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 on GP access.

With regards to the demand and capacity for appointments, the Associate Director highlighted that, as requested, data had been provided in relation to how long patients were waiting for appointments. This data, which was subject to quality improvements, indicated that the majority of appointments were within 1-14 days. There was a small percentage (10-15%) of appointments that passed this point – however this was expected as there would be patients that required routine care or follow up appointments, and would continue to be actively monitored. It was noted that there were data quality issues as practices recorded their data in different ways – national guidance had recently been issued in terms of coding, and it was anticipated that locally, and across the country, a standardised mechanism would be used for consistency and like-for-like comparison. A Member said that the challenges were acknowledged, but not as much granular data had been provided as hoped for – it was questioned if GP practices were performing well and if patients were getting appointments when they wanted them. The GP Clinical Lead said that the ask of GP practices was to respond to patients at the first request; offer patients an appointment within 2 weeks; or, where appropriate, see them on the same day. Some of these requests were based on ‘perceived need’, as opposed to ‘perceived want’. The Associate Director advised that, at the next meeting, they could provide data broken down into smaller periods of time. They could not provide data in terms of what a patient wanted, but the national GP patient survey data could provide a sense of whether patients were happy with the timing of the appointment offered. In response to a further question, the GP Clinical Lead noted there would be a limit to what could be demonstrated in terms of meeting accessible choice. The ‘Did Not Attend’ (DNA) deep dive indicated that most of these people were working age adults, and consideration may need to be given as to what options were available for appointments. In terms of more than 15 days, the GP Clinical Lead highlighted that patients had to be allowed to book appointments further ahead and some patients would require follow-up appointments. The Portfolio Holder for Adult Care and Health noted, that in terms of patients getting the appointment that they wanted, the expertise of the practice manager and clinicians needed to be taken into account to prioritise those with the most urgent needs.

The Associate Director informed Members that DNA rates had been published in February 2023 by NHS Digital, which was the first set of data available in recent months. Again, there were limitations in terms of data quality, but this was something that was expected to improve. In Bromley, the percentage of DNAs varied between practices, from the least at 1.35% to the most at 5.99% of all appointments available at the practice. Work was being undertaken to try and reduce avoidable DNAs and GP practices were trying to maximise the number of appointments utilised to the best effect. The GP Clinical Lead advised Members that software had been purchased which acted as an analysis tool allowing practices to look at demand, capacity and appointments and drill down into specific areas. This highlighted particular ‘hot-spots’ for DNAs – some of the highest rates of DNAs were for same day appointments, which could be due to patients trying multiple routes to get access or using the Urgent Care Centres to avoid waiting for an appointment. The example provided showed data relating to long-term conditions and there were clear variations in DNAs – this could be impacted by vulnerabilities, for which consideration may need to be given as to how access was provided, or GP practices reaching out to patients who required safe monitoring. A Co-opted Member highlighted the benefits of using text reminders, particularly for people with long-term conditions. The GP Clinical Lead advised that at his practice they had been struggling with urine testing for patients with diabetes – since implementing text reminders for patients, asking them to bring urine samples to their appointments, this was nearly at 100%. The Associate Director said that text messaging was considered to be a good way of providing convenient reminders to patients, however it created a cost pressure which was no longer funded nationally. They were being encouraged to increase the use of the NHS app, which was much more cost effective.

The Associate Director advised that work had been undertaken in relation to messaging, and demystifying the ways in which patients could access their practices. A more positive messaging style had been built upon, thanking patients for attending their appointments which allowed the NHS to use its resources more wisely. In terms of health inclusion, it was clear that the new channels to access GP practices would remain in place. This was extremely popular in Bromley, and the borough had high levels of digital literacy, but they were trying to improve all the ways in which patients could access their GP practice. An important element was the practice websites, which were moving from basic to more sophisticated models, which were easier to adapt and navigate. In response to a question from a Co-opted Member, the Associate Director advised that the hosting service for the new websites allowed things such as colours to be changed to make them easier to read. They had not yet undertaken work to simplify the language used as it had been a huge task to transfer so many websites to the new platform – however they would work with patient groups to test the websites and gather feedback in terms of them being easy read. The new platform would allow any common information to be changed on all practice websites in one go.

A Member noted the upgrades to the telephony software and equipment that had been discussed at a previous meeting and enquired how this work had progressed. The Associate Director advised that not all GP practices were using a cloud-based system, but they were working with those that did to encourage them to use its functionality to its full potential. It was intended that all GP practices would be transferred to a cloud-based system as soon as possible. However there were some barriers, such as high costs for exiting current contracts and it being a more expensive system for smaller practices – they were working with providers to try and address these issues. Regarding the "8am rush”, practices were looking at doing things differently to avoid unnecessary calls – such as repeat prescriptions requests, test results and referrals via different routes. They were also looking to see how changing the distribution of clinics, and weighting them by demand, could help.

The GP Clinical Lead advised that another risk identified was the resilience of practices. In terms of workforce, they were still seeing more doctors and nurses leaving the profession than were joining. To try and address this locally, they were looking to expand the number of GP trainers in the borough – they were aware that if GPs were trained in a borough they were more likely to stay in that borough. They were also continuing to support a local GP flexible staffing bank and there was an education training hub which developed nurse facilitators, who created networks and provided training opportunities. It was acknowledged that a large proportion of the workforce were non-clinical staff, who needed technical skills and personal resilience to deal with patients and all practices needed good practice management. A recruitment campaign would be launched in May 2023, with One Bromley, to encourage people to come and work in the borough. Another risk identified related to premises. The GP Clinical Lead noted that this was a complex arrangement, with a mixed ownership model in place – 42% of premises were owned by GP partners; 16% by NHS property management organisations; and 42% by private landlords, including recently retired GPs where brokering arrangements for handover were in place. This was a big area of risk – there was a need to ensure that buildings were at the required standard and had the space to house the expanding clinical workforce.

In response to questions regarding avoiding the closure of GP practices, the Associate Director advised that work was being undertaken in anticipation of these risks. They did actively intervene if practices notified them of any difficulties with landlords, and would act as mediators. Following the changes in planning rules, which meant that there were fewer obstacles to change the use of premises, landlords were finding other uses more attractive. The GP Clinical Lead noted that they were engaging with practice managers and undertaking an estates survey – it was important that practices protected themselves, such as ensuring that practices agreements stated that ownership passed over to partners. In terms of recruitment and retention, and making Bromley an attractive place to work, the extended roles implemented required cross-working between practices at Primary Care Network (PCN) level.

The GP Clinical Lead advised that, in March 2023, they had started a process of engaging with GP practices – many of them shared the same concerns raised by Members in terms of capacity and demand, and they wanted to try and inform how health and care services were transformed. It was noted that the national Access Recovery Plan for General Practice would be used as a focus to progress discussions.

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

RESOLVED that the update be noted.