The Leicester, Leicestershire and Rutland 2019/20-2023/24 Primary Care Strategy is submitted by the Leicester City, West Leicestershire and East Leicestershire & Rutland Clinical Commissioning Groups. The Commission is recommended to scrutinise the Strategy and comment as appropriate.
The Leicester, Leicestershire and Rutland 2019/20-2023/24 Primary Care Strategy was submitted by the Leicester City, West Leicestershire and East Leicestershire & Rutland Clinical Commissioning Groups (CCGs).
Tim Sacks, Chief Operating Officer at East Leicestershire and Rutland Clinical Commissioning Group, explained that the CCGs had been asked to produce the Strategy, to show how primary care practice would be driven forward, including how it was envisaged Primary Care Networks (PCNs) would work together and impact on the functions of CCGs. This therefore was a high-level plan, from which an operational plan would be developed.
The Strategy would be delivered through the PCNs, but meetings to discuss how this would be achieved had only just started, so it was anticipated that it would take time to implement the Strategy. Directors across the three organisations were taking the lead on portfolios within the Strategy to ensure their delivery.
To facilitate this, new funding was being provided, which included funding for the PCNs and for 12 or 13 additional clinical staff. Initial funding was for five years and it was hoped that during the first year funding would have been accessed, staff appointed and trained, and patients would be seeing improvements in access and care. Government guidance indicated that funding would only be released when the additional clinical staff had been employed. There also had been an increase in funding for GP practices this year, with an additional 1.5% being provided for core practice services.
The Commission expressed some concern that structures were being funded, not services. In reply, Mr Sacks explained that the roles in PCNs were very specific, so with the additional staff delivering other services more time was available in practices for providing core services.
It was stressed that the differences between PCNs, (for example, in demographics and resources), needed to be taken in to account. Services therefore needed to be locally responsive and to address the concerns of patients in each area, so would be commissioned accordingly. Practices could ask to move between PCNs, or they could be expelled from a PCN, which could change the resources and demographics of those PCNs and it was anticipated that there would be some movement over time.
Improvements in primary care would be determined through analysis of data by NHS England and the establishment of local benchmarks. The three basic aims of improving care, access and outcomes had been set by the CCGs and would be achieved through delivery in the seven key contract areas. At present, performance indicators for these had not been created, so work was underway to establish the base line. Risk stratification scores and national standards of care also would be used to direct service delivery and improvement. Progress with the Strategy was monitored through the national workforce survey, which was held every three months and to which all practices were required to respond.
This structure meant that it was possible that improvements would not be reflected in patient surveys during the first year, but it would be disappointing if improvements were not seen in the second year.
Michael Smith, Healthwatch, stressed that patients’ experience of visiting GPs was an important part of this and Healthwatch would know quickly if improvements were being made, (for example, if greater, and more timely, access to GPs was available). He suggested that monitoring the use of primary care hubs could be an indicator of such improvements, as the improvements described should reduce the need for people to use the hubs.
Concern was expressed that as the number of PCNs increased, so did the possibility of privatising services if users’ needs were not being met. In reply, Mr Sacks explained that GP practices in PCNs still had their own independent contracts with the NHS. The PCN contract was an addition to this, but could mean that service delivery had to change to enable the practices to work together in different ways through the PCNs.
During discussion on the Strategy, the Commission noted that social prescribing was a way of supporting GPs in relation to patients’ non-clinical needs through prescribing things such as swimming sessions. In order to maximise opportunities for this, consideration needed to be given to how health organisations and local authorities worked together.
The Commission noted that, although a priority in relation to personal health budgets was to work with people with frailties, these people could be reticent to take up these budgets. In reply, Mr Sacks explained that there were defined markers for frailty, but a personal health budget was a choice, so people did not have to have one and did not receive a lesser service if they chose not to have one.
Members also expressed concern that the target of recruiting 30 GPs from overseas in the next five years appeared to lack ambition. It was noted by Mr Sacks that reference to this in the Strategy related to relocation costs for 30 GPs, not pay, and funding was only for 30, so any more would have to be funded by the CCGs. However, Richard Morris, Director of Corporate Affairs at Leicester City Clinical Commissioning Group, noted that the increase in GPs from abroad coming to Leicester in recent years was higher than the national average, as a result of ongoing work to encourage GPs to consider moving to the city. Mr Sacks also advised that more newly qualified GPs who trained in Leicester, Leicestershire and Rutland stayed in the area than the national average, but many GPs working in these areas were doing fewer clinical sessions.
Mr Smith asked that consideration be given to consulting on the different parts of the Strategy whenever possible, as this helped to build public trust. Mr Sacks advised that this was done, and would continue, as engagement was considered to be very important.
Members were reminded that information on attendance statistics at hospital Accident and Emergency services had been circulated following the last meeting of the Commission, (minute 10, “Primary Care Hub Access at the Merlyn Vaz Health and Social Care Centre”, referred). These statistics are attached at the end of these minutes for information.
Mr Morris noted that the number of attendances at the Accident and Emergency department by people aged 21-25 were consistent with expectations in a city like Leicester. Tamsin Hooton, CCG Director Lead for Community Services Redesign, explained that these numbers partly reflected the number of young people in the city due to it having two universities, but they also were partly due to people choosing to go to Accident and Emergency services, rather than seeking alternative assistance. Work therefore needed to be done on encouraging them to deflect to other services where appropriate.
Some GP practices had low presentation rates, with more of their patients using Accident and Emergency services. This could be for a number of reasons. For example, it was known that one practice in the city with low presentation rates had the highest number of registered patients living in care homes in the city and these residents often were taken to the hospital Accident and Emergency department as a first choice destination.
It was noted that homeless people could register with a GP practice, but nationally there were problems in encouraging them to do so. Homeless people therefore tended to present in high numbers at Accident and Emergency services, but locally Inclusion Healthcare was rated excellent and was very pro-active, including walking round the streets with clinical staff and having conversations with homeless people about their health.
1) That the Leicester City, West Leicestershire and East Leicestershire & Rutland Clinical Commissioning Groups be asked to provide the Commission with:
a) a review of progress with implementing the Leicester, Leicestershire and Rutland 2019/20-2023/24 Primary Care Strategy early in 2020, this review to include information on funding and expenditure; and
b) information on the work being done to deflect people from using hospital Accident and Emergency services when appropriate; and
2) That Healthwatch be asked to provide the Commission with a review of progress it identifies in the implementation of the Leicester, Leicestershire and Rutland 2019/20-2023/24 Primary Care at the same time as the review requested under 1a) above is presented to the Commission.
Councillor Dr Sangster left the meeting during discussion on this item.