Agenda item

Leicester City Clinical Commissioning Group (CCG) to submit a report on the challenges in primary care in the City and what is being done to respond to these challenges.  Simon Freeman, Managing Director, Leicester City CCG and David Sharp, Director, Leicestershire and Lincolnshire Area, NHS England will present the report at the meeting.

Leicester City Clinical Commissioning Group (CCG) submitted a report on the challenges in primary care in the City and what was being done to respond to these challenges.  Dr Simon Freeman, Managing Director, Leicester City CCG and Sue Lock, Chief Operating Officer, Leicester City CCG and David Sharp, Director, Leicestershire and Lincolnshire Area, NHS England presented the report to the meeting.

It was noted that national and local policies required efficiency savings and improved quality of services to be delivered by expanding out-of-hospital services through creating sufficient capacity and capability in the primary medical care services.

The report identified the major challenges facing primary care, from both a patient and a practice perspective and gave a summary of the planned solutions to address them.

Tackling GP recruitment was the highest short-term priority as an effective and efficient GP service was vital to looking after patients and reducing the number of hospital admissions.  There was a local aging population and a backdrop of global financial pressures which required local solutions to meet the needs and deliver quality care within the resources available.

The CCG had undertaken an analysis of the local health economy and of the 62 GP practices in the City, 13% were single GP practices compared to a national average of 9%.  In addition, approximately 50% of the principal GPs were aged over 50 years old.  There was a changing GP workforce profile in Leicester from one which was predominately comprised of principal GPs to one that was now approximately a third principal GPs, a third salaried GPs and a third locum GPs.  Given the changing emphasis of health care to focus on prevention and reducing hospital admissions, it was considered essential to address the GP recruitment issue, particularly in view the large proportion of the population living in deprivation, which was a key driver of health needs.  The diversity of the population, particularly where English was not spoken as a first language presented further challenges to conducting effective consultation on services.  A number of engagement activities had been undertaken with the public, patient groups, member practices and wider stakeholders since November 2013 to understand the perceived issues and challenges.  The results demonstrated that the challenges facing practices were causing the issues and concerns raised by patients.  This supported the view that addressing the GP issues was a key factor in delivering the Better Care Together programme.

NHS England were proposing a pilot project to address GP recruitment and retention issues in order to underpin the overall strategy for developing a growing range of primary care services and to develop the 7 day per week market for providing services.  Attracting GPs to enter and stay in the local workforce required incentives in order to compete with the competitive market for GP services.

Following the outline of the pilot proposals and questions from Members, it was noted that:-

a)         The pilot scheme would involve a fund of £250k to recruit and retain GPs in the City by providing an incentive to work in surgeries within deprived areas, with the aim of encouraging new GPs to progress in practices to become ‘principal’ GPs.

b)         NHS England was meeting the Local Medical Council later that day to discuss whether the pilot would address the concerns expressed by both GPs and patients in consultation and summit exercises.

c)         The scheme would be administered through the Joint Integrated Commissioning Board and, after the initial payment of incentives for recruitment and retention; there would be an evaluation of the pilot in approximately a year’s time.

d)         The proposal would benefit from being included in the Better Care Fund programme as this would remove the pressure to spend the allocation of funds within a single financial year.

e)         The CCG were continually testing service provision to ensure that services were fully accessible by everyone.  For example, although the number of NHS health checks carried out in the City was one of the highest in the Country, it was still important to check that all parts of the community had equal access to the programme.  The University of Leicester were currently undertaking research to check that older members of the BME community had been able to access dementia services as one element of the programme.

The Strategic Director of Adult Social Care and Public Health commented that the majority of the public’s interaction with the NHS was through primary care services.  The current emphasis on preventative measures for health relied heavily on the capacity and quality of the primary care services to deliver the services.  NHS England’s decision for funds to follow need was welcomed as a positive step to address health in the City.

The Chair commented that whilst it was important to address the strategic needs he was keen that the everyday issues that were of concern to the public; such as phone systems, appointment system and on line access to services, were not overlooked.  These everyday concerns framed the perceptions, experiences and views of health care by the public and this was equally important in achieving the desired outcomes under Better Care Together.

RESOLVED:

1.    That the report analysing the challenges facing primary medical care in the City be noted.

2.    That tackling GP recruitment be agreed as a short-term priority.

3.    That the principle of the proposed pilot GP recruitment scheme be welcomed and supported and that the funding be added to the Better Care Fund to be administered through the Joint Integrated Commissioning Board.

4.    That a further reports be submitted to a future Board meeting on how and where the funds are being used and whether this is achieving the aims of recruiting and retaining GPs in the City.

5.    That Healthwatch be asked for a view on whether some of the existing public sector funded premises around the City, which have excess capacity, could have the potential to be used as surgeries by GPs who are currently operating in inadequate premises.