Agenda item

The Panel was asked to give consideration to a presentation, which covered; 

·         Findings of the latest GP Patient Survey;

·         Current access to primary care across Doncaster;

·         National, South Yorkshire and Local approaches to improvement; and

·         Primary Care Estate development across Doncaster.

The Panel discussed the following areas:

GP Survey – Clarification was sought around information provided on the presentation showing results from the GP Survey.  This related to green bars indicating experiences of Primary Care Networks to be lower than  that of national and Integrated Care System levels.  It  was explained that there were a number of questions asked within the survey that formed part of a particular theme.  Members heard how this was about tailoring the offer back as part of the support for quality, telephony, capacity and demand where it can be sought from other practices, tailoring to that particular Primary Care Network.  It was acknowledged that this might be different in the south to what it was in the north.

It was explained that there could be 7/8 practices in a Primary Care Network.  Members were informed that the survey had not brought up any areas that they were not already aware of.  It was recognised that what was important was what was being done going forward.

It was added that many areas undertaken nationally, were still split on list size or numbers. It was explained that this had not yet moved towards a more needs based approach and it was felt that this was perhaps the national direction, from an inequalities point of view. 

In relation to the Inverse Care Law, it was explained that when a practice was struggling, it could become a difficult place to work and therefore attracting new people became more challenging.  Members heard that although this was the reason behind the new roles, there was a need to make those struggling practices (particularly those linked to areas of deprivation) a good place to work with the hope that people will remain.

A question was asked about the origin of the qualitative data.  It was explained that the consultation around Enhanced Access was undertaken with the GP Federation working with HealthWatch.  It was added that Primary Care Doncaster and North Primary Care Network, had also undertaken some initial engagement on what the local population wanted.  It was continued that from a broader point of view  around how they work with practices, a triangulation of evidence was brought together that included; the data, qualitative information and what the practices were providing.  Finally, it was explained that work had been carried out to share intelligence from good practices to be used to support those practices that were struggling.

Glyn Butcher thanked Primary Care for what they do and explained his observations from the work that he had undertaken with communities and SafeSpace.  It was felt that people often attended their GPs due to   habits and intergenerational patterns and that the key to addressing demand included promotion and re-educating people to consider alternative routes and to change mind-sets. It was also noted that there was potential in what could be achieved within communities to provide alternative ways.  Finally, Glyn spoke about the success of the mental health alliance, SafeSpace, Openminds and Mind and believed that a different approach was required with GPs and Primary Care. 

The Director of Health and Wellbeing spoke about the Fuller review (by Dr Clare Fuller commissioned by NHS England to assess how newly formed Integrated Care Systems and primary care could work together to improve care for patients.), and that all Integrated Care Board leads (including South Yorkshire) had publicly co-signed a letter supporting the 15 recommendations made (8 of which were for the Integrated Care Boards).

Reference was made to a recommendation, which was to ‘Enable all Primary Care Networks to evolve into integrated neighbourhood teams’.   This was about thinking creatively with neighbourhood teams being a group of people that will listen to and understand the needs of local people.  It was added that this was behind efforts being made by the Primary Care Network to bring Integrated Care more closely with the locality agenda.  A second recommendation was highlighted to ‘work alongside local people and communities and the planning and implementation process and ensure plans were appropriately tailored towards local needs taking into account demographic and cultural factors’.  It was considered positive that we have an Integrated Care Board that was signed up to these recommendations and recognised these as clear issues that were in line with what the Panel would like to see happen.

The Chair welcomed an opportunity for local councillors or community members to a look at creative ways of integrating neighbourhood teams.  The Executive Place Director also recognised the value of spending time with GP Practices.

Role of Nurse Practitioners – Concern was raised about the recent practice of including Nurse Practitioners within the GP:Patient ratio.  It was questioned whether Nurse Practitioners taking a more central role, was being recognised and rewarded appropriately for their additional responsibilities and role within the practice.  In terms of nurse roles, it was explained that nurse roles in general practice weren’t typically ‘Agenda for Change’ and it was down to each practice, as an individual business, as to how much they paid, reflecting the achievement of a diploma to become an Advanced Nurse, level of expertise and autonomy that went with this role. 

Impact of New Housing Developments  - Concern was raised around the impact of new housing developments on local GP Practices and how those practices would be able to meet increasing demands when they were already very busy.

The Executive Place Director discussed the work taking place across the Borough that included Rossington, Bentley and Thorne.  Members informed that there was an Estates Strategy in place for where such builds were being made.  It was outlined that GP practices were paid by numbers on their lists and with increasing numbers, there should be the investment into their workforce to meet demand.  It was noted that there continued to be ongoing challenges around recruiting individuals into such posts.

Telecommunication Systems in GP Surgeries – The Executive Place Director explained that they were waiting for the national response due to the complexities involved and were trying to take a Primary Care Network and practice-by-practice approach.  It was noted that less than a third of practices had cloud-based solutions at their practices but that more were being included in this, as time progressed.   It was commented that this was not the only solution and that one size did not fit all, for example, work was being undertaken on the digital triage of patients at Conisborough.

It was added that the telephone system would continue to play a significant part for the foreseeable future.

A Member of the Panel spoke about a local merger of practices and sought clarification on the process and consultation that would have taken place. 

A Member of the Panel raised concerns around the impact arising from cross county developments concerns in terms of increased demand.  The Executive Place Director noted the benefits of a South Yorkshire Integrated Care Board, which would have sight of such things.

RESOLVED that the Panel note and comment on the information provided by the NHS South Yorkshire Integrated Care Board around Access to Primary Care update.