Agenda item

Julie Dandridge (Strategic Lead for Primary Care across Oxfordshire -Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) has been invited to present a report on General Practice Access and Estates 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 (Strategic Lead for Primary Care across Oxfordshire - Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) was invited to present a report on General Practice (GP) Access and Estates in Oxfordshire.

Also in attendance to support the Committee and answer their questions were Matthew Tait (BOB ICB Chief Delivery Officer), Dr Michelle Brennan (GP and Chair of the Oxfordshire GP Leadership Group), Rachel Jeacock (Primary Care Lead), Veronica Barry (Executive Director of Healthwatch Oxfordshire), Peter Burke (Chair, Thames Valley Faculty Board, Royal College of General Practitioners), Ansaf Azhar (Director of Public Health at Oxfordshire County Council), and Karen Fuller (Director of Adult Social Services at Oxfordshire County Council).

The Strategic Lead for Primary Care highlighted progress through new approaches and increased GP recruitment. She acknowledged persistent challenges with primary care estates, such as inadequate premises and limited funding, though some expansion projects were in progress. The Strategic Lead for Primary Care also stressed that strengthening general practice was key to future neighbourhood health plans, with further improvements still needed.

The Chair of Thames Valley Faculty Board echoed concerns about estate resources, referencing the Ten-Year Health plan and Leng review. He stressed prevention, evidence-based screening, and the vital role of primary care amid rising demand and insufficient GP growth in Oxfordshire.

Members raised the following questions and concerns:

• How widely the Modern General Practice Model had been adopted across Oxfordshire’s 64 practices. Officers indicated that the model had been implemented as a national programme, not by local GP choice, and that practices had adopted omni-channel access, though the communication to patients about these changes could have been improved.

• What strategies were in place to maintain or improve the current rate of 88% of patients being seen within two weeks. The response explained that maintaining or improving the 88% rate of patients being seen within two weeks depended on continuously adapting systems and being agile, but was fundamentally limited by the finite number of appointments GPs could offer each day due to staffing and estate constraints. The introduction of additional roles through the reimbursement scheme had helped improve access, yet the lack of physical space in practices restricted further expansion. It was described as a "chicken and egg scenario," with improvements in access reliant on both workforce and estate capacity, and while some progress had been made, significant further improvement would require addressing these underlying resource limitations.

• While the patient survey showed above average ease of contacting practices by phone, some practices had as low as 21% reporting easy access, indicating wide variation. The Strategic Lead for Primary Care explained that the ICB supported practices with lower scores by deploying a team to help improve access, sharing successful approaches from higher-performing practices, and introducing cloud-based telephony systems to better manage call queues and reduce complaints about long waits.

It was also discussed and noted that national efforts, such as the red tape challenge and recommendations from the NHS Confederation, aimed to clarify which administrative tasks should remain with hospital clinicians rather than being shifted to GPs, with examples like fit notes after operations. It was also mentioned that new contractual changes from October would require online access to remain open during core hours, potentially increasing administrative burden and raising concerns about the risk of waiting lists in general practice.

• How estate organisation responded to planning applications, the use of section 106 agreements, and the ICB’s approach to prioritising estate improvement projects, including the role of the Community Infrastructure Levy (CIL) in South Oxfordshire, the Vale, and other areas, as well as the ICB’s capacity to release funding in the context of urgent population growth.

It was explained that the ICB generally responded to all planning applications notified by councils and was successful in securing developer contributions, particularly in South and Vale, but faced challenges in spending these funds due to capital and revenue constraints. The use of CIL was highlighted as offering greater flexibility and the ability to accumulate and use funds upfront, with ongoing efforts to expand its use in West Oxfordshire and Cherwell. The urgency of population growth and the need for timely release of funding, especially for projects like Great Western Park, were acknowledged, with the current delays attributed to NHS bureaucratic processes rather than lack of funds.

• What was the best way for local councils to assist the ICB in planning the use of CIL and section 106 funds, and what would be the quickest method to ensure the money was spent. The Strategic Lead for Primary Care indicated that councils should provide clear, written plans detailing their needs for health infrastructure, as this would enable the drafting of robust section 106 agreements and facilitate the allocation of CIL funds. It was noted that processes remained slow due to bureaucracy and grant agreements, regardless of the funding route, but ongoing dialogue between councils and the ICB was encouraged to improve efficiency.

The Director of Public Health noted that rising primary care demand was a national issue, with population growth outstripping GP capacity, especially in Didcot. They highlighted the need for neighbourhood health centres, expanded roles for other clinicians, and clear communication with the public to help manage demand and create additional GP capacity.

The Chair of Thames Valley Faculty Board added that there was now an underused resource of GPs, with some unemployed and even emigrating due to lack of job opportunities, despite calls for more GPs. He suggested that the system should better utilise available GP resources to address demand.

• What safeguards were in place for patient safety regarding physician associates, and whether the ICB had observed any changes in patient outcomes or satisfaction related to their use. It was explained that physician associates generally did not see undifferentiated patients, were supervised by GPs, and had regular debriefs; the ICB had not observed any changes in patient outcomes or satisfaction linked to physician associates.

Cllr Sargent left the meeting at this stage

• How was Oxfordshire preparing to align with the neighbourhood health service model and whether there would be an opportunity to scrutinise the governance arrangements. It was explained that Oxfordshire was at the start of its neighbourhoods journey, already delivered many community services, and was developing layered approaches and governance structures involving the Health and Wellbeing Board, the Place-Based Partnership, and a Primary and Community Care Board, with a commitment to bring back details for scrutiny as arrangements developed.

The Committee AGREED to issue the following recommendations:

1. For the ICB to develop regular reporting on access equity across Oxfordshire, including digital exclusion, rural access, and variation in appointment availability between practices.

2. To publish a rollout plan and evaluation framework for the Modern General Practice model, including metrics for patient experience, staff wellbeing, and service efficiency.

3. To urgently progress and provide a written update on the timeline of delivery of the Great Western Park and Bicester Projects.

4. For the ICB to work with district valuers and local authorities to explore alternative funding models and design solutions for estate expansion where traditional schemes are deemed unviable. It is recommended that the ICB produces a plan for Oxfordshire.

5. For the Committee to AGREE to establish a Primary Care and Community Working Group to conduct a deep dive into some of the challenges in primary care capacity, access, estates, and provision.