Agenda item

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Lynda Dando, Director of Primary Care

GP Representative

Dr Gemma Moore, Clinical Director of Droitwich and Ombersley Primary Care Network

The Committee was led through the Agenda and attached presentation, entitled ‘General Practice in Worcestershire during COVID-19’.

Members were reminded of the origin of Primary Care Networks (PCNs) locally and the nationally mandated creation of PCNs as part of the NHS Long Term Plan.  Since 1 May 2019, Worcestershire GP practices had a contractual requirement to work together in groups covering a minimum population of 20,000 to enable improved quality of care and resilient and sustainable groups of practices. 

In Worcestershire there were 11 PCNs, led by 13 Clinical Directors, based around natural local communities, working together with a range of local providers to offer more co-ordinated health and social care support.  Members were directed to the map within the presentation for the PCN locations.  The new PCN model would also help to address recruitment and retention difficulties in parts of the County.

The Primary Care response to the COVID-19 pandemic had seen nationally mandated changes from 27 March to free up capacity in general practice and keep staff safe.  In addition, a national standard operating procedure (SOP) was introduced.  From 11 July 2020, some GP services could be restored, however, current access arrangements were likely for the foreseeable future.

Worcestershire residents saw GP access triaged remotely, with online video and telephone consultations available as appropriate.  Practices were grouped to ensure separate spaces for different patient cohorts if face to face assessment was required, i.e. shielding patients, those showing symptoms of COVID-19, wider population etc.  Those patients with COVID-19 symptoms were directed to NHS 111 in the first instance.

CCG support for GP Practices included digital enhancements, workforce, physical adaptations (such as screens and hard flooring) and stocks of personal protective equipment (PPE).  A process for the reimbursement of additional costs has been agreed by the CCG, including staffing costs related to staff absence, costs incurred by bank holiday working, adaptations to premises and expenditure relating to PPE and infection control.

Nationally, General Practice was now in the restoration stage of COVID-19, however, remote triage would continue and, when appropriate, the use of technology for consultations would remain.  It was vital that patient contact continued to be minimised and PPE used appropriately.

Moving forward, key priorities for General Practice included Immunisation, essential screening, unmet demand and backlog, the management of long term conditions, shielded patients and patients in Care Homes.  However, the impact of delivering these key priorities were around fewer available appointments due to longer consultation times, the threat of practices being overwhelmed especially in relation to the onset of flu and of general winter pressures.

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

·         General Practice had always been open and no Worcestershire Surgery had to be closed due to the pandemic.  Ways of accessing a GP service had changed as a result of COVID-19 and surgeries continued to work in a different way

·         A Member asked how residents would have known about the access changes outlined in the presentation.  In response, it was explained that patients would have telephoned their usual GP Surgery and been given clear instructions on next steps, which may have resulted in a remote consultation or visiting a different Practice to their own

·         The Committee expressed concern about the backlog of routine services paused, such as managing long term conditions and immunisations

·         It was stressed that GPs had always been available for urgent problems and a County wide plan to manage the backlog was being developed.  In addition, urgent referrals to an acute setting had continued

·         In response to a query on the process of recalling patients for routine assessment, it was explained that each Practice operated individually, however, it was likely that there would be 3 forms of contact before a patient was taken off the Practice list

·         Face to Face contact was increasing each week and medical staff absence as a result of the pandemic was currently very low

·         Each Practice was developing a risk strategy for all of their patients, however, minor surgery and steroid injections were examples of local procedures which continued to be paused

·         A Member asked about possible virus mutations from COVID-19 and in response the Director of Public Health suggested that mutations in viruses was normal and nationally, nothing had been reported at present

·         The pace of change had been dramatic and the implementation of new measures a challenge, such as assessing buildings for movement of people and physical changes such as replacing carpet and erecting reception screens

·         Moving forward, discussions were being held about how services may be managed effectively, such as ‘drive through’ clinics for delivering the annual flu vaccine.  It was noted that national plans for flu vaccination were awaited

·         The needs of all Care Home patients had been managed by GPs to ensure that hospital admissions were avoided where possible.  This service had extended to the weekend and had resulted in retired GPs being on rota

·         The Committee commented that although technology had helped enormously, it wasn’t the solution for every patient – a point noted by those in attendance

·         The HOSC Chairman referred to recent media coverage of a survey rating GP Practices.  For clarity, the CCG Director referred to the national patient survey, which was undertaken annually and reported to the CCG Board.  Worcestershire’s results were above the national average and further details would be provided to HOSC Members. 

The Chairman of Healthwatch Worcestershire was invited to comment on the discussion and raised the following main points:

·         Healthwatch agreed that the initial response to COVID-19 by GPs was good and although centrally driven, very few comments had been received in the response phase

·         From July, soft intelligence received suggested that things were less good around the County and the lack of patient involvement in developing services was troubling

·         From feedback it was suggested that different Practices had different ways of working, with examples given of patients waiting all day for answers or not being able to access prevention services.  In response it was noted that the SOP continued to be in place and there was no going back to the ‘old’ way of working

·         Healthwatch would be willing to share evidence with the CCG and work to improve patient engagement, a point which the CCG Director welcomed.

The following information was requested:

·         Further information on the national patient survey.