Agenda item

(To receive a joint report from Sarah-Jane Mills (Chief Operating Officer, Lincolnshire West CCG) and Wendy Martin (Chief Nurse, Lincolnshire West CCG), which provides an update to the Committee on the development of primary care services to meet the patient need following the closure of the Lincoln Walk-in Centre on Monks Road)

Consideration was given to a report from the Lincolnshire West Clinical Commissioning Group, which provided the Committee with an update on the development of primary care services to meet the needs following the closure of the Lincoln Walk-in Centre.

Detailed to the report for the Committees consideration were the following Appendices:-

·         Appendix 1 - Alternative Provision Plan;

·         Appendix 1A -  Alternative Provisions Description;

·         Appendix 1B -  Alternative Provision Engagement Plan;

·         Appendix 1C - Alternative Provision Communications Review;

·         Appendix 2 - GP  Practice Impact Review;

·         Appendix 3  – A & E Attendance Impact Review; and

·         Appendix 4 – NHS 111 Lincolnshire Calls.

The Chairman welcomed to the meeting Dr Sunil Hindocha, Chief Clinical Officer, Lincolnshire West Clinical Commissioning Group (LWCCG), Sarah-Jane Mills, Chief Operating Officer, LWCCG; and Wendy Martin, Executive Lead Nurse and Midwife, Quality and Governance, LWCCG.

The Chief Clinical Officer introduced the report and advised that the LWCCG had as a result of the requests for information raised by the Committee at the February meeting had in the report been able to provide an update relating to the following issues:-

·         Abbey Medical Practice – the Committee had requested further information regarding the impact on this practice following the closure of the Walk-in Centre;

·         GP Practices List Sizes – a question had been raised as to whether there was capacity to meet the demand;

·         GP Appointments/Primary Care Access; and

·         Reception Staff Training.

The Chief Operating Officer, LWCCG advised the Committee that in relating to the Abbey Medical Practice, an additional GP, practice nurse and clinical pharmacist had been recruited to manage presenting demand following the closure of the Arboretum Surgery and the Walk-in Centre.  It was also highlighted that a plan was being developed with a business case, for approval by the Primary Care Commissioning Committee to enable the practice to consolidate their services on to one site.  The Committee was advised that the additional staffing had provided capacity to meet demand; and that work would continue to secure the development of services to one site.  

It was reported that the majority of patients who had attended the Walk-in Centre over the last two years had been registered with GP practices located in the LWCCG.  It was noted that only 3.3% of patients who had attended the Walk-in Centre had been unregistered.

The Committee was advised that the provision of additional resources and better use of existing resources at GP practices had enabled GPs to manage presenting demand.  Appendix 2 to the report provided the Committee with responses from the eight GP practices.

Reference was also made to the fact that the Lincoln University GP practice had actively promoted registration to increase their GP list size to manage their demand, which had resulted in additional registrations and increased daily appointment demand.

In relation to access to pre-bookable and same day appointments, the Committee was advised that any impact had been managed through extended triage, clinics and additional resources or better use of existing resources.  It was noted that a group of practices had come together to extend their evening surgery opening times and also provide Saturday access for patients; and that these would be operational from September 2018

The Committee was advised that making Every Contact Count training was currently being delivered across LWCCG.  The Committee was advised further that 112 reception and administration staff had completed the training and that the rest would be completed by the end of May 2018.

It was highlighted that the implementation of the GP Forward view was increasing time for GPs to provide care. 

Executive Lead Nurse and Midwife, Quality and Governance advised that the utilisation of NHS 111 and the Clinical Assessment Service had increased across Lincolnshire during the winter and spring period.  Appendix 4 to the report provided details of the number of calls to NHS 111 for Lincolnshire.

It was highlighted that A & E data was continuing to be monitored and to ensure that any potential impact from the Walk-in Centre was quickly identified and that plans were put in place to mitigate the impact.  Appendix 3 provided the Committee with comparison information.  It was highlighted further that preliminary data had suggested that there had been an increase in A & E attendance of on average 10 patients per day since the closure of the Walk-in Centre.  Further analysis of the data had then suggested that of the attendances only five from this total were likely to be previous Walk-in Centre users, and that these cases could be accommodated through available Urgent Care Streaming.

During a short discussion, the Committee raised the following issues:-

·         The effect the closure of the Walk-in Centre was having on homeless people.  The Committee was advised that the effect had been minimal as many were using GP practices.  It was highlighted that work was ongoing with homeless organisations;

·         Clarification was sought regarding the information at the top of page 108 relating to A & E.  The Committee was advised that it was not possible to provide definitive data whether these patients who attended A & E would have previously attended the Walk-in Centre; as this had not been a question that had been asked of those attending A & E.  The main focus had been on educating patients to contact their GP or Out of Hours provision;

·         One member requested further information regarding GP Optimisation.  The Committee was advised that GP Optimisation enabled GP practices to make the most effective use of primary care resources by transforming the way administrative tasks were carried out within general practice;

·         A question was asked as to what improvements had been made to remedy the issues residents were experiencing accessing 111; and also the issues faced with differing services offered across the pharmacies.  The Committee was advised that the 111 and Clinical Assessment Service in Lincolnshire were leading the way.  It was noted that the 111 and the Clinical Assessment Service considered carefully the issues raised by patients, making sure that the advice given was appropriate.  The Committee was also advised that urgent repeat prescriptions were now available through contacting 111.  It was noted that a least 80 pharmacies had signed up to provide the service in Lincolnshire;

·         The timescale for the services at the Abbey Surgery to be consolidated – The Committee was advised that this was still work in progress; and

·         Whether there were any issues around the signposting to the correct service for the publics needs and issues with regard to quicker access to GPs and what was being done to improve this.  The Committee was advised that there were four Clinical Pharmacists based in the Lincoln who would see patients and free up GP's appointment time where appropriate. Same day access for urgent need was available at all practices. It was noted that additional appointments were being provided at the University of Lincoln practice; and that a pilot to use Skype appointments was being explored.  

In conclusion, it was agreed that a large amount of work had been carried out since the February 2018 meeting; and the Committee agreed that a progress report should be received by the Committee in six months' time.

The Chairman extended thanks on behalf of the Committee to the three LWCCG representatives for their update.

RESOLVED

1.    That the report presented concerning Access to Primary Care – Lincoln Area be received.

2.    That a progress report be received by the Health Scrutiny Committee for Lincolnshire in six months' time.

The Committee adjourned at 1.00pm and re-convened at 2.00pm.

Additional apologies for absence for the afternoon part of the meeting were received from Councillor M T Fido and Dr B Wookey (Healthwatch Lincolnshire).