Agenda item

Yasmin Sidyot, Deputy Director Integration & Transformation, Leicester City Council to give a presentation on primary care development plans in Leicester City which covers the context, key achievements, vision, focus areas and priorities. 

Yasmin Sidyot, Deputy Director Integration & Transformation, Leicester City Council submitted a report on the Identification of Unregistered Patients Programme and gave a presentation on primary care development plans in Leicester City which covered the context, key achievements, vision, focus areas and priorities.

During the presentation it was noted that:-

·         The last 2 years had placed unprecedented demand on health and social care.

·          LLR Primary Care Networks and practices had collaboratively implemented a very successful Mass Covid Vaccination Programme, staffed by local primary care staff, wider health and social care teams and volunteers from local communities.

·         The pandemic had significantly impacted on staffing levels due to sickness, self-isolation and the opportunity to recruit into vacancies.

·         During the Covid period, practices had very quickly set up more telephony and virtual based contact with patients and this had been challenging for a number of reasons including the telephone systems that were in place were not equipped to deal with the call demands placed upon them.  Although most practices had upgraded their systems to move to cloud-based telephony it had required retraining staff in the use of the new technology and having the right technology infrastructure in place that could support it.

·         The aim to improve access to priority care included:-

o   Negating the need for patients to ring at 8.00am and ensure that same day access must be fit for purpose and needs based.

o   Where patients required additional services not offered by general practices, practices must have local services to book patients into where a GP is not appropriate for:-

§  1. Pharmacy

§  2. Optometrist

§  3. Therapy services

§  4. Mental health services

§  5. Urgent treatment Centres / minor injury services

·         Develop & implement service delivery models at neighbourhood / place level i.e. minor surgery etc.

·         An understanding of the variation in access, outcomes and service utilisation would be co designed and officers would work in partnership with practices and PCN’s to understand how variations can be reduced.

·         Where practices were struggling, officers would jointly agree a plan to tackle the issues and then work together with each PCN to implement working jointly with the LMC co produce a framework to support a Quality Improvement approach.

·         Practice sustainability and business continuity plans would be part of the joint improvement programme at practice level, with support provided to practice managers / business managers to enable plans to be stress tested and regularly reviewed.

·         The improvements planned for service delivery models were outlined.

·         Workforce and leadership development proposals were explained in the presentation.

·         The planned Primary Care trajectories were:-

o   Return to 2019 appointment levels across all general practice

o   Benchmarking of Practice appointments against locally agreed standard of minimum 75 appointments per 1000 population

o   100% of completion of all Primary Care Backlog by Q3 2022/23

o   Improvement in prevalence targeted Long Term Conditions

o   50% of GP appointments are face to face

o   100% active participation of general practice in CPCS

o   Increase in FTE GPs

o   Balanced scorecard and benchmarking for all practices completed be end of Q1 22/23

·         Following funding awarded to the CCG it had enabled them to meet part of the NHS’s pledge to reduce health inequalities, working with areas of high deprivation and large BAME communities.  The work had involved working with local communities, patient groups, identifying unregistered patients and supporting them through the process.  Additionally, it had involved registering patients with ‘No Legal Status’ in the UK, informing them of all the healthcare and benefits provided by NHS.  The target had been to register 5,000 new patients by January 2022.  The success and effectiveness of the programme were measured regularly and by the end of December 2021, 51,545 new patients were registered within Leicester City which was an increase of 22,323 new patients than in year 2020.  Full details of the methodology, engagement, communications and the learning outcomes were fully detailed in the report.

·         In order to understand the depth and challenge of the problem of unregistered patients 2 GP registration officers had made contact with organisations, religious sites, voluntary sector bodies and food banks to undertake outreach work and register patients with GPs.   When the  vaccination programme was launched it had enabled staff to utilise the programme to promote the benefits of registering with GPs as it  enabled access to health services.  A number of unregistered patients had underlying health issues and had not previously accessed services  The outreach model had resulted in more registrations as the community groups and representatives understood the barriers and challenges involved and working with GPs enabled a 2 way dialogue to work across both sectors.  The model to register Afghan and other refugees had been deployed quickly to get them registered and access health services.  The feedback from GPs had indicated that they had found it useful to both themselves and for the individuals.

·         Engagement with the community had been prepared in a language the patient could understand in the form of a conversation.   The information was made available via a leaflet, Facebook, twitter and other communication methods.

Following the presentation members of the Board commented that:-

·         The Strategy was considered to be good, but it hinged around staff supporting it and it would be useful to see how many CPCS and practice nurses per 100k were there, what was being done to increase numbers and how the City compared to surrounding areas.

·         Different parts of the health and care system had access to patients records and hospital, social care and primary care staff should have the same access to patients’ records, the current arrangements could be improved to be more effective.

·         More diagnostics could developed within the community diagnostic programme.

·         More still needed to be done on equitable access to services and this should be at the fore and centre of the Strategy.

·         The work on patient registration was welcomed but there were still challenges on capturing remaining numbers of unregistered patients before they attended A&E departments for treatment.

·         Healthwatch commented that patients told them they had left hospital without a sick note and had been told to see their GP to obtain one.  It was felt that patients should be advised not to see their doctor but contact their medical practice to allow them to decide who followed up on issuing the certificate.

·         Partners should support the changing ways to deliver primary care.  For example, GPs used to see 50-60 patients per day and now new GPs don’t see more than 20-25 patients a day as the rest of the practice team was growing by the addition of qualified health practitioners/pharmacists etc so that the GP was not the only person patients needed to see in the practice.

·         The early identification of patient issues and treatment not only benefited the patient but also patient care, UHL and LPT.  An update in 6 months to provide an update on progress would be helpful.

The Chair commented that issues around primary care were crucial for city and suggested that these be discussed at the next board meeting with particular focus on workforce and engagement.  There should be more of joined up approach by the ICS, the Council, LPT and UHL working together on these issues.

RESOLVED:-

That officers be thanked for the report and the presentation and that partners on the Board actively support the work being taken forward to improve Primary Care Development.