Agenda item

(To receive a report from NHS Lincolnshire Integrated Care Board (ICB), which advises the Committee on ICB and partner processes to quality assure General Practice and where quality concerns are identified, the support provided to enable quality improvement within and across General Practices. Nick Blake, Programme Director – Primary Care NHS Lincolnshire ICB and Wendy Martin, Associate Director of Nursing and Quality NHS Lincolnshire ICB  will be in attendance for this item)

Consideration was given to a report from the NHS Lincolnshire Integrated Care Board (ICB), which advised the Committee on the ICB and partner processes to quality assure General Practices and where quality concerns were identified, the support provided to enable quality improvement within and across General Practices.

The Chairman invited the following presenters from the NHS Lincolnshire Integrated Care Board to remotely, present the item to the Committee, Nick Blake, Programme Director – Primary Care and Wendy Martin, Associate Director, Nursing and Quality.

The Committee was advised of the general levels of support available to General Practices, details of which provided in the report presented.  It was also highlighted that the ICB had well established and effective processes, working with relevant partners including the Local Medical Committee, Healthwatch and the Care Quality Commission, to identify quality concerns for Lincolnshire’s General Practices and to support practices to make any required quality improvements.  The Committee noted that these processes were further enhanced with the implementation of the Primary Care Access Recovery Plan and the associated Support Level Framework and the General Practice Improvement Plan.

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

·       The Committee was advised that there were three locality, Quality Assurance Oversight Groups, a west group, east group and a south and southwest group.  The Committee noted that the groups comprised of members of the quality team, ICB Primary Care Team members, GP clinical leads and performance and information team members.  It was reported that the groups looked at some of the following: performance data; the overview of quality of practices, GP workforce and non-GP workforce;

·       It was reported that the level of support to practices was dependent on the level of support, and the actions required.  It was noted that the ICB would be looking for the practice to deliver the actions using the resource they had at their disposal.  For example, if the GP practice had a dispensing issue, a talk on medicine optimisation would be provided and any additional support needed, but the delivery action would be the responsibility of the practice;

·       It was reported that currently there were 10 practices that were medium to higher risk rating and approximately three/four at very high-risk rating.  It was highlighted that levels of support matched the risk ratings accordingly;

·       The Committee noted that monitoring would be picked up through the county level, Quality Assurance and Oversight Group, and that lessons learned would be picked up through local Quality Assurance Oversight Groups

·       It was reported that if a practice was having intensive support, they would be receiving regular visits, an action plan would be formulated from which the practice would be measured against their actions for achievement and that actions were driving forward improvements.  Confirmation was given that any general learning points highlighted for practices would be cascaded through clinical forum to all practices or through the regular primary care newsletter;

·       That quality surveillance, outcomes and performance information and metrics about each practice helped inform the risk rating for each practice.  Some Committee members felt that more needed be done to find the things that were not being addressed before they became significant issues, for example periodic checkups.  It was highlighted that there appeared to be inconsistencies across Lincolnshire in this regard;

·       The Committee was advised that health checks for people aged 40 to 75 were a statutory responsibility for the County Council to commission. GP practices were paid to carry them out, and that close attention was paid to the uptake and delivery of the quality of the health check.  Confirmation was given that those eligible were offered a health check every five years.  A suggestion was made for a further discussion on population health management and the role of primary care networks;

·       Some concerns were expressed that some patients were afraid to raise their concerns with their local practice as they were fearful of reprisal.  One member enquired whether there was a way that a patient could complain without going through their practice.  The Committee was advised that any patient with a complaint was encouraged to approach their GP practice in the first instance, if there was a fear of doing this there was also a route to raise a compliant through the NHS Midlands Primary Care Team.  Other routes referred to were via the Integrated Care Board Feedback team, the Care Quality Commission (CQC) or HealthWatch;

·       Medication changes and the effects that had on some patients.  One member enquired whether the changes in brands of medication were due to financial savings.  It was highlighted that in any case where a medication was not suitable at controlling a patient’s symptoms, the patient needed to discuss this with their GP.  The Committee noted that medication changes could be down various factors, one of which was the availability of medications.  A suggestion was made that further information around prescribing might be useful for the Committee to look at as a future agenda item;

·       How patients would know what was going on within their surgery. The Committee was advised that the only rating for practices was the one published by the Care Quality Commission, which was available on their website.  It was noted that there was also patient GP survey information which was also publicly available;

·       One member expressed gratitude to the urgent treatment centre at Louth Hospital;

·       Whether large organisations that were responsible for NHS practices had to adhere to the same contractual obligations as a single practice.  The Committee was advised that the GP contract, terms, and conditions were the same for a larger organisation or a smaller GP practice.  The Committee noted that if there were any quality issues with a larger organisation, meetings would be held with the leadership team to ensure that they were fully supportive of the actions needed for the practices they had in Lincolnshire and for them to deliver on any improvements as would be done with any individual practice;

·       The Committee was advised that each of the NHS contracts had a quality assurance mechanism and KPI’s and that all practices were treated the same;

·       Confirmation was provided that Lincolnshire had a low rate of inadequate practices and a low rate of practices requiring improvement compared to other areas.  It was however highlighted that very few practices had been inspected since before Covid-19 from the CQC perspective;

·       It was reported that requests were received for section 19 funding and that any application needed to have the support of the ICB.  The Committee was advised that only one request had been received in the last 12 months; and

·       That the Branston and Heighton Family Practice had received a rating of ‘Good’ in October was down to the hard work of the practice in terms of making the required improvements, and that in terms of the support, the ICB had been able to work with them to understand what their improvements needs were and providing support to the practice to help them make those improvements.

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

RESOLVED

That the activities of the NHS Lincolnshire Integrated Care Board supporting GP practices in need of improvement be noted.