Agenda item

This report provides the Health and Wellbeing Board a further update on the process of the primary care access priorities, associated challenges, and the planned proposals for further improving access to primary care services in Brent.

Versha Varsani (Head of Primary Care - Brent) introduced the report, which provided an update on access to primary care following the previously presented paper a year ago which had responded to the ‘No One Left Behind’ Scrutiny Task Group Report into access to primary care. In introducing the report, she highlighted that ‘No One Left Behind’ had made a number of recommendations and the report presented an update on progress against those. Some of the key points were highlighted as follows:

• In terms of the patient population, there was a diverse population with the number of patients growing year on year. People were living longer and having lengthier periods of ill health.
• There was a lot of work being done around proactive healthcare and neighbourhood work.
• The demand for GP led appointments surpassed the supply, so primary care was continually seeking different avenues and providing progressively more services to meet this demand.
• There were 51 GP surgeries across Brent, and in a period of one month, GPs collectively provided 210,000 GP led appointments.
• Enhanced access hubs were available which provided delivery of services across the 5 different hubs in the borough and operated outside of GP core hours – in the evenings from 6:30pm–8pm Monday to Friday, and Saturdays 9am–5pm. Those hubs provided an additional 12,500 appointments per month.
• Between GP-led appointments and enhanced access hub appointments, there was an average of 3 appointments per month per patient, or 36 appointments per year per patient. Not every patient registered with a GP would need an appointment, so some patients would have more access than others, but this gave an understanding of the  offer.
• NWL was currently piloting a service operating between November 2023 to March 2024 with PCNs to provide more at scale services during core hours and was beginning to analyse the data from that trial.
• There had been additional pressures over winter due to the usual winter pressures, as well as Junior Doctor strikes. PCNs stepped up to provide additional access over the 3 bank holidays during Christmas.
• PCNs and GP practices had active triage models and aimed at signposting patients to the right place at the right time to see the right professional.
• There had been an increase in employees on the Additional Roles Reimbursement Scheme (ARRS), with 206 full-time equivalent additional roles, such as pharmacists, dieticians and social prescribers, compared to 88 two years previously. These additional roles provided specialist skills within GP practices and PCNs.
• A priority of primary care was to help patients chose the right setting to access and there was a range of services to chose from including community pharmacy services, NHS 111 for non-life threatening conditions, and promotion of self-care. Community pharmacists were expanding their offer with the Pharmacy First Scheme in line with the national programme. Pharmacy First would be a walk-in service for access to treatment for minor ailments, initially with 7 pathways. There would be ongoing work to further integrate all these additional services, and pharmacists were currently undertaking training to ensure they could provide the enhanced service.
• Digital technology was advancing with the NHS app. There was awareness that not all communities in Brent were digitally literate, so work was happening to educate residents on how to use the app and enabling residents to use it properly. The technology within the app allowed both GPs and residents to gain access to their patient records.
• There was a vision to align and streamline the access model so that there was one direct phone line for patients to access and work would take place over the coming year towards that.
• Brent Health Matters (BHM) was supporting community engagement to raise awareness with residents about services and NWL continued to update its communications strategy and engagement plans to ensure residents were aware of what to expect from their primary care.

In considering the report, the following points were raised:

·         Members highlighted that many GP surgeries already had an app where patients could book appointments and other actions, and asked how aligned those apps would be with the NHS app to ensure there were not too many applications patients were required to access and look at. They heard that the direction of travel nationally was to move towards using only the NHS app as one application. The NHS app was a highly tested app and had gone through strict governance processes to ensure it was completely safe to use, including in relation to the protection of patient data. The NHS app also allowed two-way messaging between the patient and GP surgery. Data showed that 3 in 4 people had downloaded the NHS app, but that did not necessarily mean they were using it, so the next step was to encourage use of the app.

·         Dr Haidar added that digital inclusion work could be presented at a future meeting as there was work being done by NWL NHS around health inequalities and digital exclusion.

·         The Board highlighted that a potential barrier for using the app would be accessibility and hoped it had been robustly tested. For example, the Board asked whether the app took account of British Sign Language use. It was agreed that action would be taken to identify whether British Sign Language needs were catered for within the app.

·         The Board felt the report missed information relating to women’s health needs specifically and Well Woman Clinics. Versha Varsani explained that NWL NHS was currently working with a specialist GP to focus on developing women’s health clinics across the borough.

·         The Health and Wellbeing Board highlighted that many constituents experienced challenges with the 8am rush in their GP surgeries, for most GPs it was currently necessary for patients to call the surgery at 8am to get a same day appointment, this often coincides with many residents morning commute to their place of work. Tom Shakespeare (Director of Integrated Care Partnership) explained that this challenge was one of the key factors that the ICP wanted to focus on over the next 12 months and there was a triage pilot currently running with 23 of Brent’s GP practices. Triaging was being looked at from a borough perspective and considered as part of business modelling, with the intention to manage that demand at 8am by streamlining and filtering demand differently. The pilot was working towards one single access number, where if someone was unable to get a response from their GP surgery, they could use the single access hub and be directed to the right service.

·         The Board highlighted that only 55% of the appointments offered were face to face, as outlined in the report. They queried whether there was confidence that this was reflective of the needs and preferences of patients. Officers were of the belief this was reflective of patient preference. If a patient wanted to be seen face to face they would be triaged into being booked in to a face to face appointment. The figure was in line with the average benchmark for NHSE, which was closer to 60%.

·         Dr Melanie Smith (Director of Public Health, Brent Council) highlighted the achievement outlined in the report that 100% of GP practices had been accredited as Safe Surgeries. She queried how that was working in practice and suggested that a mystery shopping exercise be carried out, which would be arranged outside of the meeting.

·         The Chair asked whether, anecdotally, there had been a reduction in people presenting to A&E which could be linked back to Safe Surgeries, as those without documentation could now register with a GP. Simon Crawford (Deputy CEO, LNWUHT) was not aware that there had been a reduction in attendances for this specific reason, but agreed to undertake further analysis of this. He highlighted that A&E had been extremely busy in terms of winter pressures, although there was good work happening in the community and primary care to support the pressures with alternative pathways.

As no further issues were raised, the Chair drew the discussion to a close, asking the Health and Wellbeing Board to note the work to date to improve access to primary health care and note the proposals in the paper for GP-led services in 2024-25. He requested that the next update included the work which health and the local authority were undertaking in relation to digital inclusion, women’s health and the communications strategy, as well as the information regarding Safe Surgeries and any analysis of the impact this has had on A&E attendances and the mystery shopping exercise outcome.