Agenda item

13:30

The Committee will scrutinise the issues surrounding GP appointments and action being taken by the OCCG and GP Federations (JHO10). It will cover:

·         Contracting for GP Services in Oxfordshire.

·         Extended hours GP appointments – commissioning provision. Availability and uptake of extended hours appointments.

Dr Ed Cao-Bianco, Locality Clinical Director, OCCG; Jo Cogswell, Director of Transformation, OCCG; and Julie Dandridge, Deputy Director and Head of Primary Care & Localities, OCCG attended for this item.

Dr Cao - Bianco introduced the report highlighting the following points:

-       There were 70 appointments per 1,000 patients in a week;

-       Difficulties experienced in the training of GPs;

-       There was a variety of ways that patients could interact with GPs, including telephone and on-line appointments, where patients could complete medical questionnaires and receive a response the same day;

-       E - consult – one of the online consultation platforms via a private provider. The first wave of 10 practices had signed up to this. There had been a slow uptake as Oxfordshire had one of the most aged populations in the country. However, the patients who had used it had found it both easy to use and speedy;

-       A member commented that his surgery did not offer online appointments but offered a morning walk-in service. This had resulted in long waits for patients. It had given the impression that the surgery was managing its booking service rather than conducting a good customer service for its patients. Dr Cao-Bianco responded that there had been challenges with regard to what people needed, whether that was a health care assistant, a mental healthcare worker, or a clinical pharmacist etc. He added that a survey had recently been undertaken on all Oxfordshire GP practices, and it had been found that out of all of the practices in the county, 56 had operated a receptionist triage service. The vast majority operated appointment booking or telephone triage offering appointments afterwards. Not many offered a walk-in system where patients waited to see a doctor, adding a proviso that this could be due to workforce pressures.

A member commented that it was her view that the data submitted masked what was actually taking place on the ground. There were long waits for same day appointments, following triage, for up to 3 hours. She added that this was not a good patient experience and proved very difficult for patients suffering from long-term conditions – adding also that a patient might have to wait 5 weeks to see a doctor who had an oversight of their condition. Julie Dandridge responded that data had been collected on a national basis, not at practice level. Moreover, data from patient surveys was used and detail collected allowed the OCCG to target where patient satisfaction was not ideal. She agreed that the problem with patient surveys was that many people had not experienced anything better than waiting for 3 hours. However, PCNs were already seeing patients coming together to exchange information – and PCNs should solve this with the sharing of practices. With regard to those patients waiting a long time with long-term conditions, Julie Dandridge added that, for those patients where continuity of care was not important was where single and group consultations with specialist nurses helped (for patient asthma and diabetes, for example). Jo Cogswell added also that once the PCNs were rolled out, training would be offered to Committees on what they could offer patients.

Dr Cao-Bianco was asked for his perspective on the length of routine appointments? He reported that they were 15 minutes long in some practices in order to try to manage some of the complex problems experienced by some patients. Some practices gave 10 minutes but gave those patients who saw their named GP as much time they needed. These were then signposted to alternate appointments with other practitioners such as pharmacists and nurse specialists. He added that this would increasingly take place when the PCNs were introduced.

A Member reported that her GP practice was excellent, in that there was a Saturday morning walk-in service for emergencies, which worked very well. She advocated being seen by a different practitioner to the patient’s named one, as often they highlighted different aspects of a condition which might not have been discussed previously. Also, many GPs nowadays worked part-time hours and patients may have to wait a long time to see them.

A Committee member pointed out that GP numbers varied in each surgery in his ward and it was his view therefore that the way doctors were trained needed to be looked at. Health Education England needed to train more GPs who were able to work week-ends and evenings and for all practices to have the ability to move patients to other practices in rotation to even out the numbers. Julie Dandridge added that often patients thought they needed to see a doctor when a telephone appointment would suffice. A member of the Committee who was a retired GP, differed from this view stating that a patient’s pathology could be missed this way, which was mainly emotional.

The Chairman pointed out that the paper submitted had informed the Committee (page 88 on the Agenda) that the numbers of Oxfordshire patients seen by a GP was above the national average by 2.3%. At his request, the OCCG AGREED to circulate this trend data, particularly highlighting the points where they dipped to below the national average. He added that telephone appointments were 10% above the national average. Julie Dandridge pointed out that it would be the national data which would be circulated – when in the future individual practice data was produced, this would be monitored.

A member commented that it was difficult to see how the PCN clustering would work given that there might not be any transport facilities between practices in many rural practices, when sharing services. He asked if patients would have a choice about going to a practice in another PCN? Also would patients be consulted about the plans?  Jo Cogswell responded that the long - term plan was published in January of this year – and detailed guidance was due on 29 March, to date it had yet to be delivered. Implementation would be at the end of July. There was a significant amount of work for Federations, Local Medical Councils and GPs to do in this regard. When PCNs arrived on the horizon, work with Oxford Health was undertaken to think about how practices could be supported. There had been an uncertainty about what to advise one another, and it had been decided to run some workshops in which all were encouraged to work together to deliver a new and enhanced service.

Jo Cogswell added that stage 2 of PCNs implementation would involve a broad range of clinical practitioners. The PPGs were aware that there would be regulations for practitioners to engage in. During the previous week the CCG had run a wider workshop which had involved the locality forum chairs, HWO and third sector providers; the key outcomes for which were about how to engage patients, how to be coherent and consistent and what needed to be communicated.

Jo Cogswell, Julie Dandridge and Dr Cao-Bianco were thanked for their attendance.