Agenda item

Further to Minute 13(2) of the meeting held on 3^rd September 2019, the Committee received a presentation providing the requested update, noting that the review now more broadly addresses the future of all of General Practice in Oldham, rather than just urgent primary care.  Work had commenced to develop a Primary Care Strategy that would identify priorities to address the known challenges in primary care which, despite those challenges, continues to improve and in the main was working as planned to reduce inequalities and improving health outcomes.  However, a new model of Primary Care is required to provide assurance as to the sustainability of the primary care offer, with a strong workforce who have manageable workloads that is able to meet the needs of the population and demands on the system. Work was also going progressing on a new assurance framework for General Practice in Oldham with a focus on both clinical quality and practice governance.

The presentation noted that the NHS Five Year Forward View set out the case for change in healthcare and that Oldham CCG aimed to enable general practice to play an even stronger role at the heart of more integrated out of hospital services.  Key themes considered were

·         addressing the increasing demands of an aging population and raised patient expectation and the service variations that arise due to the different contractors providing services;

·         sustaining a competent and motivated workforce and addressing the issue of a local aging workforce

·         the need for integrated approaches to address the complex contracting and funding arrangements within primary care;

·         the Walk-in Centre Review findings;

·         potential future services to deliver alternative urgent care services to deliver ambulatory care services and Long Term Condition management to support reductions in out-patient activity.

Work was also required to update and understand where each Primary Care Network (PCN) was against the PCN Maturity Matrix.  The Matrix was designed to support network leaders, working in collaboration with systems, places and other local leaders within neighbourhoods, to work together to develop individual Networks and support groups of Networks to collaborate in the planning and delivery of care across a number of roles.

Further to the presentation, the Committee was asked note that the health system was now in a similar position with regard to supply and demand that had existed at the time of the last review of GP contracts in 2014, and that the position of being able to offer people an appointment within two weeks had generally been lost.  While the situation was at saturation point nationally, Oldham did well on some metrics, a point not recognised by people.

A Member noted that the problem of people attending A&E unnecessarily continued, querying whether this was down to people not understanding a system which, while in transition, remained complex.  The issue, and the complexity of addressing it, was acknowledged, with it being clear that it took several years to educate people to access health care at the appropriate point.  The large numbers contacting practices on a Monday was another issue which, while impacted on by levels of Universal Credit take-up, relative deprivation etc, was an indicator that work needed to be done about appropriate use of not just A&E, but of urgent care centres, GPs, the 111 telephone service etc.  Such work was ongoing but again it would take some time for patient education to take effect.

The information available to patients to inform their decision making was queried.  The Committee was advised of the NHS national programme around Right Choice which relied, to an extent, on GP surgeries and it was conceded that coverage might be patchy.  It was suggested that ‘telling’ people what to do might not have impact, but that signposting, consistency across websites etc might be a better way forward.  At this time, attendance at A&E might be seen as a lack of confidence in and/or knowledge of the other offers.

Referring to figures provided from the Walk in Centre Review concerning the number of unregistered patients attending, it was queried whether anything was done to address this.  The Committee was advised that the issue had been recognised and the system would incentivise registration and action was being taken to address this issue.

A Member queried the implications for future delivery of a new model of primary care from practices based in outdated and/or sub-standard buildings.  While acknowledging that this could be a barrier to change, the Committee was asked to note that, other than in some particular circumstances, practices could not be forced to move.  The CCG had had some success in achieving some practice moves in a cost efficient manner: some funds were available locally and work would be ongoing to raise the benefits of moving with other, specific practices.

Noting the report that Oldham had achieved delivery of a seven day service but this was not being taken up fully, it was suggested that not enough had been done to publicise the offer.  Reference was then made to patients attending practices to book appointments rather than phoning, noting that many people seemed to consider it difficult to get through to practices by phone and attending in person appeared a more sure way of getting an appointment.  The Committee was advised that the telephone systems contract lay with another NS organisation, but that Oldham practices were on a rolling programme for new systems.  There was also a development programme to better equip staff to be increasingly public facing.

A Member queried the implications of patients not attending appointments and action taken in this regard.  The Committee was advised that the facility for practices to send text reminders was universally available and it was likely that most practices used the facility.  It was suggested that if non-attendance was eradicated patients could possibly be seen up to one week sooner.

RESOLVED that –

1.            the presentation from Oldham CCG relating to the review of Primary Care be noted; and

2.            a further update on progress of the Primary Care Review and Strategy be submitted to this Committee in September 2020.