Agenda item

For the Health and Wellbeing Board to receive a GP access update.

Fana Hussain (Assistant Director Primary Care, NWL ICS) introduced the report, highlighting the challenges in relation to GP access that the NHS were trying to address. She advised that, while the NHS were trying to manage and increase GP access to the population, the demand continued to increase. For example, there was a backlog within the acute trust, and the acute trust had been directing more activity into GP practices to support the management of those patients waiting for their operations. In some cases, there had been a 30% increase in demand for GP appointments since the pandemic. There had also been another wave of Covid-19 which had resulted in stack sicknesses, and GPs were finding it difficult to recruit locums and salaried GPs due to the rate of pay increase. Brent also had difficulties with retaining staff due to being outside of the inner London weighting, which attracted more staff. NWL NHS were tracking the number of appointments being offered using a national system, which was available publicly for people to see the number of appointments being offered in each ICP area.

In order to address the challenges, additional inequalities clinics had been arranged on alternate Saturdays and GP practices and access hubs were opening during evenings and longer hours, attempting to see new and more patients and opening in new locations. Fana Hussain highlighted that there was innovation and ideas around improving access. NWL were committed to ensuring easy digital access for patients, making it easy for patients to complete online consultation, including for patients whose first language was not English. In the new system that had been commissioned, patients would be able to change to their language preference at the click of a button and in future would be able to enable speech to text. Patients using the new system had offered feedback that it was a lot more user friendly. With that digital innovation came a focus on digital poverty and work was ongoing there. From 1 October 2022, access hubs would transform into ‘Enhanced Service Hubs’ where they would provide a service particularly focused on seeing residents face to face, and residents would be able to obtain an appointment for urgent care on the day of demand, as well as pre-book appointments available 2 weeks in advance. To ensure those appointments were used for their intended purpose, patients would be triaged. NWL were creating an environment focused on cohesive partnership working.

In relation to children and young people, Fana Hussain advised that NWL NHS were conscious that the younger generation needed dedicated services, and there had been a focus on expanding the number of paediatric GPs from 2 to 4, dedicated to looking at pathways and supporting GPs to manage complex patients and improving care for younger patients.

Fana Hussain advised that it was important that patients understood how they could access appointments. This could be done online, via the NHS app, over the telephone, directly by providers or directly by 111. Community pharmacy schemes could also give on the day support, and there were 76 community pharmacists in Brent that she felt were an untapped resource. NWL NHS were working with the Local Pharmaceutical Committee (LPC) to ensure work there was taken forward.

In concluding the update, Fana Hussain advised that NWL NHS continued to look at standards across GP practices.

The Chair invited comments and questions from those present, with the following issues raised:

·         The Board were advised that NWL NHS were very strong on ensuring any communication and engagement pieces adhered to the NHS Accessible Information Standard, and any communications were reviewed prior to publication to ensure they were in accessible format.

·         In relation to digital access, the Board highlighted the work the Council were doing on digital inclusion. They queried whether there had been any joint work between health and the local authority on digital access. Fana Hussain agreed that the Council had been very proactive on that work, and the NHS had provided a small amount of funding to the team undertaking that work to promote the digital access programme and tap into those skills the team had in order to avoid any duplication. 

·         Going forward, patients would be able to see exactly what had been written about them in their patient notes, including test results and referral letters. In order to ensure this was effectively communicated with patients, the outreach team worked very closely with the Council’s digital access team and Brent Health Matters to reach communities and faith leaders and organisations with influence. The Chair expressed the need to brief members on the new offer so that they could effectively communicate with residents.

·         The Board noted that there were people in Brent who were not registered with a GP, and queried what was being done to ensure people were registered with their GP. Fana Hussain confirmed that NWL NHS did have a feel for unregistered patients through their contact with 111 and Urgent Treatment Centres where they claimed to be unregistered. If a patient gave a different name or date of birth then it may not be possible to identify that individual’s medical record. There were support systems in place to encourage a patient to register and make it simple to register, including a contractual obligation for 111 to assist someone to register if requested. Feedback suggested that some residents found it difficult to register with a GP due to the barriers in place such as documentation required, and vice versa feedback from GPs raised concerns around safeguarding. For example, a methadone user may register at multiple practices with a slightly different spelling of their name to obtain certain medications and avoid being traced. Going forward, NWL NHS hoped to make it very easy for people to register, and where there were concerns then the GP may ask for additional official documents with correct spelling of a name. Melanie Smith (Director of Public Health, Brent Council) added that if GPs were experiencing difficulty with methadone users attempting to register with multiple practices then they could join the Shared Care Scheme which had ways to prevent that from happening.

·         The Board queried whether the local authority could assist in data management and sharing issues. Fana Hussain advised that NWL NHS continued to liaise with the local authority around data. Tom Shakespeare (Integrated Care Partnership Director) added that this related to the work around population health, looking for additional capacity from the NHS team to look at the Wissick Tool which brought together certain data. The local authority could help that work by ensuring data was input into that system to enable the population health team to look at a more integrated approach to population health.

·         In relation to the section in the report detailing the increase in demand from patients waiting for elective procedures and being referred back to their GPs, the Board queried whether there had been any improvement in that following the pandemic. Fana Hussain advised that the situation was a challenge and there was a constant focus on waiting lists in acute services and ways to reduce those. Pressures in the system continued and it was anticipated that there would be a bad flu season with another covid wave during the winter. There was effort and energy being put in to reduce those waiting lists but the system had not yet fully recovered.

·         In relation to patient choice, the Board were advised that the offer and direction from NHS England, which NWL NHS adhered to, was that patient choice was paramount and if a patient requested a face to face appointment they should be offered one. It was important that NWL NHS were given the names of practices who were not offering their services in line with the national guidance and regulations so that those practices could be supported to provide face to face services.

·         Fana Hussain highlighted that the public had a part to play to enable the NHS to provide the care they needed by taking responsibility for their care where they could. For example, around 30% of calls to 111 over bank holidays and weekends were for repeat medication prescriptions that were urgently needed as they had ran out. She advised there were many avenues for medication requests such as asking the local pharmacy for a three day supply until the GP practice reopened, or asking the pharmacy to order repeat prescriptions. If patients requested their medication in a timely manner before running out then this would reduce pressure on the system.

RESOLVED:

i)              To note the contents of the action plan and challenges faced by the NHS, including the implications of the rising Covid cases.

ii)             To note that GP access remained a development area.

iii)           For the NWL NHS communications strategy to be presented at a future meeting.

iv)           For the NWL NHS to provide information to councillors in relation to the NHS app and new IT system arrangements for patients.