Report of the Head of Legal and Governance
Hazel Buchanan and Dr Hugh Porter, from the Nottingham City Clinical Commissioning Group (CCG), attended to update the Committee on the work taking place to ensure that all citizens had access to good quality General Practice (GP) services now and in the future.
Hazel Buchanan reported that there were 53 GP practices in the City of Nottingham of a mix of sizes, but that the number of practices with only 1 GP had reduced to 9 following a scheme of mergers. While 1 practice had closed in the last 12 months, this was due to its joining with another practice.
The following points on the circulated Nottingham City CCG Primary Care update were highlighted:
(a) section 3 set out the extra funding going into Primary Care, with a focus on improving access to GPs. As part of this, the GP Alliance was identified as a group of practices that had come together in the City to provide good collective support. The Alliance was providing extended hours (representing 700 additional appointments per week), which had been well-booked and attended, and opened an additional 700 appointments for December 2018 and January 2019 during normal opening hours, which relieved pressure on hospital Accident and Emergency units. The Alliance aimed to establish a multi-disciplinary team (including pharmacists and healthy lifestyle specialists) to find the right skills mix to give the right service to patients;
(b) the Primary Care Patient Offer launched in 2016 focused on increasing access to GPs, with more same-day urgent appointments, bookings for nurse appointments available 4 weeks in advance and more GPs available for video consultations. Longer, interpreter-assisted appointments are available at 13 practices, to better support the City’s diverse population;
(c) in the City, there have been 2 boundary reductions to improve access and 1 practice list has been closed (with permission from the CCG), for a 6-month period;
(d) the Care Quality Commission (CQC) has inspected all 53 GP practices, with 4 rated ‘outstanding’, 42 ‘good’, 6 ‘requires improvement’ and 1 ‘inadequate’. The 6 practices requiring improvement have been re-inspected and the majority are progressing to ‘good’, with the CQC offering support in the delivery of action plans for improvement;
(e) the GP Alliance will be taking over the ‘inadequate’ Bilborough practice from 1 April 2019 as the contractors, as they have done before at South Lake, where the practice was turned around within 6 months;
(f) there is variation in the workload between practices, with extra funding injected to bolster reception and clerical staff, with more active signposting of patients towards other services that they might need. Workforce numbers are a serious concern at both the local and national level and the international recruitment drive resulted in only 1 applicant for the area. However, there has been an increase in GPs coming into Nottingham to train and there are opportunities to keep these people and their skills, as well as introducing pharmacists into GP practices;
(g) Dr Hugh Porter reported that the GP Forward View seeks to align with the NHS Long Term Plan, improving access and quality for patients and resilience in the workforce. The Plan aims to reorient the NHS to respond better to cost pressures and changing demographics and expectations. There will be a move away from competition and towards Primary Care Networks, which will focus on individual populations and their health needs. The new 5-year GP contracts will encourage practices to collaborate at the Network level and engage with other partners to react to community needs and address other health-related issues, such as loneliness, more effectively;
(h) the Government aimed to increase GP numbers by 5000, but numbers are lower currently than they were in 2016. More support is being built through GP+, with funding for further access to social prescribing, physiotherapists and pharmacists, to support GPs. Positively, the current GP training cohorts have been filled, with the new 5-year contract designed to provide stability and resilience, and the opportunity to develop holistic thinking for the quality of care to be provided to communities.
Following further discussion and questions from the Committee, additional information was provided:
(i) With regards to how citizens who moved between practice catchment areas frequently (particularly those with a high level of vulnerability) would maintain easy access to referred services such as mental health, Dr Hugh Porter explained that practices are linked to a national contract, which includes the establishment of a CCG-agreed catchment area where GPs will be able to carry out home visits when needed. Other options exist and are being trialled, but practices have full discretion to decide whether they will continue to offer services to patients who have left their catchment, or not. To make movement between practices more straightforward, an electronic system for transferring patient records has been put in place. Provision has also been made at a local level for supporting patients of no fixed address, while access to mental health services is provided though two areas across the City. It is intended that, by 2021, more practices will be able to carry out consultations for patients outside their catchment areas;
(j) practices are able to both offer interpreter options in advance and when a patient arrives at a practice without forewarning, as this is a legal requirement. Funding beyond the core standards is being given to practices in the most diverse areas so that they can manage the longer appointment slots needed for patients who required interpreters;
(k) that the decision whether to have drop in surgeries to ease appointment waiting time is a decision made at the discretion of the individual practice, but there are required response times for routine and emergency appointments. As there has been a huge increase in demand over the last 5 years, the GP Alliance aims to bring practices together to offer support and share effective practice;
(l) support is being offered to practices struggling with estates issues, as these could have a negative impact on morale and recruitment;
(m)the CCG has a major focus on the homeless, who are clearly very vulnerable people. Practices in areas where homeless people frequent have been provided with extra support to build expertise and create homelessness hubs, working closely with homelessness teams;
(n) the number of single-handed practices is shrinking and experience suggests that the younger generations of doctors prefer to work in larger teams. It is a challenge for a practices to achieve a large size, but this offers the benefits of being able to provide a wide range of services and strong staff resilience. However, it is considered important to establish practices of a manageable size that will be locally responsive and maintain a good continuity of care;
(o) the new contacts will be put in place on a tight national timeframe, with the Primary Care Networks to be identified by the end of May 2019. The needed cultural change will follow more slowly after the structural reorganisation, with support to help practices ease into the new system;
(p) progress is being made in meeting the action plan for improvement at the Bilborough practice rated as ‘inadequate’, and the CQC will inspect the practice again after the GP Alliance has taken over management from 1 April 2019.
1) thank the representatives of the Nottingham City Clinical Commissioning Group for their presentation and note the contents;
2) note that positive progress has been made in enabling access to GPs; and
3) request further update on the progress of the GP Forward View in 6 months’ time.