Agenda item

The Integrated Care Board will provide the Commission with an update on Leicester, Leicestershire and Rutland Integrated Care Board’s progress to date in delivery of the 24/25 Primary Care Access Recovery Plan.

The Senior Integration and Transformation Manager presented the report. It was noted that:

·       In April 2024 NHS England (NHSE) published the delivery plan for recovering access to primary care

·       The delivery plan had set out key deliverable actions for Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB) to implement during 2024-25. The key determinant of this delivery plan was to tackle the 8am rush, improve access in primary care, reduce bureaucracy, improve primary and secondary care interface and support primary care to move towards digital systems.

·       In Leicester, 1.8 million appointments had been provided for the year up to October 2024. In October, 267552 appointments had been provided, which was a 16% increase on the previous year. With an overall 9% increase on appointments compared to the previous year. Around 70% of those appointments were face to face.

·       This time last year Community Pharmacy and Pharmacy First was launched. 81 out of 82 City pharmacies were participating in that programme. Work had been taking place to engage the remaining pharmacy to the programme.

·       Up until November 2024, there were 13257 referrals in to the community Pharmacy First Programme in the city.

·       Out of the GP practices in the city, 39 out of 51 actively engage in that programme. The progressive was good, but further work still needed to be completed with the remaining GP surgeries.

·       A 100% of city practices now had Cloud Based Telephony installed, work was still required to improve the service.

·       The usage of the NHS app had increased to 1.4m people, which was an increase of 89%. Not everyone in Leicester City has access to online technology, but it was clear that those who do were utilising it as 41% of people were using the app for repeat prescriptions.

·       90% of appointments were now being delivered within 2 weeks, a 4% improvement on the previous year.

·       December 2024 was the first month of the additional GP appointments being available and 5 care providers were delivering those on behalf of the city, with 72% utilisation of the appointments.

·       Work force needed to deliver the increases and it had been challenging, however small improvements were now visible.

·       The Cities registered patient to GP ratio was 3262 patients per whole time equivalent GP in December 2024. January 2025 figures showed we are now 2829 registered patients per whole time equivalent GP. Work would continue to improve the figures to be at least in line with the regional average of 2266 patients.

·       GPs primary work was in practice, but general practice had modernised over recent years additional roles have come into place as a primary care network footprint. City practices have recruited fully to these roles with no gaps at present. These roles included;  65.6 Clinical Pharmacists, 40.5 Care Coordinators, 14.7 GP Assistants and 14.4 Pharmacy Technicians and 13.8 Advanced Nurse and Clinical Practitioners.

In response to comments and questions from Members, it was noted that:

·       The current data available from the NHS app was basic. Access was now available to the prescription data usage which has supported staff in better usage of calls for patients who do not have access to the NHS app. While this had not necessarily reduced the number of phone calls to GP practices, it had helped to better direct those calls to the appropriate services. Family members could access the NHS app and order medication on their family members behalf.

·       Quality development discussions with patient participation groups at GP practices had indicated a generally positive experience, though challenges remained. Further exploration was needed on how telephony systems can be improved to enhance patient access and experience.

·       The ongoing pressures within primary care had shown that demand had increased significantly since the COVID-19 pandemic whilst workforce numbers and facilities had remained unchanged. Despite limited resources and reduced funding for GPs, efforts continued to improve service delivery. One approach has been streamlining administrative tasks, such as directing sick note requests to an automated system, which assesses the issue and processes requests accordingly. This had helped to free up appointments for those in greater need.

·       Work was also underway on preventative measures, including hypertension management, stroke prevention, and school-based education initiatives, all aimed at reducing future pressures on hospitals.

·       The Pharmacy First scheme had been instrumental in increasing capacity, with pharmacies seeing approximately 3,000 patients per month. Despite historical underfunding in the city, these initiatives are helping to bridge the gap and improve healthcare accessibility.

·       While data on NHS app usage was not broken down in detail, the app remained a valuable tool for those who can access it. By offering more digital options, it also allows GP practices to focus their support on patients who need additional assistance in accessing healthcare. There were still challenges for practices serving communities with higher levels of digital exclusion. Discussions had taken place on whether practices supported each other in addressing these challenges and how patient participation groups could help identify issues and needs within the wider community.

·       There were currently 52 GP practices in the city and 126 across the wider Leicester, Leicestershire, and Rutland (LLR) area. When implementing new technology, it was important to consider the varying levels of digital readiness across those practices. Some were using digital tools for the first time and remained apprehensive, presenting challenges that would need to be addressed in the coming years. Ongoing work was needed to ensure adequate support was in place for those who are digitally excluded and to help practices integrate new technology effectively.

·       The GP to patient ratio had historically been a challenge in the city, exacerbated by high levels of deprivation and poverty. City-based GPs provided more appointments than those across the wider Leicester, Leicestershire, and Rutland (LLR) area, leading to high service demand. The city also had the highest use of GP locums. Some practices opted to replace a returning GP with alternative clinical staff, such as pharmacists, to help manage costs effectively. The complexity of demographics and workforce retention remain key challenges.

·       Efforts to better utilise pharmacists across the city were being discussed, particularly in managing long-term conditions. A well-skilled workforce could help reduce GP pressures by providing alternative routes for patient care.

·       Concerns were raised around surgery and pharmacy closures, as these were business decisions dependent on financial viability. Practices needed to assess whether continued operation was sustainable.

·       Considerable funding had been allocated to advanced practice in the city, with £7 million invested based on a nationally acclaimed health and inequalities funding model. The city had the highest health inequalities, making this funding essential. Additional funding had also been allocated to support blood tests and wound management, increasing the capacity of city practices.

·       The commissioning team closely monitored GP investments to ensure funding was directly improving patient outcomes. A key focus was identifying areas of inequality and ensuring resources are allocated effectively.

·       The team were reviewing how GP practices had utilised funding and the most effective model for commissioning and accountability moving forward.

·       Patients in care homes were able to receive home visits to reduce hospital admissions. Community-based care planning ensured medications were reviewed, issues were addressed and follow-up testing was conducted where necessary. The approach aimed to improve patient well-being while reducing unnecessary hospital pressures.

·       There had been some growth of the amount of GPs in the City, although not significant. The landscape of general practice had changed, with a greater clinical presence beyond traditional GP roles. Support for older patients in care homes and ensuring the right clinical input was crucial. The GP role remained vital, but a wider multidisciplinary team is essential for meeting patient needs. Improvements would continue to be made, but further collaboration was needed to develop a system that serves the population effectively

·       The importance of getting GPs contract right was emphasized. This would support a more effective model of care. The city’s approach had gained interest from other authorities looking to replicate its success.

·       Funding was allocated based on patient need, and business intelligence was used to assess and address patient challenges. Some areas may require alternative approaches, and further support would be welcomed.

·       Data on patient registrations would take time to update. Some practices such as Downing Drive, had a tight boundary of patients. Requiring conversations to encourage them to accept new patients. The ICB had engaged with practices to address complaints related to patient access.

·       After recent flooding in the city, practices supported each other to still be able to provide care for patients that had been affected by the flooding.

AGREED:

·       That the report be noted.

·       To enquire into a possible breakdown of GP data for the NHS app.

·       Breakdown of data for GP appointments and hubs to be shared.

·       Wider clinical practise team to be added to the Work Programme for 2025/26.