Agenda item

14:15

The Committee will scrutinise the issues surrounding the local GP Federation landscape across Oxfordshire (JHO11). It will cover:

·         What are the Federation funding arrangements?

·         What are the Federation governance arrangements for public transparency and accountability?

·         How is the quality and effectiveness of Federation-delivered services understood? How successful are they meeting those performance and quality standards for residents across Oxfordshire?

·         What are the challenges and opportunities for Federations in Oxfordshire?.

The following representatives of the GP Federations attended the meeting to present their reports and respond to questions:

·         Dr Ben Riley and Dr Louise Bradbury from OxFed

·         Derek Sprague, CEO, Abingdon Federation

·         Andrew Elphick, CEO, PML

·         Dr Ed Capo-Bianco, SEOx

Andrew Ephick recognised that delivery of Integrated Care is critical.  It acts as a glue between practices and facilitates more consistent provision. The Oxford Care Alliance are willing participants though not formally constituted yet.  They deal with primary care and community services.

The federations have sought to engage where any practices were in crisis.  Their policy is to support individual practices first, then look at working with neighbouring practices and to step in only if all that fails.

Asked about Patient Care Networks (PCNs), Dr Ben Riley said that they would be particularly beneficial for those with frailty or multiple issues.  He said that it has been the federations’ experience that practices at the scale of 30 to 50,000 patients work well.  At that scale 19 PCNs would be needed in Oxfordshire.  The networks could better share resources such as IT, communications, appointments, GDPR knowledge and facilitate team systems, career development, disease prevention and health promotion.  They will be able to think more about the community needs.

An Oxfordshire training network has been set up to help improve failing practices and address workforce issues such as when a partner is retiring.

The federations have funding for a mentoring scheme to help improve efficiency in practices.  There is a risk of greater access issues for PCNs in rural areas.  Despite Oxfordshire being relatively attractive, the county has only 85% of the GPs it needs.

Dr Louise Bradbury described how networked practices can provide additional roles such as social prescribing, clinical pharmacists and paramedics.  These have been well received by practices and patients.  The whole team can learn from each other.

OxFed has seconded paramedics to offer home visits where they can assess and sometimes make decisions or discuss the next steps with the GP. They can make a big difference to GPs’ lives but it is not clear yet if it will help with availability of appointments.

Derek Sprague warned that paramedics are a scarce resource as they are sought by the acute sector as well.

Councillor Hilary Hibbert-Biles expressed concern about competition for paramedics with the ambulance service.  They are also used as first-aid units outside normal hours.

Andrew Elphick responded that they are training their own paramedics as well.  Individual paramedics look for different work experiences.

Dr Louise Bradbury stated that all parties are talking to each other – they share the same set of patients – and ensure that resources are apportioned as appropriate.  Being able to assess needs across networks enables better decision-making.

Dr Keith Ruddle expressed concern that a rush towards new arrangements will take over without any health improvement.  There were pay-offs in scale but disadvantages at a local level too.  He said that everyone needed to work with the communities on this.

Dr Ben Riley said that federations are trying to help PCNs by working on model frameworks, templates for governance and decision-making.  Data protection is a difficult issue as practices do not have the expertise individually.

Derek Spraque added that they have begun conversations on improving district nursing and community services.

The federation representatives gave examples of how they work together:

·         employing Data Protection Officers

·         visiting each other’s practices, sharing learning and replicating elsewhere

·         networking clinical systems to enable consultation across practices.

Andrew Elphick stated that the PCNs all have federated practices.  They will not disappear but will operate between PCNs.  He clarified that Year 1 of the process starts from 1 July 2019.

The Chairman thanked the federation representatives for a very useful engagement.