Agenda item

General Practice Access and Demand

(To receive a report from the Lincolnshire Local Medical Committee, which provides the Committee with information relating to GP access and demand.  Dr Kieran Sharrock, Medical Director will be in attendance for this item)


The Committee gave consideration to a report from the Lincolnshire Local Medical Committee, which provided an update on General Practice (GP) access and demand.            


The Chairman welcomed to the meeting Dr Kieran Sharrock, the Medical Director of the Lincolnshire Medical Committee.


It was reported that all health services were seeing increasing demand; and a change in the complexity of medical needs.  It was highlighted that there was now an increasingly frail and older population; and more patients with multiple long term medical conditions.


The report highlighted that nationally there had been a drop of 600 GPs from January to December 2018, with 230 less GP partners.  Despite shortages, GPs were trying to provide appointments for patients on basis of need; and that each practice had a different method for doing this, some having 'sit and wait' clinics; and others using a duty-doctor system.  The report provided a list of possible solutions to help with demand and access issues.


It was highlighted further that Lincolnshire was adopting all of the solutions over time, as it was felt that these approaches would provide better health outcomes for patients.  Details of workforce initiatives in progress and their results were shown on page 105 of the report.  The Committee was advised that the workforce modelling and planning had utilised Whole System Partnership's Strategic Workforce Integrated Planning and Evaluation Framework, which provided a strategic approach to transformation, incorporating population needs, the future vision for meeting these needs and workforce requirements.  Detailed at Appendix A to the report was information relating to the Strategic Workforce Integrated Planning & Evaluation (SWiPe) Framework.


It was highlighted that care navigation was in place across the county, which directed patients at first point of contact to the most appropriate professional for their care.  It was highlighted further that the professional seen might not always be a GP, but could be a pharmacist or advanced nurse practitioner.


In summary, the Committee was advised that general practice in Lincolnshire was under pressure, due to workload shortages. To help ease this pressure a number of solutions were being implemented by the Lincolnshire system, but as mentioned earlier this would take some time to come into effect.


 During discussion, the Committee raised the following issues:-


·         Charging patients for missed appointments – The Committee was advised that this was not something GPs could introduce, as there was no basis in existing NHS law to make charges for missed appointments; and furthermore, there would have to be a change to the national policy for such a suggestion to be implemented.  The Committee was advised further that such a scheme would probably cost too much to administer;

·         Up skilling of practice staff. It was reported that this was already being done across the county, patients were being directed to the most appropriate professional;

·         The need to encourage people to take more responsibility for their health; and for more focus to be placed on prevention, particular reference was made to obesity, health and wellbeing, and diabetes;

·         Some concern was expressed to the continued unavailability of GP appointments.  The Committee was advised that new initiatives were in place with Primary Care Networks to share telephony and IT and to have a Central Hub, which would provide additional capacity. The Committee noted that 'Ask my GP' on-line App was being trialled across the county.  Some members felt that further training needed to be given to receptionist staff.  The Committee was also advised that a NHS App had been launched in September 2018, which provided access to Choice and Information.  It was highlighted that GP surgeries also provided the option of on-line booking of appointments. A suggestion was made for GP's in one locality to operate from one building. The Committee noted that all GPs were independent and that the proposal of such working arrangements would work better in an urban area.  A further point highlighted was for patients who worked, there was still no ability to pre-book an appointment.  One member enquired what safeguarding measures would be in place with regard to online consultations, for example to prevent misdiagnosis.  The Committee was advised that online consultations would not be replacing face to face consultation; they would just supplement them; as there were many conditions that did not require face to face appointments;

·         The issuing of proof of sickness notes – Confirmation was given that this process did not warrant being seen by a GP, a proof of sickness note could been completed over the phone;

·         Training of GPs – The Committee was advised that the whole training process for a GP took 10 years.  It was highlighted that at the moment Lincolnshire had a good record of retaining doctors that had trained in Lincolnshire.  It was noted that some doctors after graduating from medical school were not taking up a medical profession, and that between 10 per cent and 20 per cent of trained doctors left the profession straight away; and

·         One member enquired as to how practices general felt about the changes?  The Committee noted that the majority of practices were willing to embrace the changes.  There was recognition that any changes had to take into consideration the older population.  Confirmation was given that all practices still made home visits based on clinical need.


The Chairman on behalf of the Committee extended his thanks to Dr Sharrock for his informative update.




That the update report relating to General Practice Access and Demand be received.        

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