Agenda item

Julie Dandridge (BOB ICB Lead for Primary Care across Oxfordshire) has been invited to present a report on GP provision in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Julie Dandridge (BOB ICB Lead for Primary Care across Oxfordshire) and Dan Leveson (BOB ICB Place Director, Oxfordshire) presented a report on GP provision in Oxfordshire.

The BOB ICB Lead for Primary Care across Oxfordshire introduced the report. Addressing an item on which the Committee had previously received a briefing, the partners at Botley Medical Centre had handed back their contract the previous year and the ICB worked with the residents and the Patient Participation Group around Botley Medical Centre and with local providers to find two new practices willing to take on the patients. The draft Primary Care Strategy had been co-produced with a number of stakeholders and the feedback was being collated into a final version, to be signed off by the ICB Board in May. There was a recognition of the increase in GP appointments, but also an acknowledgment that patients and the public were still having difficulty getting through to GPs by phone to get an appointment. There had been much progress in improving primary care estates. Some things were unfortunately beyond the control of the ICB, but work was continuing with GP leaders to try and improve access for patients.

The Committee asked in what respects had the National Recovery and Access to Primary Care Programme funded, influenced, and shaped the decisions and measures taken around GP provision in Oxfordshire. The BOB ICB Lead for Primary Care explained that the national primary care access and recovery. had come with some funding to support it. This funding was partly for practices to have time to implement what they called modern general practice, which involved assessing how and by whom patients should be seen. All their practices had submitted plans on how they would do this at the primary care network level. There was also funding for IT, specifically to ensure that all their practices had functioning cloud-based telephony and to drive forward other innovations in IT.

The Committee queried the extent to which the development of the Primary Care Strategy involved adequate levels of public and stakeholder engagement. The BOB ICB Lead for Primary Care had stated that engaging everyone was challenging. They had co-produced the draft strategy with GP leaders and Primary Care Network clinical directors, and held webinars and sessions for the public and professional colleagues. A detailed public engagement report was available, and Healthwatch had been used to disseminate information and hold seminars. Feedback received from public engagement indicated a need for more co-production of communications. The strategy would only work if the public was taken along, their concerns understood, and if they helped to drive it forward. Engagement on the strategy had closed as they wanted to get a final strategy out and ready. The strategy was put in place to help with the challenges faced by GPs and the public in terms of access. None of the components in the strategy were going to be mandated but were suggestions to colleagues in general practice on how to progress to enable better access for patients. There were good examples of where some of the integrated neighbourhood teams and acute same-day hubs really worked and made a real difference to patients and access, but it was not going to be universal. In terms of further engagement, this would now take place locally as they defined and shaped it for every local footprint.

The Committee asked for more information about the development of proactive and personalized care in the community setting for people with complex health needs.

The BOB ICB Lead for Primary Care emphasised the importance of the development of care closer to home, with services being moved out of hospitals into the community for easier patient access. Integrated neighbourhood teams were brought together, uniting experts in care to move things forward in a unified direction. This was part of developing a patient-focused approach, which had been implemented in some cases, but not optimally across all areas. Resources included NHS staff in the community and staff in general practice. The goal was to join up and streamline processes, using the same records to release capacity for personalized care for those who needed it most. There were many teams that needed to be brought together to drive this forward, and good work was being done across Oxfordshire to achieve this in certain places.

The Committee enquired as to whether any extensive progress had been made for the ICB to work closely with District Councils to enhance GP access and services and deal with primary care estate issues. The BOB ICB Lead for Primary Care had explained that their town planner was actively participating in the district councils' planning discussions, building relationships, and driving things forward in a more organised manner. The engagement with individual councillors was primarily through the officers rather than direct interactions with the councillors themselves.

The Committee queried whether the Great Western Park project in Didcot was going according to plan. The BOB ICB Lead for Primary Care stated that they had made significant progress with the Great Western Park development. This progress was marked by the ICB's agreement and the extension of the Section 1 agreement that was already in place with the developer. The council was preparing to receive the land and the fund. Despite the complexity of the legal agreement involving three or four parties, they were on the right path and intended to maintain the momentum. The next steps, which included finalising the legal agreements and submitting a planning application, were clearly in sight.

The Committee enquired as to whether there was any record keeping of ‘failed service requests’, and whether this was followed up. The BOB ICB Lead for Primary Care had responded that, at that time, the only method of testing was through the GP patient survey. Nationally, from October, call data would be collected. They acknowledged the existence of a significant amount of unmet need and emphasised the importance of reaching those individuals who might be deterred from accessing their GP if they failed to get through. Regarding how to assist these patients, more work needed to be done on the ground with patients, including working with support groups, to ensure these individuals could access the necessary services.

The Committee asked whether the ICB monitored each practice against requests for online and urgent appointments being closed. The BOB ICB Lead for Primary Care explained that the Primary Care Strategy was initiated to address the need for capacity in general practice. The ICB was aware and captured details about practices that struggled to remain open due to a lack of capacity and appointments. The default solution was to use the 111 service, which could perform early triage and determine the urgency of a patient's need to be seen, but efforts were being made to assist practices that regularly had to switch to the 111 service.

