Agenda item

The Committee scrutinised a report of the Place Lead – Oldham, NHS Greater Manchester Integrated Care, which informed members of the current position in respect of access to General Practice in Oldham and presented the national and local context in respect of access to General Practice and provides locality data and actions that are being taken.

The Committee considered the numbers of GPs in the Borough. In 2017, there were 143 GPs, excluding locums and trainee doctors, in Oldham, working across 44 practices. According to the latest NHS Digital data, there were currently 140 GPs working across 39 practices. This data reflected the national picture of a stagnation in the growth of the number of GPs since 2015.

In February 2020 the Government had announced a drive to recruit an additional 6,000 GPs by 2024. However, these initiatives had not yet had the desired impact on increasing the number of qualified GPs – in fact, numbers have continued to decline nationally. In the same period, the number of patients registered with a practice in Oldham had increased from 246,039 to 262,400. This was also a trend that was reflected nationally.

In recent years, there had been several national objectives aimed at increasing both the number of staff in general practice and the variety of roles. The emphasis on workforce had began to move to ensure that patients see the right person in the right place, first time. During the Covid-19 pandemic, patients had seen a move by practices towards “triage systems” which helped to direct them to the most appropriate clinical professional to meet their needs. There has also been an un-precented increase in the use of digital systems and remote consultations. Since the lifting of Covid-19 related restrictions practices have retained this technology and ‘digital first’ as an option although patients should now be triaged first and offered a face to face or digital appointment as appropriate.

An important fact to consider when looking at the number of GPs working at practices was that different providers used different staffing models: there was no mandated workforce model for general practice and providers could choose the blend of staff which they thought would best meet the needs of their patients. Whilst GPs continue to be the pivot point for practices, the roles carried out by nurses, pharmacists, healthcare support workers and other clinical professionals were considered just as vital. High quality care depended on all of these roles, underpinned by the inestimable contribution of the practice administrative staff.

It was reported that from 1^st October 2022, Primary Care Networks (PCNs) have been required to provide Enhanced Access between the hours of 6.30pm and 8.00pm Mondays to Fridays and between 9.00am and 5.00pm on Saturdays (“Network Standard Hours”), in accordance with the requirements set out in the Primary Care Network Direct Enhanced Service (DES) Specification.

The Primary Care Networks in Oldham succeeded in mobilising the Enhanced Access service in their networks by 1^st October 2022. Whilst national IT, estates and workforce situations have created issues, the PCNs have managed to provide workarounds to these and delivered against the requirements of the Primary Care Network Direct Enhanced Service Specification.

NHS Digital had been collecting data from general practice appointment systems and publishing local monthly data, since 2018. This published data provides a picture of general practice appointments and included details such as the number of appointments, the healthcare professional carrying them out and where possible the mode of delivery, such as. face-to-face, telephone. Historically this had only been available at locality level.

On Thursday, 24^th November 2022, NHS Digital published practice level data for the first time as laid out in the Secretary of State for Health and Social Care’s “Our Plan for Patients”. The aim is that patients will have more information available to choose the right practice for them.

Greater Manchester Integrated Care - Oldham Locality would continue to work with practices to address these issues outlined above. In the last 12 months, there had been an investment of £42,000 in a scheme that focused on providing GP trainees with the knowledge and skills to work in areas of disadvantage within the locality. Trainees were to be encouraged to continue working in the areas in which they train, with aim of improving the availability and quality of healthcare in those areas and reduce health inequalities.

The number of GP training practices in Oldham had increased in recent years, with more practices now offering placements for doctors as they completed their GP training. The NHS in Oldham was also working with newly qualified GPs to support them as they begin their post-qualification careers, setting up a peer network that can help ease the transition from trainee to GP.

Greater Manchester Integrated Care - Oldham Locality was to continue to invest significant money and resources in 2022/23 into improving the rates of GP retention and recruitment in the short- and long-term. A significant piece of work was being undertaken to address historic telephone issues and it was hoped that a technical solution can be provided that will improve the experience for patients of booking an appointment with their practice.  Historically, appointments have been booked via telephone and in-person. However, post-pandemic, an increasing number of practices are using online triage and this has had a positive impact on both access and waiting times. The Oldham Locality has invested in a new triage platform which can reduce telephone demand for patients and make it easier for those patients who would rather call their practice. We will be looking to support practices to adopt this system.

The impact of Covid-19 meant that there were staff shortages during the pandemic, and the recent increased in cases continues to impact on GP practices, although the most recent data shows that their resilience is high and there has been continuous service throughout the last two years. We monitor these staff absences and support practices to alleviate any staffing issues that arise.

The Committee considered the report is detail asking about how the residents of Oldham are coping with revised ways of making appointments and educational initiatives that were being made to assist, especially for the most vulnerable groups including the disabled and the elderly. Members also commented on the role of pharmacists and the help and support that they can provide to GP practices.

Resolved:

1.    That the report be noted and welcomed

2.    That further updates on this issue be presented to the Committee in due course.