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Scrutiny Review - GP Surgeries - Witness evidence

Minutes:

Katherine Gerrans, Primary Care workforce, and Rebecca Kingsnorth, Assistant Director, Primary Care, Islington CCG were present at the meeting and made a presentation to the Committee, a copy of which is interleaved.

 

During consideration of the presentation the following main points were made –

 

·         A new five - year framework was announced in January 2019 between NHS England and the General Practitioners Committee, England, and will introduce increased workforce, creating networks, and see reconfiguration of services

·         The changes will provide much needed support, and resources, for general practice, expanding the workforce, reducing workload, increasing funding, retaining GP and partnership autonomy, and ensuring GP’s have a leadership role at the centre of primary care

·         Practices will form Primary Care Networks through a new Directed Enhanced Service, and Networks can facilitate shared decision making between practices for their total network populations, typically 30-50000), around funding and workforce distribution, and augmented service provision. Networks will need to be geographically contiguous

·         Practices will sign a network agreement that outlines what decisions the network has made about how they will work together, which practice will deliver what for specific packages of care, how funding will be allocated between practices, and how new workforce will be shared, including who will employ them

·         Practices will be expected to work together in networks to provide extended opening hours, currently provided on an individual practice basis

·         In full from 2020/21 the DES specification will require networks to outline how they will provide specific support for those in care homes, and undertake medication reviews

·         From 2020/21 the delivery of personalised care will commence, early cancer diagnosis will be supported, diagnosis and anticipatory care, and how data will be shared within the network will take place

·         From 2021/22 onwards, additional requirements will be added to Cardiovascular disease, prevention and inequalities, although these details are still to be negotiated. These areas will be linked to the expanded workforce employed by the network

·         In relation to Primary Care networks, additional workforce will be introduced and partially funded through the Network. The number will build up over 5 years

·         NHS England will fund 70% of each professional, including on costs. Networks will need to fund the additional 30% themselves. The exception is social prescribers, which NHS England will fund 100%, including on costs

·         The Network will decide how the additional workforce is employed

·         The workforce and network will be led by a Clinical Director, chosen from within the GP’s of each network. The Clinical Director will be funded, an average of a day a week for a network of 40000 patients, including on costs, from new funding provided by NHS England

·         In 2019, there will be 1x clinical pharmacist and 1x social prescriber, in 2020 first contact physiotherapist and physician associates, in 2021 all of the these will increase and community paramedics will be introduced, in 2022/23 all of the above workforce will be increased, and by 2024 a typical network will receive 5 clinical pharmacists, equivalent of one per practice, three social prescribers, three first contact physiotherapists, two physician associates, and one community paramedic

 

·         Changes will also take place to support electronic access, to appointment booking, and to information, and this will be phased in over a number of years. A programme to digitalise paper records will commence to enable the creation of a complete electronic record for each patient

·         Practices will be required to offer 1 appointment per 3000 patients per day, for NHS 111 to book registered patients in, following triage. These are existing appointments, as decided by the practice, but should be spaced evenly throughout the day

·         Practices will no longer use fax machines for either NHS or patient communications

·         From 2019 the GP contract will increase by 1.4%, in addition to the funding through networks.  This includes a 2% uplift for GP and staff pay, and an uplift for practices to establish and develop networks, via an additional service within the global sum, an uplift due to population increase, adjustment for an indemnity state backed scheme, an increase to the value of giving some vaccinations and immunisations, including influenza, a £20m recurrent for costs associated with subject access requirements, and £30m for practices to make appointments available to NHS 111

·         There will be changes to the GP Quality and Outcomes framework through which practices receive payment for achievement against specified indicators, and there will be the introduction of Quality Improvement programme at network level

·         The new GP contract supports and accelerates many aspects of work in Islington and North Central London Primary Care strategy. Further detail is awaited on many aspects of the contract, and it was noted that the timescales are ambitious

·         Encouraging conversations are taking place with the Islington GP Federation and Local Medical Committee about working jointly to support practices as the existing network arrangements become more formalised through the contract

·         Digital Developments include – the development of and NHS app, which will be activated in Islington in April 2019, enabling patients to access their GP records, book appointments online, request repeat prescriptions, undertake a symptom checker which has the potential to release capacity in general practice. Due diligence process is underway, including testing in a live practice environment (e.g. direct integration into EMIS appointment booking)

·         Video consultation functionality will be available from mid-March 2019. The NCL supplier is piloting this in another area. An app version of the solution is expected to be available in February 2019, and so will be available in those practices who have expressed interest to offer this service, once this solution has been implemented. Initial discussions with the supplier have indicated that they have the capability and interest in aligning their product with the NHS app over time

·         There are a number of North Central London wide workforce projects taking place, including NCL workforce action plan/GP strategy implementation, international GP recruitment, a GP retention scheme, new employment models in primary care, practice educator team development (formerly superhubs), GP nursing 10 point plan, physician associates in primary care, super admin, care navigation, clinical pharmacists in general practice, trainee nursing associates, general practice nurse training, and the Learn and Earn Pathway apprenticeship scheme

·         It was stated that is felt that Islington is well placed to implement local and national strategies

·         It was noted that Islington has better patient to GP ratios than Barnet, Enfield or Haringey

·         In terms of funding it was stated that the CCG were currently funding the current cohort of community pharmacists, however there is a need to look at affordability of the future roll out of cohorts

·         There is a need for GP practices to look at what works for them, and how changes will benefit practices

·         In relation to social prescribing this is to address the non-medical needs of patients that could be of benefit to them, and work will take place on the experience working with Age UK

·         In terms of staff recruitment this will be varied, and there is a need to look at the development of these roles across the North Central London network

·         Reference was made to some pregnant ethnic minority women being refused treatment and access to medical services. It was stated that generally access to services is allowed, if a person has been in the country for more than 6 months but this may be an issue that the Committee could look at in more detail at a future date

 

The Chair thanked Rebecca Kingsnorth and Katherine Gerrans for their presentation

 

Supporting documents: