Agenda item

Presentation by Lynette Daws, Assistant Director of Commissioning - Primary Care, NHS Nottingham City Clinical Commissioning Group

Lynette Daws, Assistant Director of Commissioning, Primary Care NHS Nottingham City Clinical Commissioning Group (CCG), delivered a presentation regarding access to GP services within Area 1.

In addition to the information provided in the presentation of the following points were made:

(a)  Bulwell and Bulwell Forest have more than the City average of older citizens, the highest proportion of residents with poor mental health, and the highest proportion of residents within the City who smoke and are overweight;

(b)  the mystery shopper survey can only be considered as a snapshot as it was carried out by HealthWatch Nottingham with two calls made to 8 surgeries, requesting appointments over two days. Where surgeries were unable to provide either a routine appointment within one week or same-day urgent appointment, this has been investigated further;

(c)  within Area One there are 17 whole-time equivalent GPs providing 550 GP sessions each per week;

(d)  it has been a struggle to get trainee GPs to work in Nottingham as generally trainees tend to stay in the area in which they trained. As a result, 30% of available training posts were not filled in the last year;

(e)  newly trained GPs do not generally want partnerships and prefer initially to remain either salaried or work as locums. This impacts on the cost of providing locum or agency cover to an extent which is not sustainable for some practices; one practice within Bulwell held a GP vacancy for one year even though the vacancy had been advertised nationally throughout that period;

(f)  many practices are working to use clinical staff more effectively and promote the advice available from pharmacy staff;

(g)  suggestions regarding how appointments are booked and cancellations made include text messages to remind patients of their appointment, but which also offer a facility to cancel the appointment;

(h)  the ‘Physio First’ pilot enables patients to make appointments directly with the Physio Service instead of requiring referrals from a GP;

(i)  the new ‘Self-Help’ pilot operating within Bulwell will provide one central point which citizens can access to find self-help facilities such as referrals. The information will be kept up-to-date on a weekly basis;

(j)  the City Council’s Health Scrutiny Committee is considering the quality of GP practices in Nottingham and the information gathered so far can be found here: http://committee.nottinghamcity.gov.uk/ieListMeetings.aspx?CId=614&Year=0 ;

(k)  ideally, all surgeries would be able to offer a same day urgent appointment or a three-day routine appointment.

Lynette responded to the Committee’s questions as follows:

(l)  there are five practices within Bulwell which operate extended hours beyond the contractual requirements;

(m)  there is no specific CCG policy regarding patients making, but not attending, appointments. This is a waste of resources but more importantly, it wastes an appointment which may be used by another patient. Some practices do have their own policies where if patients do not attend (DNA) a set number of appointments, they are removed from the surgery’s register. However, this can just move a problem to a different practice so educating patients is the preferred option;

(n)  there are no plans to move to a seven day surgery week within the Bulwell and Bulwell Forest area although this is a longer term aim nationally. Seven-day appointments will be expensive and it should be noted that patients would not necessarily see their own doctor;

(o)  the CCG oversee the surgery contracts. Where practice communication is not good, patients can complain to the Clinical Commissioning Group. However, if the issue is in regard to a specific to GP, patients can complain to the practice manager, the CCG or NHS England;

(p)  with regard to GP training contracts and recruitment , Health Education East Midlands (HEEM) have changed how trainee GPs can select where they would like to work so that choices can be specific to towns and districts rather than an allocation anywhere within the East Midlands;

(q)  the CCG are trying to attract training GPs to the area, especially as 38% of training placements are vacant;

(r)  currently is not possible to cap the price paid for locum or agency GPs although bidding for the highest wage not an issue isolated to Nottingham. Practices are encouraged to utilise their nurses to help meet patient demand.

Community representatives and Councillors made the following points:

(s)  sometimes patients have been unable to contact the surgery to cancel appointments as the telephone lines are always busy;

(t)  currently, in some practices patients cannot book appointments for one week’s time even if the GP has requested this;

(u)  booking a GPs appointments can be especially difficult for people who work;

(v)  it’s frustrating that when an appointment can be made, patients rarely see the same doctor;

(w)  communication to and with patients, and even within the same surgery, can be very poor, causing confusion and distress to some patients.

RESOLVED

(1)  to note the presentation and that surgery and GP complaints may be forwarded to the CCG at: www.nottinghamcity.nhs.uk/have-your-say/complaints.html, or, Doctor (GP), dentist, pharmacist or optician contact the service directly or the NHS England Customer Contact Centre on 0300 311 22 33 or email england.contactus@nhs.net
Other NHS services in Nottingham City contact NHS Nottingham City Clinical Commissioning Group Patient Experience Team on 0115 883 9570 or patientexperienceteam@nottinghamcity.nhs.uk;

(2)  to note that the health profiles of Area One (Group One) can be found here: http://www.nottinghaminsight.org.uk/insight/search/list.aspx?fl=139191.