Agenda item

3:25

15 minutes

Person(s) responsible:        Oxfordshire Clinical Commissioning Group/NHS Commissioning Board (South Central)

Persons giving report:         Clinical Chair, Oxfordshire Clinical Commissioning Group and Director of Finance, NHS England (Thames Valley)

A joint report prepared by Oxfordshire CCG and NHS England (Thames Valley) on the current state of General Practice in Oxfordshire and transforming primary care is attached at HWB12.

The Board is advised that this report was considered by the Oxfordshire Joint Health Overview & Scrutiny Committee at its meeting on 5 February 2015. The Committee was pleased to have a constructive discussion with commissioners and providers. It identified a weakness in the provision of primary care services in areas of growth and recommended that NHS England be considered as a statutory partner when housing growth (large and small planning applications) is considered by Councils.

Action Required: to discuss the report and to consider the inherent challenges and service development required.

The Board considered a joint report which had been prepared by the OCCG and NHS England (Thames Valley) on the current state of General Practice in Oxfordshire and transforming primary care (HWB12).

The Board were advised that the same report had been considered by the Oxfordshire Joint Health Overview & Scrutiny Committee at its meeting on 5 February 2015. The Committee had been pleased to have a constructive discussion with commissioners and providers. It had identified a weakness in the provision of primary care services in areas of growth and recommended that NHS England be considered as a statutory partner when housing growth (large and small planning applications) were considered by Councils. In response to this, James Drury reported that population growth within areas was one of the actions being taken forward by NHS England.

Rosie Rowe, Head of Provider Development (Out of Hospital), OCCG, attended for this item.

Dr McManners introduced the paper pointing out that the Oxfordshire GP service had been nationally recognised as a high quality service but highlighting the pressures on a service which had been designed 50 years previously. He reported that four federal practices had emerged, or were about to emerge in Oxford City, the South East of the county, Abingdon and in private practice (Principal Medicine Limited (PML)), each with their own autonomy and management. All were working to offer services across the various organisations to enable more services to be delivered closer to the patient’s own home. He added that more work was still needed to be done on the skill mix and it was envisaged that senior nurse practitioners, paramedics and home workers would work together with primary care teams to deliver locally based services, whilst working in partnership with acute trusts and other services.

James Drury reported that the joint commissioning process between NHS England and the OCCG was now in place.

At the request of the Board, Rosie Rowe provided further information on the Prime Minister’s Challenge Fund to which the OCCG had submitted a bid for finance to take forward some system-wide ideas such as:

·         A web - based directory – which would provide information on local self- management.

·         Same day primary care access with reference to a neighbourhood hub, giving immediate care where patients did not necessarily need to see their own GP. This would enable longer time to be devoted to appointments where doctors were seeing patients with complex needs and would also free up time for doctors to visit these patients at home. A scheme had already been started in the north of the county.

·         An early visiting service whereby urgent home visits for people with complex needs or frail patients could be undertaken by paramedics and senior nurse practitioners, whilst referring them to Emergency Medical Units (EMU’s) if necessary.

·         Care navigators to support GPs to link in closely with neighbourhood Community Health and Social Care teams (a pilot was underway in Oxford City).

·         New ways of working such an E consultations and the use of skype were also being trialled.

An announcement would be made shortly if Oxfordshire had succeeded in their bid. If not successful the CCG would look at alternative ways of going forward.

Discussion then ensued in relation to the following areas:

-       How GP practices would fare in rural areas when referring patients to hubs if patients did not have available transport – Rosie Rowe explained that rural neighbourhood hubs were currently being trialled in the Banbury/Chipping Norton area to gain a sense of how it might work in a rural setting, adding that, as a result of this, plans may have to be modified. She also explained that it would be purely the decision of practices whether they wished to engage in federation;

-       The availability of paramedics when there was already an insufficiency of ambulances with paramedics in the county – Rosie Rowe explained that practices which had already federated were already in discussion with Oxford Health and the South Central Ambulance Service to address the additional capacity required adding that recruitment to Oxfordshire was an attractive opportunity via an overall workforce plan.

-       The lack of broadband or public transport availability from small villages and whether IT systems were being signed up to – Rosie Rowe responded that IT was a key enabler to these schemes and would be speeded up if the bid was successful. Furthermore, IT inter-operability between practices was becoming more possible and would be most helpful for a patient presenting at a hub in need of urgent care.

-       The importance of cross-border communication in rural areas.

-       Joint commissioners to ensure that information is disseminated as widely as possible during the process to ensure the public are aware of what is happening in their locality.

-       The question of whether further assistance would be required to carry out safeguarding briefings and support for each practice. Dr McManners undertook to pick this up with the safeguarding leads in the CCG and NHS England.

David Smith pointed out that the major challenge for the whole system was how to get capital into primary care premises, the question being should finance be put into improving existing premises or should there be a real increase in resources via expansion?

Following the debate, the Board AGREED to:

(a)  note the report;

(b)  request an update on the outcome of the bid to the Prime Minister’s Challenge Fund and in respect of any further plans; and

(c)  request that Primary Care strategy on the expansion of practices and the joining up of the workforce element be brought back to the Board for discussion.