The Committee queried whether the ICB was reviewing the number of GPs and number of additional primary care roles per practice. The BOB ICB Lead for Primary Care acknowledged that there was variation across GPs. They utilised several data sets, including the Patient Access Survey, which consistently ranked practices and provided a clear indication of where they needed to focus on. This was something they constantly monitored and provided support to a number of practices for.

The Committee asked how the ICB was anticipating future housing developments and population increases. The BOB ICB Lead for Primary Care explained that their town planner played a crucial role. The planner was meeting with officers to review upcoming plans and submit requests for support for general practice primary care infrastructure. There were plans in place in some locations, for example they had strategies to increase provision across Bicester and Kidlington using developers' contributions. The planner was aiming to look ahead, to create long-term plans rather than reactive ones.

The Committee asked whether the ICB thought there was a need to explore more strategically the potential to partner with the local authorities in provision of new primary care premises. The BOB ICB Lead for Primary Care mentioned a Section 2 agreement for working in collaboration with local authorities and councils, which was a significant opportunity for general practice on the ground. They acknowledged that the ICB had no capital, and their only source of funding was through revenue. They saw potential opportunities in collaborating with local authorities and expressed a strong interest in exploring them.

The Committee asked why the initial focus was on prevention around cardiovascular disease. The BOB ICB Lead for Primary Care responded that they believed there was still significant room for improvement in cardiovascular disease. They acknowledged the substantial benefits this could have, not only for patients but also for the system and resources. They confirmed that cardiovascular prevention had been agreed upon as a BOB system priority. However, they had also received feedback suggesting that prevention should not be limited to just cardiovascular disease but should also encompass areas such as oral health and children’s preventative health. The ICB did not want their strategy to be so broad that it encompassed everything and ended up delivering nothing, which was why they narrowed their focus to one area. However, they anticipated that other aspects of prevention would be broader than just cardiovascular disease.

The BOB ICB Place Director for Oxfordshire added that cardiovascular disease was identified as the leading cause of premature death and noted a significant inequality in its occurrence, which explained their focus on it. The BOB ICB Place Director and the Director of Public Health chaired the Prevention Health Inequalities Forum and were examining better access to and advertisement of NHS health checks, and had made significant investments promoting activity. They emphasised that there was a lot to do, and that they needed to preserve with prevention and inequality work, as the positive impact from this would be more visible in the long term.

The Committee enquired as to how the GP retainer scheme would help to enhance the retention of GPs. The BOB ICB Lead for Primary Care explained that there was a 'new to practice' GP fellowship that provided support to new GPs and the implementation and delivery of the Primary Care Strategy could attract new GPs. The introduction of innovative ways of working with patients was thought to help retain GPs and the developments to roles were found to be very rewarding for the staff.

The Committee asked whether administrative staff received appropriate training in being able to support clinicians and patients. The BOB ICB Lead for Primary Care responded that the receptionist had traditionally been the first point of contact for someone trying to access a GP appointment. They were upskilling those receptionists to become care navigators so that they could direct the right patients to the right place. The reception staff were trained to understand what the important questions were so that they could point patients to the right clinician; whether that be a pharmacist, a physiotherapist, or the GP. There was a national training program for receptionist care navigators and most practices had their own training in place as well. All NHS staff, including administrative staff, were bound by confidentiality. The ICB was committed to work with the public to help shape what information they needed to participate and feel confident in the range of staff that were now working in general practice.

The Committee asked what could be done to alleviate the pressures in community pharmacy. The BOB ICB Lead for Primary Care replied that Pharmacy First had launched on the 31st of January and it was welcomed by the profession and by community pharmacists. As Pharmacy First developed and as more conditions became available for pharmacists to treat, it brought more income into the community pharmacy, which was really welcomed by their pharmacies, especially smaller independents.

It was AGREED that the BOB ICB Lead for Primary Care would provide the Committee with a breakdown of how funds from the National Recovery and Access to Primary Care Programme were being spent.

It was also AGREED that the BOB ICB Lead for Primary Care would liaise with the ICB Director of Comms and Engagement to respond to the Committee’s question on what prevented the ICB and the local managers from taking on board the scrutiny committee feedback about engagement.

The Committee AGREED to issue the following recommendations to the ICB:

1.            To ensure continuous stakeholder engagement around the Primary Care Strategy and its implementation, and for the ICB to provide evidence and clarity around any engagements adopted and on key feedback themes that were received from within Oxfordshire. It is also recommended that there is a clear implementation plan to be developed as part of the Primary Care Strategy, and for this to be shared with HOSC and key stakeholders.

2.            To continue to work on prevention of medical and long-term conditions besides cardiovascular disease.

3.            To review ICB capacity to ensure adequacy, with a view that the ICB can work in a timely way with all District Councils across Oxfordshire on the securement and spending of infrastructure funding.

4.            That an expected date for the signing of the legal agreement on Didcot Western Park is provided to the JHOSC, so there can be reassurance about the likely timescale for the tendering process.

5.            That the ICB checks which practices are closing e-connect and telephone requests for urgent appointments and for what reasons; and that there is a communication with the public to provide improved clarity and communication about the statistics concerning access to appointments.

6.            For there to be clarity and transparency around the use of any competency frameworks and risk assessments around the role of non-medical staff who are involved in triaging or providing medical treatment to patients.