To receive a presentation from Oldham Clinical Commissioning Group presenting a review of Primary Care in Oldham.
Mike Barker, Joint Strategic Director/Chief Operating Officer and Nicola Hepburn, Director of Commissioning and Operations, Oldham CCG delivered a presentation setting out a vision and ambition for primary care services in Oldham. The drafted Primary Care Strategy had been written in the context and framework of the Oldham CCG Vision and Objectives and described how primary care services will work with partners and the contribution they will make to the following strategic objectives –
· Clinical leadership – to improve the population’s health and drive better wellbeing outcomes;
· Nursing and quality improvement – to ensure that services become the highest quality and safest in the region;
· Commissioning operations – to deliver an effective and strategic approach to commissioning that focuses on tackling health inequalities;
· Finance – to ensure that local health and care services are sustainable for future generations;
· Strategy and support – to lead partnership working and collaboration across a sustainable health and care system; and
· Transformation – to create a place-based health and care system that is closer to people’s homes.
It was noted that Primary Care, like many parts of the health service, was under increasing pressure and struggling to deliver ever more complex services. In developing the strategy the CCG had identified a number of challenges in primary care which needed to be addressed, leading to a number of Primary Care Strategic Priorities being identified and which were presented under collective headings of Restoration of Primary Care Services and strengthening the foundations of Primary Care; Partnership working to reduce inequalities and improve health and social care outcomes; and Delivering Integrated Health and Social Care.
To deliver the strategy, Primary Care Networks (PCNs) would become the primary vehicle for the delivery of integrated primary and community care, with resources increasingly organised to respond to the needs and priorities of the people that live in each locality. A key objective for PCNs would be to shift the pattern of care and services to be more preventative, proactive and local for people of all ages, working with other system partners to deliver more care at home and in the community, with people being supported to remain independent in their own home for as long as possible. A number of measures that would be reviewed over time to measure outcomes were further considered and presented under headings of reducing health inequalities, access to clinical services, and workforce.
The Committee was reminded that Oldham, like all other Greater Manchester authorities, operated a Locality Plan that set out the health and social care priorities for five years. The Primary Care Strategy followed the same principles for tackling health inequalities and also reflected the national context of developing PCNs, collections of GP practices aligned to local authority boundaries, to deliver primary care. The health inequality challenge in Oldham could be represented by the expected 5-10% incidence of complex issues being as high as 40% in certain areas, pointing to the fact that a ‘one size fits all’ approach was inappropriate. The CCG had a Quality Strategy directing how improvement would be made, highlighting challenges such as developing alternate work and roles in primary care to enable professionals to address inequalities, looking to improve the estate where required, and how to provide digital services, particularly in light of Covid-period experience and the need to ensure inclusion of those with, for example, mental health and cognitive issues. It was noted that there were a number of single GP practices and there was a need to ensure that these were joined up in the system to make sure that no-one missed out.
A Member noted the similarity of issues related to staffing, services and estates to those that had been considered at the previous meeting of the Committee in connection to the Northern Care Alliance. The position of the CCG in respect of these issues was queried, with particular reference being made by Members to the use of prefabricated buildings and buildings in poor condition with access difficulties. The Committee was advised that the CCG had a Workforce Plan and it was known which areas were in need of additional recruitment and where work was required with colleges to develop particular skills. The Plan could be shared with members of the Committee. While Oldham was well placed with regard to the amount of new estate, it was acknowledged that focus was needed particularly on a number of smaller practices with their own buildings. A position statement on the estate could be shared with Committee members. Members were reminded that such practices were individual businesses and control was exercised mostly by regulatory bodies. The CCG had limited powers via contracts but could not impose changes. However, the CCG would work with and encourage these practices and provide assistance, for example to identify funding sources, where possible.
Pharmacy provision was queried, particularly where GP practices were grouped in new buildings incorporating pharmacies which appeared always to be allocated to large chains rather than to local independent pharmacies. Reference was also made to charges made by the large chains for home deliveries and the implications for those on benefits or low incomes. The Committee was advised that Oldham was unusual in that it had more pharmacies than GPs which, it was suggested, needed attention and that the allocation of pharmacies to such buildings was not a CCG responsibility. Members were also asked to note that expenditure on prescriptions in Oldham was very high when compared to, for example, Bury, and that expenditure on medication exceeded that on GPs. Both these issues needed consideration in respect of their long term implications and the effective use of resources, though the implications of the levels of local deprivation on the personal affordability of even the cheaper medicines needed to be factored in. It was suggested that the Committee might wish in the future to consider the Pharmacy Needs Assessment and a Prescription Strategy that might look to control that budget through, for example, educating the community about these issues.
The need for health education across the community was considered. While it was acknowledged that people might approach GPs for reassurance, people needed to be aware of what alternatives existed and, for example in circumstances where it was suggested that people approached GPs for personal re-assurance, what they could and should expect from the health service. Members considered patient involvement and the contribution this could make to health education. The Committee was advised that while the CCG could go into practices with Health Watch, it also needed the support of patients to drive change with individual practices. The need for health learning across Oldham was recognised, along with the support this would need from within the local community to work with the health sector. However, the challenge was to how to ensure diversity in involvement in an area which, with a reference to Patient Participation Groups, had historically been difficult to achieve.
A Member noted that prevention had been a major theme of reform discussions over recent years and queried where the Primary Care Strategy fitted with this and what steps could be taken to increase the focus on prevention rather cure. The Committee was advised of work undertaken with the Managing Director Community Services and Adult Social Care with regard to system integration across health and social care, looking to redirect the workforce, funding etc. There was a need to work closer to understand health and wellbeing needs down at the Ward level to ensure that the PCNs, Public Health etc all reached out with appropriate levels of care. Reference was made to the bringing together services so that these could be accessed from a single point and of a need to consider the public sector estate as a whole.
It was acknowledged that a wide range of issues had been identified in discussion that the Committee might wish to pursue and which could form the basis of a work programme for the Committee going forward.
1. the presentation on the Primary Care Strategy and the Primary Care Strategic Priorities 2019/20 - 2021/22 be noted;
2. the Chair, Vice Chair and other members of the Committee as available meet with the Chief Operating Officer/Strategic Director Commissioning, the Director of Commissioning and Operations and the Managing Director Community Services and Adult Social Care to consider future issues for consideration by the Committee arising from discussion under this item.