Agenda item

10.05

For the Committee to receive a paper from the Oxfordshire Clinical Commissioning Group on the current position of primary care services.

The Committee considered a paper setting out the key aspects of delivery in the provision of primary care services in Oxfordshire, specifically general practice services.  It included appointment data including the significant contribution that was made to the COVID vaccination programme, and recent patient feedback on accessing GP services.

The following people had been invited to participate in the discussion on this item:

from Oxfordshire Clinical Commissioning Group (OCCG) -

Jo Cogswell, Director of Transformation

Julie Dandridge, Deputy Director of Primary Care

Dr David Chapman, Clinical Chair Oxfordshire CCG and GP in Oxford City

Dr Sam Hart, North Network Clinical Director

from the Local Medical Committee -

Dr Helen Miles, GP at Woodlands Medical Centre

Nargis Khan, Practice Manager Representative.

Jo Cogswell introduced the report.  The feedback included information from Healthwatch as well as an engagement exercise conducted as part of the commissioning contract.

The graph at 3.1 in the report was based on a national data set and unfortunately does not go back far pre-Covid.  The number of appointments face-to-face and virtual were shown.  It should be kept in mind that these levels of work were maintained while the vaccination programme was being rolled out.

Dr David Chapman noted that there had always been a mix of interactions and flexibility in the system with a lot of professionals involved, not just GPs.  Covid accelerated the triage-based system.  GP services never closed during the pandemic – they continued to operate under contingency plans for a major epidemic despite the lack of PPE in the early weeks.

Statistics showed that appointments now were up 10% on 2019.  Primary Care should be congratulated for continuing to deliver services thanks to the hard work of GPs, receptionists, practice nurses and practice managers.  A GP gets about 90% of the necessary information from talking and only about 10% from examination.  Patients were always seen face-to-face if it was necessary.  Many patients liked the new ways.  Opinion polls had indicated that satisfaction levels with Primary Care compared very well with other services.

Dr Helen Miles added appointments were really the tip of the iceberg of GP work.  There were also tests, prescriptions, supervision, training etc.  There was now extra work that was traditionally done elsewhere like tests that used to be done in hospitals.  There were also hours of work spent with the administration of different funding pots.  She also outlined staffing issues.  Negative media was impacting on staff morale and turnover was higher than ever.

Nargis Khan emphasised that if it had not been for the technology now available, practices would have had to close at times.  Fortunately staff self-isolating were able to work from home – patients may not have even been aware of the difficulties practices were facing.

Members thanked those working in Primary Care for their hard work in keeping services going through the pandemic.  However, Members were very disappointed at the lack of information on workforce in the report.  There was nothing on the number of GPs, how that was benchmarked against comparable areas, nothing about government plans on recruitment, on quality of premises which must be an issue.  Was there a difficulty with GPs not wanting to be partners in practices – just salaried?  There was nothing in the report that would help Members to respond to the many representations they receive on access to GP services and the report did not meet the spirit of the commission in respect of understanding current pressures on primary care and GPs in particular.

Members also raised a number of other issues:

·       Only 59% of those over 75 got the second booster.

·       Over what timeframe will the advanced telephone system be rolled out to GP practices?

·       The number of practices offering e-Consult appeared to vary across the county.  Many people found it too clunky and ended up phoning anyway.

·       Difficulties accessing GP practices amounted to a significant proportion of casework for councillors.  The experience once into the system was positive but accessing was a problem.  There was a lack of metrics such as call waiting times.

·       There were particular problems for those with mental health needs and other vulnerable populations – with some falling out of the system.

·       There were issues around the length of consultations especially considering that the complexity of health issues was increasing.

·       The public perception was that Covid was over and there was an increased expectation of access to services getting back to normal.  Perhaps clearer communications on the continuing threat of Covid was needed.

·       The survey did not distinguish between the different types of demand – acute, routine or chronic.

·       How will areas of high housing growth impact on the service?  How can the planning system support this?

These were responded to as follows:

·       Weariness had crept in with each round of vaccines.  Those eligible can ask for it at any time.  There was likely to be a new round every autumn – probably with the flu vaccine.  There will be campaigns to encourage uptake.

·       It was expected that the advanced telephone system will be rolled out this year.  It will allow more cross-practice working with other added benefits.  There will still be issues around capacity – people were needed to answer the phones and there was still a limited number of appointments available.

·       All but one practice was using some form of online consultation (e-Consult was one package available).  The systems were used to varying degrees – some turning it on and off according to capacity.  OCCG was working with practices to explore reasons for difficulties and learn from the best practices.  A strategy had been developed to assist practices in their decisions on what system to adopt which will help even out some of the differences.  It would be beneficial for Primary Care Networks to adopt the same system to maximise cross-PCN working.

·       It had been estimated that 6,000 more GPs were needed across the country – the figure was probably closer to 7,500 now.  The workforce issues were in common with many sectors across Oxfordshire.

·       There were also issues with estates nationally with many existing premises unsuitable to cater for current requirements.

·       It was agreed that better metrics on access were required including the profile of calls.

·       OCCG was concerned about the sustainability of GP practices but believed that integration through PCNs will serve them well.

·       Work by Public Health was also important in helping communities especially in the areas of mental health for young people, obesity, housing and recreation.  GPs will play an important role in all of that.

The Chair summarised the discussion:

The Committee appreciated the work of GPs and the Primary Care sector in general through the pandemic and under the current pressures and was committed to supporting future planning for resilience especially on the issues of workforce and estate.

The Chair stressed the importance of whole system working and scrutiny.  The Committee was disappointed at the lack of information on workforce issues.  There was agreement that it would be useful to have a workshop to explore issues in greater detail.  The Committee will look at that in terms of its work programme.

There was an urgency about the estates issue in particular for Didcot and the development around Great Western Park.  The recent developments at Wantage & Grove were welcome and brought hope to the area.

Actions for the OCCG:

·       Provide trend data to be able to compare with pre-Covid.

·       Circulate the results of the March 2022 survey when available.