Agenda item

11.05

This item enables the committee to look in detail at how the commissioning and delivery of primary care is changing. A background report (JHO7a) prepared by the current primary care commissioners at the Primary Care Trust sets out the background and key changes of the four areas of primary care; medical, dental, ophthalmic and pharmacy

 

Representatives from the Primary Care Trust, Clinical Commissioning Group, Commissioning Board (Local Area Team) and Local Medical Committee (GP representatives) will be attending the meeting.

 

The second paper (JHO7b) provides members with background and an update on the contract performance of the Banbury Health Centre (GP-led Health Centre).

 

Also included is an update report (JHO7c) outlines Oxfordshire PCT’s position on the provision of annual health checks to people with learning disability and reports progress so far this year.

Stephen Richards, Chief Clinical Officer, OCCG

Ginny Hope, Head of Primary Care Contracted Services, NHS Oxfordshire

Dr Geoff Payne, Medical Director, Thames Valley Local Area Team, NHS Commissioning Board

Dr Prit Buttar, Chair, Oxfordshire Local Medical Council

Dr Paul Roblin, Chief Executive, Local Medical Council, Thames Valley

Angie Eachus, Programme Manager, Primary Care, NHS Oxfordshire,

 

Primary Care

The Chairman introduced the discussion by explaining that about 90% of the public’s contact with health services is through primary care, but this committee has not examined it before.

Ginny Hope gave the committee a short overview of Primary Care in Oxfordshire. The NHS is currently undergoing its most radical reorganisation in sixty years. There are new functions and new relationships that have to be developed. Under the new structure there will be a single performance model and single set of performance data. There will be an increased role for local government through Health & Wellbeing Boards.

 

GPs

The chairman asked about the future of the various GP contracts currently in existence (GMS/PMS/APMS).

GP contracts will be negotiated at the national level, although APMS contracts will still continue. There will be reductions in the resources and funding available for GPs, although the exact figures are currently unknown. The committee will be informed once the amount becomes available.

 

Oxfordshire is considered a wealthy and healthy county, so will face greater funding pressures than elsewhere. The expectation is that most practices will lose several thousand pounds, but some will see six figure reductions. These losses will inevitably impact the services provided and staffing.  However, whilst funding has shifted to secondary in recent years, the introduction of GP commissioning and the move to community-provided services (mirroring in a way the old out-patient clinics) means GPs have faced an increased workload. There is a requirement for a mix of clinical and managerial skills in the service, but variation in the quality of management across the county’s 83 practices needs to be addressed.

 

Medicines Usage Review

There are far more medicines available now than in the past. Regular reviews ensure patients are taking the right medicines for their conditions. This is particularly important for those taking a variety of medicines as combinations can cause issues. There are benefits to working with community pharmacies to ensure reviews cover over-the-counter medicines and any herbal supplements people might be taking.

 

Rural dispensing

The committee asked about rural dispensing.

29 practices in rural areas can also dispense medicines. There are still gaps in provision, although rural dispensing is tightly-regulated to reduce potential conflicts of interest and impacts on other dispensers. No practice is allowed to dispense if there is a pharmacy within a radius of 1.6km.

 

Service commissioning

Primary Care will be commissioned by the Local Area Teams of the NHS Commissioning Board. Whilst there is a single operating model, they take a cross-Thames Valley approach. The relationship between GP commissioning and the local area commissioning team is an important issue for OCCG.

 

Cllr Pressel asked if the traditional model of general practice can survive.

Cheaper ways of providing GP services need to be found. There is an increasing reliance on salaried staff and locums, as well as a higher turnover of staff, which can impact on continuity of care. This also reflects the trend in new entrants moving away from traditional 365 GP work.  Concerns also exist that contracts for health centres like Deer Park in Witney are too easily dominated by big conglomerates and that local GP groups cannot compete. It was noted, however the commissioning boards cannot assist with bid preparation without risking legal challenge. The role of the commissioner it was noted is to hold under performing primary care to account in the way that happens with underperforming schools.

 

There are national rules on how large a tender has to be, and the commissioners have a range of contracts they can choose to employ depending on the situation. However, a provider’s previous service history cannot be taken into consideration when assessing tenders.

 

The committee asked if Banbury Health Centre is value for money.

 It is run by local shareholders and is a dedicated local provider. Although the creation of the centre was imposed from above and it receives three times more funding per patient than other practices, it is open for longer and provides services to groups that have been difficult to reach in the past. Whilst it means that funding is being distributed disproportionately to the north of the county, the experience gained could be used to provide a similar service in Oxford. The committee were keen to see that learning is shared across the county.

 

The committee asked about arrangements for patients using services in other authorities. Patients living on the county’s borders have often used GP services in other counties, and there are long-standing processes to handle this which will continue under the new regime.

 

Learning Disabilities Services

The committee expressed concern about access to services for those with learning disabilities. There were now 79 practices signed up for the LD healthcheck scheme, and that they were still being supported by liaison nurses.  Around 2000 people have been identified as requiring services. The Health & Well-being Board has said that the service should be offered to all those who require it. 

The Local Medical Council said that as they were discretionary services not all practices were offering the services themselves although all had access to a register of where they were available so can refer patients.