Agenda item
Primary Care Transformation
This report provides the Community and Wellbeing Scrutiny Committee with an update on the Brent Clinical Commissioning Group’s (Brent CCG) programme of Primary Care Transformation. This work is led by NHS Brent CCG alongside Primary Care providers and stakeholders who include the London Borough of Brent, the other 7 CCGs in North West London (NWL), NHS England and other providers and patient representatives.
Minutes:
Sheik Auladin (Chief Operating Officer at Brent Clinical Commissioning Group (CCG)) and Sarah McDonnell (Deputy Chief Operating Officer at Brent CCG) presented the report which covered some of the main drivers around primary care transformation. They informed the Committee that some of the challenges faced by Brent CCG were a growing number of people aged 85 and over; demand on services was outstripping Brent CCG’s ability to deliver care; variation in care quality and outcomes; financial pressures; aging infrastructure; and issues related to recruitment and retention of General Practitioners (GPs). The Committee heard that the four key areas on which Brent CCG would focus were access, resilience, commissioning of primary care, and delegation. In addition, Dr Ethie Kong (Chair of Brent CCG) said that two videos had been shown around the Borough with the aim to increase residents’ awareness of the role of care navigators and to inform them how to utilise the services of GP access hubs. Councillor Hirani (Cabinet Member for Community Wellbeing) commented that the present situation required items (services) to be added to existing contracts to ensure the needs of the local community were met.
A Member of the Committee enquired whether the growth in the registered population for primary care was concentrated in particular parts of the Borough or among certain groups of the population. In response, Ms McDonnell said that growth had been uniform across Brent, with a main factor contributing to the increased number of people registered for primary services being the housing developments. She highlighted that while the number of primary care contacts had doubled, there was a marginal decrease in patient satisfaction levels and ability to access appointments. She noted that one of Brent CCGs key aims was to manage these two factors, while exploring potential ways of delivering extended opening hours. In relation to a question that related to the regeneration areas in Wembley and South Kilburn, Ms McDonnell stated that Brent CCG had strategic estates updates and worked closely with developers to try to identify hot spots and provide input into what a primary care facility might look like. She gave Park Royal as an example of an area where undersupply of GPs had led to the procurement of a practice at Central Middlesex Hospital (CMH) - a joint venture with the London Borough of Ealing, opened to patients from both boroughs. She made it clear that according to the current provisions, practices were commissioned by National Health Service England (NHSE) so what Brent CCG could do was to maximise the services delivered by the existing 62 practices. In terms of challenges, Ms McDonnell said that the biggest issues were related to small practices (located in houses), shortage of workforce and cost of locating practices in new developments (spaces available might not be affordable). Therefore, Brent CCG was looking into developing long-term plans for practices and handover protocols.
In response to a question that related to measures being taken to ensure that vulnerable residents were not adversely affected by changes to primary care delivery, Ms McDonnell said that one of the groups disproportionately affected by transformation were new residents as they might not have a GP and might have found it difficult to register. Therefore, she stressed the importance of informing residents what they could do if a practice refused to register them. Dr Kong added that all practices had defined catchment areas and maintained open register so if a practice refused a new registration, this could result in a complaint.
As far as what a vision for primary care should look like, Ms McDonnell informed that committee that the primary care strategy had to be refreshed which would happen in the autumn of 2017. She went on to explain that the structure of three GP networks and a Federation contributed to improving primary care by providing out of hospital services. She commented that patient satisfaction with the integrated model and the hub was high and more could be done to ensure providers would sign up for it. In relation to the Personal Medical Services contract review, Ms McDonnell said that Brent CCG had started an informal consultation and that there were significant differences between the 11 practices so the next step would be to have one-to-one discussions to consider how these could be addressed. She noted that many decisions and functions were still led by NHSE, with Brent CCG focusing on management of contracts with practices – for example, all practices had to cover core access (core hours) and extended hours were subject to negotiation.
In relation to Brent CCG’s priorities in 2017-18 and improving the quality of frontline primary care, the Committee heard that Brent had one of the highest rates of uptake of annual health checks. Sarah Basham (Vice Chair and Co-Clinical Director at Brent CCG) said that Brent CCG’s programme focused on people who were frail, had long-term conditions or were part of a vulnerable family. Dr Kong added that there had been a ten-year difference in life expectancy between males in Kenton and Harlesden, which had been tackled down and reduced to seven and a half years. Ms Auladin spoke about care management and the provision of services in nursing homes to prevent patients being admitted to hospitals. He said that KPIs would be regularly examined to assess the impact of transformation on patients. Dr Kong suggested that this approach could be supplemented by encouraging Brent CCG’s partners to carry out independent surveys to assess the commissioned services.
Members questioned how patients had been chosen for the trial of the Babylon application (paragraphs 3.33-3.36 on pages 35 and 36 to the Agenda pack). Ms McDonnell explained that the application had not been rolled out across Brent and, in fact, no practice in North West London had implemented it. She said that a detailed risk assessment had been undertaken as it was a clinical tool and it had been certified safe. In relation to selecting patients, Ms Donnell clarified that users had not been chosen as the tool had been promoted to residents, meaning that sign up was voluntary. Ms Donnell said that she did not have information if the application was available in other languages to address Brent’s diversity.
RESOLVED that:
(i) The contents of the Primary Care Transformation report, be noted;
(ii) The following potential recommendations be identified by the Committee for further consideration:
1. Brent CCG considers the implementation of one public sector communication strategy (including links to the Brent website) that not only gives residents information, but also provides answers to common questions.
2. General Practitioners are strongly advised to display information about new developments.
3. Brent CCG works together with Brent Council’s Planning Service to ensure that provision of health services is included in discussions about what developers have to provide when (re)developing a site.
4. Brent CCG is encouraged to provide a clear guidance what good looks like in terms of primary care and how Brent Council could assist delivery.
5. Brent CCG is advised to inform residents about their rights in case a practice refuses to register them.
Councillor Hoda-Benn left the meeting at 9:50 pm.
Councillor Perrin entered the meeting at 9:50 pm.
Supporting documents: