Agenda item

Attending for this Item from NHS Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG) were:

Charmaine Hawker, Deputy Director of Primary Care

Dr Jonathan Leach, Primary Care GP Lead.

HOSC Members had received a Report as part of the Agenda.  A summary of key points was presented.

The way in which general practice (GP) operated had changed since the beginning of the COVID-19 pandemic.  The latest central Government directive, given in July 2021, included the Standard Operating Procedure to continue with infection control measures and the wearing of masks.  It was mandated that a blend of face to face and online appointments be given, increasing patient choice.  From October 2021, there would be a minimum number of online consultations permissible.  HWCCG believed that many patients liked the telephone/online offer.

The NHS acknowledged that there was a significant backlog of cases, huge workload and capacity constraints in primary care, however GPs had contributed hugely in the COVID-19 vaccination programme and the flu vaccination programme.  Furthermore, the County had an aging and growing population, which added to the challenge.

Recruitment and retention was a national issue and Worcestershire was no different.  Since 2015, the number of full time equivalent GPs had reduced by 15, with 7 GPs leaving in the last Quarter.  GPs were demoralised and practice staff were under strain, including reception and administrative staff who were often the first point of contact for patients. 

There were 80 GP practices across the 2 Counties.  Appointment data collected nationally suggested that Herefordshire and Worcestershire was performing well in most areas and activity had increased 7% since August.  54% of patients were seen face to face and more appointments were available per head of population than nationally.  Before the pandemic, 50% of patients were seen same day and currently this was 57% locally and 54% nationally.  Overall, Herefordshire and Worcestershire benchmarked well.

A recent audit reported that, on average, telephone calls were answered within 7 minutes.  If a practice was found to have calls unanswered within 45 minutes, a package of support was given by HWCCG, including the technology to move to a cloud based telephony system, which would result in more telephone lines being available.

Associated issues for GPs included the backlog in hospital procedures and practices, resulting in patients asking for progress in hospital matters, which were out of the GP’s control. 

HWCCG was clear that if concerns were raised, they would be addressed, however, the workforce had not grown and the pressure remained.

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

·         The NHS intent was that all GP practices would have a cloud based telephony system by the end of 2021, resulting in increased telephone lines and the ability to monitor inbound and outbound call volumes.  This would support each practice in managing capacity and staffing.  Furthermore, the ability to log in to the system could result in calls being answered securely from those working off site.  The disadvantage of such a system was the single point of failure, whether data or telephone and the requirement to have reliable broadband

·         A video to outline to patients the role of each professional within a GP surgery was in production.  It was noted that 40 clinical pharmacists were employed in surgeries across the 2 Counties and that up to 15 job roles could be available within a surgery

·         The NHS Long Term Plan had recognised that general practice was not sustainable at the pre pandemic rate and that new ways of working were required.  The advancement of remote appointments and the ability to self-refer to services such as physiotherapy, optometry and hearing services, was a benefit.  Members believed that further promotion of these options should be considered

·         Members heard that blood pressure monitoring was increasingly done in the home, with machines costing less than £25 or on loan from a surgery.  Patients could record readings over a week and return results to the surgery for analysis.  This initiative saved professional and patient time and was generally a more accurate way of recording blood pressure

·         It was noted that for every three hours of GP consultation time, around one hour of administration was generated

·         The number of patients choosing private medical care was increasing as the time to wait to be seen by a consultant had grown.  Examples were given of patients borrowing money to speed up their referral

·         GPs were sensitive to patient need and if conversations were better had in person, then they would aim to achieve that.  In addition, if there was a clinical requirement for a GP to see a patient this would be arranged, often providing same day access, i.e. a telephone consultation in the morning may be followed up by an in person appointment later in the day

·         NHSE/I had set out a plan which included contractual requirements to support improved patient access to primary care, with reference to the reduction in the proportion of patients waiting longer than 2 weeks for a routine GP appointment.  In August 2021, 42,000 patients were waiting over 2 weeks, an improvement from August 2019, when the figure was 64,000.  This was in part attributed to the increase in remote consultations and it was suggested that around 40% of all appointments were undertaken by telephone or video

·         Across Herefordshire and Worcestershire, 7 practices were involved in the NHSE/I Improving Access Programme, with progress overseen by the HWCCG Primary Care Commissioning Committee

·         In response to a question about the availability of capital funding to build additional resources to meet demand resulting from house building, the HOSC heard that although Worcestershire had been previously very successful, the national scheme had changed and Primary Care was now in direct competition with Acute Trusts nationally.  It was suggested that with increased integration, the one public estate could solve the building issue.  The introduction of Primary Care Networks had also benefited provision across a cluster of practices in an area to deliver better outcomes for the local population

·         The Government had recently announced an additional £250m of funding to increase the number of appointments available.  When asked to what extent this would help Worcestershire, it was reported that it would be helpful to a degree, but locums were already being utilised as standard

·         It was clarified that Receptionists were not clinical staff, nor should they be acting as a barrier to services.  Their role was to guide a patient to the most appropriate care or support and confidentiality was a contractual requirement.  Training was the responsibility of each Practice, most likely through a cascade method of delivery, in subjects such as conflict resolution.  Safeguarding training would have to completed by all Staff

·         Unacceptable behaviour from a Practice should be reported to HWCCG, however, every Practice had a complaints procedure

·         GPs were able to guide patients to appropriate support, such as signposting patients to Healthy Minds or Armed Forces veteran support.  Social prescribing had increased in recent years and the benefits were noted.  It was believed that society needed to change to ensure that patients with more complex needs were able to engage with a GP and community services were utilised further

·         Communication was generally poor between primary and secondary care and secondary care with patients.  An improvement in this area would be welcomed and would improve wellbeing of practice staff who were often a first contact for patient follow up

·         When asked about flexible working opportunities, Members heard that there had been a massive shift in the workforce, with many GPs choosing hours to suit their personal circumstances or other non-clinical commitments 

·         Worcestershire’s daily appointment numbers were 28% higher than the national average.  This was largely due to the County having a high number of frail elderly patients, especially those aged 80+

·         Younger residents preferred instant access and online services and remote consultations would continue to be an alternative channel.  40% of patients had access to online GP services, compared to 10% nationally and 33% of patients were ordering repeat prescriptions online, compared to 20% nationally   

·         It was not known whether the number of GP sessions available now was more or less than pre-pandemic, however, there had been a significant increase in demand, as much as 20%.  However, the way in which services were delivered had reconfigured overnight and there was much closer co-ordination within the Primary Care Networks.  Ongoing challenges included infection control measures and the need for social distancing.

The Managing Director of Healthwatch Worcestershire was invited to comment and referred to a Healthwatch Report on GP access.  He welcomed the improvements to telephony.  The Deputy Director of Primary Care reported that without COVID-19, the digital transformation programme would have taken years to achieve and not every Practice would have been engaged.  However, the programme had been achieved in 18 months and it was now timely to develop working practices and encourage residents to contact their GP if required.

The Chairman thanked everyone for the helpful discussion and requested an update at an appropriate time in the future.