Agenda item

14:00

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG) will present the draft framework for Primary Care in Oxfordshire. The framework is attached at JHO10.

David Smith, Dr Joe McManners and Julie Dandridge, OCCG attended for this item.

The Committee had before them a paper produced by the OCCG setting out a draft framework for primary care in Oxfordshire (JHO10). The Chairman, in introducing the item, referred to the Committee’s discussion at the last meeting and the questions arising from it. A major issue raised was what could be done about the problems in the short term.

David Smith introduced the draft framework citing all the issues that primary care had experienced over the last 10 years, such as a rise in the numbers of older people with complex needs, double numbers of consultations for the over 80’s and the difficulties in recruiting and retaining GPs and other professionals in primary care. He explained that the OCCG was trying to identify a broad strategy to be used by groups of GP practices, localities and neighbourhood areas. This would entail looking at population groups, ways of expanding the workforce and at issues relating to premises. An action plan would be compiled looking forward and also looking at what was required in the short-term, such as how to attract more GPs and professionals and also to look at how to establish different roles within practice teams.

Questions asked by the Committee were in the following areas:

·         The size of the GP units – was there a standard size?

·         Whether practices were being encouraged or ‘nudged’ towards working together;

·         The recruitment of more doctors;

·         The appropriate circumstances to award a 15 minute appointment;

·         Progression of 7 day a week working in GP surgeries;

·         More funding for larger practices;

·         Installation of IT to support the changes;

·         Inclusion of patient transport in the framework – not just for older people, but for all ages needing it;

·         The impact of the framework on residents in Bicester and Banbury;

·         Whether practices were opting out of the Out of Hours service;

·         It had long been noted that patient discharge would be made more rapid in the future. Did the Framework take account of this?

·         When would there be consultation on the Framework?

Answers received were as follows:

·         The Strategy was not about stipulating practice size, it was more about working across practices of approximately 30-50k residents in a neighbourhood with multi-skilled teams. There was a need to look at having a few practices working together, sharing the risks and even teams. This was the direction of travel the service had seen over the last few years;

·         The OCCG was careful not to stipulate how practices should be organised because, for example, City practices were very different to those in Banbury and the strategy would have to work for the local area. This was a framework, not a plan. However, the OCCG would assist them in their move towards a better service, such as the establishment of clinical pharmacists in GP practices who would follow up on notes, blood results etc. Practices would also need to ensure that there is proper value for money for services;

·         The recruitment of more doctors was a local and a national problem.  The OCCG was looking at how to make Oxfordshire more attractive to doctors and other professionals. GPs were very reliant on the teams surrounding them. If the workload balance was right in the practice, then the OCCG could begin to attract people. It was often found that if a surgery was difficult to recruit to, then a downward spiral would result;

·         Some practices gave 15 minute appointments already and also had a triage in place as it was important to identify the right patient to provide for. A clinical triage process was carried out by a GP or nurse. Patients were encouraged to see a nurse or pharmacist for minor illnesses. There were a number of models for this and the OCCG was not going to be prescriptive;

·         Most surgeries were increasing access to additional appointments from 1 February, and in Oxford City from 1 March. Information regarding this could be found on individual practice websites. No contact for routine appointments could be made at weekends when the Out of Hours Service or Service 111 was available for urgent access. Not all practices would be operating 7 days per week all at the same time. The Government had to provide 30 minutes for every 1,000 patients. At the moment it was not looking to provide appointments all day Saturday and Sunday. There was a need to look at demand and the availability of appointments. GP or nurse appointments were already being offered across the county for at least one and a half hours in the evening and at least 3 hours on Saturday and Sunday. The OCCG was trying to tie the hospital and GP appointments together in a pragmatic way. By working across practices there could be quicker access for patients;

·         The OCCG needed to think about whether there were sufficient numbers of patients in a locality to require a particular service to be run. For example, a diabetic specialist nurse might be available in a locality, but not a bone cancer nurse. The challenge was to get as good a fit as possible with what funding, staffing, local access, etc. was available. If there was a group of practices specialising in care for older people, this could be pooled. This would also support the aim of giving more support to older people in their own home;

·         Much of the IT and technological work had already been implemented. GPs could already see each other’s records in a large part of the county. There was a need, however, to work across practices sharing good practice;

·         Currently GP practices were paying for their own transport for patients. More work was required on this, together with thought given to options to provide it for all age groups. Investment had already been made in holistic services, for example, the OCCG was looking to trial more local drop-in services to be available at the end of the school day. Julie Dandridge undertook to report back to the Committee at a future date on this issue;

·         The OCCG had discussed services in neighbourhoods in Bicester and Banbury. The manner in which the services would be designed would depend on where the patient was registered;

·         GPs are independent and separate businesses – it is their choice whether to join a large hub which includes an Out of Hours service;

·         With regard to patient discharge, there was a need to become more creative in Oxfordshire with, for example, joint posts with acute hospitals, or with combining research with clinical practice and seeing patients. Furthermore, a full day’s work used to be a lot less than nowadays. This was one of the reasons why doctors were retiring. It was thought that better use could be made of the John Radcliffe as a teaching hospital. As more patients are discharged earlier from the OUH, there would need to be proper multi-skilled teams of hospital doctors and GPs to provide aspect. The Framework was about looking at people’s health holistically from a biological and a social side;

·         Consultation on the Framework would be part of Phase 2 of the OTP consultation but, in the meantime, the OCCG would wish to engage with GP practices about what it meant for them. The discussion would be based on where primary care fitted in with community hospitals/community care. Also, to inform the Phase 2 consultation, thought needed to be given to what network of services would be provided in the patient’s own home. Discussion groups and forums had already taken place on this subject. These discussions would roll out more widely once the OCCG could be more specific about what was happening in the localities.

All were thanked for their attendance.