presentation referred to the term 'at scale'; it was clarified that this did not mean Practices merging, rather working together.  This was the case in Redditch, where 6 GP Practices were developing a Hub to improve access

·         Everyone agreed that communicating any changes to residents was vital to ensure that all patients knew what services were available, where and when

·         It was reported that around 26% of GP appointments could be better dealt with elsewhere, whether by another employee within the Practice or elsewhere in the community.  Generally for every three hours of appointments, one hour was required for administration including analysing test results

·         Signposting patients was sometimes more appropriate, especially when queries involved care in the community.  It was noted that Receptionists were very able to undertake this role and there was increased investment in training to support this

·         Some Members questioned the perception of the integrity of Receptionists and reported public concern over a potential lack of confidentiality.  After learning that employee code of conducts were in place, Members suggested a poster in each Practice highlighting that all Staff were bound by strict confidentiality

·         As there was a desire to move more services away from Secondary Care, a more flexible approach to access was required.  It would be hoped that this would result in appointments being more widely available, for example across a group of Practices.  However, patients would need to accept that the setting may not be their usual one

·         Members questioned why there were different approaches to booking appointments across the County.  In response, it was broadly stated that as each Practice varied in size it was difficult to have one set approach and the individual Practice was better suited to determine what was most appropriate.  It was also reported that GPs worked differently, such as the use of telephone consultations; however, it was clarified that every Practice always had a Duty GP

·         It was acknowledged that the proposals would make a difference.  However, longer appointment times were needed, in other words seeing less patients for a longer period of time.  Telephone consultations had a place and the option of also seeing the patient that day remained

·         When asked, the Director was not aware of any GP closures, however, she acknowledged that with contracts changing there may be circumstances whereby a particular post may no longer be based in a particular Practice

·         In response to a query as to why South Worcestershire seemed to be ahead, it was explained that in 2015, South Worcestershire CCG was successful in bidding for £1.8m of national funding, which meant that area was further developed

·         There was increased joint working with both Worcester and Birmingham Universities and the number of apprenticeships was increasing

·         The Out of Hours GP service was provided by Care UK and although many GPs do work out of hours, it was acknowledged that it was unsafe for them to work all hours consistently.  Individual Practices were experimenting with opening hours, however, by enabling appointments for example on a Saturday morning it was likely to result in no surgery on a weekday morning.

During discussion, reference was made to the Healthwatch Worcestershire report, "Going to the Doctors".  This summarised local views about access to GP services and indicated little appetite for weekend access and differences in views between different age ranges about telephone consultations.  The survey had been presented to the CCGs.  Members asked that they receive a copy of the updated Healthwatch Worcestershire report in due course.

The Chairman thanked those present for an informative discussion.