Agenda item

(To receive a report from the Lincolnshire Clinical Commissioning Group, which advises the Committee of the current service provision by general practice across the county.  Sarah-Jane Mills, Chief Operating Officer (West Locality) Lincolnshire Clinical Commissioning Group will be in attendance for this item)

Consideration was given to a report from the Lincolnshire Clinical Commissioning Group, which provided the Committee with an update on the current service provision by general practice across the county.

The Chairman invited Sarah Jane Mills, Chief Operating Officer, (West Locality) Lincolnshire Clinical Commissioning Group, to present the item to the Committee.

An acknowledgement was given to the outstanding contributions of GP colleagues across the county who had continued to provide local primary care services throughout the pandemic, in addition, to working with Primary Care Networks (PCNs) in delivering the Covid-19 vaccination programme to people living in their local communities.  It was however recognised that there were continued challenges associated with increased demand and workforce availability, which meant that the model of primary care service provision would need to change and evolve in the coming years to meet the required need.

There was recognition that there were problems accessing GP services, and that data had shown when compared to the same period pre-Covid in 2019/20, GP colleagues were providing on average 20% more appointments.  It was highlighted that the ‘Ask my GP’ App had seen an increase of 5% in same day appointments and a 4% increase in appointments being provided between 1 – 6 days.

It was reported that practices were mindful that new ways of accessing primary care services had been welcomed by some patients, whilst others felt the new arrangements did not meet their personal needs.  As a result, practices were working hard to understand these issues, to be able to refine their processes and enable the continued development of local access arrangements.  It was noted that in the coming year, the CCG along with GP colleagues and other partner organisations would be continuing to develop arrangements to improve access to primary care services, which would include developing services for a timelier access for people with minor illnesses, which would then enable the GP to develop local arrangements to create time to support more vulnerable people and those with more complex health needs.

(Councillor Mrs L Hagues left the meeting at 12:37)

It was reported that although the CCG continued to work closely with practices to ensure and help facilitate continuous improvement, the assessment of the Care Quality Commission (CQC) was relied on to provide an independent assurance of the quality of GP service provision.  Current CQC rating details were provided within the report which indicated that Lincolnshire practices were in a good position, with 80 practices being rated good or outstanding.

The Committee noted that the makeup of GP teams had changed and developed in recent years; and those practices independently of Primary Care Networks (PCNs) had introduced new roles to provide additional capacity and professional support to help treat each patient’s individual needs.

Although Lincolnshire had a slightly lower than the national average number of GPs, the number of clinical staff working in primary care compared favourably.  Details of the current position relating to GPs compared to the national average were shown on page 52 of the report for the Committee to consider.  The Committee noted that there had been a reduction in the number of GP partners and an increase in salaried GPs, which was consistent with the national picture.  It was noted further that this had prompted a national discussion with regards to the need to reform general practice. 

The Committee was advised that PCNs enabled GP practices to come together to share staff and collaborate to deliver extended primary care services to the local community. It was highlighted that PCNs had become an established part of the NHS structure across Lincolnshire.

A copy of the Lincolnshire Primary Care Network Alliance Annual Report for 2020/21 was attached as Appendix A to the report for consideration by the Committee.

In conclusion, the Committee was advised that the establishment of PCNs, increased availability of digital services and that the opportunity to work in partnership with other agencies/services would influence and enable how people access primary care in the future.

During consideration of this item, the Committee raised some of the following comments:

·       The problems patients had encountered in getting an appointment to see a GP or being able to obtain access to their surgery physically.  The Committee was advised that practices had multi-disciplinary teams, with professionals being able to deal with the issues on a daily basis, which then enabled GPs to be able to have more time to see patients with more complex needs.  There was recognition that some patients were still unclear as to how to access their GP, and how the service model had changed.  The Committee noted that telephone systems were continuing to be upgraded, and that a programme of modernisation was planned, to ensure services were better connected to the wider health system;

·       Digital technology. It was reported that digital technology was being used and from patient feedback 90% of patients using it preferred it as a way of contacting their surgery.  It was recognised that digital contact was not the preferred option for all patients.  Some concern was expressed that the statistics were incorrect, as they were not asking the right questions of patient users.  Some disappointment was also expressed that there was very little patient feedback.  The Committee was advised that the CQC report would be able to provide further information.  Reassurance was given that the CCG quality team worked with practices that were rated as requiring  improvement or inadequate.  With regard to patient feedback the Committee was advised that the CCG worked very closely with Healthwatch Lincolnshire;

(Dr B Wookey left the meeting at 13:10)

·       Personal experiences of using ‘Ask my GP’ App, and to the fact that some surgeries were turning the app off.  The Committee was advised that post pandemic, to mitigate risks, some practices had turned the app off, due the increased volume of demand and staff absences.  It was reported that at the end of 2021 GP practices were received up to 6,000 calls in a day, and with the introduction of digital technology, this had been reduced to 600 a day.  It was highlighted that the introduction of Ask my GP and e-consultations provided patient choice.  Reassurance was given that GP services were safe and where there were concerns, the CCG were proactively working with practices, and where necessary providing support.  The Committee was advised that the GP model, as independent businesses had its challenges and that there was more to be done to understand local delivery; and

(Cllr R J Cleaver left the meeting at 13:17)

·       The need for GP provision to be improved on the east coast to address their needs, as services provided were inconsistent to other areas in the county.  There was recognition that recruitment was a challenge, and work was on going to make Lincolnshire more attractive for people to want to come to for work.  Concern was also expressed at the increased population along the east coast during the holiday season, which resulted in an increased demand on services, which were already over stretched.  A question was asked as to whether a plan was in place to deal with the challenges faced.  The Committee was advised that there was a People Board in Lincolnshire, which looked at workforce needs across a whole range of services with regional and national teams.  The board also informed training and development needs in the county and additional training for extended roles.  It was also noted that a board had been established specifically for primary care, and that the coastal issues were known and were being considered.

RESOLVED

1.      That thanks be extended to the Lincolnshire NHS Clinical Commissioning Group for presenting information on general practice provision.

2.      That a further update on GP provision be considered in six months’ time.