Agenda item

(To receive a report from the Lincolnshire Clinical Commissioning Group, which provides the Committee with information on primary care services.  Sarah-Jane Mills, (Chief Operating Officer, Lincolnshire Clinical Commissioning Group) will be in attendance for this item)

The Chairman welcomed Sarah-Jane Mills, Chief Operating Officer, Lincolnshire Clinical Commissioning Group to the meeting and invited her to present the report to the Committee.

The item as detailed on pages 37 to 77 of the agenda pack provided the Committee with information of GP primary care services in Lincolnshire.  The report also provided an overview of the national requirements from primary care during Phases 1, 2 and 3 of the responses to Covid-19; the current arrangements and plans for continuing to ensure local people can access primary care services; and the future development of primary care services as part of the wider integrated care offer from health and care.

Attached to the report were the following Appendices for the Committee to consider:

·       Appendix 1 – A copy of the Lincolnshire Primary Care Network Alliance

– Annual Report 2019-20;

·       Appendix 2 – Primary Care Access Arrangements; and

·       Appendix 3 – Case Study regarding the introduction of Ask my GP.

The Committee was advised that since 5 November 2020, the NHS had returned to Incident Level 4.  This meant the NHS had moved from regionally-managed, but nationally supported Incident Level 3 to one that was co-ordinated nationally.

The Committee was advised that the most significant changes patients had experienced in recent months had been the introduction of remote consultation.  Appendix 2 to the report provided the Committee with a list of all practices and the arrangements that had been adopted to facilitate remote consultation.  It was highlighted that there were three methods being used by GP practices across Lincolnshire, these were: Telephone consultation; E-Consult; and Ask My GP (Appendix 3 to the report provided details of a case study of Ask My GP).

It was reported that one of the core services provided by GPs was to support patients who were vulnerable.  The type of additional support provided included the review of care/treatment plans; remote consultations and home visits when necessary; home delivery of medications; and outreach contacts from wellbeing services and volunteers.

The Committee noted that when the NHS had declared a national level four incident, the Clinical Commissioning Group had established a Primary Care Cell.  It was noted further that the role of the Primary Care Cell was to provided direct support to GPs and primary care colleagues; co-ordinate a response to the national request; and assist teams and managers to manage local issues and integrate with the wider system.  

Page 45 of the report pack provided the Committee with details of the on-going development of primary care services.  It was noted that Primary Care Teams would continue to provide support to GP practices, as they worked together as Primary Care Networks and other agencies to develop service provision arrangements. 

In conclusion, the Committee was advised that primary care services were and would continue to be available to people across Lincolnshire.  There was recognition however, that the accelerated introduction of remote consultations had not, in some instances given time for practices and their patients to understand how best to use the new facilities.  The Committee noted that feedback from patients and practices pre-Covid-19 had shown that the arrangements could be effective.  It was further noted that some practices needed to upgrade their infrastructures; particular reference was made to telephony systems, as some practices were having problems coping with increasing demands.

During discussion, the Committee raised the following points:-

·       What level of complaints the Clinical Commissioning Group (CCG) and Primary Care Networks (PCNs) were receiving regarding the lack of access to GP appointments and telephone access problems.  A request was made for numbers and trends regarding complaints to be shared with the Committee.  Confirmation was given that there had been some complaints and the Trust was happy to share this information with the Committee.  The Committee was reminded that the changes had been expedited as a result of Covid-19, and that specific areas of concern highlighted were being addressed.  The Committee noted that the use of E-Consult had provided patients at some surgeries with greater access.  PCNs had also gone from strength to strength, as GPs were able to signpost patients to the right professional, as in some cases, the GP was not always the right person to see.  Some members provided examples of their personal experiences, which in one instance had highlighted that patients were not being made aware of the different access options available open to them from their surgery.  Some concern was also expressed at the length of messages a patient was confronted with when making contact with a practice.  The Committee was advised that work was on-going in relation to national message requests; and that the CCG was supporting practices to develop their own individual messages;

·       Reference was made to pages 73-75 of the report which stated that a number of the PCNs had e-consultations planned.  A question was asked whether the timescales for this was available and could this information be shared with the Committee.  The Committee was advised that this information would be shared with the Committee;

·       What future planning had been done to take into consideration an increasing population, as a result of increasing housing development and the effect this would have on GPs and PCNs.  Confirmation was given that there was no development threshold at which the NHS should be consulted.  Reassurance was given that the NHS was working with all district councils on developer contributions for health care facilities, and that any help for practitioners regarding this matter would be appreciated;

·       Funding of additional professional roles within a PCN.  The Committee noted that each PCN had a budget to recruit professionals required, based on the needs of the local community.  The Committee noted further that the last six months had seen better recruitment and that First Contact Practitioners was an initiative that would be rolled out across the whole of England;

·       Reassurance was sought as to whether there was sufficient Personal Protective Equipment available to deal with the second surge of Covid-19.  Reassurance was given to the Committee that stronger supply arrangements were now in place for GPs; and that supplementary arrangements were also in place in Lincolnshire;

·       Support for care homes.  The Committee was advised that there had been significant developments over the last few months which included more collaborative working arrangements to minimise the number of professionals attending a care home; and the implementation of Telemedicine and WHZAN, a Telehealth early warning detection and monitoring kit.  The Committee noted that there was still more to be done;

·       Feedback from Healthwatch.  The Committee was advised that the NHS always welcomed feedback from Healthwatch and that some planned engagement work was due to be discussed with representatives from Healthwatch in the following week; and

·       When face to face appointments were likely to return to normality.  Clarification was given that face to face appointments were still available to patients and that patients were being seen who needed to be seen.  The Committee noted that even pre-Covid-19 new ways of working were being explored which had been accelerated as a result of Covid-19; and that steps were being taken to continue improvements to services; and that the learning from Covid-19 was a positive experience for primary care.

The Chairman on behalf of the Committee extended his thanks to the presenters.

RESOLVED

1.    That the Primary Care Services update be received.

2.   That further information be requested relating to:

·       The timetable for GP practices to adopt e-consultations;

·       The level of and type of  complaints on GP practices; and

·       Any feedback from patients on AskMyGP, and additional data in relation to the presented case study.