Agenda item

Cheryl Rehal, Associate Director of Primary and Community Care, Bromley –  SEL ICS (“Associate Director”) and Dr Andrew Parson, Co-Chair and GP Clinical Lead – One Bromley Local Care Partnership (“GP Clinical Lead”) delivered a presentation outlining progress towards improving the experience of accessing primary care services; data on demand and activity in general practice in Bromley; and transformation initiatives in train to improve access in Bromley.

The GP Clinical Lead advised Members that there had been some unexpected challenges faced in primary care, particularly in relation to the increased prevalence of Strep A, a potentially fatal condition which could put children at risk, and scarlet fever. This had an unprecedented effect on demand as it coincided with a high prevalence of other viral respiratory illnesses. There had been a huge demand for medical attention and the prescription of antibiotics had put pressure on pharmacies. In terms of winter pressures, the GP Clinical Lead advised that services had been particularly busy this year and it was noted that strike action could have a knock-on effect to primary care.

With regards to the data on appointments, the GP Clinical Lead informed Members that general practice appointment delivery continued to rise, and was returning to the pattern seen pre-pandemic. It was noted that NHS Digital had recently published ‘experimental’ GP appointments data. It was highlighted that, although it provided a picture, the data did not include all types of appointments, nor did it include related clinical activity. There was still some data quality issues to be resolved, and therefore it did not currently match directly with the practice or ICS data on appointment numbers.

In response to questions, the GP Clinical Lead advised that the graph on page 49 of the main agenda pack showed the number of appointments (rates per 1,000 patients) offered at the 43 GP practices in the borough during October (blue lines) and November 2022 (orange lines). It was noted that a number of practices appeared to have offered more appointments during October, compared to November, which may be due to the data counting extra flu vaccinations clinics that were delivered. The GP Clinical Lead said that the capacity of a practice was constrained by the number of appointments offered – demand generally continued to outstrip capacity everywhere, so it was therefore unusual to have unfilled capacity. The difficulty with the data was that it was how appointments were being coded and work may need to be undertaken with practices in term of how this married up. With regards to small versus large practices, the Associate Director advised that by using the rates per 1,000 patients they had tried to take account to ensure that the size of the practices was not misrepresented. The Member further questioned if there was a data set available to see how quickly patients were being seen. The GP Clinical Lead advised that a data set was being put together by NHS Digital to look at how far in advance patients had booked their appointment. There would be a breakdown of which patients needed to be seen same day/urgently; those requiring follow-up appointments (booked well in advance of 2 weeks); and those booking non-urgent appointment, with the aim of being seen within 2 weeks. The Associate Director highlighted that, with the caveat that the data set was not wholly reliable, during October and November 2022, 81% of patients had been seen within 2 weeks. It was also noted that some patients booking appointments did not necessarily want to be seen within 2 weeks, and were instead booking their vaccinations/health checks well in advance – it was not possible to differentiate, and this was something that they would be looking at.

In terms of the types of appointments, there had been a continual increase in the proportion of face-to-face appointments compared to telephone and digital. The GP Clinical Lead emphasised that there was a real need for GP practices to be able to deliver the latter, which patients requested and appreciated, and would remain a large part of delivery within primary care. The Chairman highlighted that general practice was now very different from the stereotypical view, and provided a range of services. The challenge was how it could be communicated that although general practice had changed, there were many more options available – some patients preferred to have virtual appointments, and these were positive changes. Another Member enquired if a breakdown of the number of missed GP appointments could be provided. The Associate Director agreed to see what information could be provided to the next meeting of the Health Scrutiny Sub-Committee.

The Associate Director said it was recognised that demand was higher than ever, and practices worked in groups to support their response. Workforce was a key challenge, and Primary Care Networks (PCNs) had worked hard to recruit and train up staff into new roles. It was noted that this itself was challenging as a PCNs across the country were all doing the same thing, and this created competition – however it was noted that they had successfully utilised all funding allocated to Bromley practices, and they were seeing the roles fully embedded. The PCNs were also continuing to deliver enhanced access clinics. It was noted that the appendix of the report contained some patient case studies which brought to life the range of needs, preferences and options for patients. The primary care campaign had commenced to inform the public about the key changes in general practice and explain the ways patients could access their GP practice. The next stage would be to engage with individuals and communities in a meaningful way, and any ideas as to how this could be done were welcomed.

The Associate Director highlighted that improving access continued to be a priority in Bromley, as well as a priority nationally. The greatest challenge continued to relate to the workforce and a One Bromley recruitment campaign was underway to bring staff into the borough, and its practices, to build up capacity. In response to questions regarding barriers to public engagement, the Associate Director said that they had learnt a lot from the universal COVID-19 vaccination programme, and there were residents who were generally concerned/hesitant about accessing healthcare. The mainstream approached work for the majority, but not all, and they needed to think about how they could reach out in different ways. For example, they were looking to work with organisations and services that provided digital skills and training to local residents. They were aware that different challenges were faced in different areas of the borough, and it would be beneficial to work with Members to look at doing this in a more tailored way. The Associate Director advised that data on the use of e-consult varied by area as did the use of digital tools, such as the NHS app, and uptake of routine screenings and checks. The GP Clinical Lead said that with the help of wider business intelligence they would be able to identify particular groups who did not access healthcare. As there had been rapid changes to the way that patients could access services, it was important that they kept up the level of training and education for those using these tools.

In response to questions regarding an ongoing strategy for ensuring the continuation of practice in the borough, the GP Clinical Lead said that the situation was complicated. Generally, primary care was delivered through a partnership model – practices delivered contracts, and partnerships may, or may not, own their own premises. In terms of holding of a contract via a partnership, if a GP in a smaller partnership wanted to retire, they may face challenges in identifying someone to take over. This was a risk for smaller practices – larger practices may be thought to be more resilient, but this was not always the case. They were trying to create an overall picture and understand the risk across all practices in Bromley – looking at the age of partners, although this was not always a key indicator, other staff and who owned the buildings within a partnership. The Associate Director said that these were all factors relating to the resilience of primary care. In term of premises, following the relaxation of planning rules, some had become more attractive to landlords. There was a risk that landlords may sell premises on for other uses, and practices would then no longer have a home. Partners who owned premises were well within their rights to retire and consider the investment that they had made – they would be looking to work with all practices where there was a risk associated with ownership and consider succession planning for their long-term future. In terms of the number of practices they were concerned about, the Associate Director said that there were a number of nuances as sustainability in primary care was generally challenging.

The Chairman thanked the Associate Director and GP Clinical Lead for their update to the Sub-Committee.

RESOLVED that the update be noted.