Agenda item

The Chair to update Members on the work of the Task Group and to receive any evidence that has been submitted prior to the meeting.  An extract of the Minute of the Health and Wellbeing Board held on 2 February 2016 relating to the issue is attached for information.  

The Chair updated Members on the work of the Task Group and the Commission received evidence that had been submitted prior to the meeting. An extract of the Minute of the Health and Wellbeing Board held on 2 February 2016 relating to the issue was previously circulated for information with the agenda.

The evidence received at the meeting included a formal response from the Deputy City Mayor to the Task Group’s Review, the views of Professor Harris at the University of Leicester and a briefing paper form the National Health Executive.

Prior to discussion on the Task Group’s work,the Director of Corporate Affairs, Leicester City Clinical Commissioning Group reported that Danum Medical Services had advised the CCG that they would not be able to fulfil their contractual obligations to provide GP services at Asquith Surgery and Bowling Green Surgery after 11 March 2016.

The CCG had put in place temporary and urgent measures to allow patients to receive care at both practices as normal through caretaker arrangements from other local providers until a longer term solution could be found.  Both practices would still be able to register new patients.  This had only been possible in this instance as both premises were owned by the NHS and had list sizes that were likely to make practices clinically and financially viable going forward.

Expressions of interest were being sought from other GP practices wishing to take on this role and any bids received would be evaluated and it was hoped to make an announcement on March 14^th.

Following comments from members, the Director of Corporate Affairs, Leicester City Clinical Commissioning Group stated that single handed GP

Practices were more vulnerable than larger practices, particularly when the principal GP wished to retire or resign.  Practices affected by the changes from PMS to GMS contracts were also potentially vulnerable, and CCG staff had been in discussions with those practices affected to determine the effects this may have.   The CCG were seeking assurances from GPs moving from PMS to GMS contracts that they had plans in place to enable the practice to manage in the future.  To date some practices were developing plans and others required additional support in the process.

Those GP practices that could not demonstrate they could provide the additional services required by the new national contracts would have their funding reduced over a 6 year period. 

The Chair referred to the suggestion at the Health and Wellbeing Board that single GP practices be invited to enter into a voluntary agreement to give 6 months’ notice rather than the 3 months required by the national contract agreement.  The Director of Corporate Affairs, Leicester City Clinical Commissioning Group stated that some had already agreed to this and others were still in discussion.

It was noted that 4 GP service hubs established by the CCG earlier in the year had provided approximately 2,000 extra patient appointments per week.  The hubs were well used Monday to Friday but there was a drop in usage at weekends.  It was also noted that many GPs were reporting increased workloads with up to twice as many consultations as they carried out 5 years ago.

The Healthwatch representative commented that more needed to be done with patients at an early stage when GP practices closed, particularly when large number of patients did not speak English as a first language and were less able to organise themselves and articulate their concerns.

The Director of Corporate Affairs, Leicester City Clinical Commissioning Group stated that the CCG had established a Patient Community Steering Group, which had representatives covering all 9 protected characteristics, various organisations and faiths within the city.  It was accepted that the CCG had not engaged some groups as well as they could have done in the past.

The CCG was engaged with the Patient Participation Groups which meet regularly and this provided good information on current issues affecting patients.  17 large scale community events had been held between August and December aimed at groups and communities that did not normally engage with the system.  The CCG had also launched a procedure whereby GPs could report patient experiences at both an individual and a community level to a dedicated team who could then take the issues forward.

The Chair stated that the Task Group had heard submissions from:-

·         A GP

·         2 GPs at different stage of training

·         Practice Nurses

·         The Deputy City Mayor

·         The CCG

The Task Group’s findings were being prepared and the following issues had been considered:-

·         Whilst the Universities provided good training courses for GPs, many did not stay to practice in Leicester after qualifying.

·         Many preferred to remain locums as they could earn more than becoming permanent members of a practice and could gain wider experiences by moving to other medical practices.  This however was considered to be to the detriment of continuity of care for patients.

·         Career options were not made clear enough to trainees during the early stages of their training in sufficient time for them to consider other options in their training.

·         There were concerns about the pressures that the CQC Inspection regime had upon single GP practices and some GPs had indicated that they found the inspections too onerous and time consuming to the point where they had considered ceasing to practice.  80% of GP practices were compliant with CQC inspections and the CQC were currently reviewing their inspection process as a result of reducing funding.

·         There were similar issues with training practice nurses as those for GPs in that primary care options were not offered at the early stages of nurses training.  The CCG and De Montfort University were currently considering this issue.

·         There were variances in the availability of staff being released for training purposes.

·         Some GPs had managed pressures by recruiting health professionals including paramedics and nurses to treat some patients’ conditions and illnesses.

It was intended to provide a draft of the Task Groups report to members prior to it being considered by the Overview Select Committee in March.  The final report was also intended to be available to be considered at the Deputy City Mayor’s health summit.

The Deputy City Mayor outlined the comments made in his submission to the Commission.  He also outlined the arrangements and purpose of the health summit.  The aim of the summit was to get everyone involved in health provision and social care to come together and to align their plans and achieve an understanding of the financial constraints faced by each other and the implications this had for resources to deliver integrated health care.  He wished to see a succinct, pragmatic and overarching plan for primary care in Leicester that reflected the current health and primary care landscape.  He was waiting for the Health Minister’s to indicate his availability before setting the date for the summit as he felt it was imperative for the Health Minister to be in attendance.   He felt it was important for the Minister to appreciate grass root concerns and see at first hand the impact on patient care at a local level of GP practice closures and other pressures on the health system.

The Chair welcomed the planned outcomes of the Deputy City Mayor’s primary care health summit and felt that the work undertaken by Scrutiny would help to provide evidence to highlight the issues of concerns.  Together with the Health and Wellbeing Board, the Commission would continue to monitor the primary workforce planning involving partners and other organisations.

AGREED:

That the update be received and comments made by the CCG and others at the meeting be noted and reflected in the Task Group’s findings.