Agenda item

Eshwyn Prabhu, Islington Planning Department, Alan Keane and Jonathan Weaver, NHS England and Fiona Ernes and        ,  Islington CCG were present for discussion of this item and made a presentation to the Committee, copy interleaved.

During consideration of this item the following main points were made –

·         There are cost pressures in London however there are a number of initiatives to improve capacity and access to primary care

·         There is an Islington I HUB pilot which has secured funding from PM Challenge Fund which will extend core GP hours in Islington, provide three physical hubs across the borough, with a single point of entry via a smart phone telephone interface, including clinical triage and be supported by digital information channels

·         Islington has the lowest proportion of single handed contracts compared to other NCL boroughs. Since October 2014, 3 single hander GP practices have closed with a combined list of 4711. Capacity audits of neighbourhood GP practices during the consultation indicated that patients could re-register

·         Islington is above the national average for FTE GPs per 1000 patients

·         The average GP and Nurse FTE per 1000 patients combined across London is 0.75 and Islington is the highest in North Central London. This indicates that Islington provides sufficient clinical capacity for GP and Nurse FTE per 1000 patients

·         The GLA estimates a projected increase of 41,500 (20%) over 15 years

·         Growth varies by ward from 11% in Canonbury to 34% Bunhill however there is uncertainty as the actual number of homes or bedroom sizes are not known until planning permission is finalised

·         Islington GP consultations are high at the start of life and from middle age increase sharply. Islington population aged 65-74 is expected to grow by 35% and aged 75+ by 39% from 2011-16

·         Research has shown that someone living in the most deprived areas consults a GP as often as someone 20 years their senior in the least deprived areas

·         There are a number of issues associated with Primary Care premises –

Complex arrangements of tenure, where premises are improved and have rent increases this is picked up by the CCG to ensure alignment with strategy, Better Care for London recognised that across the capital up to 30% of primary care premises are not compliant with the Equality Act 2010, strong focus from national bodies on how estates can be an enabler to service transformation

·         From 1 October 2015 Islington CCG became a co-commissioner with NHS England which means that they both worked together to commission primary care

·         Estate is a priority across North Central London CCG’s who are working together to develop plans and Islington and Haringey are working on a joint strategy due in December 2015

·         The strategic direction is to develop more local provision in the community so it is likely that there will be more co-location of primary care

·         The recent Bunhill example showed how local planning could work and the project team included NHS England, L.B.Islington Public Health and Planning, NHS Property services, Islington CCG and the NEL Commissioning Support Unit

·         The projected residential development and population increases arising from development over the next 15 years arises from developments particularly concentrated around Finsbury Park, Bunhill, Archway and Clerkenwell

·         In the near future, the majority of development outside of, but adjacent to Islington, is planned in the Hoxton West ward, in the area north of City Road, and one development in the Hoxton East and Shoreditch wards, east of City Road

·         There is a methodology used for options appraisal – public health maps of Islington, the City and Hackney wards, practices within one mile of the development, ratio of patients to GP’s and nurses, space requirements, etc.

·         The options available to cope with the recent decision for Bunhill population increase included – do nothing, grow existing practices within current premises, develop and improve existing practice premises, or relocate an existing GP practice into the City Forum development or commission new premises and a new contract

·         In terms of the Bunhill development options appraisal there is an approval process in place and this was outlined, although this may not be suitable for other future developments

·         The use of the Finsbury Leisure centre for the new GP premises is positive as it enables a co-location with a leisure facility with the stability of the Council being the landlord

·         Members expressed concern that they would not like to see in future developers not being made to avoid their obligations to provide suitable premises and that it was important to develop a strategy with NHS England and the Planning Department to ensure that premises that are required are delivered at the right time and that any potential difficulties were identified at an early stage and there were no gaps in the process

·         In response to a statement that GP’s are independent contractors, it was stated that there were however levers that were in place to encourage them to change premises and that by having a competitive process GP’s could be persuaded that this was a good idea

·         It was stated that if there is significant population growth a new practice can be established and that the City Road development of 4000 additional patents, was not significant enough for this so the most viable option was to increase capacity at an existing practice. City Road practice were keen to expand and NHS England the Council were keen to work with them

·         Reference was made to the previous item on the London Ambulance service where it was noted that 25% of Londoners were not registered with a GP and whether it was envisaged that this would increase. It was stated that it is hoped that new practices will pick up some existing residents who are not registered, however there is variable registration across London and whilst they were looking at hotspots for non- registration it was a difficult problem to resolve

·         It was stated that there is a constant churn of people in the borough and that NHS England were working with the Council to look at information on projected population growth and it would be important for them to work with Public Health and Planning to be aware of projected population growth

·         Reference was made to the fact that there is often a limited amount of space to develop the capacity of GP surgeries in an inner London Borough such as Islington

·         The Chair stated that it is hoped that Islington Planning would be able to deliver suitable premises through planning gain and in conjunction with an NHS needs assessment followed by NHS England seeking suitable providers

The Chair thanked all the witnesses for attending