Agenda item

Leicester City Clinical Commissioning Group to give a presentation on the challenges faced by primary care in the city and the plans being developed for a Primary Care Strategy to address these.  The strategy will be finalised once the local Sustainability and Transformation Plan is completed in September 2016, which is including work around general practice. In addition it will be informed by the Primary Care Summit which is being held on 9 September 2016.

Sarah Prema, Director Strategy and Implementation, Leicester City Clinical Commissioning Group, will attend the meeting to present the item.

Professor Farooqi, Co-Chair Leicester City Clinical Commissioning Group (CCG) and Sarah Prema, Director, Strategy and Implementation, (CCG) gave a presentation on the challenges faced by primary care in the city and the plans being developed for a Primary Care Strategy to address these.  The strategy would be finalised once the local Sustainability and Transformation Plan was completed in September 2016; which included work around general practice. In addition, it would be informed by the Primary Care Summit that had been organised for 9 September 2016.

During the presentation it was noted that:-

a)         The number of single handed practices in the City had decreased from 26 to 6 in recent years as a result of some GPs retiring and others merging with other practices.

b)         There were 59 practices in city of which 14 were training practices. The average list size of a practice was 6,531. This was slightly lower than the national average of 7,225.

c)         There were a large number of Alternative Provider Medical Services (APMS) contracts; 13 practices out of the total number of 59 practices in the City.  This was in contrast to the county area where there were no APMS contracts. This was an indicator of the difficulty in ensuring services in the City.

d)         More practices in Leicester were rated as good by the CQC compared to the England and Midlands and East averages.

e)         The number of primary sector consultations had increased continually over the last 13 years.  Applicants to GP training had dropped by 15% and in 2014 one in ten slots for new GP trainees remained vacant.  The number of unfilled GP posts nationally had quadrupled in the last 3 years.

f)          The average funding for a GP in the city was approximately 10% below the national average.

g)         The city had been divided into 4 Health Need Neighbourhoods to enable a locality delivery of primary and community care.  These would include extended hours provision, urgent care services (including diagnostics), community nursing and therapy services, social services, voluntary service, self-care and patient education.  The focus of the Health Need Neighbourhoods would be on prevention and mobilising community “assets” as well as the development of integrated teams to support patients with the most complex needs.

h)        The CCG were also developing a HUB within 2 Health Need Neighbourhoods to provide patients with access to wider services.  The strategy also included a number of initiatives (outlined in the presentation) to improve access to the services.

i)          There was raft of initiatives to improve the recruitment and retention of staff in primary care.  These were listed in full in the presentation.

j)          The 59 GP practices were delivered from 60 main premises and 12 branch sites.  There were a number of practices operating from converted houses and the CCG supported practices to apply to the NHS England Estates and Technology Fund and 5 developments to the fund were made in 2016.

k)         The CCG supported the development of Federations which supported practices to become more sustainable, combine back office functions, provide uniform delivery of services, share staff across practices and provide the potential to deliver a wider range of services.

l)          There was a need for some changes in patient expectations as not all services in the future may be provided by one practice and patients may be ‘referred’ to a HUB for specialist services such as diabetes etc.  Also patients needed to understand that minor ailments such as sore throats, colds and flu and sprained ankles etc did not require appointments with GPs; as treatment could be safely provided by other qualified health professionals.  This would reduce the burden on GPs time to concentrate on patients with more serious illnesses.

The strategy would continue to evolve and comments were welcomed.

The Chair commented that it would be helpful to have milestones for the initiatives.  It was recognised that some solutions were easier than others to implement and some would be more popular than others.  It was, therefore essential to develop these through engagement and discussion and the forthcoming Primary Care Summit would provide a good opportunity to begin this process.  He also asked what the impact of having 1 federation and Health Needs Neighbourhoods would have on the financial viability of GP practices.

Members of the Board commented that:-

a)         Primary care was critical to the success and sustainability of health services and there was a real challenge in the city to achieve this.  A more ambitious strategy to achieve national averages of performance in the primary care services would be welcomed.  Given the intention to transfer significant activity from UHL and LPT in the future to the primary care sector through BCT and STP, it would be essential to have a robust primary care sector in place to achieve this.

b)         Integrated teams already made differences to the ways in which patients were presenting to the acute sectors and were transforming services for better patient experiences.

c)         Continuity of care was the prime consideration of patients and this should be linked to BCT and STP

At 5.57pm the Chair was called away from the meeting on other Council business and Assistant City Mayor Piara Singh Clair took the Chair.

In response to the Chair’s and Board Members’ comments, Professor Farooqi stated that:-

a)         The CCG recognised that the strategy needed to be ambitious and link in with the government’s initiative to recruit an additional 5,000 GPs.

b)         Retention of GPs was still challenging.  A number GPs recruited from aboard eventually move to Canada, Australia and America after a period of training in the UK.

c)         Providing a portfolio of experiences for GPs would lead to making careers more attractive.

d)         There was a challenge in breaking the circle of heavier workloads for GPs which were exacerbated in some practices by a GP leaving and the practice being unable to recruit a replacement.

e)         There was scope within the integrated teams for UHL and LPT staff to work part time in the community.

f)          Continuity of care was fully recognised and the planning of long term or complex conditions would require stable teams to be in place.

g)         There would be consultation with the public as it was essential for them to be involved in designing the services for the future.

h)         Currently 30% of GPs were aged over 50 years old which could lead to 50 GPs being recruited in the next 5 year to maintain the status quo of current number of GPs.

AGREED:

That Professor Farooqi and Sara Prema be thanked for their presentation and the Boards comments be taken into account in developing the Primary Care Strategy.