Agenda item

For the Health and Wellbeing Board to receive an update from the Integrated Care Partnership (ICP) on primary health care.

Fana Hussain (Assistant Director Primary Care, NHS NWL) introduced the report, which provided an update on the actions taken to improve GP and primary care access in Brent. She highlighted that access to primary care remained on the agenda as a priority area for all boroughs in NWL. NWL had been working alongside GP practices after the ‘no-one left alone’ report and recommendations. In updating the Board, she highlighted the following key points:

·         The Primary Care Team had been looking at how to improve access to appointments, including online consultations, as well as how to improve the number of staff working in GP practices and how primary care worked with partner organisations. A lot of work on this had been undertaken in the past year and members’ attention was drawn to Table 1a of the report, which showed the number of GP appointments offered in NWL. In the month of December 2022, Brent had been the borough with the second highest number of GP appointments, and in January 2023 had moved to joint second position alongside other boroughs. The graphs showed appointments at GP practice level but did not include appointments held at the Access Hubs.

·         The main focus areas had been:

o    Increasing appointments outside of core hours (8:00am – 6:30pm, Monday to Friday), looking at how appointment options could be expanded up to 8pm and on weekends

o   Offering additional appointments in health inequality clinics and promoting uptake.

·         As such, GPs were seeing more patients who were diabetic, had long term conditions, and were offering screenings and immunisations. Enhanced Access Services were now providing double the number of appointments they had previously, with 135,000 appointments now being provided in hubs where patients could get an appointment outside of core hours. Booking for those remained through GP practices and calling 111, but the aim was to enable direct booking into those slots once IT barriers had been resolved.

·         Face to face appointments had remained a focus, as primary care were aware patients wanted to be seen face to face. Two thirds of appointments in most GP practices were provided face to face with one third online. It was understood that there was also a demand for online consultation, particularly from the younger generation and those with IT skills, so that hybrid model was available.

·         The focus on improving access to primary care had also concentrated on access to registration. Primary care understood that patients were experiencing issues registering with GPs, and so this had been highlighted and taken forward, working with an organisation called Doctors of the World. As part of this, surgeries were being offered accredited training on ‘safe surgery’, which looked at barriers to registering. 40 GP practices had now been accredited as safe surgeries and the remainder would go to the next programme. Registration was now much easier and more fluent with documentation no longer required and, going forward, the NHS app would allow patients to change GP practice at the click of a button.

·         Additional staff were being recruited to increase capacity in GP practices, including Clinical Pharmacists, Physiotherapists, Paramedics, Nursing Associates, and Health Care Assistants. The number of additional roles had been increased by 101% within the year.

·         Reception staff had been upskilled with customer care training, managing difficult conversations, supporting patients and signposting to help navigate patients into the right setting.

The Chair thanked Fana Hussain for her introduction and invited contributions from those present. The following issues were raised:

·         The Board were pleased with the details in the paper and the different initiatives to improve access. In relation to Enhanced Access Hubs, they queried whether there was any data on the uptake of those out of hours appointments and whether they were being utilised. Fana Hussain confirmed that Enhanced Access Hubs were commissioned and monitored at PCN level. Utilisation was around 92% across all PCNs, but there were some areas with less utilisation, such as Kilburn which had 65% utilisation.

·         Dr Haidar congratulated the Primary Care Team for their response to challenge around access, and felt the work was an example of moving forward as a system together. One of the mission statements for primary care was around changing definitions, for example, instead of saying ‘hard to reach populations’ this was now ‘hard to access services’. The Primary Care Team were working together to take services out to patients and communities and access would remain a focus for the ICP.

·         In relation to the communications plan, the Board asked if the ICP were confident that GP practice staff knew about the additional access hubs and how to refer, as well as how the ICP would raise awareness with Brent residents of the additional services. Fana Hussain highlighted that this work would be taken forward once the access line into the Enhanced Access Hubs was available to promote. Currently, all GP websites were being updated with this information and practices were aware those appointments were available and what their allocation of appointments was. Information would be disseminated to all Brent residents and the ICP were working closely with the local authority’s communications team to include an article in the Brent Magazine to highlight the hubs and how they could be accessed. The timing of that messaging was imperative to ensure the technology around direct booking was in place prior to sending out messages. In addition, all information would be available on the ICP website.

·         The Board asked about eligibility for free treatment for non-residents or residents who had been away from the country for 12 months. Fana Hussain explained that everybody was entitled to register with a GP, even if they were a visitor from another country. To receive services in an acute secondary setting, such as a hospital, there was a team who would assess whether a patient was entitled to that treatment and whether there may be a charge, for example if someone went to the hospital to deliver a baby or manage a condition. However, if a patient entered an Urgent Treatment Centre and their life was at risk then that treatment was free. These were national requirements and not derived locally.

·         In relation to paragraph 3.15 of the report about joint working, Fana Hussain advised the Board that the vision for the Enhanced Access Hubs was to incorporate wider community and partner organisations so that the hubs were running alongside all other partnership teams. For example, having colleagues such as the Housing Team and Cost-of-Living Team alongside the hubs so that their sessions could run at the same time in order for residents to access several services at once. The ICP were also working with community providers to see how they could deliver some enhanced services jointly. For example, a few years previously, womb care management was introduced in GP settings and the community team had trained nurses to deliver that. Integration was about having a seamless service where partners worked as one within the setting, so there could be a go-to place for everything someone needed. In response to what the local authority could do to ensure that happened, Tom Shakespeare (Director, Integrated Care Partnership) confirmed that the Integrated Care Partnership (ICP) priority was about wraparound care with partnership at the core of the hubs. The work was still in its development phase.

RESOLVED: To note the progress on the priorities and thank the Primary Care Team in the Brent Borough-Based Partnership.