Agenda item

(To receive a report from Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) which provides an update on the services running at GP Practices recently awarded under contracts from NHS England East to Universal Health Ltd.  Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

A report by Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust (LPFT)) was considered which provided an update on the four GP Practices recently awarded the contracts by NHS England to Universal Health Ltd.

Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust) and Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) were in attendance for this item of business.

Members were advised that the GP Practices referred to were the Arboretum and Burton Road Surgeries in Lincoln, Pottergate Surgery in Gainsborough and Metheringham Surgery.  Universal Health Ltd, a consortium of Lincolnshire Partnership NHS Foundation Trust (LPFT) and Lincolnshire and District Medical Services (LADMS), were awarded four Alternative Provider Medical Services (APMS) contracts in 2015 with effect from 1^st April 2015 (and from 1^st July 2015 in the case of the Burton Road Surgery).  There were 11,000 registered patients across the four practices.

Both clinical and non-clinical staff teams within the surgeries had ensured that the services offered continued seamlessly during the transfer of the contracts to Universal Health Ltd.  Due to the shortages there were challenges in recruiting nursing and medical staff particularly to the role of General Practitioner (GP) and the costs incurred with using locum medical cover to ensure services continued.  It was reported that this was not uncommon across Lincolnshire as challenges with the ongoing stability of primary care continued.

Universal Health Ltd was a Joint Venture company created by LPFT and LADMS in late 2014 and established a new provider vehicle to transfer, stabilise and transform services.  Any potential profit made by this company would be reinvested in local services.  Universal Health Ltd had a formal Board governance structure with director and non-executive director portfolios and also held separate financial accounts.

The challenges and risk presented for these contracts were:-

·       The recruitment and retention of skilled, primary care trained staff to build resilience and capacity in the system.  The recruitment of these staff was becoming increasingly difficult due to the changing workforce profile, for example a large number of GPs were expected to retire in the coming years.  The medical staff at these particular practices were Salaried Doctors rather than GP Partners.  Innovate options were required to ensure that these staff were supported to stay in general practice;

·       The surgeries were open to new patients who needed to register with a GP.  Those patients who were not currently registered with a GP were being encouraged to choose these surgeries due to the capacity for them to take on new patients onto the registered list;

·       Staff working in the surgeries had been through a period of disruption and change over 12 months as well as future uncertainties.  Priorities for Universal Health Ltd were to retain good staff and offer opportunities for new staff;

·       The service offer would be developed to offer alternative services in primary care for patients.  This would include, for example, including Physiotherapists within the clinical team to assess and advise patients who required this service.

It was reported that Burton Road Surgery and Metheringham Surgery had been inspected by the Care Quality Commission in December 2015 and formal reports would follow.

As the mobilisation and initial stabilisation phases were almost complete, opportunities for transformation and integration of additional services were being pursued.

At this stage of the proceedings, Councillor Mrs P F Watson asked the Committee to note that the joint Chief Executive of Universal Health Ltd, Dr Neil Parkes, was her GP and a personal friend.

Members were given the opportunity to ask questions, during which the following points were noted:-

·       Some GP practices operated a strict 10 minute rule for each appointment but it was felt that this was inappropriate for someone presenting with a mental health issue.  Appreciation was noted that GPs needed to manage their time to the best of their ability but this could present an issue to these patients.  There was work ongoing to align the mental health offer to the patient as much as possible but it was acknowledged that this was a difficult balance to reach;

·       National discussions were helping to destigmatise mental health and, although there had been improvements, it was a slow process but projects such as this one was helping with that process;

·       For these practices, the majority of people requesting an appointment was within two days depending on their particular need;

·       Further information was requested about LADMS and it was explained that this was a joint venture and not just within these four surgeries.  LADMS was similar to a GP federation and was a membership organisation with the ability to bid for additional work to provide to health organisations, such as out-of-hours cover, sexual health services, etc.  The Committee would be sent a brief of the organisation to assist with their understanding of LADMS;

·       The four practices had salaried GPs rather than partners and it was asked if this was a risk or a benefit to the practices.  The GPs received a salary for their service rather than a being a partner whose role was to run the practice as a business working with commissioners to develop services.  It was, however, difficult to recruit either type of GP which, in turn, increased the risk in being able to provide continuity of care. Progress had been made in permanently recruiting to these posts and in particular, GPs with special interest in other areas of care, for example mental health;

·       Although there was a risk of a higher turnover in GPs, it was noted that some GPs wanted to be salaried as they believed that this type of role enabled them to have a better work life balance;

·       The condition 'Bipolar' was explained to the Committee as previously being known as Manic Depression where patients have varying episodes of mania and depression;

·       It was stressed that the four surgeries referred to in the report operated as any other GP practice and were not a new primary care service.  This item was being considered by the Committee due to the proposal of NHS England, in 2014, to close one of the practices, the Burton Road Surgery;

·       Some large practices had taken on other business in addition to their general practice, for example, minor operations or psychiatric rotations.  The funding stream for this type of work would need to be done through a commissioning service but, as a general principle, consideration was being given to expand those service within practices;

·       A suggestion was made that, if the committee was seeking to look at the broadening of the services provided by primary care, a presentation from the Local Medical Committee (LMC) may be beneficial to the Committee.

RESOLVED

1.    That the report and comments be considered; and

2.    That a further update be scheduled for a future meeting of the Health Scrutiny Committee for Lincolnshire.