Agenda item

This report provides the Health and Wellbeing Board with an update on the progress of the Brent Integrated Care Partnership (ICP) Transformation Executive Group.

Zaid Dowlut introduced the report, which provided an update on the projects being progressed within the primary care programme covering general practice. In introducing the update, he highlighted the following key points:

·       The recently published NHS 10-year plan had now been published, which set out significant changes due to take place moving forward from the current way of working to a more neighbourhood health approach. Primary Care was at the core of the model and would be asked to work closely with communities to tackle health inequalities and deliver better access and co-ordination of services locally.

·       The national General Practice Improvement Programme (GPIP) also introduced a focus on health inequalities and the wider determinants of health in 2023 in light of growing challenges.

·       The Brent Primary Care Transformation Executive Group (PCTEG) was responsible for overseeing the delivery of primary care transformation and change priorities relevant to the local partnership and system, and aimed to align primary care with both national policy and local plans, including the NWL Joint Forward Plan and the Council’s Borough Plan 2023-25.

·       The next steps that the PCTEG was looking to implemented was to move to a neighbourhood level approach for primary care, which would require a different way of funding. 

·       Locally, colleagues across the ICP and primary care were working together to look at models of multi-disciplinary working and the report set out that approach, including Child Health Hubs, local enhanced services, population cohorts with specific needs and improving access to primary care.

·       In relation to access to primary care, a new access model had reduced pressure on other parts of the system, including urgent and emergency care, and the report detailed the 9 extended access hubs now available offering a range of face to face and telephone appointments. These additional appointments had achieved an overall utilisation of 93% across Brent.

·       Registration of patients on the NHS had increased, and Brent, compared to NWL, had higher rates of appointments being booked through the NHS app, showing a good indication of engagement with the new digital environment.

·       The paper set out key progress since the previous year and some of the challenges for some services. It was hoped that with better access, capacity and transition planning that performance would have improved by next year.

·       In relation to cancer screening and early detection, 33 GP practices across Brent remained below 60% uptake for cervical screening, below the national efficiency standard of 75%. It was hoped that with the new integrated approach the performance would strengthen. A new HPV self-referral approach was being deployed, and cervical screenings were now being offered at enhanced access hubs, and a local cancer improvement programme was in development to reach communities with low uptake of screening.

·       Child Health Hubs were due to come on stream in July, running initially at PCN level with the aim to scale that up to a neighbourhood level, working as multi-disciplinary teams supporting children and young people with complex needs in the community without them having to attend outpatient or acute hospitals unnecessarily.

·       Primary care now had a diverse set of roles including pharmacists, clinicians, social prescribers and others, and primary care was keen to maximise the opportunities to enable training and development for the workforce in partnership with the NWL training hub. 

The Chair thanked presenters for the introduction and invited contributions from those present, with the following points raised:

• The Board welcomed the child health hub initiative, which they felt would be beneficial for families and for streamlining services in primary care. Noting the paper stated that the service would be scaled up into a neighbourhood delivery model, they asked for further detail about how that would be achieved. Zaid Dowlut advised that the service was due to start in July across 7 Primary Care Networks (PCNs). As referrals from practices increased, plans would be finalised for neighbourhood working. Jonathan Turner explained that there would be one hub in each of the 5 connect areas with 5 GPs recruited to do that work. The hubs would have a GP and consultant led model with consultant paediatricians from LNWT and Imperial Health Trust. The clinic would take place once a month at an outpatient community setting and would help to take pressure off hospitals and reduce some non-elective admissions for common physical health conditions such as asthma and epilepsy. Once there was confidence that the service was ready there would be communications disseminated on that.
• Noting that the report detailed low covid vaccination figures, the Board asked whether that was cause for concern and what the current recommendations for vaccination were. Dr Melanie Smith advised that the recommendations for Covid vaccination had been pared down, with fewer groups now advised to get vaccinated. Those who were advised to get vaccinated were those where the consequences of infection were more severe and those in whom the vaccination was less effective as their immune system was suppressed. She added that the pattern of covid infection was changing and further guidance was expected on vaccination based on the JCVI.
• The Board noted that only 10% of those severely immunocompromised had been vaccinated. Dr Melanie Smith confirmed that public health would want that figure to be 100% because that was the only way that cohort could be protected from covid. She advised that this was a challenging group in terms of vaccination as they were protective about their health and held a set of health beliefs that were best addressed in clinical encounters rather than community outreach.
• In relation to paediatric phlebotomy being listed as an underperforming service, Zaid Dowlut would ask the medical director to provide a written response on the reasons for that. The Level 2 diabetes MDT service was marked as underperforming as 2-3 PCNs did not achieve the targets set on care plans due to capacity.
• In relation to table 2 of the report, the Board noted that the level of activity in each quarter reduced and asked why that was. They heard that planned quarter 4 activity was usually less than the rest of the year due to the need for primary care to complete admin requirements for quality outcomes framework indicators.
• The Board asked what work was taking place to harmonise PCNs with localities. Robyn Doran advised that this was an ongoing discussion locally about Brent’s future as neighbourhoods as opposed to PCNs so that services were built around neighbourhoods. The new NHS 10-year plan expected primary care to operate at a neighbourhood level and health services awaited further details on that.
• In relation to table 3, it was noted that Kilburn appeared to have a lower level of activity than other PCNs and the Board queried that. Zaid Dowlut would look into this and provide a response. It was added that it would be useful to have the full names of the PCN and details of the geography they covered in future reports.
• Noting that the workforce composition for extended access hubs differed across the 3 PCNs, the Board asked why that was, highlighting this did not form a common offer. Zaid Dowlut explained that there were a variety of roles in PCNs, and whilst there was a requirement that there was a GP in a hub, there were other roles that the hub may then also provide such as pharmacists and nurses. He added that during core hours the whole team would be there, but during enhanced hours the service was restricted. The Board asked whether any work had been undertaken to agree those model arrangements, which officers did not think had been the case. Officers agreed to go back to PCNs to ask why some hubs had pharmacists and others did not and provide a written response.

As no further issues were raised the Board noted the report and recommended that work be undertaken to ensure a standard offer for health care practitioners working in the hubs. They welcomed the work being undertaken to ensure services were delivered on a neighbourhood basis.